Donald Berwick  Responsible Health Reform

Donald Berwick Responsible Health Reform

Patients and Physicians working together to protect medical care from "ObamaCare"

Price transparency in health care & prescription drugs

Posted on July 1, 2011 by admin Leave a comment

Why does medical care in the United States cost so much? Why do prescription drugs cost so much?

Joseph R. Antos, the William H. Taylor scholar in heath care and retirement policy at the conservative American Enterprise Institute:

Health care is expensive because of the pervasive entitlement attitude held by literally everyone in the system: patients, providers, suppliers, insurers. Government insurance (Medicare, Medicaid, veterans, Department of Defense) covers 87 million; tax breaks subsidize 176 million in employer coverage; insurers and other third-party payers take care of the bills for 85 percent of Americans.

This virtually guarantees payment to the medical community, who are the gatekeepers to health care. There is little awareness of the full cost or value of medical treatment on the part of consumers or providers, and little opportunity for individuals to choose their own coverage or make informed decisions with their doctors about treatment.

The health bill will add another entitlement to existing ones, providing large subsidies to millions of additional people without addressing the cost drivers except in demonstration projects that might pan out in a decade. Even the Medicare cuts are speculative, since they depend on future Congresses going along with decisions made this year. Taxes, which pay for about half of the reform, do not reduce health spending—they enable more spending.

Jacob S. Hacker, the Stanley B. Resor professor of political science at Yale University and a liberal proponent of a government-run health insurance plan.

A common lament is that we don’t know how to control costs. That’s false. Other nations with broad health programs have a much better track record than we do, and even the Medicare program has controlled costs better than the private sector. These experiences suggest that a big reason health care in America is so expensive is that there’s too little countervailing power in the markets for health insurance and health services.

Insurers, pharmaceutical companies, device manufacturers, doctors and hospitals are all able to drive up prices with limited pushback. On the one side, insurers have virtual monopoly power in many markets. Without serious competition for their business, they often have little incentive to contain costs. On the other side, providers of health care services have enormous market power in many local markets. Without insurers jawboning them to bring down rates and improve efficiency, they continue to charge too much and operate without proper economy.

Unfortunately, the proposed legislation does not do enough to strengthen competition and rein in costs. The public health insurance option was the best means of bringing countervailing power to bear. In its absence, the hope is that regulations on insurers will encourage them to focus on keeping down the underlying cost of care, rather than shifting costs onto consumers or avoiding costlier patients. But the legislation lacks strong enough incentives for insurers to behave differently and strong enough tools for government officials to respond if, as I fear, costs continue to rise more or less unabated.

Both of these well intentioned gentlemen miss the point completely.  The fewer intermediaries between the medical professional and the patient . . . the better. Better health care and transparency in pricing.

I get some of my medications from a compounding pharmacist from UNC School of Pharmacy.  He mixes the compound, hands it to me, I pay the compounding pharmacist out of pocket and then file a claim with my health insurance company.

Sure, we don’t need compounding scientist for every drug.  But why on Earth do we need HMOs, insurance companies and Medco (the federal government’s Medicare Part D administrator) to negotiate with pharmacies, medical facilities for the price of the medicines?  Why don’t we all pay the true, real cost of the medicine? Then, our insurance pays and we never know the cost of the product.

As a patient, my primary relationship should be with my physician.

As a financially responsible patient, I purchase insurance in the event I have a catastrophic illness (I have cancer and tibial osteomyelitis).  But, as a cancer patient, I should know what the true cost is of every drug, test, scan, procedure.  The true cost – not what insurance will pay or my co-pay.  I take care of myself and know that some procedures, drugs have more risks than benefits.

Unless I have all of the relevant information in front of me (including the true, actual cost of the medical cost or service) then I am just feeding off the medical system like a cow at the trough.  And, unnecessary use of scarce medical resources (ie managed care, ObamaCare plan) has overburdened the medical system, created incentives for insurance companies, “big pharm,” hospitalists to distort the true cost of health care costs.

Lack of transparency in costs cannot survive in a capitalist market. Sooner or later, the real people catch on.  We start getting that our doctor seems to have more of a relationship with BCBS than us (the patient).

It must stop.  It will stop.

A great first step would be for doctors to determine the actual costs of their services, create a prototype plan using a lean business model and implement the plan in a few counties that cannot afford its state Medicaid system. And that is RHR_Chat’s plan.  We are in the brain-storming/planning stages.   Exciting.  Doctors will actually have control over the planning.

Florida is doing this with HMOs.  We’d like to do it with just medical professionals.  Join us.

Posted in Donald Berwick, Jacob D. Hacker, Joseph Antos, Medco, Obama Care, Responsible Health Reform, Transparency in healthcare pricing

We Can Stop Another CMS Administrator (Berwick) Recess Appointment

Posted on April 20, 2011 by admin Leave a comment

“The decision is not whether or not we will ration care. The decision will be whether we ration care with our eyes open.”

Quote by: Donald Berwick, M.D. (recess appointee in July 2010 as Administer of the Centers for Medicare & Medicaid Services (CMS) by President Obama) http://goo.gl/s8E73

The power to make recess appointments is granted to the United States President by Article II, Section 3 of the U.S. Constitution

The President shall have Power to fill up all Vacancies that may happen during the Recess of the Senate, by granting Commissions, which shall expire at the End of their next Session.

The President may appoint the person to a position for any length of time whenever Congress is not in session.  The appointed person assumes his or her appointed position without the approval of the Senate.

The Constitution does not specify a minimum length of time the Senate must be in recess before the President can enact a recess appointment.

Theoretically, the Senate must approve the appointee by the end of the next session of Congress or when the position becomes vacant again.  But as with Barack Obama’s recess appointment of Donald Berwick, M.D., the President can withdraw the appointee from confirmation consideration.  Then, as with Berwick, the appointee continues in the position (causing havoc to the Medicare and US healthcare system generally) while the President, Congress, Berwick and even Berwick’s family know that he could never be confirmed.

The intent of the Founding Fathers in Article II, Section 3 was to grant the President the power to fill vacancies that actually occurred during a Senate recess.  And that is precisely where we should return.

Both “Republican” and “Democrat” Presidents have ignored the Founding Fathers intent and replaced the original intent with a liberal interpretation, using the clause as a means of bypassing Senate opposition to controversial nominees. Presidents expect that opposition to their recess nominees will lessen by the end of the next congressional session.

Has that worked with President Barack Obama’s recess appointment of Donald Berwick, M.D. as Administer of the Centers for Medicare & Medicaid Services (CMS)?  Nope.  The Berwick appointment is seen for precisely what it is – a “subterfuge.” That is why Berwick’s final confirmation is so unlikely that Obama will not pursue it.

What other Presidents have used or abused the recess appointment privilege?

President George W. Bush placed several judges on United States courts of appeals via recess appointments when Senate Democrats filibustered their confirmation proceedings.

Judge Charles Pickering, appointed to the Fifth Circuit U.S. Court of Appeals, withdrew his name from consideration for re-nomination when his recess appointment expired.

President Bush appointed Judge William H. Pryor, Jr. to the bench of the Eleventh Circuit Court during a recess, after the Senate repeatedly failed to vote on Pryor’s nomination.

President Bill Clinton appointed Bill Lan Lee as assistant attorney general for civil rights. That recess appointment became controversial when it became clear that Lee’s strong support of affirmative action would lead to Senate opposition.

President John F. Kennedy appointed Thurgood Marshall to the U.S. Supreme Court during a Senate recess after Southern senators threatened to block his nomination. The full Senate later confirmed Justice Marshall after the end of his “replacement” term.

President Theodore Roosevelt took liberal advantage of the recess appointment privilege.  Roosevelt made several recess appointments during successive one-day Senate recesses.

Now the big question – what are we as a country going to do about a new Administrator of CMS?

Are we going to allow President Obama to ignore the intent of our Founding Fathers again and bypass the Senators that were sent to Washington, D.C. to represent the people?  That is precisely what Obama did with Berwick and the results have been horrific.  Berwick envies the U.K.’s healthcare system, universal healthcare single payer system and rationing of medical care.

We must demand that our Senators stop President Obama from abusing the recess appointment privilege.  The role of CMS Administrator is too important as our country is in the process of redesigning the medical care system.  It is not the time for “politics as usual.”  I don’t care how many other Presidents have interpreted the privilege “liberally,” the practice of using the office of POTUS to further personal agendas must stop now.

Have you got your Senator on speed dial yet?  Make sure he or she is ready to return to D.C. at a moment’s notice to stop a CMS Administrator recess appointment.

Posted in Donald Berwick, Obama Care, Responsible Health Reform

Would Getting Rid of Donald Berwick, MD Mean the End of ObamaCare?

Posted on April 11, 2011 by admin Leave a comment

Lest anyone think I was exaggerating, Berwick has written that the British health-care system is “more likely to succeed” than the American one; that he feels “an optimism about the [British] NHS [National Health System] that is hard to find in the UK nowadays”; that he thinks “nationalized health care was a wise choice in 1948 and that it remains so now”; that “the social budget” — the social budget! — “is limited”; and that “[t]he decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.” This is who President Obama wants to have running Medicare, Medicaid, and significant portions of ObamaCare.

In July 2010, President Obama bypassed Congress and appointed Donald Berwick, MD to run Medicare and Medicaid.  The White House communications director said the “recess appointment” was needed to carry out the new health care law. The law calls for huge changes in the two programs, which together insure nearly one-third of all Americans.

According to the New York Times, President Obama decided to act because “many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points,”  said Dan Pfeiffer, White House Communication Director.

As a recess appointee, Dr. Berwick will have all the powers of a permanent appointee. But under the Constitution, his appointment will expire at the end of the next session of Congress, in late 2011.

On March 11. 2011, The Weekly Standard confirmed Politico reports that “Senate Democrats have given up on confirming Don Berwick, MD as CMS administrator in the wake of a letter from 42 Republican senators opposing the nomination,” as “there’s no way for Berwick to get the 60 votes needed to clear the Senate.”

Weekly Standard writer Jeffrey H. Anderson explains:

Lest anyone think I was exaggerating, Berwick has written that the British health-care system is “more likely to succeed” than the American one; that he feels “an optimism about the [British] NHS [National Health System] that is hard to find in the UK nowadays”; that he thinks “nationalized health care was a wise choice in 1948 and that it remains so now”; that “the social budget” — the social budget! — “is limited”; and that “[t]he decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.” This is who President Obama wants to have running Medicare, Medicaid, and significant portions of ObamaCare.

So, does America really have to wait until the end of calendar year 2011 to get rid of Donald Berwick, MD when everyone in DC knows he is a “short termer “?  Medicare and Medicaid are effectively on hold while we run the clock out?  Why?

42 Republican Senators wrote to the President.  Are those Senators going to follow through?  Can we get Berwick out sooner or are we going to wait until the 2012 elections? Because that is just plain crazy talk.

Posted in Donald Berwick, Obama Care

Recent Posts Price transparency in health care & prescription drugs

We Can Stop Another CMS Administrator (Berwick) Recess Appointment

Would Getting Rid of Donald Berwick, MD Mean the End of ObamaCare?

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