The Coming of ObamaCare Ethics

Just when you thought Obamacare and  Contraceptives were fun…

All student health care plans covering female college students in the United States must include coverage for free voluntary sterilization surgery, the Department of Health and Human Services announced late Friday afternoon.

Women of college age who do not attend school will also get free sterilization coverage whether they are insured through an employer, their parents, or some form of government-subsidized plan.

“In a study of the cost-effectiveness of specific contraceptive methods, all contraceptive methods were found to be more cost-effective than no method, and the most cost-effective methods were long-acting contraceptives that do not rely on user compliance,” said the Institute of Medicine report on its mandate recommendations.(CNS)

Say Just say “yes” to Sterilization, and No to “Just say no” abstinence!

“The reduction in the number of pregnancies compensates for the cost of contraception,” HHS Secretary Sebelius has said in the past.

The prestigious Journal of Medical Ethics has just given us a sneak-peek into what ObamaCare will surely be mandating in the not-too-distant future.

The Journal published an article this month seeking to mainstream the view that infanticide is a health-improving measure.  Calling it “after-birth abortion,” two philosophers argue that killing a newborn should be a purely elective decision of parents who believe the baby would be a burden or would negatively impact their family’s well being. (life News)

So, they way to cover cost of Obamacare is to have less people in the system!!

For the past several years, the medical profession has been undergoing a disturbing transformation. The process was begun by the Centers for Medicare and Medicaid Services (CMS) in an effort to control exploding Medicare costs, and was accelerated by the passage of the Patient Protection and Affordable Care Act of 2010. As a surgeon in practice for over 30 years, I have witnessed this transformation firsthand. I fear that my profession will soon abandon its traditional code of ethics and adopt one more suited to veterinarians.

For centuries, my predecessors and I have been inculcated with what has come to be called the “Hippocratic Ethic.” This tradition holds that I am ethically required to use the best of my knowledge to recommend to my patient what I consider to be in my patient’s best interests—without regard to the interests of the third-party payer, or the government, or anyone else.

But gradually the medical profession has been forced to give up this approach for what I like to call a “veterinary ethic,” one that places the interests of the payer (or owner) ahead of the patient. For example, when a pet owner is told by a veterinarian that the pet has a very serious medical condition requiring extremely costly surgery or other therapy, the veterinarian presents the pet’s owner with one or more options—from attempt at cure, to palliation, to euthanasia—with the associated costs, and then follows the wishes of the owner.

In a few years, almost all doctors will be employees of hospitals and will be ordered to practice medicine according to federally prescribed guidelines—guidelines that put the best interests of the state ahead of the interests of individual patients.

Several factors in combination are bringing this ethical approach to my profession.

Since the mid-1980s, Medicare has imposed price controls on health care providers. Over the years, in order to accommodate increasing Medicare utilization, physician payments have steadily dropped.

Meanwhile, the regulatory burden on physicians has increased. In the last few years, CMS required all providers to adopt electronic health records or face economic sanctions from Medicare. It is the ultimate goal that every health care provider, including pharmacies, will have electronic databases that will be accessible to the U.S. Department of Health and Human Services (HHS).

In 2009, as part of the so-called stimulus bill, the Federal Commission for the Coordination of Comparative Effectiveness Research (FCCCER) was created. Its mission is to collect the data culled from all electronic health records and make recommendations regarding the comparative effectiveness of drugs, procedures, and therapies. In rendering advice, the FCCCER will essentially answer the following question: What is the most cost-effective way of allocating a fixed amount of resources among a population of roughly 310 million people?

With this same question in mind, the U.S. Preventive Services Task Force, a committee that reports to HHS, concluded in 2009 that mammogram screenings should not be recommended to women under age 50. This caused an uproar among both private health care providers and breast cancer advocacy groups, and the task force soon backed down. Similarly, in the fall of 2011, the task force recommended the abandonment of certain routine prostate cancer screenings. Once again, health care providers and cancer advocacy groups protested, and the task force rescinded its recommendation.

In 2010 the Patient Protection and Affordable Care Act established an Independent Payment Advisory Board (IPAB). Beginning in 2014, the 15 presidential appointees on this board will determine what therapies, procedures, tests, and medications will be covered by Medicare, using advice provided by the FCCCER. Such determinations will then be used to design the coverage packages for the non-Medicare insurance offered through the government–run exchanges. The decisions of the IPAB are not subject to Congressional oversight or judicial review.

Meanwhile, in an effort to control costs now, CMS has developed practice guidelines and protocols for physicians to follow. Committees of health care academics and statisticians developed these guidelines, using data from large population samples.

These protocols govern the therapeutic decisions made by the health care practitioner—right down to the pre-operative antibiotics a surgeon may order. Despite the fact that several recent peer-reviewed studies concluded that the protocols have had no positive effect—in fact, one study showed post-op skin infections increased since the protocols were instituted—CMS imposes financial penalties on hospitals that fail to get protocol compliance from their medical staff.

Medical students and residents are now being trained to follow federally-derived protocols and guidelines as a normal part of medical practice. As a result, this new generation of doctors will be less inclined to challenge the recommendations of federal task forces and agencies. Some academics also worry that “teaching to the protocol” might discourage independent thinking and the use of intuitive knowledge, two traits essential to the practice of good medicine.

In addition, decreased reimbursements and increased regulatory demands on physicians have led many to sell their practices to hospitals. The New England Journal of Medicine* estimates that 50 percent of the nation’s doctors are now hospital employees. As private medical practice becomes more economically untenable, look for the overwhelming majority of doctors to become salaried hospital employees—many working in shifts—in the next few years. Virtually every doctor now graduating a residency program is taking a position as a salaried hospital employee.

Ten thousand people will turn 65 every day for the next 19 years, placing an even greater fiscal burden on the Medicare program.

One way CMS is trying to deal with this is by penalizing hospitals and doctors who treat patients with resistant problems. Effective this year, any patient readmitted to a hospital within 30 days of discharge for the same or a related problem will be treated by the hospital without compensation. The plan is to implement the same policy with respect to the original treating physician in the near future.

To help deal with this more definitively, an old concept with a new name is being promoted and encouraged by the Affordable Care Act: the Accountable Care Organization (ACO). The ACO harkens back to the infamous HMO capitation system of the early 1990s over which the population rebelled.

In a nutshell, hospitals, clinics, and health care providers have been given incentives to organize into teams that will get assigned groups of 5,000 or more Medicare patients. They will be expected to follow practice guidelines and protocols approved by Medicare. If they achieve certain goals established by Medicare with respect to cost, length of hospital stay, re-admissions, or other “core measures,” they will get to share a portion of Medicare’s savings. If the reverse happens, they will face economic penalties.

Private insurance companies are currently setting up the non-Medicare version of the ACO. These will be sold in the federally subsidized exchanges mandated by the Affordable Care Act. In this model, there are no fee-for-service payments to providers. Instead, an ACO is given a lump sum, or “bundled” payment for the entire care for a large group of insurance beneficiaries. The ACOs are expected to follow the same Medicare-approved practice protocols, but all of the financial risks are assumed by the ACOs. If the ACOs keep costs down, the team of providers and hospitals reap the financial reward: a surplus from the lump sum payment. If they lose money, the providers and hospitals eat the loss.

In both the Medicare and non-Medicare varieties of the ACO, cost control and compliance with centrally-planned practice guidelines are the primary goal. The hospital and provider networks will live or die by these objectives.

When almost all health care providers are salaried employees of hospitals, hospitals might then be able to get ACOs to work better than their ancestor HMOs. The hospital administrators will have more control over their medical staff. If doctors don’t follow the protocols and guidelines, and desired outcomes are not reached, hospitals can replace the “problem” doctors.

So where does all this place the medical profession with respect to its ethical credo? In a few years, almost all doctors will be employees of hospitals and will be ordered to practice medicine according to federally prescribed guidelines—guidelines that put the best interests of the state ahead of the interests of individual patients.

When the physician’s primary obligation is to satisfy the wishes of the payer—ultimately the wishes of the state—how can patients be truly confident in their doctors’ decisions?

I submit that it all boils down to a question of professional ethics.

The medical profession must decide—and soon—which ethical doctrine to follow: Are doctors to be agents of their patients or agents of the state? All of us should dread the latter choice—because we will all be patients some day.

Jeffrey Singer practices general surgery in Phoenix, Arizona, writes for Arizona Medicine, the journal of the Arizona Medical Association (Goldwater Institute)

Obama Memo on the Obamacare Case at the Supreme Court:

WHERE’S MY RECOVERY?

Today, over 4 years since the recession started, there are still almost 24 million Americans unemployed or underemployed. That includes 5.6 million who are long-term unemployed for 27 weeks, or more than 6 months, the highest since the Great Depression. The number of Americans employed part-time for economic reasons was still 8.1 million. The Bureau of Labor Statistics (BLS) says, “These individuals were working part time because their hours had been cut back or because they were unable to find a full-time job.”

Another 2.6 million persons were marginally attached to the labor force, essentially unchanged from a year earlier. The BLS says, “These individuals were not in the labor force, wanted and were available for work, and had looked for a job sometime in the prior 12 months. They were not counted as unemployed because they had not searched for work in the 4 weeks preceding the survey.”

African Americans have been suffering an outright depression under Obama, with unemployment today, 51 months after the recession started, still over 14%. Black unemployment has been over 14% for Obama’s entire term in office. Black teenage unemployment today is still nearly 35%, where it has persisted for Obama’s entire term as well.

Hispanics have also been suffering a depression under Obama, with unemployment today still in double digits at nearly 11%, where it has also persisted for Obama’s entire term. Over one fourth of Hispanic youths remain unemployed today, which also has persisted for years.

The Census Bureau reported last September that more Americans are in poverty today than at any time in the entire 51 year history of Census tracking poverty. Americans dependent on food stamps are at an all time high as well. White House spokesman Jay Carney recently tried to blame the Republicans for that, saying that it was their policies of deregulation that caused the recession. But actually it was liberal policies of overregulation forcing the looting of the banks for subprime loans under threat of discrimination suits that caused the recession. See, e.g. Paul Sperry, The Great American Bank Robbery.

Moreover, it was Obama’s responsibility to foster a timely, robust recovery restoring traditional American prosperity. Where is that? The absence of that is because Obama doesn’t believe in traditional American anything. (American Spectator)

The New Jersey Office of Homeland Security and Preparedness has released a new document entitled “Terrorism Awareness and Prevention”. The paper is aimed at raising awareness on how New Jersey residents can help combat terrorism, including tips on how to spot signs of suspicious activities and behaviors.

So what are these suspicious behaviors? “Look for signs of nervousness in the people you come in contact with.” This includes “exaggerated yawning when in a conversation,” “repetitive touching of face,” “increased breathing rate,””unusual perspiration,” “excessive fidgeting,””trembling” and “goose bumps.” Though some might say these are all completely natural body reactions, the document says otherwise.

While pacing around and being jumpy is also listed as a potential indicator of malicious intent, standing still in a rigid posture also fits the bill of terrorist intent. So what should you do to avoid getting flagged as a potential enemy of the state? Stand still, or gesture profusely? In reality, there’s probably not much you can do.

You’re just toast.

Hot dogs. Bison Wellington. Baby back ribs.

President Barack Obama is roaming all over the culinary map this week.

The president made a lunchtime detour to a barbeque and ribs joint Thursday on his way back to the White House after a speech about energy policy.

The president came away from Texas Ribs & BBQ with a takeout bag containing 2 slabs of baby back ribs and a brisket sandwich with fries.

Earlier in the week, Obama downed a hotdog at an NCAA basketball game in Ohio. And on Wednesday, he dined on bison at a fancy state dinner.

So “Let’s Move”!! :)

ANOTHER TSA UPDATE

Passengers at airports can now avoid TSA pat downs, long lines and can carry liquids on board by paying $100.

However, the TSA’s new fast track ‘Precheck’ screening is likely to rile the family of a wheel-chair bound toddler who was recently subjected to invasive security checks.

Unlike the background check passengers in the scheme, who will be able to skip screening, the three-year-old was stopped at O’Hare Airport in Chicago.

‘We can reduce the size of the haystack when we are looking for that one-in-a-billion terrorist,’ TSA Administrator John Pistole told the Journal.

And a Three year old in a wheelchair is definitely a candidate for that 1 in a Billion!
So you just have to bribe them a $100 bucks! Gee…
FAST & FURIOUS

Breitbart.com has uncovered video from 1995 of then-U.S. Attorney Eric Holder announcing a public campaign to “really brainwash people into thinking about guns in a vastly different way.”

Holder was addressing the Woman’s National Democratic Club. In his remarks, broadcast by CSPAN 2, he explained that he intended to use anti-smoking campaigns as his model to “change the hearts and minds of people in Washington, DC” about guns.

“What we need to do is change the way in which people think about guns, especially young people, and make it something that’s not cool, that it’s not acceptable, it’s not hip to carry a gun anymore, in the way in which we changed our attitudes about cigarettes.”

Liberal leopards don’t change their spots.
Now don’t you feel better about Obamacare, The TSA, Security and The Economy! :)
Political Cartoons by Gary Varvel

 Political Cartoons by Glenn Foden

About indyfromaz

Born in Michigan. Been a Resident of Arizona for 25 years. Doctor Who and Foodie Fan. Cynical Conservative-Bent Tea Party Independent
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