August 1, 2009 Legislation


Nursing Board

Joint Commission

Red Flag


The House has put out on the floor the first draft of their healthcare reform bill.  This, of course, will not pass into law but it is a first salvo.  The Democrats who put this bill forward had no Republican support nor any support from those moderates in their own party.  They did not assign any monetary value to the plan but others place it at the repugnant value of $1.5 TRILLION.  At the same time a Senate Committee passed out a Kennedy bill on a party vote of 13-10 which is to be about $600 Billion.  I never thought Kennedy was frugal but next to Pelosi he is a real miser. The only thing cheap in the bill in the payment to physicians in the public plan of Medicare plus 5%. The cost of the plans are on top of a currant debt of $1 TRILLION and a doubling of that before the end of the year.  This will cause inflation and make those in China and other places that purchase our T Bills think twice.

Speaking of global economy, it should be noted that the total bailout costs to America could rise to $24 TRILLION. This is only for TARP and the programs of Bush, Obama and the Fed Reserve.  This is from the treasury department.  For a clear picture of our debt, please go to .

A poll by the University of Texas stated that 50% were against the House bill and only 42% supported the bill.

In a new poll taken a few days prior to this edition, about 60% of the public doesn't believe Obama and the Congress will help them in healthcare.  

The LA Times has an article stating that healthcare overhaul will not decrease healthcare spending.  The business coalition that originally backed some of the changes in policy that would increase coverage and decrease costs now state that the decrease costs have been dropped from the equation.  The amount paid to hospitals will go down initially but then raise to be either neutral or positive by the end of the decade.  Physician payments will change as primary care physicians get about 8% more and specialists get up to 40% less. This eventually will cause British type waits for specialist care.  I have seen 6 month waits for breast cancer radiation so that the people have come to the US for therapy.

As the Congressional healthcare bill was passing a committee on partisan voting plus some Democrats voting against the bill, the Congressional Budget Office was giving a report to another committee that the passage of any of the Congressional bills will not only not lower federal healthcare spending but will increase it.  Congress was mad at the office for telling the truth.  The report stated that taxing healthcare benefits and scuttling the public insurance plan may be helpful but Obama has been against this.

After the CBO gave its unbiased report the Senators who are pushing the bill through said the CBO should not have put in the costs physician fees.  I guess physicians will be unpaid under the new regime.  The three Senators then figured out that without the physicians there would be a $6 Billion surplus over the decade.  What a spin.

The CBO also believes that there will not be over 100 million people going to the public option, only a mere 11 million. They also do not believe that businesses will drop their insureds nor the insureds will drop the employer plans.  They do state that with the less amount of people uninsured the hospitals that now pay out about $35 Billion will pay out alot less.  Remember that figure of $35 Billion per year versus $1.5 TRILLION over ten years.  It does not compute.

To make sure the above happens, Peter Orszag sent a letter to puppet Pelosi wanting a Congressional vote on giving power to set fees to a new executive committee that is not elected and therefore only beholden to his excellency Obama. 

Obama is now starting to take legislation ability away from Congress.  He is circulating a proposal that the above five person Independent Medicare Advisory Committee be beholden to the Executive branch and they will set rates for all providers.  This is how NICE in England started.  This takes the onus of the projected monetary problems of healthcare reform away from the Congress and onto this small committee. 

A Congressional Budget Office assessment of the White House’s proposal to establish an independent agency charged with setting Medicare payment rates finds that the plan may save up to $2 billion between 2016 and 2019—a relatively small share of Medicare spending across those years, which is expected to total at least $2.8 trillion, the New York Times reports.

Support of the new healthcare plan continues to erode and as it does Obama becomes more of a fixture on TV.  Think of how much money this will cost to insure under 5% of the population, since many of the uninsured are illegal aliens who will not be included in the plan, unless they will.

The "blue dog" Democrats met with Obama with 10 demands to make the reform less costly.  They did agree that MedPAC would be the ogre and decrease Medicare payments under the guise of the executive branch in the future but Congress could override the decisions.  The artificial August recess time is probably dead.

The health insurers which originally were all for the reform plan are now being more circumspect.  They are dead set against the public plan option.  It should be noted that if a public plan does pass, it will raise havoc with ERISA and many other federal and state insurance laws.

It is hard to believe but the AMA has supported the House bill with its paying physicians Medicare plus 5%.  This is the reason the AMA is not the voice of physicians as it only represents 25% of the physicians and about half of them are first year medical students.  The bill was amended to add a clause against physician hospitals and payments for MRI and CT scans in physician offices.  This will lead to long waits in urban areas and long travel as well in rural areas as physicians say the payments are not worth the costs. The sponsor was Rep. Speier of San Mateo, California. I hope the physicians in that county rally for her opponent in the next election.

The Wall Street Journal had an editorial regarding the the self destruction of the AMA with the potential for the loss of 17 state medical societies and three specialty organizations over its capitulation to Obamacare.  More specialist societies will also defect and do their own lobbying.  I received a fax from the AMA, I do not belong, telling me they voted for the House version and asking me to go online to find out why.

Most physicians, with the exceptions of the primary care organizations, are against MedPac doing the math as to who gets paid what.  The primary care physicians want more money but they will get a larger percentage of a smaller pie.  This means they will get the same or less than they are getting now.

The AHA originally said they would give $150 Billion to the healthcare reform.  This was a sham and the Congress repaid them by stating they will be paid under the public option, if there is one, 32% less than they get paid by private plans.  They will get paid Medicare rates.  Thanks hospitals.

Obama held a live question session and stated unequivocally that he would not sign any health care bill that did not reduce health care costs and also reduce the deficit.  If that were true there would be very little arguments and almost the entire top part of this section could have been eliminated.  However, the bills do not reduce the deficit but increase it.  I believe he would sign anything that comes out of Congress no matter the cost. 

In a new idea there may be taxation on the insurers that make expensive healthcare insurance available to its insureds.  Of course the cost will be passed on to the insureds thereby going against Obama's stand of not taxing health care benefits.

The Democrats are so mad at the Republicans that they took away their franking ability to send letters to their constituents against the health care bill.      

The Senate has put a hold on the poorly thought out plan until the fall.  This way they can read it and hear from their constituents about the plan and its costs. When this was announced the White House called in some of House " Blue Dogs" but got nowhere.  Some of the Senators also want to begin to add mandated coverage for alternative therapies that are not covered in standard plans or Medicare. The House is probably going to wait for the Senate to go forward. The Senate is considering taxing health benefits that cost over $25,000 per year and do away with the public health plan.

The last House committee approved a plan after originally making a deal with the "Blue Dogs" and then making a separate deal with the progressives.  The House members may now return to their districts for the August recess and hear from their constituents on this bill.  It may make for an interesting September. 

The House is actually doing something else besides the healthcare bill.  They have approved a bill to lift the 21 year moratorium on needle exchange programs. 

While the above was going on, the healthcare plan at the tiny Republic of Massachusetts was in trouble.  This is the plan that the US plan is based on.  The Republic's plan can not pay for all so they are dropping all the legal aliens from the plan.  This sends the message that healthcare for all is a costly proposition, especially in a recession with high unemployment and therefore less tax monies.  The Republic is paying about twice to insure what it now costs.  Stupidity continues to thrive in the Republic. (See Recent Legal this edition)

A week after the above the Republic bowed to political pressure and restored money they don't have to insure the legal immigrants.  

The Republic also is considering going back to capitation for hospitals and providers.  This is to save money under their universal health system.  If this small area and population has to do this, think what will happen if the US Democratic bill passes.

The Republic has shown the country the flaw in government run healthcare.  They are putting in multiple mandates of coverage as they get pressured by lobbyists and of course not funding them.  The insurers would have to eat the cost.  The Republic already is over $1000 more per family than the national average.  

Connecticut has a new law allowing hospitals to purchase physician groups for outpatient care.  They had a law allowing it in the hospitals.  The law requires that the board of this medical foundation must have equal numbers of physicians and non physicians.         Top

Nursing Board

After The Terminator terminated the majority of the California Nursing Board of not doing its job, the main cause of the problem, the executive director, resigned.  The new board will now have a clear track to make changes in order to rid it of a backlog of complaints against nurses.        Top

Joint Commission

After several years of haggling the special commission of the Joint Commission has come up with a draft of a new standard MS 1.20.  This is now called MS .01.01.01.  The JC did not put the version on its web site but one hospital friendly attorney group did.  The AMA got the new version from the web site and sent it to a friend who sent it to me.  It is only a  draft and not a standard but it does change the original 1.20 to allow important items to be not put in the bylaws, only the processes. The medical staff still can bypass the MEC and submit bylaws directly to the Board. Once it is sent out for field review physicians and physician friendly attorneys who care about hospital control should be writing to the JC regarding the proposal.     Top

Red Flag

The FTC just days prior to the August 1 beginning date has delayed the onset of the Red Flag rules until November 1.  The reason is to reassess who is covered under the rules.        Top


DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.