FMA and AMA

OOPEN LETTER TO THE DCMA LEADERSHIP:


According to the published summary of a recent Board of Governors meeting, the Florida Medical Association is actively pursuing a reevaluation of its relationship with the American Medical Association. "We also began the process of a very serious and methodical reassessment of the FMA’s relationship with the AMA. Specific time will be set aside at the spring Board meeting to continue the discussion. Please feel at liberty to share your thoughts on the FMA-AMA relationship with me."
In this context the Board also tried to pass a bylaws change making the FMA President Chair of the AMA Delegation. This attempt to undermine the AMA delegations role did not pass. Furthermore, the Florida AMA Delegation did not support Dr. David McKalip run for office in the AMA , but the FMA Board of Governors overturned their decision. This is the same Dr.McKalip who was forced to step down as President-elect of the Pinellas County Medical Association, apologizing profusely for forwarding an e-mail image that portrayed President Barack Obama as a witch doctor in a loin cloth and headdress with bones in his nose. In a statement, the Florida Medical Association said it found "the actions by Dr. Mc Kalip to be hurtful and in poor judgment" but he still remains on its board ( District C, David M. McKalip, M.D., St. Petersburg). At that time he said that he is taking a year's leave of absence from a leadership role at the American Medical Association. He also planned to take a lower public profile in the health care reform debate. Instead, he was celebrated by the Tea party activities and spoke at several meetings. Now the FMA is using him as the ideological bulldozer to destabilize the AMA and Dr. Miguel Machado, a neurosurgeon and former DCMA President, runs for FMA leadership office spearheading the separation from the AMA.
Whats the goal? The FMA want to take the lead to form a new and "pure" national medical organization based on their ideological principles.
Its just astounding that physicians never miss an opportunity to divide the House of Medicine. That's the reason why I left the FMA .
There are many other important issues we should focus on to help physicians to survive and succeed in the rapidly changing healthcare environment. We need leaders who base their decisions on rational thought but not partisanship and ideologies.
I call upon each you to challenge the FMA and Dr. Machado to clearly and publicly state their support for the AMA and their policies. Furthermore, they should assure each and every AMA member that they refrain from dividing the House of Medicine and that they stop collaborating with other state medical organizations(s) to create a separate national medical organization. Dividing us just plays in the hands of our political opponents. As a loyal DCMA and AMA member I expect that my county medical society supports my right to be represented by the AMA and to stop supporting candidates who undermine the important function and role of the AMA. Otherwise, I have no other choice but to relinquish my DCMA membership effective immediately!
Its your choice to unite or to divide the House of Medicine.
Yours
Bernd
Immediate Past DCMA President

Words That Kill!

Words That Kill!! Hatred in America


"We need to address it as if it [Progressivism] is a cancer. It must be cut out of the system because they can not coexist. … You must eradicate it.”


In his speech on Saturday at CPAC (conservative Political Action Committee) in Washington, DC, the conservative news commentator Glenn Beck brought his chalkboard. He wrote the word "Progressivism" on it and said, "This is the disease."

"Progressivism is the cancer in America and it's eating our Constitution, and it was designed to eat the Constitution - to progress past the Constitution," Beck said.

He said that the only difference between a communist and a progressive is that communists seize power through revolution and progressives through evolution.

"We don't want to evolve," Beck shouted.
 "It's big government. It's a socialist utopia."

"We need to address it as if it is a cancer. It must be cut out of the system because they can not coexist. … You must eradicate it," Beck told the cheering crowd of conservatives.

The message is clear. Progressive are the enemy. We must get rid of them. Progressives are like cancer and cancer need to be dealt with.

No, this is not taken from a textbook of Hitler's Germany but it is being broadcasted in the United States of America in 2010! There will be those who will take it literally and act accordingly. From Timothy Mc Veigh, the Oklahoma city bomber, to A. Joseph Stack III,the suicide pilot, who targeted the IRS building in Austin. There will be more on the waiting list of right-wing homegrown American terrorists who will strike sooner or later. Hate mongers like Glen Beck may provide the disciples of hatred the ideological ammunition to strike. Its now open season on Progressive, and anyone can pick whom they consider a Progressive. So, because I am a Progressive , I am now a target, too?

When do we learn to stand up against hatred, intolerance and prejudice? What else has to happen before its too late?

Yours

Bernd

Why We Need Health Care & Health Insurance Reform?

The attached ABC news report highlights the fact that the largest health insurers in America have declared more than $12 billion worth of profits in 2009 but are requesting premium increases of anywhere from 20 percent to over 50 percent!
It was a banner year for health insurers. While those profits were coming in, 2.7 million of the companies' customers lost their insurance. Health insurance companies are dropping "unprofitable" patients and demand higher premiums from their remaining customers who cannot afford dropping their insurance. Meanwhile, CEOs and shareholders are collecting big paychecks, bonuses and profits.
What can be done? We must pass comprehensive health care reform now even without bipartisan support. Any reform proposal must contain provisions curbing the insurance companies profit margins, strip health insurance companies of their antitrust exemption, creating an health insurance exchange for those self-employed seeking insurance coverage, eliminating preexisting condition exclusions, full transparency of health insurance companies cost and expense structure and mandatory comprehensive insurance coverage. We also should support a strong public option!
We have to stop the bleeding now!
Yours
Bernd


Administration Says Insurance Companies Pull in Profits While Raising Premiums

By KATE SNOW, DAN HARRIS, HANNA SIEGEL and BRADLEY BLACKBURN
Feb. 18, 2010—

Health and Human Services Secretary Kathleen Sebelius railed against the insurance companies today for raising premiums at a time when companies still post profits.

"The five largest insurers in America have declared more than $12 billion worth of profits in 2009," Sebelius said at a news conference. One of those companies, WellPoint, is a for-profit company that owns Anthem Blue Cross of California. They are about to increase rates on coffee shop owner Jesse Fink.

Come May, he'll pay $325 more per month to insure his family.

"I felt like it was extortion. I felt like it was a crime. They had you by the throat and if you don't like it leave. That's not right," said Fink.

2009 a Record Year for Insurance Company Profits

it was a banner year for health insurers. While those profits were coming in, 2.7 million of the companies' customers lost their insurance and the average premium for health insurance went up -- 5.5 percent for family coverage and 2.6 percent for individual coverage, according to the Kaiser Employer Health Benefits Survey.

Today, the government pointed to examples in six states where insurers request premium increases of anywhere from 20 percent to over 50 percent.

Companies Say Higher Medical Costs Mean Higher Premiums

The insurance companies see it differently. Though in most states, the companies don't dispute the numbers in the government report, but they say the requests for higher premiums were not driven by profit.

Insurance Companies Say They're Losing Money

Brad Fluegel of Wellpoint told ABC News, "What we're experiencing in California is very rapid increases in medical costs."

And as more healthy people lose their jobs and drop their insurance coverage, more sick people -- the most expensive patients -- remain in the insurance pool.

Other insurers say they are actually losing money right now. Blue Cross Blue Shield of Michigan estimates they lost $280 million last year and by law have to ask for an increase in premiums to cover their losses.

"We're not prospering here. Our reserves have declined for 5 straight years. We're paying out $1.20 for every dollar we collect in premiums. We're losing hundreds of millions a year on only 7% of our total membership," said Andrew Hetzel, spokesman for Michigan Blue Cross Blue Shield.

Critics Say Insurers Are Dropping Unprofitable Patients

Critics of the companies don't buy it. "While everyone else seems to be in a recession, the private health insurance companies are making a tremendous amount of money," said Jackie Schechner, the National Communications Director for Health Care For America Now.

How could that happen? Schechner says the companies essentially get rid of customers who aren't going to make them any money -- old, sick, or high-risk patients. That way, healthy customers are still paying high premiums but the insurance companies have to make fewer big payouts. If that accusation were true, the companies could be in violation of the law.

"They raise rates and companies can't afford to cover their employees anymore" says Schechner. "People try to go out and get insurance in the private market and it's just entirely unaffordable for them because the prices of premiums are so high. And if you can get something you can afford and the premiums are low, chances are it's going to be lousy coverage and it's not going to actually give you the health care benefits you need."

Schechner says the answer is health care reform. That's one point that the critics and insurance companies can agree on. Brad Fluegel of Wellpoint said, "We're eager to have a fact-based, rational debate about the drivers of these issues and what we can do to fix them."

The trouble is that the insurance industry and the Obama administration have very different ideas about what that reform should look like.

Copyright © 2010 ABC News Internet Ventures

Doctors versus Medicare

Attached a very interesting article from Saturday's Miami Herald emphasizing the issue of cost-control in healthcare and the resistance by physician groups to accept the inevitable truth: we must bend the cost curve, otherwise someone will bend it for us!We definitely need to shift our paradigm of thinking: from quantity to quality, from volume to value, from physicians- centered to patient-centered care. Now is the time to discuss and resolve the issue. Politicians from both parties must understand that concessions may only provide short-term gains but represent long-term loss. Lets not miss this opportunity.
Yours
Bernd
==============================================================================

Cardiologists battle Medicare over payment cuts

BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
RICK NEASE / MCT
In a striking example of the conflict between controlling healthcare costs and providing quality service, a group of South Miami cardiologists has written a letter to patients complaining that huge cuts in Medicare rates may force many heart specialists out of business or mean reduced services for their patients.

The doctors of South Miami Cardiology said that on Jan. 1 Medicare reduced ``reimbursement for cardiac services on average by 40 percent. This is unrelated to the current healthcare reform, which is planning an additional 21 percent reduction, effective March 1.''

In fact, none of the cuts are related to the healthcare reforms before Congress. They're Medicare actions required by existing laws in an attempt to moderate doctor pay while not going broke -- a painful issue that reveals how difficult any kind of reform can be when strongly entrenched interests disagree on what should be done.

In this case, the nation's outraged cardiologists filed a federal lawsuit in Miami and have persuaded 50 members of Congress to co-sponsor a bill to rescind the cuts.

Some healthcare experts like the cuts.

``I'm not at all sympathetic with the cardiologists,'' said Robert Berenson, a doctor who was once in charge of Medicare payment policy and now is a fellow with the Urban Institute. ``Studies show they make well over $400,000 a year'' -- more than twice what a family practice physician earns.

In fact, Medicare is reducing pay to cardiologists as part of a rebalancing plan in which primary care doctors will get a 7 percent increase. ``This system is much more fair,'' said Lori Heim, president of the American Academy of Family Physicians. ``It's not the savior for primary care, but it's a start.''

Heim finds it ``disingenuous'' that the cardiologists' letter blames reform proposals for their rate cuts.

Most of the cuts involve expensive imaging diagnostics, like $800 nuclear stress tests. Studies show that when physicians have expensive imaging machines in their office, they tend to prescribe far more tests.

That's particularly true in Florida, where a study by the Government Accountability Office, the investigative arm of Congress, found that in-office imaging per senior cost $472 in 2006 -- eight times more than in Vermont.

Still, cardiologists say the changes have been devastating. Manuel Abella, a cardiologist in a large group practice in West Kendall, said he and his colleagues have been forced to lay off 15 people, cut salaries 10 percent and eliminate health insurance.

`BASIC TOOLS'

``When a patient comes in and says he has chest pains, you have to have state-of-the-art technology,'' said Romeo Majano, one of the three South Miami cardiologists who sent the letter. ``These are basic tools of our trade, and it's imperative patients have access to them.''

``This technology has greatly improved care,'' said Jack Lowen, president of the American College of Cardiology. ``We've seen a 30 percent reduction in morbidity and mortality in heart disease over the past 10 years.''

``The most affected, of course, will be the patients,'' the South Miami cardiologists warned in their letter, ``as cardiologists will be either forced out of business or forced to drastically increase the number of patients seen, most likely with physician assistants or nurse practitioners to help manage the increased volume.''

The cardiologists say that if Medicare won't pay for, say, a nuclear stress test in a cardiologist's office, the patient will have the test performed at a hospital where it might cost three to five times as much.

Medicare spokeswoman Ellen Griffith said, ``It is difficult to compare payments head-to-head because services may not always be directly comparable.'' Hospitals often get paid more for a service because they must be open around-the-clock and by law must provide coverage for the uninsured in their emergency rooms.

Berenson at the Urban Institute looks at it this way: ``If the hospitals are getting paid too much, the answer is to reduce their payments.'' He doubted the cardiologists' threat of giving up Medicare patients, noting that oncologists made a similar threat several years ago when they saw certain payments taken away and it didn't bear out.

For years, Republicans were leaders in the movement to curtail soaring Medicare costs. Tommy Thompson, secretary of health and human services under President George W. Bush, has frequently given speeches that Medicare costs must be brought under control or aging baby boomers would bankrupt the plan.

But in recent months, as the reform debate intensified, Republican leaders warned that the proposed bills would cut seniors' benefits. A poll this month by the Kaiser Family Foundation found that 48 percent of those over 65 are opposed to the reform bills while 37 percent support them.

In fact, for the past 12 years, under the Clinton, Bush II and Obama administrations, Medicare has been ordered to find ways of curtail costs without reducing quality of care. The Balanced Budget Act of 1997 required physician payments by Medicare to be adjusted annually so that the program didn't go broke.

Every year since 2003, Congress has listened to doctors' complaints and halted pay cuts. Each postponed cut gets added to the next year's calculation and this year all doctors are facing a 21 percent reduction. Congress postponed the cuts until March 1, when they take effect unless lawmakers take action.

Meanwhile, Medicare made a second set of calculations -- about how to split up the budgetary pie among doctors. Both Republicans and Democrats have agreed for some time that primary care is a key to improved healthcare -- because these doctors can coordinate treatment and reduce unnecessary tests and repetitive care.

A 2009 study by Medpac, a federal group that studies Medicare costs, found that, even adjusted for severity of illness, cardiology patients going to a doctor with imaging equipment in his office were twice as likely to get a test as those seeing doctors with no equipment.

Going further, Medicare surveyed physicians about their costs. Based on those findings, Medicare decided to reduce overall payments to cardiologists by 13 percent over four years -- while payments for their imaging services were cut by 30 or 40 percent.

`ERRONEOUS'

The ACC complained that the survey data for cardiologists was based on 55 interviews -- out of 20,000 in private practice. It called the resulting data ``patently erroneous and unreliable.'' When Medicare refused to budge, the ACC filed a lawsuit on Dec. 28.

The government argued that the courts did not have jurisdiction over a Medicare fee dispute. The judge agreed. The cardiologists have now gone to Congress, where lawmakers have a history of reversing Medicare pay cuts to pacify providers.

Griffith, the Medicare spokeswoman, said the agency is ``confident that the policies we have adopted are the most appropriate and will enhance overall access to physician services for beneficiaries. . . . If we find that there are unintended adverse consequences . . . we will have the opportunity to revisit them as part of the annual rule-making.''

Should We Stop Healthcare Reform Now?

Should We Stop Healthcare Reform Now?

After the election in Massachusetts many predict the collapse of the health care reform efforts. President Obama seems to seek a scaled back version, which is acceptable for Republicans who are blocking ANY reform efforts. But why do we need health care reform NOW? Lets look at the facts: If nothing will happen healthcare spending will continue to outpace the growth in the rest of the domestic product by at least 2.5% annually. Despite the overall slowdown in national health spending growth in 2008, increases in this spending continue to outpace the growth in the resources needed to pay for it! At that rate health spending will absorb 40% of GDP by 2050! The suggested reform proposal will provide 30 Million uninsured Americans adequate coverage requiring about $800 Billion to $1 Trillion in federal subsidies over the next decade. This represents only 3% of the $35 Trillion projected by actuaries to be spent on U.S. health care in the coming decade in the ABSENCE of reform. The relatively small $ 1 Trillion investment in preventing the surge of neglected chronic disease will save Trillions of healthcare dollars normally spent for the emergency room care needed to serve the growing numbers of uninsured! We need to invest money in order to save money!!!
Furthermore, health care insurance companies know very well that the initial rise in health care stocks, on expectations that the Massachusetts’s vote might derail health care reform, may symbolize a pyrrhic victory only! Even though, the reform package included mandated coverage for everyone, regardless of health status, it also offered to heavily subsidize the health care for 30 million Americans who are currently uninsured. This potential financial windfall may not materialize. Insurance companies are very well aware that selling insurance package to employers has slowed because of rising premiums, which reflect rising health care expenditures. The insurance companies must have an interest to bend the cost curve and to expand insurance coverage to offer competitive products. Insurers may gamble with their financial future by supporting the Naysayer because without an overhaul of the insurance industry and the health care market they may face an even bleaker future, which will force draconian government intervention to cut costs.
Therefore, we must support rational reform efforts and President Obama should stop pandering to the opponents of any meaningful reform efforts. We have to act now to avoid a future financial crisis!


Bernd Wollschlaeger,MD,FAAFP,FASAM

What can we learn from Israel's efforts in Haiti?

Attached a video link to a CNN report contrasting Israels disaster response in Haiti with the US response.
In the words of Dr.DiGennaro, a Broward county physician, "it makes you almost embarrassed being an American."
Currently, the Israelis run the only fully functioning hospital in Haiti!
Its another example that we fail to understand that disaster and emergency preparedness is not measured by the amount of $$ we throw at the problem AFTER the fact but to continuously prepare and train teams of professionals in emergency and disaster response measures.This does not require a lot of money but dedicated leadership and commitment!
In 2006 I have witnessed the training of the Israeli team on a military base and participated in multiple training sessions myself. I can attest to the fact that they have mastered the art of perfection; each step is documented in a manual and everyone knows how to work in a team and per checklist.
Why we can't do it here? Because we are talking the talk instead of walking the walk. In October 2001 I was appointed by then Governor Bush to the Emergency and Disaster Preparedness Taskforce and urged on multiple occasions to follow the Israeli model. Nothing happened. Yes, we have special teams but too few and far apart. We need local teams that train on a quarterly basis and manage their own equipment and supplies. Do we need to learn another painful lesson from the next natural disaster or do we have to memorize the phone # of the Israeli team instead?
Kudos to their bravery and tireless efforts.

http://www.cnn.com/video/?/video/world/2010/01/18/dnt.cohen.haiti.patients.dying.cnn

Bernd

Florida Doctors Lead The Fight Against Change

Dear Friends and Colleagues:
An article in today's (12/29/2009) New York Times, "Health Lobby Takes Fight to the States," reports that Florida is debating a proposed amendment to its state constitution that would try to block, at least symbolically, much of the proposed federal health care overhaul on the grounds that it tramples individual liberty. Its 42 co-sponsors, all Republicans, were almost all recipients of outsized campaign contributions from major health care interests, a total of about $765,000 in 2008. Last year, for example, the drug industry poured more than $20 million into political contributions in states around the country. In California alone, the industry spent an additional $80 million on advertising to beat back a California ballot measure intended to push down drug prices. The idea of amending state constitutions to block the core of the federal health care legislation, including the requirement that individuals and businesses buy insurance, began at the conservative Goldwater Institute in Arizona, the state where the first such measure will appear on the ballot next year. The states where the amendment has been introduced are also places where the health care industry has spent heavily on political contributions in recent years, according to figures from the National Institute on Money in State Politics. Over the last six years, health care interests have spent $394 million on contributions in states around the country; about $73 million of that went to those 14 states. Of that, health insurance companies spent $18.2 million, according to the institute. In Florida, where health interests have given a total of about $32 million over the last six years, the state medical association has become an especially important backer of the proposed amendment. In contrast to the American Medical Association, the Florida Medical Association has come out firmly against the current Congressional proposals, and a spokeswoman said the Florida group had embraced the proposed state amendment “to protect Florida from being forced into a federal government mandate that would hurt patients.” Dr. Madelyn E. Butler, president elect of the Florida Medical Association, said, “We are trying to ameliorate the effects of national health care reform on the State of Florida.” James Greer, chairman of the Florida Republican Party, said he too supported the proposal, which could be on the ballot in 2010 or more likely in 2012. Whatever its legal weight, Mr. Greer said, its mere presence on the ballot would give it political force. Its time that doctors stand up against those powerful interest groups. In some areas in Miami (Hialeah) the Uninsured rate has surpassed 50%. Many of my patients will be forced to drop health insurance coverage in 2010 because they cannot afford the high premiums. One of my family members was told that her back pain constitutes a pre-existing condition and her employer informed her that his small group insurance premiums will increase if he decides to continue providing coverage for her. As physicians we have the moral obligation to protect our patients interests and to stand up against the powerful and mighty insurance industry. Enough is enough!

Have a Happy New Year.

Yours Bernd

Doctors in the News

Well, I guess we can add another "present" under the Christmas tree.
Attached more information about the Zachariah saga which keeps getting juicier and more embarrassing.
Why does greed and lust for power seem to affect doctors more than others?
Because we do not speak up and thereby nurture those behaviors.
Its time to change our approaches and question the format and structure of our organizations.
Merry Christmas
Bernd


Print This Article
Posted on Thu, Dec. 24, 2009
2 Broward doctors settle insider trading case

BY DAN CHRISTENSEN
browardbulldog.org
The former chairman of the Florida Board of Medicine and another Fort Lauderdale physician have agreed to pay substantial sums to settle federal civil charges of insider stock trading.

Dr. Mammen P. Zachariah, appointed to the board of medicine by Gov. Jeb Bush in 2004, and Dr. Sheldon Nassberg allegedly reaped illegal windfalls by acting on stock tips supplied by Mammen Zachariah's brother, prominent Broward heart specialist and major Republican fundraiser Dr. Zachariah P. Zachariah.

Zach Zachariah, who has raised millions of dollars for Republican causes and candidates, including both presidents Bush, faces similar charges, but has declined to settle his case. A federal magistrate has set trial for Aug. 23, 2010.

That trial promises to offer a unique look at Republican fundraising and how political access is bought and sold. Among the expected highlights is witness testimony from two of South Florida's better-known corporate chieftains -- The Geo Group's George Zoley and Phil Frost, formerly of IVAX.

The Zachariah brothers and Nassberg, all of whom practice at Fort Lauderdale's Holy Cross Hospital, were named in a May 2008 civil complaint brought by the U.S. Securities and Exchange Commission. The complaint accuses them of collecting more than a half-million dollars in illegal profits during a fraudulent stock-trading scheme in 2005.

Without admitting or denying the government's allegations, Mammen Zachariah, 61, agreed to pay nearly $136,000 in what a judge labeled ``ill-gotten gains,'' plus an equal amount as a civil penalty. Nassberg, an endocrinologist, agreed to similar payments totaling $52,668. He admitted no wrongdoing. Both men are required to pay up by the end of the month.

The final judgments signed by U.S. Magistrate Linnea Johnson on Wednesday also include permanent injunctions that restrain both doctors from future securities law violations.

Zach Zachariah, another past chairman of the Florida Board of Medicine, is alleged to have used nonpublic information to buy and sell shares of two unrelated Florida companies, Miami-based generic drug maker IVAX and Sarasota's Correctional Services Corp. (CSC).

Zachariah was on IVAX's board of directors in July 2005 when company chairman Phil Frost informed him that IVAX had agreed to be acquired by Teva Pharmaceuticals for $26 a share. Within minutes, Zachariah bought 35,000 IVAX shares for about $21 a share, the SEC said. At the time of the alleged purchase, company insiders were forbidden from trading in IVAX stock.

Zachariah also allegedly tipped off his brother, who bought 2,000 IVAX shares for about $23 a share on the last trading day before the deal was announced in July 25. Zachariah allegedly used inside information to make even more money trading shares of CSC, which was acquired by The GEO Group of Boca Raton in 2005. According to the SEC, the Zachariah brothers and Nassberg turned $380,000 in quick profits.

The government says Zachariah acquired that inside knowledge in a couple of ways. One was through his son Zachariah ``Reggie'' Zachariah, who worked in GEO's mergers and acquisitions department. Reggie Zachariah has denied under oath tipping off his father to the deal. Another was through Zachariah's own moonlighting work for GEO. The SEC says Zachariah made ``millions of dollars'' as a corporate consultant, service provider and lobbyist for GEO, a giant prison contractor once known as Wackenhut Corrections.

Zachariah, who owns a $2.3 million home on the Intracoastal Waterway in secluded Sea Ranch Lakes, said under oath last winter that he was paid to provide access for GEO chief executive George Zoley to top federal and state Republican politicians.

Those politicians include former President George W. Bush, former Senate Majority Leader Bill Frist, former Florida Senate President Tom Lee and House Speaker Alan Bense and former attorney general Charlie Crist, now Florida's governor.

Dan Christensen, a former Miami Herald reporter and columnist for The Daily Business Review, is founding editor of BrowardBulldog.org, a nonprofit online-only newspaper.

Medicare Payment Cuts Reversed

The Medicare Physician Payment Reform Act Of 2009 passed the House on 11.19.2009 with 243 Ayes and 183 Noes. The measure would reverse a 21.2% payment cut planned for Jan. 1, 2010, wipe out the accumulated physician spending debt and implement a new formula.
242 Democrtes and ONE(1) Republican (Michael Burgess,MD, Texas) voted in favor and 172 Republicans and 11 Democrates ( including Suzanne Kozmas, FL) voted against.
Lets be clear who our FRIENDS are: Democrats and NOT Republicans! But the FMA leaders are still supporting those politicians who voted AGAINST the passage of this reform act: Tom Price, Ros Lehtinen, Diaz Balart, Mack, etc.)
Go figure out there logic!!!

Bernd



For more information see AMA News.

House votes to scrap Medicare doctor pay formula
The bill, which would base pay more closely on costs, now moves to the Senate. That chamber has already rejected a similar measure this year.
By CHRIS SILVA, amednews staff. Posted Nov. 19.

Washington -- The U.S. House of Representatives passed a major bill Nov. 19 that would abandon the current Medicare physician payment formula and allow future rates to increase based more closely on doctors' costs, a revision that is expected to cost roughly $210 billion over 10 years.

By a vote of 243-183, the House approved the Medicare Physician Payment Reform Act of 2009. The measure would reverse a 21.2% payment cut planned for Jan. 1, 2010, wipe out the accumulated physician spending debt and implement a new formula.

The new spending growth rate target for physician services would be equal to the gross domestic product plus 1%. Preventive care and evaluation and management services would have a separate target of gross domestic product plus 2%, allowing primary care pay to increase at a higher rate over time.

"Without action by both houses of Congress, Medicare will cut payments to physicians by 21% in 2010, with more in years to come. Today's House vote is the first step toward preventing this cut and eliminating the formula that creates a roller coaster of uncertainty for seniors and physicians who care for them," said American Medical Association President J. James Rohack, MD, who called on the Senate to act on the legislation. "Promises have been made to seniors and military families -- and the House recognizes that those promises must be kept."

The White House in advance of the vote issued a statement strongly supporting the legislation. "The administration believes Medicare and the country need to move toward a system in which doctors receive better incentives to provide their patients with higher quality and more efficient care," said the Nov. 18 statement from the Office of Management and Budget. "A cut of this magnitude could reduce access to physicians for Medicare beneficiaries throughout the country."

The Senate must still approve the legislation before it can head to President Obama's desk. The upper chamber has already rejected a bill once this year that would have eliminated the Medicare physician payment formula. That legislation ran into opposition from Republicans and fiscally conservative Democrats who said they did not want to raise the federal deficit by hundreds of billions of dollars.

The House measure was originally part of the chamber's health system reform bill but was stripped out for separate floor consideration. The primary reason for this was to decrease the total cost of the main reform package and to keep the final dollar figure under a White House-imposed limit.

Appointment

Governor Crist appoints Past DCMA President to the Prescription Drug Monitoring Program Implementation and Oversight Taskforce.



http://www.flgov.com/release/11150

GOVERNOR CRIST APPOINTS NINE TO THE PRESCRIPTION DRUG MONITORING PROGRAM IMPLEMENTATION AND OVERSIGHT TASK FORCE

November 12, 2009

Contact:

GOVERNOR'S PRESS OFFICE
(850) 488-5394

TALLAHASSEE – Governor Charlie Crist today announced the following appointments:

Prescription Drug Monitoring Program Implementation and Oversight Task Force

· Andre Benson, 62, of Tampa, physician, Operation PAR Inc., appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Lora “Lorrie” Brown, 44, of St. Petersburg, pain physician, Coastal Orthopedics, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Kristen Cortes, 45, of Panama City, Florida Department of Law Enforcement agent, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· David Craig, 41, of Tampa, clinical pharmacist specialist, H. Lee Moffitt Cancer Center and Research Institute, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Joel Kaufman, 57, of Ft. Lauderdale, vice president, United Way of Broward County, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Nilesh Patel, 45, of Bradenton, interventional pain management physician, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Donnie Reynolds, 41, of Weston, chief operating officer, Automated Healthcare Solutions, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Paula “Pepper” Wakeland-Hewitt, 60, of Sarasota, pharmacy manager, Davidson Drugs, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Bernd Wollschlaeger, 51, of Miramar, self-employed primary care physician, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

Cover Florida

Attached an article in todays Miami Herald pointing out the problematic issues of the so-called " Cover Florida" insurance program touted by Governor Christ as the solution for the Uninsured.
Here are some facts:

* in many cases it offers a barebone service package.
* participating insurance companies still do not offer comprehensive services for competitive prices DESPITE the claims made by the Governor that" each provider was chosen by the state through a competitive bidding process."
* To date, about 4,500 people have enrolled -- about 0.1 percent of the state's uninsured population. More than 3800 Floridians loose their health insurance every week!!!

The question remains: is this program the result of an honest effort to find a solution to cover the Uninsured, or just another political campaign trick meant to boost the chances of Governor Christ to enter the US Senate?
Needless to say that he still refuses to accept a public option, but has yet to declare if Florida will opt out such an option if offered on federal level.
My gut feeling? He will do anything to get elected even if it means to scarify more Floridians on the altar of political vanity.
Yours
Bernd





Posted on Sat, Oct. 24, 2009
Crist exaggerates benefits of Cover Florida Health Care program

BY CATHARINE RICHERT
PolitiFact Staff Writer

In a recent Fox News interview, Florida Gov. Charlie Crist boasted about Cover Florida Health Care, an effort to provide low-cost healthcare coverage to the nearly four million uninsured in the state.
``There are no government mandates to it, no tax dollars utilized for it,'' Crist said on Wednesday. ``Just good, aggressive negotiating by our administration with health insurance companies. . . . And, really, the problem with healthcare is that it's expensive. And so what we've attempted to do is reduce the cost by reducing the expense and the premium of health insurance, and we've had success doing so. Usually it's about $900 a month to get health coverage. We've reduced that, on average, to about $150 a month.''

Given all the debate over the high cost of healthcare, we wondered if the plan could be as inexpensive as Crist claims. We found he was distorting the savings by mixing apples and oranges.

The program, which was started in 2008, allows individuals who have been without coverage for at least six months to pick from plans offered by six insurance companies. Each provider was chosen by the state through a competitive bidding process, and each offers at least two options -- one with catastrophic and hospital coverage, and another plan that can provide less coverage.

The program's website says that individual plans can be purchased for as little as $23 or as much as $800 a month, depending on age, gender and level of coverage. Patients pick and choose between various options offered through the six insurers. So, for example, a woman who is between 19 and 29 years of age can pay $130 a month for a plan that includes no deductible, $10 copays for doctor visits, but no hospital inpatient coverage.

NOT DOING ENOUGH

Since Cover Florida Health Care was enacted, critics have said the program hasn't done enough to cover the uninsured. To date, about 4,500 people have enrolled -- about 0.1 percent of the state's uninsured population.

The low-cost options so often touted by state officials don't offer patients much of a safety net, said Florida state Sen. Nan Rich.

``People are beginning to see that it doesn't cover anything,'' said Rich, a Democrat from Weston. ``It may be inexpensive, but it's inexpensive for a reason. It's a very low level of coverage.''

When we asked Crist's office about his claim -- that healthcare costs are on average $900 a month compared to $150 under Florida's plan -- we were told that the $900 figure cited by the governor came from the nonpartisan Kaiser Family Foundation and that it refers to the amount of money a family pays, on average, per month. Crist's office also noted that the figure is outdated (for instance, in 2006, the average monthly cost per family was about $950) and pointed us to a new Kaiser report released Sept. 15, 2009, that estimates families now pay about $1,114 a month.

So Crist is off by about $200 for family coverage.

AVERAGE COSTS

As for the average cost under the Cover Florida program, Crist's office pointed us to a document that lists the different providers and their rates for individuals. The average for the higher-end coverage, which would include hospitalization and catastrophic insurance, is about $227, while the average for the less-expensive ``preventive'' plan was $89. So Crist's $150 number is the approximate average of the two.

But wait. The first number Crist cited is the Kaiser estimate for a family. The second number is for an individual.

We went back to the Kaiser report and found that the average cost for an individual plan is actually around $400 a month, which would mean the gap was not as dramatically different as Crist claimed.

Crist spokesman Sterling Ivey acknowledged the apples and oranges comparison but said the underlying point is still valid that the Florida average is lower.

But we find Crist is using sleight-of-hand, comparing numbers that aren't comparable. He's used a higher family number with a lower number for individuals. We rate his claim False.

Herald/Times staff writer Steve Bousquet contributed to this report.

Healthcare Reform and Insurance Exchanges

Saturday, October 10, 2009


Letter To The Editor:

When reading John Dorschners article “Healthcare reform proposal on insurance exchanges was tried in Florida” I reached only one conclusion: why to try it again ?
The current system is broken. Costs are soaring and so are the numbers of uninsured Floridians.
The current reform proposal would require all Americans to purchase a flawed product: private health insurance which wastes one-third (31 percent) of Americans’ health dollars on nonsensical administration, huge profits and exorbitant executive pay. But there is one solution which few dare to explore: a single-payer system. Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Single-payer financing is the only way to recapture wasted and precious healthcare dollars. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care. Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace skyrocketing insurance premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing. Lets not waste this opportunity for meaningful change. It’s not too late!

Bernd Wollschlaeger,MD,FAAFP,FASAM
Board Certified Family Physician & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com

The Old Guard Reveals Itself!

In a recent member communication the President of the FMA reflects on the issue of "Advanced Medical Home" and the primary physician shortage. I agree with him that we need more primary care physicians but his remarks reveal the true attitude towards family physicians by stating that "We in organized medicine need to make sure that secondary providers don’t usurp our traditional role as captain of the ship." Who are those "secondary providers?"
Family doctors, general internists, pediatricians, ARNPs, PAs??? Are we second class citizens too???
This dismissive remark is indicative of the pervasive mind set within the leadership of the FMA which thrives on the cold war-like black-and-white view of the world. But the current healthcare industrial complex (HDIC) consists of a tight web of services delivered across a horizontally and vertically structured set of providers, including physicians and allied healthcare professionals.
Its takes an unhealthy dose of delusional thinking to claim that ANYONE will be the "captain of the ship."
Moreover, Dr.Dolan and other FMA leaders refuse to recognize this reality and want to roll-back in time to the Garden of Eden of medicine where doctors and patients lived together happily until someone introduced the forbidden fruit of health insurance and government intervention.
We have to strike back against the perpetuation of those false beliefs suggesting that family physicians are taking over medicine as THEY know it.
These ideologues are beyond education. They cannot be talked too anymore. Its also useless to work with them on any issues as it pertains to primary care!! We have to define who we are and what we want and work together with consumer groups, unions and patient advocates to create the healthcare delivery system that we all deserve. Change is tough but necessary. Success favors the prepared and open mind. The odds are in our favor. Lets not miss this opportunity.
Yours
Bernd

FMA Board Member in the News

In an (attempted) scholarly treatise Betsy McCaughey, the self-declared patient rights advocate, cited another "scholar", a fellow Florida doctor, as the new oracle of Delphi predicting the demise of medicine. Dr. David McKalip, a Florida neurosurgeon and a board member of the Florida Medical Association, predicts: "The only doctors left in Medicare will be those willing to ration care and practice cookbook medicine." Well, I am glad to know that Dr.Mc Kalip's looney-tunes are hitting the national headlines because it illustrates how he, and his fellow FMA apostles, really think about the future of medicine in this country.
The editorial is filled with half-truth, delusional confabulations using fear-based agitprop, or political propaganda promulgated chiefly in the former USSR.
Well, read it yourself to understand how our fellow FMA colleagues really feel. Enjoy and if you need something for nausea call me.
Yours
Bernd

NEW YORK POST

The 'kill granny' bill
By BETSY MCCAUGHEY
Last Updated: 11:18 AM, October 5, 2009
Posted: 1:05 AM, October 5, 2009
AS the health-reform bills move through Congress, the prognosis for Medicare pa tients gets worse and worse.

The Senate Finance Committee bill (generally called the Baucus bill, after Chairman Max Baucus) robs the elderly to cover the uninsured -- like snatching purses from little old ladies. The House bills already cut future funding for Medicare by $500 billion over the next decade. The Baucus bill would slash a similar amount, just when 30 percent more people enter the program as baby boomers turn 65.

The Baucus bill also puts new limits on what doctors can do for patients in Medicare:

* A "race to the bottom" provision (p. 102 of the revised chairman's mark) would take effect each year for the next five years. The provision penalizes doctors who end up in the 90th percentile or above on the cost of what they use to treat their patients, compared with national averages. The intent is to force down the cost of care, year by year. Yet this blunt instrument can't determine which care is actually wasteful -- it will punish doctors for treating high cost patients with complex conditions. Inevitably, it will lower the quality of care.

* Even more devastating is the amendment Sen. Maria Cantwell (D-Wash.) got inserted into the bill (revised chairman's mark, pp. 102-3). It gives the Secretary of Health and Human Services the power to define quality, cost-effective care for each medical condition and penalize doctors who spend more on their patients.

The law establishing Medicare in 1965 barred the federal government from interfering in doctors' treatment decisions. Slowly, Medicare regulations have begun unraveling that protection. Now the Cantwell amendment finishes the job.

This is the most extreme change to Medicare ever. Dr. David McKalip, a Florida neurosurgeon and a board member of the Florida Medical Association, predicts: "The only doctors left in Medicare will be those willing to ration care and practice cookbook medicine."

It's reasonable for Medicare administrators to strive to get value for dollars spent. In recent years, Medicare has taken a slow, tight-fisted (and sometimes arbitrary) approach to paying for new drugs or medical devices. But Cantwell aims directly at doctors' decisions.

That's not surprising. President Obama and his advisers vilify doctors for over-treating patients. Dr. Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel and a key Obama health-care adviser, argues that the Hippocratic Oath is largely to blame for the "overuse" of medical care.

In his view, doctors focus too much on the needs of their own patients; they should be taught to ask whether the money they're spending on a patient is worth it. To curb doctors' spending, the stimulus legislation launched a process of sending doctors protocols via computer on what the government deems "appropriate" and "cost-effective" care. Doctors who are not "meaningful users" will be punished financially.

When I warned that this meant the government would be interfering in doctors' treatment decisions, CNN and FactCheck.org said that was untrue. But Dr. David Blumenthal, appointed in March to head the new system of computer-guided medicine, settled that debate. In the New England Journal of Medicine (April 9), he confirmed that "embedded clinical-decision support" (his term for computers telling doctors what to do) would be used to reduce costs, and he predicted that some doctors might rebel against tight controls.

The Baucus bill completes the framework for tying doctors' hands when treating the elderly.

Driving all this is the misconception that doctors spend wastefully on patients who are about to die. Newsweek's recent cover story, "The Case for Killing Granny," argues that "the need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate."

Numerous studies prove that is false. In 2006, Emory University researchers examining the records of patients in the year before they died found that doctors spend far less on patients who are expected to die than on patients expected to survive.

The Emory researchers said it's untrue that "lifesaving measures for patients visibly near death account for a disproportionate share of spending." They also found that doctors often can't predict when a patient is in the last year of life.

In any case, the health-reformers' plan to cut spending on patients 65 and older won't simply reduce end-of-life care, it will also eliminate care for patients who are perfectly capable of surviving their illness and going on with life.

Betsy McCaughey is chairman of the Committee to Reduce Infection Deaths and a former New York lieutenant-governor.

Leaving the FMA

LETTER TO THE PRESIDENT OF THE FMA,DR.JAMES DOLAN:

Dear James:
I hope that you are doing well.
For several months now I witness the relentless anti-AMA rhetoric applied by the FMA leadership and the continuous attacks on any meaningful healthcare reform efforts which are sorely needed. I am also outraged that you continue to ignore the reality of the growing number of uninsured in Florida calling it a "myth."
In Miami we reached a 36% Uninsured rate and in Hialeah alone 56%!!! This is not a myth but REALTY! Not only does this trend challenges our public health but also adversely affects the financial viability of medical practices and hospitals and we must find a solution to this problem!!
After long deliberations I finally reached the conclusion that I have no place in the FMA. I fundamentally disagree with the FMA policies and am especially appalled by the vitriolic criticism of the AMA. It already triggered an increase in the AMA member non-renewal rate and will further diminish our representation within the AMA House of Delegates. This criticism is especially difficult to understand because Cecil Wilson is the AMA's President Elect! Why are we stabbing him in the back? Therefore, I relinquish my membership privileges effective immediately. I am saddened that I was forced making this decision but I see no other option.
Stay well.
Yours truly,
Bernd

Ed Annis,MD: A Final Goodbye

Dear Friends and Colleagues:

Today, on the first day of Rosh Hashana, I attended the Memorial Service for Dr. Edward R. Annis who passed away on September 14th, 2009.
Ed's service was attended by many friends and fellow physicians including senior AMA representatives Drs. Hove,Heyman and Wilson.
Cecil gave a moving eulogy followed by very personal presentations of family members including Dr. Joe Annis. Ed's touched so many peoples hearts and minds but remained a humble and faithful person. I remember him as a patient listener who always provided me with advice and guidance. He had the ability to accept and tolerate other opinions and lead by example. I will never forget him and the seed he planted in my heart and mind will continue to grow. Thank you Ed.

Yours truly,
Bernd

Healthcare Reform: A Different Perspective

New uninsured figures show Massachusetts, touted as model for national reform, is failing to cover the uninsured

17,000-member organization of physicians says latest numbers understate the problem and show urgent need for single-payer health reform

Official estimates released this morning by the Census Bureau showing a marginal increase in the number of Americans without health insurance in 2008 - now estimated at 46.3 million, up from 45.7 million in 2007 - masks the true dimensions of the problem, a national doctors' group said.

Significantly, in Massachusetts, where an individual-mandate health reform law, much like what President Obama is proposing on a national scale, was passed in 2006, at least 352,000 people, or 5.5 percent of the population, remained uninsured in 2008. That number was actually (but non-significantly) higher than the number of uninsured in 2007, before strict enforcement of the individual and employer mandates went into effect.

"The legislation championed by the president and the congressional leadership is a virtual clone of the Massachusetts plan," said Dr. Steffie Woolhandler, professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program (PNHP). "Today's numbers show that plans that require people to buy private insurance don't work. Obama's plan to replicate Massachusetts' reform nationally risks failure on a massive scale."

Woolhandler said last year's job losses in the recession, and the corresponding loss of health coverage by many workers and their families, are inadequately reflected in the new data. An estimated 2.6 million people lost their jobs in 2008, most of them toward the end of the year. Those who lost insurance at the end of the year would probably be counted as insured in the Census data, she said.

Census officials cited a drop of 1.1 million in the number of persons who were covered by employer-based insurance, continuing an 8-year trend. Whereas 64 percent of Americans had employer-based coverage in 1999, only 58.5 percent had such coverage in 2008.

Dr. Quentin Young, national coordinator of PNHP, said had it not been for a leap of approximately 4.4 million people newly covered by government programs like Medicaid and Medicare, the overall uninsured rate would have set a new record.

Young said the "tragic and painful persistence" of tens of millions of uninsured persons in the country is "completely unacceptable" and underscores the urgency of enacting a Medicare-for-all program.

"The only way to solve this problem is to insure everyone," he said. "And the only way to insure everyone is to enact single-payer national health insurance, an improved Medicare for all. Even President Obama has acknowledged this fact."

Young noted that Rep. Anthony Weiner, D-N.Y., is introducing an amendment to the House leadership's health reform bill, H.R. 3200, which would essentially delete its present language and substitute the language of Rep. John Conyers' single-payer bill, H.R. 676. "It's not too late for Congress to do the right thing," Young said.

Dr. Don McCanne, senior policy fellow at PNHP, noted that the Census Bureau was once again silent on the pervasive problem of "underinsurance." People are usually defined as underinsured if they spend 10 percent or more of their income (or 5 percent if they are low-income) on out-of-pocket medical expenses in the course of a year.

"Not having health insurance, or having poor quality insurance that doesn't protect you from financial hardship in the face of medical need, is a source of mounting stress, anguish and poor medical outcomes for people across our country," McCanne said. He noted that a recent study showed 62 percent of personal bankruptcies in the U.S. are now linked to medical bills or illness and three-quarters of those who went bankrupt had insurance when they got sick.

*****

State-by-state data on the uninsured from 2005-2009 can be found here: http://www.pnhp.org/uninsured2008/Uninsured-by-State-2005-2008.pdf

For more information on Massachusetts, see: http://www.pnhp.org/change/Why-MA-style-Reform-Wont-Work.pdf

Physicians for a National Health Program (www.pnhp.org), a research and educational organization of over 17,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Senator Nelson and the Public Option

UU.S. Sen. Nelson says “public option is dead,” believes Co-Ops will be possible alternative for nation’s 47 million medically uninsured

U.S. Sen. Bill Nelson, D-FL at the Greater Miami Chamber of Commerce monthly luncheon Wednesday said when it came to a comprehensive change in health care delivery and medical insurance being debated around the country, the Senate; a smaller body will likely craft much of the final product and believes it will involve the use of medical insurance “co-ops that are owned by the policy owners.”
Senator Nelsons support for a co-op sounds more like a cop out.
What does he really support? Few politicians can clearly define either of both entities. The only thing they know that it’s politically less risky to use the term co-op than the perceived evil word “public option.”
So what would it be? Insurance co-ops or health insurance purchasing co-ops?
An insurance co-op requires sustained funding, must develop a large network of providers offering discounted health care services, develop brand identity, figure out how to handle claims, develop actuarial expertise, establish reserves, meet state licensing requirements and solvency requirements. Once a co-op passes all those hurdles it needs to attract and retain customers, lots of customers, to compete with existing insurance companies. In contrast, health insurance purchasing co-ops are based on the idea that consumers bargain with insurance companies to buy insurance. They’re not insurance providers themselves. Most of such initiatives failed to provide the desired benefits for their member.
So what’s left? 1) a solid public option offering an insurance option for those who currently cannot afford to buy insurance or are underinsured; 2) a political consensus to strictly regulate insurance companies like we do with utilities; 3) a single-payer insurance plan, a public service financing the delivery of healthcare.
Single-payer health insurance operates by arranging the payment of services to doctors, hospitals, and other health care providers from a single source established and managed by government. This source replaces private insurance companies with a single, public entity.
These are the options and the choice is ours.Lets have a honest and unbiased debate about those options. Time (or better money) is running out!

Bernd Wollschlaeger,MD,FAAFP,FASAM
Immediate Past President, Dade County Medical Association

White House Conference Call

Dear Colleagues:

Today in the evening, I participated in a White House Office of Health Reform conference call to discuss health insurance reform. The call was intended as a briefing for physicians to discuss issues related to health reform. It started at 8:35pm and lasted for an hour. The call was moderated by Dr.Kavita Patel, who serves with Senior Adviser Valerie Jarrett and worked herself a practicing Internal medicine physician. According to her information ~ 1900 physicians participated and > 400 questions were submitted in advance.
After a briefing about the status of the current health reform efforts ( see http://www.healthreform.gov) Dr. Patel answered several questions submitted in writing and then also by people who queued for a life Q&A sessions.
Several of these questions can be grouped as follows but this does not represent a complete list:

1) Medicare Advantage plans and how they can be adjusted to provide competitive and similar-priced services to all Medicare recipients. This question focused on the preferred financing of CMS for Medicare Advantage plans.
2) Increased reimbursement for primary care services and emphasis on quality versus quantity of care. Dr.Patel clearly identified with practicing primary care docs because she herself experienced the grueling schedule and resulting deficiencies in quality of care.
3) Training of more primary care physicians by dramatically increasing funding for the National Health Service Corps programhttp://nhsc.hrsa.gov/. Unfortunately, she missed addressing the necessary funding increase and removing of restrictions for primary care residency positions.
4) One doctor suggested moving from a fee-for-service reimbursement system to a global fee schedule, which in my opinion is sorely needed.
5) Another doctor suggested an end-of-life conference at the White House to rationally discuss this controversial issue and to debunk the "death-panel" propaganda perpetuated by some media outlets and political pundits.
6) In a final question a doctor asked why CMS does not reimburse for preventive care services.Definitely, a golden opportunity to change the current reimbursement system to emphasize and validate our daily effortsd and hard work.

In summary, this was an excellent opportunity to connect, to listen and to ask questions in a relaxed, well organized and calm atmosphere. The focus is on primary care: to emphasize preventive services, and to provide funding for increased reimbursement.
I am pleased that rational thought can prevail and I applaud the White House of Health Reform for their efforts. They announced more phone calls in the future. I strongly urge each of you to participate and to engage in a thoughtful conversation.
Yours
Bernd

Bernd Wollschlaeger,MD,FAAFP,FASAM

Universal Health Insurance

Attached you find a summary of a bill (HR676)which so far has not been discussed during the current healthcare refom debate.It should be at least considered as an option and not discarded just because its politically difficult to promote.
Bernd Wollschlaeger,MD



H.R. 676, “The United States National Health Care Act,”
Or “Expanded & Improved Medicare For All”
Introduced by Rep. John Conyers, Jr.


Brief Summary of Legislation

The United States National Health Care Act (USNHC) establishes a unique American universal health insurance program with single payer financing. The bill would create a publicly financed, privately delivered health care system that improves and expands the already existing Medicare program to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income or health care status. In short, health care becomes a human right. With 47 million uninsured Americans, and another 50 million who are underinsured, the time has come to change our inefficient and costly fragmented non-system of health care.

Who is Eligible

Every person living or visiting in the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards.

Health Care Services Covered

This program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, palliative care, podiatric care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. There no co-pays or deductibles under this act.

Conversion To A Non-Profit Health Care System

Doctors, hospitals, and clinics will continue to operate as privately entities. However, they will be unable to issue stock. Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHC program. Exceptions to this rule include coverage for cosmetic surgery, and other medically unnecessary treatments. Those workers who are displaced as the result of the transition to a non-profit health care system will be the first to be hired and retrained under this act. Furthermore, workers would receive their same salary for up to two years, and would then be eligible for unemployment benefits. The conversion to a not-for- profit health care system will take place as soon as possible, but not to exceed a 15 year period, through the sale of U.S. treasury bonds.

Cost Containment Provisions/ Reimbursement

The USNHC program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment. A “Medicare For All Trust Fund” will be established to ensure a dedicated stream of funding. An annual Congressional appropriation is also authorized to ensure optimal levels of funding for the program, in particular, to ensure the requisite number of physicians and nurses need in the health care delivery system.

H.R. 676 Would Reduce Overall Health Care Costs


Families Will Pay Less

Currently, the average family of four covered under an employee health plan spends a total of $4,225 on health care annually – $2,713 on premiums and another $1,522 on medical services, drugs and supplies (Employer Health Benefits 2006 Annual Survey, Kaiser Family Foundation and Health Research and Educational Trust; U.S. Department of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey.) This figure does not include the additional 1.45% Medicare payroll tax levied on employees. A study by Dean Baker of the Center for Economic Research and Policy concluded that under H.R. 676, a family of four making the median family income of $56,200 per year would pay about $2,700 for all health care costs.

Business Will Pay Less

In 2006, health insurers charged employers an average of $11,500 for a health plan for a family of four. On average, the employer paid 74% of this premium, or $8,510 per year. This figure does not include the additional 1.45% payroll tax levied on employers for Medicare. Under H.R. 676, employers would pay a 4.75% payroll tax for all health care costs. For an employee making the median family income of $56,200 per year, the employer would pay about $2,700.


The Nation Will Pay About the Same, While Covering All Americans

Savings from reduced administration, bulk purchasing, and coordination among providers will allow coverage for all Americans while reducing health care inflation in the long term. Annual savings from enacting H.R. 676 are estimated at $387 billion (Baker).


Proposed Funding For USNHC Program

· Maintain current federal and state funding for existing health care programs
· Establish employer/employee payroll tax of 4.75% (includes present 1.45% Medicare tax)
· Establish a 5% health tax on the top 5% of income earners, 10% tax on top 1% of wage earners
· ¼ of 1% stock transaction tax
· Close corporate tax loopholes
· Repeal the Bush tax cuts for the highest income earners