Politics and religion.

[blue]

No, I was able to do it immediately.

If your reference -- poorly worded, was meant to indicate the time it took for me to respond - you will have to understand I have a life - you know, friends, husband, social activities, a home to take care of, volunteering. And a job.

Fun things that involve real live people!

And the word is spelled congratulations....

You're welcome!

Shame on you Sara. You mean to say you don't hang on his every word?

[RICHARD]

A Tribble??? lololol

So, some idiot takes photos of nyc and now they are top secret? THAT'S my government at work, I cannot blame BO, he's too busy spending REAL money.

[blue]

A Tribble??? lololol

You dare disrespect the Captain??

[RICHARD]

You dare disrespect the Captain??

No disrespect intended to JTK?

[RICHARD]

LOLOLOLOL,
BO actually thinks he can get the healthcare reform ball rollig?

I guess he can-see what the threat of socialized medicine can do?

---------------------
And wait until the probs with the electric medical records become apparent!

[blue]

At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Chad Crowe


Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.

The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.

Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.

Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.

These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.

So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.

But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.

Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.

Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.

There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.

Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.

There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.

Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies .

Link.

The Eagle Tribune
May 10-2009
by Taylor Armerding


What a difference an inauguration makes.

It was only a few months ago that "dissent is the highest form of patriotism" was still the rage among the elite, liberal, "tolerant" class.

But then Barack Hussein Obama became president. And now, suddenly, dissenters are paranoid, violent extremists worthy of surveillance by the federal Department of Homeland Security. Returning war veterans, who tend to be conservative and believe that terrorists ought to be called terrorists, need to be watched.

Average working Americans who held polite "Tea Party" protests on April 15 against confiscatory taxes and rampant government spending — protests marked by a lack of broken windows, overturned cars, torched buildings and injuries — are mocked with a not-so-veiled reference to a gay sex act. Conservative television and radio commentators are not only crazed nutcases, they are dangerous purveyors of hate and violence, unlike the civil, ballanced, issue-oriented discourse of Keith Olbermann and Bill Maher.

Suddenly, there is no tolerance for dissent. It is tantamount to treason.

It was only a few months ago that blocking every element of President Bush's agenda was tops on the elites' list of good things to do. Wanting him to fail was a very good thing, whether it was his effort to stabilize Social Security by giving individuals more responsibility and control of it or winning a war. It didn't matter if the Democrats didn't have a constructive alternative. Blocking Bush was enough — the highest form of political responsibility.

Then Obama became president. And suddenly any opposition to the president's agenda is not worthy of substantive debate or discussion. It is simply a very bad thing, to be dismissed with a label: The Party of No. Wanting his vast expansion of government authority and spending to fail is racist, hateful and divisive.

It was only a few months ago that the only way to have any street cred as an elite was to throw something like "BushHitler" into your conversation. Even better was to call the president an idiot, insane, incompetent and/or a swaggering cowboy.

Then Obama became president. Suddenly, "swagga" is a very cool thing. What is not cool is to suggest that the president's agenda is leading us on a path to socialism. Or to suggest that he may not be as brilliant as his adoring, lap dog press, makes him out to be, since he can't seem to go anywhere or say much of anything without a teleprompter. Those are ugly political smears. Not cool at all.

It was a few years ago, when President Bush was nominating a justice for the Supreme Court, that I heard frenzied liberal elites on National Public Radio warning of the horror of one party holding the presidency and a majority in Congress, and therefore being able to appoint justices to the Supreme Court. It was all so unfair, they wailed.

Then the Democrats took Congress. Then Hussein Obama got elected. And now there are no wails of anguish, only celebration among the elites, at the prospect of one party controlling all three branches of government.

Only a few months ago, if a presidential 747 airliner had buzzed Manhattan for a photo shoot, coming within 1,500 feet of some of the buildings, there would have been a media feeding frenzy for the blood of President Bush. The words "arrogant" and "jerk" would have been the gentler labels spewed by the liberal controlled Pravdas. The story would have played for weeks, minimum. There is no way the press would have stood by meekly while the White House issued a perfunctory apology, prodded a single aide to fall on his sword, refused to say who was on the plane or released only one of the photos — shot for publicity purposes.

But, Hussein Obama is the president now. So while there was a flurry of criticism from those quickly labeled the "right-wing hate machine," it was a one- or two-day story at most for the mainstream media. Move along. Nothing to see here. Have you heard how fantastically the administration has been handling the swine — uh, I mean the H1N1 — flu crisis?

Until a few months ago, any elite conversation about President Bush had to include a standard line about him "shredding the Constitution."

But now Hussein Obama is president. And when asked what standard he will apply when nominating a successor to retiring Supreme Court Justice David Souter, the president said he wanted someone who "understands that justice isn't about some abstract legal theory or footnote in a casebook; it is also about how our laws affect the daily reality of people's lives, whether they can make a living and care for their families, whether they feel safe in their homes and welcome in their own nation."

Not a word about how judges are supposed to be blind to personal circumstance. Not a word about the Constitution. I guess we won't have to worry about the administration or the court shredding the Constitution, because there is no Constitution to shred.

It is fine, when a new president takes office, for the agenda to change, and reflect the philosophy of his party. Not so fine for the standards and rules for judging an administration to take a 180-degree turn.

Not the kind of change I'm believing in.

[RICHARD]

I almost forgot!

Happy CINCO DE QUATRO!

[RICHARD]

I really believe that the recession is getting better.

Yeah, The news comes from some guy living in a government subsidised housing project on Pennsylvania Avenue.