Joint Committee on Taxation Estimated Revenue Effects Senate Health Bill

Here is how noted neurosurgeon Dr. David McKalip assesses the Senate health bill:

Early Analysis ……More to Come

An Act of Congress?  More Like Multiple Acts of Insanity. – Part I

We have all heard about how it takes and “act of Congress” to make major changes.  Well the Senator Reid’s so called “Patient Protection and Affordable Care Act” is more like and act of medical, fiscal and Congressional Insanity than a solution to any problem. The underlying theme of the bill, as in the House bill, is to grant broad and inappropriate powers to the government to define medical quality and create a cost-control regime directly intended to cut spending on needed medical care.  The worst aspect is that it creates a system of penalties for doctors who go over-budget and seeks to redefine the profession of medicine to one designed, managed and approved by bureaucrats and government agents.  A read-through the bill brings to mind more appropriate names for this “Act of Congress” for the hundreds of sections in this 2075 page bill that will force Americans to buy higher priced insurance and tax the economy into submission. All while placing an unsustainable economic burden on future taxpayers and our children that will grow far beyond the government’s frequently inaccurate spending forecasts.  So what kinds of Acts are more appropriate titles for the sections in this bill?

Promote the Secretary to Monarch Act. Throughout the Bill the Secretary of the department of Health and Human Services (HHS) is granted broad new powers that are completely outside of congressional oversight. The Secretary: determines quality; determines appropriate budgets for patient care; determines physician payment; penalties and incentives; determines who is eligible for key programs; determines what groups of doctors patients will see; determines where physicians can practice to avoid a penalty and more; requires reports from physicians. The term “secretary

Big Brother Is Watching Your Doctor Act.  Section 5404, p 1430[i]: A Primary Care Extension program will send government agents to physician practices to supervise doctors reporting to the government of compliance with performance measurements.  “Clinicians” can be primary care providers and are not necessarily required to be physicians. There will be an effort to disseminate “new knowledge” to ensure evidence based practices.  For instance, on insuring that only women over 50 get mammograms!

Redfine Nurses as Doctors Act – Remove Constitutional Rights act’ Section5501, page 1440 Redefines nurses, physician assistants and clinical nurse specialists as “Primary Care Providers”.  From 2011-2016- Provides a 10% “incentive” for  “primary Care services” ; Prevents administrative or Judicial Review on disputes (denies constitutional due process rights of “providers”);

“Practice Surgery Where you are Told” Act.  Sect 5501(b), page 1443: If you practice general surgery in an “underserved” area (defined by government – the Sec. of HHS), receive  an “incentive” from 2011-2016.  Be Penalized 10% for practicing surgery in an area that is not “underserved” – and lose “incentive” after 5 years and hopefully have a practice that can be sustained when incentive is gone.   

Saving Money off of Children’s Medical Care Act: Section 2706, page546:  The Secretary of HHS is granted more power to arbitrarily cut costs for medical care, but for children’s health care.  Pediatricians would be organized into “Accountable Care organizations” and given “incentives” (payments) if they achieve “minimal savings” established “by the state”.  Such incentives will be directly proportional to the amount of money saved for “the state” but there will be a cap for incentives that will limit payments to physicians.  

Penalize Doctors for Going “over-budget” Act:  Section 3022, page 739; In the “Medicare Shared Savings” sections, doctors are pressured into “accountable Care organizations” – Accountable to the Secretary, HHS. Secretary given broad new powers to define “quality” and “Efficiency” and determine appropriate “utilization” of hospitalization and ambulatory care conditions.  Equivalent to the capitation model that was widely rejected under managed care in the ‘90’s.  ACO must have primary care providers and cover at least 5,000 Medicare beneficiaries for three years.  Will Only receive a bonus (avoid a penalty) if meet the spending cut “benchmark” established by the Secretary.  Does not provide for new funds for bonuses but rewards “incentives” only based on actual savings to Medicare that will occur by denying care to patients. (VIOLATES AMA PRINCIPLES ON PAY FOR PERFORMANCE RELATING TO VOLUNTARY PARTICIAPTION, AVOIDING ECONOMIC UNDERMINING OF NON PARTICIPATING PHYSICIANS AND FAILURE TO PROVIDE NEW FUNDS FOR INCENTIVES).

Tie the doctor’s hands and deny their judicial rights act part II. Section 3022, page 750 Will Penalize a doctor who avoids a “high risk” patient to ensure costs are kept low. (The “Tie the Doctor’s Hands Act”).  There shall be no appeal rights to any administrative law judge or court for decision on payment or quality made by “the Secretary”

Patient- Go See the Doctor you are Told Act  Section 3022, page 745[ii].  “The Secretary” will decide which doctors a patients (a “Medicare Feee For Service Beneficiary”) will see by making sure they go to the ones that save the most money for the government.  Only those doctors saving the most money for the government will get the highest payments to themselves.

Put ‘em all on a Budget and make ‘em Fight for payment Act  Section 3023, pg 751-  “The Secretary” would “BUNDLE” all payments for an “Episode” of care to Hospitals, Doctors, Nursing Homes, and “other Services” (defined by Secretary) for up to eight conditions also defined by the Secretary.  Each group would have to fight among themselves for payment with doctors usually at the mercy of hospitals. Patients will lose as each group engages in a race to the bottom to deliver the cheapest possible care often by denying services to patients so they can find a way to get paid. In other words for a condition (like a heart attack), all the money is in one basket for a patient and each group must jealously guard their share and will get a bonus if they spend less on the patients. Their will be a “bidding” process to the Secretary that will result in a “low bid” mentality for patient care. Good luck Patient for any care you need 3 days prior and 30 days after hospitalization (or longer if the Secretary says so).

David McKalip, M.D., Neurological Surgeon
1201 5th Ave. N., #210, St. Petersburg FL, 33705

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