Friday, June 29, 2012

You Can Keep Your Doctor If You Want To…Unless He Is Run Out Of Business By The ACA

“A physician shortage was already expected before ACA was signed into law in March 2010, and now that gap could worsen. According to projections released last fall by the AAMC Center for Workforce Studies, there will be a shortage of about 63,000 doctors by 2015, with greater shortages on the horizon—91,500 and 130,600 for 2020 and 2025, respectively.” 1.

How will this actually affect the number of practicing Physicians? The outlook is not good. 
Two of every three practicing physicians oppose the medical overhaul plan... and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted…”  2. And, now the ACA is the law of the land. 

A major unintended consequence of the ACA is that many private practice physicians will no longer be able to stay in business for themselves. Or, is this really an unintended consequence? Fees that the Physician will be paid will be cut back significantly as dictated by the ACA. And, many Doctors may no longer be able to remain in business. It will also be difficult for new Doctors to hang up their shingle too.
Who will really want to enter the private practice field if there is not a possibility of making a decent income relative to the cost of doing business?

High costs of doing business are taken right off the Doctor’s bottom line. In addition to fixed costs like rent, office, medical equipment, and other expenses, there’s the Physician’s medical and office staff who must be paid. There are at least three staff in a Physician’s office that are important for the practice to function efficiently. The average salary of Physician Assistants is $79,000 annually. 3.  And, for a medical assistant, its $44,000. 4. Someone must answer the phones, meet the patients, and maintain the patient files. That’s the medical receptionist who make on average $28,000. 5.

Newer Physicians have a lot invested in their educations. There is four years of undergraduate, four years of medical school, three years of internship, one year of residency, and if a specialty is entered into, additional time in a fellowship. “The average medical student graduates with nearly $100,000 in student loan debt...A family practice salary may range from $73,150 on the low end and up to $249,950 on the top end, according to the report. But pay can vary dramatically by geographical region.” 6.

Most Physiciand make a good living. They have earned it. As of 2011, “On average, primary care physicians in the United States received $186,582 in pretax income a year, compared with $95,585 in France and $92,844 in Australia.7. Obama apparently wants not only to make our healthcare comparable to France, he also wants physician pay to be equivalent.  

And, Physician’s educations must be paid for, usually by student loans. And, those loans must be repaid.  Income based monthly payments on a $100,000 student loan with an interest rate of 6.8% with a 15 year repayment term is about $887.00.  8.

Part of the ACA provides 250 million for training for residency, nurse practitioners, and physician assistants. 9.
However, based on the meager payments to providers, who will be interested in a decent paying career in the medical field? A major "unintended" consequence is the loss of operating income for Physicians medical clinics.

The typical Doctor’s office has an overhead of between 40 and 60% of the total operating income for the practice. 10. But, will Doctors be able to meet their overhead, let alone take home a paycheck?

In propagandizing about Obamacare, you will remember him saying this about a diabetic foot amputation on August 11, 2009.
“Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed.” 
However, The American College of Surgeons immediately fired back, “The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight. Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.” 11.
Physicians also narrowly averted a 27% cut in Medicare payments this year through a stopgap measure passed into law that ends 12/31/2012. 12.  And, payment cutbacks in general cannot be avoided by the ACA.
There are payment cutbacks for virtually every physician payment category. But, Obama has promised many good things to healthcare providers. Although portions of the  White House fact sheet shown below promises lowering the burden of uncompensated care on physicians, hospitals, and the rest of the system, none of the promises included a “living wage” for doctors and other healthcare providers.
For health care providers, health reform is designed to make our health care system stronger and make it work better for you and your patients:
…Expanded coverage and consumer protections will offer security…  This will lower the burden of uncompensated care on physicians, hospitals, and the rest of the system.
Reduced paperwork and administrative simplification will bring down the cost of care.
Tough new consumer protections will hold health insurers more accountable for treating patients and providers fairly. 
Tough new consumer protections will hold health insurers more accountable for treating patients and providers fairly. 
Tough new consumer protections will hold health insurers more accountable for treating patients and providers fairly. 
Health care providers will help drive improvements to health care delivery.”
Strengthening and growing our health care workforce.
Investing in community health centers and new clinical settings.
Loan forgiveness and scholarships. (for those joining The National Health Service Corps)  9.

In addition to patients being at the mercy of the Affordable Care Act, so will the fates of their Doctors.  

If the above is not infuriating enough, see our other blog:

Eric Holder's Letter To Obama Asking Him To Conceal Documents Related To fast And Furious

10. Arnow FM. Acceptable overhead. Fam Pract Manag. November/Dec 2002:78

Wednesday, June 27, 2012

Letter from Rep. Issa To Obama Explaining Why He Is Not Entitled To Fast And Furious Executive Privilege

Here is the scathing letter to President Obama by Rep. Darrell Issa that explains why he is not entitled to Executive Privilege regarding Fast and Furious. 
See the letter from Eric Holder to Obama that brought about the Executive Privilege claim at:

“Dear Mr. President:
On June 19, 2012, shortly after leaving a meeting in the U.S. Capitol, Attorney General Eric Holder wrote to request that you assert executive privilege with respect to Operation Fast and Furious documents he is withholding from this Committee. The next day, Deputy Attorney General James Cole notified me in a letter that you had invoked executive privilege. The Committee received both letters minutes before the scheduled start of a vote to recommend that the full House hold the Attorney General in contempt of Congress for refusing to comply with its subpoena.
Courts have consistently held that the assertion of the constitutionally-based executive privilege — the only privilege that ever can justify the withholding of documents from a congressional committee by the Executive Branch — is only applicable with respect to documents and communications that implicate the confidentiality of the President’s decision-making process, defined as those documents and communications to and from the President and his most senior advisors. Even then, it is a qualified privilege that is overcome by a showing of the committee’s need for the documents. The letters from Messrs. Holder and Cole cited no case law to the contrary.
Accordingly, your privilege assertion means one of two things. Either you or your most senior advisors were involved in managing Operation Fast & Furious and the fallout from it, including the false February 4, 2011 letter provided by the Attorney General to the Committee, or, you are asserting a Presidential power that you know to be unjustified solely for the purpose of further obstructing a congressional investigation. To date, the White House has steadfastly maintained that it has not had any role in advising the Department with respect to the congressional investigation. The surprising assertion of executive privilege raised the question of whether that is still the case.
As you know, the Committee voted to recommend that the full House hold Attorney General Holder in contempt of Congress for his continued refusal to produce relevant documents in the investigation of Operation Fast and Furious. Last week’s proceeding would not have occurred had the Attorney General actually produced the subpoenaed documents he said he could provide. The House of Representatives is scheduled to vote on the contempt resolution this week. I remain hopeful that the Attorney General will produce the specified documents so that we can work towards resolving this matter short of a contempt citation. Furthermore, I am hopeful that, consistent with assertions of executive privilege by previous Administrations, you will define the universe of documents over which you asserted executive privilege and provide the Committee with the legal justification from the Justice Department’s Office of Legal Counsel (OLC).
U.S. Border Patrol Agent Brian Terry was killed in a firefight with a group of armed Mexican bandits who preyed on illegal immigrants in a canyon west of Rio Rico, Arizona on December 14, 2010. Two guns traced to Operation Fast and Furious were found at the murder scene. The Terry family appeared before the Committee on June 15, 2011, to ask for answers about the program that put guns in the hands of the men who killed their son and brother. Having been stonewalled for months by the Attorney General and his senior staff, the Committee issued a subpoena for documents that would provide the Terry family the answers they seek. The subpoena was served on October 12, 2011.
Internally, over the course of the next eight months, the Justice Department identified 140,000 pages of documents and communications responsive to the Committee’s subpoena. Yet, the Department handed over only 7,600 of these pages. Through a series of accommodations and in recognition of certain Executive Branch and law enforcement prerogatives, the Committee prioritized key documents the Department needed to produce to avoid contempt proceedings. These key documents would help the Committee understand how and why the Justice Department moved from denying whistleblower allegations to understanding they were true; the identities of officials who attempted to retaliate against whistleblowers; the reactions of senior Department officials when confronted with evidence of gunwalking during Fast and Furious, including whether they were surprised or already aware of the use of this reckless tactic, and; whether senior Department officials are being held to the same standard as lower-level employees who have been blamed for Fast and Furious by their politically-appointed bosses in Washington.
I met with Attorney General Holder on June 19, 2012, to attempt to resolve this matter in advance of the Committee’s scheduled contempt vote. We were joined by Ranking Member Elijah Cummings and Senators Patrick Leahy and Charles Grassley, respectively the Chairman and Ranking Member of the Senate Committee on the Judiciary. The Department had previously identified a small subset of documents created after February 4, 2011 — the date of its letter containing the false claim that no gunwalking had occurred — that it would make available to the Committee. The Justice Department described this small subset as a “fair compilation” of the full universe of post-February 4th documents responsive to the subpoena.
During the June 19th meeting, the Attorney General stated he wanted to “buy peace.” He indicated a willingness to produce the “fair compilation” of post-February 4th documents. He told me that he would provide the “fair compilation” of documents on three conditions: (1) that I permanently cancel the contempt vote; (2) that I agree the Department was in full compliance with the Committee’s subpoenas, and; (3) that I accept the “fair compilation,” sight unseen.
As Chairman of the primary investigative Committee of the U.S. House of Representatives, I considered the Attorney General’s conditions unacceptable, as would have my predecessors from both sides of the aisle. I simply requested that the Department produce the “fair compilation” in advance of the contempt vote, with the understanding that I would postpone the vote to allow the Committee to review the documents.
The short meeting in the Capitol lasted about twenty minutes. The Attorney General left the meeting and, shortly thereafter, sent an eight-page letter containing more than forty citations requesting that you assert executive privilege. The following morning, the Deputy Attorney General informed me that you had taken the extraordinary step of asserting the privilege that is designed to protect presidential decision making.
In his letter, the Attorney General stated that releasing the documents covered by the subpoena, some of which he offered to the Committee hours earlier, would have “significant, damaging consequences.”[1] It remains unclear how — in a matter of hours — the Attorney General moved from offering those documents in exchange for canceling the contempt vote and ending the congressional investigation to claiming that they are covered by executive privilege and that releasing them — which the Attorney General was prepared to do hours earlier — would now result in “significant, damaging consequences.”
The Scope of Executive Privilege
Deputy Attorney General Cole’s representation that “the President has asserted executive privilege over the relevant post-February 4, 2011, documents” raised concerns that there was greater White House involvement in Operation Fast and Furious than previously thought.[2] The courts have never considered executive privilege to extend to internal Executive Branch deliberative documents.
Absent from the Attorney General’s eight-page letter were the controlling authorities from the U.S. Court of Appeals for the District of Columbia. As the court held in the seminal case of In re Sealed Case (Espy):
The privilege should not extend to staff outside the White House in executive branch agencies. Instead, the privilege should apply only to communications authored or solicited and received by those members of an immediate White House adviser’s staff who have broad and significant responsibility for investigating and formulating the advice to be given the President on the particular matter to which the communications relate.[3]
The D.C. Circuit established the “operational proximity test” to determine which communications are subject to privilege. Espy made clear that it is “operational proximity to the President that matters in determining whether the president’s confidentiality interest is implicated.”[4]
In addition, even if the presidential communications privilege did apply to some of these subpoenaed documents, Espy made clear that “the presidential communications privilege is, at all times, a qualified one,” and that a showing of need could overcome it.[5] Such a need — indeed a compelling one — plainly exists in this case.
The Justice Department has steadfastly maintained that the documents sought by the Committee do not implicate the White House whatsoever. If true, they are at best deliberative documents between and among Department personnel who lack the requisite “operational proximity” to the President. As such, they cannot be withheld pursuant to the constitutionally-based executive privilege. Courts distinguish between the presidential communications privilege and the deliberative process privilege. Both, the Espy court observed, are executive privileges designed to protect the confidentiality of Executive Branch decision-making. The deliberative-process privilege, however, which applies to executive branch officials generally, is a common law privilege that requires a lower threshold of need to be overcome, and “disappears altogether when there is any reason to believe government misconduct has occurred.”[6]
The Committee must assume that the White House Counsel’s Office is fully aware of the prevailing authorities of Espy, discussed above, and Judicial Watch v. Dep’t of Justice.[7] If the invocation of executive privilege was proper, it calls into question a number of public statements about the involvement of the White House made by you, your staff, and the Attorney General.
Finally, the Attorney General’s letter to you cited numerous authorities from prior Administrations of both parties. It is important to note that the OLC opinions provided as authorities to justify expansive views of executive privilege are inconsistent with existing case law.
Remarks about White House Involvement in Fast and Furious
For the past sixteen months, Senator Grassley and I have been investigating Operation Fast and Furious. In response to a question about the operation during an interview with Univision on March 22, 2011, you stated that, “Well first of all, I did not authorize it. Eric Holder, the Attorney General, did not authorize it.”[8] You also stated that you were “absolutely not” informed about Operation Fast and Furious.[9] Later in the interview, you said that “there may be a situation here in which a serious mistake was made and if that’s the case then we’ll find out and we’ll hold somebody accountable.”[10]
From the early stages of the investigation, the White House has maintained that no White House personnel knew anything about Operation Fast and Furious. Your assertion of executive privilege, however, renews questions about White House involvement.
White House Press Secretary Jay Carney emphasized your denial that you knew about Fast and Furious. Mr. Carney stated, “I can tell you that, as the president has already said, he did not know about or authorize this operation.”[11] A few weeks later, Mr. Carney reiterated the point, stating, “I think he made clear . . . during the Mexican state visit and the press conference he had then that he found out about this through news reports. And he takes it very seriously.”[12]
In an October 6, 2011 news conference, you maintained that Attorney General Holder “indicated that he was not aware of what was happening in Fast and Furious.”[13] Regarding your own awareness, you went on to state, “Certainly I was not. And I think both he and I would have been very unhappy if somebody had suggested that guns were allowed to pass through that could have been prevented by the United States of America.”[14]
On March 28, 2012, Senator Grassley and I wrote to Kathryn Ruemmler, who serves as your Counsel, to request that she grant our numerous requests to interview Kevin O’Reilly, a member of the White House National Security Staff. We needed Mr. O’Reilly’s testimony to ascertain the extent of White House involvement in Operation Fast and Furious. In her response, Ms. Ruemmler advised us that the e-mail communications between Mr. O’Reilly and William Newell, the Special Agent in Charge of ATF’s Phoenix Field Division, did not reveal “the existence of any of the inappropriate investigative tactics at issue in your inquiry, let alone any decision to allow guns to ‘walk.’”[15] She further emphasized “the absence of any evidence that suggests that Mr. O’Reilly had any involvement in ‘Operation Fast and Furious’ or was aware of the existence of any inappropriate investigative tactics.”[16] Your assertion of executive privilege renews concerns about these denials.
Earlier this month, when House Judiciary Committee Chairman Lamar Smith asked the Attorney General when the Justice Department first informed the White House about the questionable tactics used in Fast and Furious, he responded, “I don’t know.”[17] He informed Chairman Smith that his focus was on “dealing with the problems associated with Fast and Furious,” and that he was “not awfully concerned about what the knowledge was in the White House.”[18]
Attorney General Holder has assured the public that he takes this matter very seriously, stating that “to the extent we find that mistakes occurred, people will be held accountable.”[19] Yet, he has described the Committee’s vote as “an election-year tactic.”[20] Nothing could be further from the truth. This statement not only betrays a total lack of understanding of our investigation, it exemplifies the stonewalling we have consistently faced in attempting to work with the Justice Department. If the Attorney General had produced the responsive documents more than eight months ago when they were due, or at any time since then, we would not be where we are today.
Moving Forward
At the heart of the congressional investigation into Operation Fast and Furious are disastrous consequences: a murdered Border Patrol Agent, his grieving family, countless deaths in Mexico, and the souring effect on our relationship with Mexico. Members of the Committee from both sides of the aisle agree that the Terry family deserves answers. So, too, do Agent Terry’s brothers-in-arms in the border patrol, the Mexican government, and the American people. Unfortunately, your assertion of executive privilege raises more questions than it answers. The Attorney General’s conditional offer of a “fair compilation” of a subset of documents covered by the subpoena, and your assertion of executive privilege, in no way substitute for the fact that the Justice Department is still grossly deficient in its compliance with the Committee’s subpoena. By the Department’s own admission, it has withheld more than 130,000 pages of responsive documents.
I still believe that a settlement, rendering further contempt of Congress proceedings unnecessary, is in the best interests of the Justice Department, Congress, and those most directly affected by Operation Fast and Furious. In light of the settled law that confines the constitutionally-based executive privilege to high-level White House communications, I urge you to reconsider the decision to withhold documents that would allow Congress to complete its investigation.
In the meantime, so that the Committee and the public can better understand your role, and the role of your most senior advisors, in connection with Operation Fast and Furious, please clarify the question raised by your assertion of executive privilege: To what extent were you or your most senior advisors involved in Operation Fast and Furious and the fallout from it, including the false February 4, 2011 letter provided by the Attorney General to the Committee? Please also identify any communications, meetings, and teleconferences between the White House and the Justice Department between February 4, 2011 and June 18, 2012, the day before the Attorney General requested that you assert executive privilege.
I appreciate your prompt attention to this important matter.
Darrell Issa
cc: The Honorable Elijah E. Cummings, Ranking Member
Committee on Oversight and Government Reform
U.S. House of Representatives
Senator Charles E. Grassley, Ranking Member
Committee on the Judiciary
U.S. Senate
Senator Patrick Leahy, Chairman
Committee on the Judiciary
U.S. Senate
The Honorable Kathryn Ruemmler, Counsel to the President”

Friday, June 15, 2012

United Nations To Convene Month Long Conference For International Gun Control Treaty In July

Its time once again to just say, "NO," to the UN

As Spain deals with a bailout to "save" the economy and the country, and while the country is engaged in its worst financial crisis in recent memory, the Spanish Parliament took time this week to push for adoption of the United Nations  Arms Trade Treaty. This is the Treaty that will infringe on the US Constitution, the Second Amendment, and your right to self defense. The United Nations and specially invited anti firearms rights groups who want to eliminate our firearms freedoms will be convening at the UN July 2nd through the 27th to draft a Treaty to accomplish the goal of regulating firearms and accessories, and ultimately the disarming all of America.  

Spain agreed with the drafters of the Treaty, with input from various international and US gun control groups, who want the “Urgent and essential” Treaty to;
"a) Include a golden rule that prohibits the authorization of arms transfers where there is a substantial risk that used to commit or facilitate the commission-¬ - serious violations of international human rights and international humanitarian law. 
b) Allow a comprehensive coverage that includes controls on weapons, ammunition and related material and on ALL (emphasis added)  transfers. 
c) explicit regulation of solid systems of licensing, transparency and reporting.” 1

International gun ban groups are telling UN member states, including the United States,  in unambiguous terms, to adopt this Treaty and clamp controls and international regulations on your firearms and ammunition, and all transfers, including purchase and sale of guns and ammunition.  By the wording of the treaty, inclusion of the “and related material” provision would include parts, accessories, scopes, stocks, magazines, and the like. The regulations are limited only by the bureaucratic enforcers imagination. And, of course, there is the "licensing" provision that all signing Countries are required to implement. 

Bill Clinton favored the provisions of the previous draft of this Treaty, but declined to present of the Treaty to the Senate for ratification. No doubt out of deference to the various strong pro gun rights organizations here, and the potential political wrath of gun owners. 

George W. Bush was against this Treaty. And, his UN Ambassador, John Bolton, helped to keep a Treaty like this just a leftist’s dream. However, with the advent of “Hope and Change” in January, 2009, Barack Obama instructed Secretary of State, Hillary Clinton, to “Be open” to the Treaty. The State Department will undoubtedly be heavily involved with the Treaty process at the UN next month.

The Conference on the Arms Trade Treaty has a already met four times to draft the Treaty that will be submitted to the UN next month.
Its efforts are being supported by the lofty sounding UN Office for Disarmament Affairs. The Treaty formulation will be carried out by the 193 countries belonging to the UN. Representatives from other organizations, including the “A” list of American gun ban groups were invited to attend. 2

Contrary to the gun control goals as outlined by the Spanish Parliament, the UN says that the treaty will not interfere with the way a country regulates civilian arms possession. 2

1. Palau Parliament, 13 June 2012   
2. The official website of the United nations Conference

Wednesday, June 6, 2012

Here's How The Obama Campaign Is Trying To Capitalize On The Wisconsin Election Failure

Here's the Obama Fundraising email received this morning.


“What just happened in Wisconsin wasn't an accident. 

Republican Governor Scott Walker and his allies outspent the Democratic challenger nearly EIGHT to ONE -- and one of the most unpopular governors in the country managed to hold on. 

This result is direct confirmation that all the outside money that's poured into elections this cycle can and will change their outcome. And it's exactly what could happen on the national stage unless we can close the gap between special interests and ordinary people.

Please donate $3 or more to support President Obama and make sure people, not special interests, decide this election.

Walker was challenged because he's spent the last year and a half promoting special interests and Republican ideologues while taking away a seat at the table for middle-class families. But when his job was on the line, those same interest groups repaid the favors -- and were willing to spend nearly EIGHT times as much money as the Democratic candidate and his allies raised.

This is the playbook Mitt Romney used in primary after primary against Rick Santorum and Newt Gingrich.

His ad buys were overwhelmingly negative, and he and his backers poured money into whatever state was next until they got the result they wanted.

Now, imagine this same scenario playing out again in Wisconsin in November, and in Florida, Ohio, Virginia, Nevada, and the rest of the battleground states.

The other side has the money. They know they can buy the election if they spend it. And they are being told every day by Mitt Romney that he will do exactly what they want him to.

We can stop them.

Please donate today:



Jim Messina
Campaign Manager
Obama for America