Opinion 1.0
Happy Christmas Eve! It is freezing here in the People's Republic of Maryland. There is stil a lot of snow on the ground. Waking up this morning, Fox was showing the senate vote and how happy the democrats were in signing this disaster of a bill. Even democratic associates and pundits are denouncing the contents of the senate bill. So why are they pushing this so badly? Obama needs something positive for his "State of the Union" speech since our economy is still in a recession, 10% unemployment, 2.2% GDP (revised downward twice), non-existent foreign policy and the President's poll numbers are at historic lows. Even some of the liberal left are turning on the President. One of the biggest problems is that no one believes anything the Obama administration says. They have been caught in so many lies and contradictions. This will be the beginning of the end for the democrats if this passes the congress. Obama will become a lame duck President two years into his first term. Congress will not be back until January 18th, two days before Obama's first State of the Union speech. I doubt congress can agree on anything in that time period. However, Obama will promote the fact that the house and the senate have approved separate bills. So much for the bi-partisanship! If he gives himself a grade of "B+," I will throw up in my mouth. He thinks he has done a good job and his administration has brought the U.S. back from destruction. Duh! He hasn't even parted the seas yet? He employs a herd of tax cheats, communists (Van Jones & Anita Dunn) and Constitution haters. And lets not forget the incredible transparency and open administration. I'm not sure if we have a Presidential administration or a CIA covert operation. Harry (Dr. Smith) Reid and Nancy (SanFranGranNan) Pelosi have already stated that healthcare negotiations will be behind closed doors. So much for transparency. I believe 2010 will show the country what the American public can accomplish by uniting against Obama's socialist's agenda. We will show our tenacity and perseverance in organizing opposition to show that we are a viable force to be reckoned with. I know the far left doesn't take this movement seriously. They will, especially, when they return home to their constituents. It will be an eye-opener. Please have a Merry Christmas and enjoy the things that are important. This is not a dress rehearsal, live life everyday, like it is your last.
The Pres - Passage of senate bill:
Michelle Malkin dicing them up:
Michelle Malkin:
What Doctors and Patients Have to Lose Under ObamaCare
Changes to Medicare will give the feds control of surgical decisions.
By SCOTT GOTTLIEB
Democrats are touting the American Medical Association's endorsement of President Obama's health plan. But there's an important reason why the American College of Surgeons and 18 other specialty groups are opposed.
The plan's most tangible efforts to restrain medical costs are through its controls on specialist physicians. Based on the government's premise that they often make wasteful treatment decisions, the health-care legislation in Congress will subject doctors to a mix of financial penalties and regulations to constrain their use of the most costly clinical options. The penalties and regulations are aimed first and foremost at surgeons and the medical devices that they use, largely because that's where the bulk of spending is.
It all starts with the sweeping power that the Senate bill gives to the Centers for Medicare and Medicaid Services. The agency will be given the authority to unilaterally write new rules on when medical devices and drugs can be used, and how they should be priced. In particular, the Obama team wants to give the agency the power to decide when a cheaper medical option will suffice for a given problem and, in turn, when Medicare only has to pay for the least costly alternative.
The government has already sought to acquire this same power administratively. But on Tuesday the Obama Justice department got swatted down by the U.S. Court of Appeals for the D.C. Circuit, in what the judges described in their opinion as an attempt by Mr. Obama's legal team to "end-run around the statute [Medicare]."
Hays v. Sebelius involved a patient who said Medicare unfairly denied her a prescribed treatment for her serious lung disease. Medicare decided instead to pay for a different drug that bureaucrats argued was a suitable but cheaper alternative.
Now the Obama team will use murky provisions embedded in the Senate bill to subtly attain in law those powers they couldn't more artfully acquire in court. In fact, the bill lets Medicare seek almost any restrictive payment authority it wants from a Medicare Commission established for the purposes of cost control.
If Congress believes Medicare has overreached, it has to pass a separate law to explicitly block the agency's newly acquired powers. These provisions are deliberately designed to leverage Congress's inability to act in a timely fashion.
The Senate health-care bill also exempts Medicare's actions from judicial review, taking away the right of patients to sue the government. Unlike existing Medicare coverage laws, patients won't have the ability to appeal any of the decisions of this new Medicare Commission.
Ironically, private health insurers must comply with new patient appeals rights under the Senate bill. The government has exempted itself from the same sort of protections.
Thus Medicare will have the power to control which medical devices surgeons use. But clamping down on expensive procedures also means the agency will need to have authority over the specialists themselves. The organization of doctors into mostly small, disaggregated practices always made it hard for a central bureaucracy to control individual physicians. ObamaCare tries to fix this by putting doctors on the financial hook for their treatment decisions.
Primary-care doctors who refer patients to specialists will face financial penalties under the plan. Doctors will see 5% of their Medicare pay cut when their "aggregated" use of resources is "at or above the 90th percentile of national utilization," according to the chairman's mark of Section 3003 of the bill. Doctors will feel financial pressure to limit referrals to costly specialists like surgeons, since these penalties will put the referring physician on the hook for the cost of the referral and perhaps any resulting procedures.
Next, the plan creates financial incentives for doctors to consolidate their practices. The idea here is that Medicare can more easily apply its regulations to institutions that manage large groups of doctors than it can to individual physicians. So the Obama plan imposes new costs on doctors who remain solo, mostly by increasing their overhead requirements—such as requiring three years of medical records every time a doctor orders routine medical equipment like wheelchairs.
The plan also offers doctors financial carrots if they give up their small practices and consolidate into larger medical groups, or become salaried employees of large institutions such as hospitals or "staff model" medical plans like Kaiser Permanente. One provision, laid out in Section 3022, allows doctors to share with the government any savings to the government they achieve by delivering less care—but only if physicians are part of groups caring for more than 5,000 Medicare patients and "have in place a leadership and management structure, including with regard to clinical and administrative systems."
While these payment reforms are structured as pilot programs in the legislation, this distinction has little practical meaning. Medicare is being given broad authority, for the first time, to roll these demonstration programs out nationally without the need for a second authorization by Congress.
Regulation of medicine has always been a local endeavor, and it's mostly the province of medical journals and professional medical societies to set clinical standards. This is for good reason. Medical practice evolves more quickly than even the underlying technologies that doctors use. This is especially true in surgery, where advances flow from experimentation by good doctors to try different surgical approaches.
The regulation of medical devices and their pricing will also have consequences for patients by discouraging innovation. Most improvements in medical devices come incrementally, with each generation of a device having small but clinically relevant advance over prior versions. This owes to the underlying hardware, which turns on embedded software and microprocessors that themselves undergo constant upgrades.
But if Medicare starts pricing similar devices off one another—a form of the same "reference" pricing schemes used in Europe—manufacturers will start holding back the small changes. Instead, they will introduce new models every four or five years that are sufficiently unique to fall outside of Medicare's pricing scheme. Meanwhile, patients will have lost the benefit of regular improvements and annual upgrades that characterize medical devices today.
The impact of these provisions won't be confined to Medicare. Private insurance sold in the federally regulated "exchanges" will take cues from Medicare, since they're both managed from the same bureaucracy. Medicare will set the standard for medical care across the entire marketplace.
Mr. Obama promised that under his plan people wouldn't have to change their doctors. But it's clear that doctors will be forced to change how they make their medical decisions.
Dr. Gottlieb, an internist and a resident fellow at the American Enterprise Institute, is a former senior official at the Centers for Medicare and Medicaid Services. He is partner to a firm that invests in health-care companies.
I would be honored to thank all of the men and women who serve our country in uniform. You are away from your families, friends and surroundings at this time of year. Merry Christmas and a Happy New Year and a safe and quick return home.
Here's to you, soldiers of the 1-17 in Afghanistan
By David Ignatius
Thursday, December 24, 2009
BASE FRONTENAC, AFGHANISTAN It's a week before Christmas Eve, and the chow hall of this forward operating base north of Kandahar is decorated with twinkling blue and white lights for the holidays. There are posters of Santa and a snowman on the walls, and in the center of the room there's a big sign that exhorts the soldiers: "Enjoy Meal." Christmas will be "a day to take your boots off" for the 800 members of the Army's 1st Battalion, 17th Infantry Regiment based here, says their commander, Lt. Col. Jonathan Neumann. It also will be a day to remember the 21 comrades who have been killed since the battalion arrived in August, and the 41 who have been seriously wounded.
The 1-17 has the grim distinction of having lost more soldiers in action than any other battalion in the Army since Sept. 11, 2001. The men's names are recorded on a concrete slab in the center of the compound, bearing the legend "Fallen But Not Forgotten."
"After a catastrophic incident, you come together and take care of your brothers," says Neumann. "Then you resolve to get back to the mission at hand." Christmas will be a moment to relax -- a day of sports, award ceremonies and a special meal. But because of combat rotation, the battalion will have to celebrate it over a series of days.
I traveled here with Adm. Mike Mullen, the chairman of the Joint Chiefs of Staff, who was making a holiday visit to the war zone. Amid the twinkling lights of the mess hall, he addressed the soldiers of the 1-17, their automatic rifles stowed under the meal tables.
"I know you've been in a very tough fight, and I'm aware of those you've lost," Mullen told the troops, assuring them: "We have the right strategy." He met afterward with a small group from units that had been especially hard hit.
This holiday season is a good time to remember these faraway soldiers. The debate over Afghanistan has provoked strong feelings, pro and con. But the country seems united in its appreciation for a military that has been suffering the stresses of war, without complaint, for the past eight years.
Soldiers are usually stoics. But the members of this battalion seem highly motivated. The sergeant of a platoon that lost nine men in two weeks asked to reenlist after a memorial service for his buddies. On the day Mullen visited here, the admiral reenlisted 10 soldiers.
The base lies in a dusty plain surrounded by jagged peaks. Nearby is the Arghandab River, which feeds a lush area of orchards and mud-walled agricultural plots that the soldiers call "the green zone." That's where the Taliban fighters hide and where the battalion has fought some of its toughest battles.
When the battalion arrived on Aug. 7, about 150 Taliban fighters were well entrenched. Neumann says his soldiers had to "fight our way to the people." By early November, the situation had begun to change. The Taliban's cadres had been killed or had scattered, their supply caches had been destroyed -- and the local population began providing intelligence.
That's the model the Obama administration hopes will be replicated in other population centers as the United States sends in 30,000 more soldiers. One thing that's painfully clear when you visit this base is that success won't come cheap. The new strategy will mean more battles, more targets for roadside bombs, and more dead and wounded American soldiers.
The White House debate over Afghanistan took place as the battalion was suffering its worst casualties. The policy-wrangling directly affected these troops, but it became "white noise," says their commander. "We knew there was a debate in Washington, but there's always a debate." The 17th Infantry has a history of tough fights. Its nickname, the "Buffaloes," dates back to the Korean War, where it fought in the battle of Pork Chop Hill, a bloody push to win territory that arguably had little strategic value. But even that conflict was easier to measure than the one the Buffaloes are fighting now. "Here, it's one small incident at a time," says Neumann.
There's a scraggly Christmas tree atop one of the prefabricated trailers where the soldiers of the 1-17 bunk when they're not out on missions. It's not a place any of us would want to spend the holidays, but in conversations with soldiers here, I didn't hear any complaints.
In this season of peace, here's a holiday toast to people everywhere who don't have that blessing today.
davidignatius@washpost.com
Quote du jour:
"Aren't we forgeting the true meaning of Christmas? You know, the birth of Santa."
Matt Groening (1954 - )
Kill Bill Vol. III:
Opposition to Senate Healthcare Bill: Call your Senators!
"We the people" must stop the Obamacare Proposals: I am formally asking (pleading) with you to muster up the initiative and enthusiasm to fight the healthcare bill that will emerge in the end of the year. First, there are 2 bills (proposals) that will somehow be merged into one bill. Liberals are adamant about some form of "Public Option" (Government Run Option) and federally funded abortion. I think the democrats believe they can push this bill through while we are sleeping. The democrats have blocked many bills that would allow the final bill to be posted on the internet 72 hours prior to a vote. Why? you know why. We must oppose this more than we did over the summer. Let them know, we are not against healthcare reform, just not a total makeover. Call and email your representatives. I have emailed and called mine so many times, they are referring to me by my first name. Write an old fashioned letter, it has a lot of importance. Attend your local tea parties and townhalls to voice your opinions and make a overwhelming presence. Below, is a little list how you can get involved. It is our civic duty. "It is our Country."
http://www.congress.org/
http://www.joinpatientsfirst.com/
http://www.freedomworks.org/
http://www.resistnet.com/
http://www.teapartypatriots.com/
http://www.teaparty.org/
http://www.taxpayer.org/
http://www.taxpayer.net/
info@cmpi.org
http://www.fairtax.org/
http://www.conservativeamericansunited.org/
CALL YOUR SENATORS! EMAIL YOUR SENATORS! CALL YOUR SENATORS! EMAIL YOUR SENATORS!
References:
http://www.hotair.com/
http://www.nro,com/
http://www.drudge.com/
http://www.politico.com/
http://www.newsbusters.com/
http://www.youtube.com/
http://www.quotationspage.com/
http://www.realclearpolitics.com/
http://www.marklevin.com/
http://www.anncoulter.com/
David Ignatius
Scott Gottlieb, MD
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