To save money, doctors and insurance companies across the nation are dramatically changing the way they do business.
As a result, tens of thousands of Maine patients — Medicare, Medicaid and privately insured — are beginning to see a change in their relationship with their providers.
At the heart of it: Health care groups are putting greater emphasis on preventive medicine and paying more attention to patient safety and satisfaction. And the healthier and happier those doctors keep their patients, the greater their financial reward.
“We’re trying (to be) more proactive instead of reactive, health-focused rather than rescue-focused,” said Dr. Ned Claxton, medical director of Central Maine Healthcare‘s new accountable care organization and president of the medical staff.
Doctors currently earn money by the patient and the service provided. A 15-minute office visit, for example, nets doctors a certain amount. The more patients a doctor sees, the more money the doctor gets, regardless of whether those patients get healthier or sicker, are happy or unhappy with their care.
Health care reform’s Affordable Care Act requires Medicare this year to establish a shared-savings program with doctors to improve care and cut costs. Because healthy patients cost insurance less than sick ones, and preventive care costs less than crisis or chronic care, the idea was to give doctors an incentive to keep patients healthy by giving those doctors a piece of the savings.
Health care providers could participate by forming accountable care organizations, known as ACOs. Already, such networks of health care providers have formed and are responsible for groups of Medicare patients. Although patients can see doctors outside the network, the ACO’s bottom line is tied to the proven health and happiness of those patients, creating a significant incentive for doctors to collaborate with physicians in and outside the ACO, to closely monitor patients’ health and to make sure patients are satisfied with the care they get.
The happier and healthier patients are, the more money Medicare stands to save. The more money Medicare saves, the more money the ACO gets.
Medicare’s first 32 ACOs were approved around the country late last year and launched in 2012. Among them was an ACO run by the Eastern Maine Healthcare System in Bangor. It is serving 9,000 patients and is expected to add several thousand more by the end of the year.
This summer, the U.S. Department of Health and Human Services approved another 89 ACOs, giving it a total has a 154 organizations in voluntary ACO programs and related voluntary Medicare “shared savings” programs. This includes about 2.4 million Medicare enrollees, or 4.9 percent of all Medicare enrollees, officials say.
ACOs in Maine include one closely affiliated with Central Maine Healthcare in Lewiston, which is expected to serve 16,000 people in central and western Maine, and one by MaineHealth in Portland, which will include St. Mary’s Regional Medical Center in Lewiston and will serve about 35,000 people.
The state of Maine is looking at forming an ACO for MaineCare, the state’s Medicaid program. And several physician groups have formed or are working on forming ACOs agreeable to private insurance companies.
“The old way of paying for health care, which is based on how much volume we deliver, that’s not acceptable to taxpayers and it’s not acceptable to employers and, frankly, it shouldn’t be acceptable to us anymore, either, because that’s what’s gotten us into the national health care crisis that we have right now,” said Andrea Patstone, vice president for strategic initiatives at MaineHealth.
Opting out allowed
How will it work? That depends on the ACO and the insurer.
Medicare patients become part of an ACO if their primary doctor is a member of one. Although ACOs will be held accountable for the care of their Medicare patients, individuals can opt out of sharing their personal, identifiable health information, limiting their participation. They can change their minds at any time.
Medicare patients choose their doctors and can see physicians outside the ACO. Although an ACO gets more money by keeping patients healthy, patients do not have to follow their doctor’s advice, submit to ordered tests or undergo surgery, even if it’s recommended by their doctor.
The state is working on developing an ACO for MaineCare, so its patient rules are not yet set, but they are expected to be similar to Medicare.
The rules can differ when it comes to ACOs that work with private insurance. State and federal laws prohibit insurance companies from infringing on many patient rights, so they cannot, for example, penalize people for failing to follow their doctor’s orders. However, insurance companies can limit benefits or use incentives — such as lower co-pays or out-of-pocket payments — to encourage patients to do what is beneficial to the insurance company.
For example, all insurance programs can make patients pay more for a doctor who is outside their preferred physician network. That may turn into paying more to see a doctor outside an ACO.
But no matter who the insurer is, experts say, ACO patients should expect at least one major advantage over the current system: more time and attention from their health care providers.
“Currently, in health care, if people stay healthy, no one gets paid,” said Elizabeth Mitchell, CEO of the Maine Health Management Coalition, a Portland-based nonprofit group of employers, hospitals, insurers and doctors.
“So they’re trying to change the incentives to enable physicians to be paid for keeping people healthy,” Mitchell said. “ACOs, in theory, will do that.”
For some patients, that could mean getting a call from their doctor’s office telling them their electronic medical records have been flagged because their age, weight and family history puts them at risk of a heart attack, and asking if they’d be willing to take a cholesterol test and meet with a weight-loss professional.
For some, it could mean a longer appointment with the family doctor to talk about vaccinations, age-appropriate health screenings and exercise.
For others, it could mean being given an email address for their nurse practitioner, physician assistant or doctor, so some of their health questions could be answered more quickly.
The downsides
But there are drawbacks.
When Eastern Maine Healthcare started its Medicare ACO in January, its staff had to read each patient 11 pages of Medicare-approved legalese to inform them of their rights. For patients, the paperwork raised far more questions than it answered.
“That was painful,” said M. Michelle Hood, president and CEO of Eastern Maine Healthcare Systems. The group has since talked to Medicare officials about trimming the required reading. “We learned some lessons . . . We’re adding additional patients in year two and hopefully, that’ll go a little bit more smoothly.”
Mitchell, at the Maine Health Coalition, said her members who purchase health insurance are concerned ACOs will create monopolies, since groups of doctors and hospitals must band together to form those networks. And once they have that monopoly, the fear is those medical providers will raise prices.
“As they become integrated entities, that is a real possibility,” Mitchell said. “The sort of irony, though, is care systems need to be integrated to coordinate the care for patients. There’s a need for clinical integration to improve care. There’s a concern about organizational integration.”
David Howes, president and CEO of Martin’s Point Healthcare, is a proponent of ACOs. His nonprofit, Portland-based health care organization runs nine health care centers in Maine and New Hampshire and provides health insurance plans to businesses and military members, as well as Medicare Advantage plans to those who are Medicare-eligible. It’s formed an ACO to cover military and Medicare Advantage members. It has developed an ACO relationship with one private insurance company and expects to develop a second. And it’s considering applying for Medicare ACO status.
But Howes sees “huge challenges” for ACOs, including the fact that health care now is designed to help people after they get sick, not before.
“We have a system that’s not being built to do this,” he said. “So we have very large numbers of specialty physicians and very extensive hospital systems that are really dedicated to rescue care. These are assets that are going to be distressed and that’s a big issue.”
He also believes it’s going to be difficult for doctors to get patients to listen to their advice about preventive care, the hallmark of ACOs.
“As a species, we really don’t want to believe these things can happen to us,” he said.
Despite the challenges, many doctors and hospital groups are betting ACOs will be “very popular.”
Martin’s Point has about 13,000 patients involved in ACOs. It expects that number to grow to 19,000 by the end of the year and to 24,000 if it becomes a Medicare ACO.
“Our vision, our dream, is that everyone who comes to us will be cared for in this way,” he said. “I think it’s the only way we’re going to get our arms around cost. And this improves the quality of people’s lives.”
Funny HMO was a preventive health care insurance and yet after 30 years people are dropping dead left and right, from “advanced health issues”. How is this going to be any different?
A very fair question. Lots of similarities between ACOs and HMOs. HMOs fell out of favor in large part because of consumer push-back. I’m not conversant with all of the details, but ACOs have plenty of protections for patients and for the most part the medical community recognizes that in the interest of the patient and sustainaibility ACO is the way to go.
I have been with my HMO, Kaiser-Permanente, for almost 30 years. I have several friends also with Kaiser and all of us report very good experiences with the program, which interestingly enough, is not a for-profit corporation. There is a big emphasis on preventative treatment and care. I could not be happier with the care I have received. I even had one operation. I brought along a friend to accompany me through this day long procedure. She works at the National Institutes of Health (NIH) and is quite aware of all the procedures. Afterwards, she commented about how well everything was handled and how professional was the staff.
I do wish people would set aside their hatred of the President for a moment and actually look into the details of ACA/Obamacare and do so unemotionally. This means turning off the Fox talking heads who couldn’t find a good word to say about sunshine after a rainshower. Do remember that both parties spoke of the mandate and changes to health care which were long, long overdue, and completely unsustainable. We paid top dollar and did not get great care. The uninsured were left to die. Those who waited until they could wait no longer, and sometimes waited too long, arrived at our ERs where heroic measures were attempted to save them, using the most expensive form of health care in the USA. Wouldn’t it have been better had those people been treated regularly and ahead of a crisis? One ER visit would have paid for a year’s worth of routine checkups and treatment.
The naysayers and Obama haters should take a step back, take a breath, and actually look at ACA. It also is a work in progress. As in all programs, it will get tweaked here and there but the overall benefits to all are well worth it. And, if you still hate Obama and have it in your mind that the only people who show up at ERs are deadbeats and drug addicts, then you should take a visit to one sometime. You look in the eyes of a kid and tell that child they are not allowed to have the best medical treatment, or that their mom, dad, brother or sister is going to die, just because their family cannot afford to pay for the doctor’s bills. You tell them that because I cannot.
When was the last time someone was left to DIE in this country? You tell people “turn off fox”, then you spout leftist rhetoric about dying on the gurney. When we are waiting six weeks for a cancer screening because the system is choked with illegal immigrants, and teenage moms addicted to opiates thats when you will see the hardships.
We all know full-well that indigent patients who present themselves at an ER must be treated by law. Those costs are paid for by the ER, usually part of a hospital, and those costs are passed on to the rest of us. However, once the “emergency” is over, they are out the door as soon as is practical. Forget about follow-on care, or care that would have allowed them to not to have to show up at an ER, in the first place, when it often is too late to save them. So, yes, they are “dying on the gurney” as they often they wouldn’t have needed to be on a gurney had they received regular care.
Your “illegal immigrants” and “teen-age mother crack addicts” are just reactionary. I can think of a whole bunch of Mainers who were hard-working people who cannot afford health insurance, don’t have it, and have exactly the same financial standing as your illegal immigrants and crack-moms. Perhaps, if they received regular care up-front, they would not be “clogging the system,” as you call it. After all, apparently to you, there are humans who deserve care and those who do not. I’m guessing you are one of those new Tea Party Christians.
“I can think of a whole bunch of Mainers who were hard-working people who cannot afford health insurance, don’t have it, and have exactly the same financial standing as your illegal immigrants and crack-moms.”
Absolutely true! Absolutely! Some self-employed, many small business, and an appalling number of chain store employees very often don’t make enough to cover the cost of a weekly premium; and furthermore, contrary to what seems to be popular belief now, often don’t go running to the ER for every pimple either.
Very good examples. Very true, they often do not run to the ER and wait instead, sometimes too long. I had a cousin that was dirt poor in Maine and finally went to the ER knowing he could not pay for a doctor. He lasted 6 days and then died. I often wonder if he had sought medical attention early on that he might have lived longer. But, he was a proud man and did not want to take charity from anyone. Of course, he told no one in the family that he was ailing and finally went to the ER when only a miracle would have saved him. Alas, they were out of miracles that day.
No one claimed that people were “dying on the gurney.
Fact: Three states that expanded Medicaid in 2001 and 2002, New York, Arizona and Maine, collectively saw a 6.1 percent decline in the death rate for people age 20 to 64 compared to neighboring states, according to the study published in the New England Journal of Medicine.
It’s also a “FACT” that ‘bad debt’ and ‘charitable deductions’ tripled over the past ten years of expanded health insurance coverage under MAINECARE. The stats are found here: http://statehealthfacts.org/profileglance.jsp?rgn=21&rgn=1# and reveal that MaineCare didn’t reduce the impact no-pays, but increased it dramatically and pushed a number of small hospitals to the edge of insolvency.
I’ve visited ERS before…..as a patient and a visiting family member. I never saw any child who is at risk of death or risk of anything else (requiring ER immediate treatment) being denied or turned away from the ER because the family members are impoverished.
BTW….I paid for my insurance policies (top dollar) through all these years (employment years and now retired) and always, and I mean always, got the best of care……..in office, outpatient surgeries, ER’s or inpatient surgeries.
I know, beyond any doubt, that I will now have to hear about palliative care (from my PCP or she won’t get paid from Medicare) and I will be required to attend end of life tutorials every 2 years as stipulated in the grand and glorious ACA. My father had life-saving surgery at age 78 and lived for 12 more years. He would have been denied the surgery under Obamacare-less. He would have received the Palliative Care lecture and his doctor would be required to remind him “Don’t you agree you’ve had a good and full life? It’s not cost-effective to hog the amount of money this surgery will entail when someone who is much younger and more valuable to society could use the money for their coverage?” Under the Sebelius/Berwick IPAB boards, his doctor would have been required to prescribe powerful pain medicines to my father and, ever so gently, turn him to a dark figure, waiting in the corner to relieve him from all life and pain.
Seniors have paid into Medicare all their lives. I have for 47 years. I say it’s criminal and macabre to cut those senior benefits (550 billion suctioned from Medicare in the ACA and spread out to cover some of the uninsured) and give them to non-senior citizens (including illegals) to create a new middle-class entitlement.
I suspect that kind of medical delivery system turns you on but there are millions of Senior citizens who are fully aware of what awaits them down the road with Obamacare. To h— with us and what we paid into Medicare for 50 years or more on the promise of being covered in our old age. HA-HA..the laughs on us!
You have many points. I will try to address them.
As I mentioned to thoughtpolicemen, no one is denied treatment at an ER if they present themselves. That is the law. We all end up paying for that treatment in increased costs to us. Had those patients received regular care, they may well have not needed to show up at a Level-1 trauma center. It would be interesting to do a survey of the ER cases and do a breakdown of how many were real emergencies vs. “emergent care” which they have in Canada (in addition to full-blown Level-1 ERs) to handle after-hours and weekend sniffles, colds, and constipation.
How fortunate for you that you were able to pay your premiums just like me. It would be nice if everyone could (1) afford it and (2) not be denied insurance. And, how nice you were able to get all the care you needed. Same with me. Too bad kids with juvenile diabetes, heart conditions, and other “pre-existing conditions” are denied insurance or soon will hit their maximum life-time limits on treatment. Then what? You also are fortunate you didn’t apparently have cancer or heart diseases where you would have burned through the cap on your policy. Too bad others can’t make that claim.
Your “death panel” claims are ridiculous. The palliative care speech is something every severely ill patient should receive. I did with my mom. I never heard of a doctor not doing this for very ill patients. The deal is this – do they want “extraordinary procedures” performed on them or not? When this is explained to a patient as to what is done to them to attempt to keep them alive, many opt for the DNR. My mother, her mother, and others in the family years ago all completed the “living will” documents that they did not want to be kept alive on respirators and machines. That was their choice and I respected it. In the case of mandatory palliative care discussions, the purpose is to educate the patient and make him aware of just what will happen and to inquire of him what his wishes would be should the occasion arise. But, the final choice is up to the patient and the doctor will respect that choice. Don’t believe me? Look it up for a change.
Now, with regard to Medicare cuts for seniors. Here is a quote for ABC News and HHS/Medicare on the point:
“They [Romney campaign] cite a memo written by Richard Foster, chief actuary of the
Centers for Medicare and Medicaid Services (part of the U.S. Dept. of
Health and Human Services), that claims the ACA will, says Romney, “cut
Medicare by more than $500 billion.”
So does it “cut” Medicare by $500 billion?
Medicare spending will continue to grow, according to the Centers for
Medicare and Medicaid Services (CMS), but ACA will slow that growth.
According to a report from the Kaiser Family Health Foundation over the
next 10 years, the federal government will devote about $500 billion
less to Medicare than it would have without ACA.
CMS and the Kaiser Family Foundation tell ABC News that there will be
no benefit cuts to Medicare. They say instead of Medicare’s being cut,
there will be much more spending at the end of a 10-year window, but it
does slow the rate of that growth. This is all unless Congress makes
drastic changes to Medicare, for example passing House Budget Chairman
Rep. Paul Ryan’s Medicare Plan.
CMS says—and Kaiser agrees—that spending will be reduced by getting rid of fraud and ending overpayments to private insurance companies. It sends a message to those insurance companies: Operate more efficiently.
And instead of cuts, the CMS says they will be able to fund new
benefits, including free preventive care and broader prescription
coverage, including closing the “doughnut hole” affecting seniors.”
Here is the article: http://abcnews.go.com/blogs/politics/2012/06/fact-checking-romney-does-health-reform-cut-medicare-levy-500-billion-tax/
I highly doubt seniors will be adversely affected. I realize you believe Obama and the Democrats are the Devil Incarnate but also remember that both Romney and the GOP were behind health care reform for years before Obama actually did something about it. They just don’t like the sour grapes of a Muslim, foreign-born, liberal, intellectual black man having gotten it done on his watch.
Let’s stop acting emotionally and start acting based upon facts.
Your argument is a good one, clear and articulate. We have different ideologies and POV. There was a time in our country when differing opinions elicited a civil and respectful response toward our neighbor who disagreed with us on how to reach the same end but favored a different route to get to that end. That civility is a thing of the past.
You say “The “death panel” claims are ridiculous.” No they aren’t. The IPAB panels have been formed and are still in the process of preparation for the disastrous medical delivery system that will prove most deleterious to Seniors. You go on to say “The palliative care speech is something every severely ill patient should receive.” We all recall the clarification that Obama gave to the granddaughter about her Grandmother receiving a pacemaker at the age of 100. It improved her condition and she was still going strong at 105.
Obama’s answer was clear. “It is really not feasible, he indicated, to take “grandma’s spirit” into account. We are going to make medical decisions (gov’t IPAB bureaucrats) based on objective evidence, and not subjective impressions. If the evidence shows that some form of treatment “is not necessarily going to improve care, then at least we can let the doctors know that – you know what? – maybe this isn’t going to help; maybe you’re better off not having the surgery, but taking the pain pill.”
BTW…Barack Obama had no idea that a “pain pill” would not address that elderly woman’s condition. Pain pills could only serve to hasten her death.
Unfortunately you couldn’t stop yourself from typing that last “over the cliff” paragraph. You lost any semblance of intellectual discourse when you said, “I realize “you” believe Obama and the Democrats are the Devil Incarnate.” (No, I don’t believe that) But saying my problem (or OUR problem) is “we just don’t like the sour grapes of a Muslim, foreign-born, liberal, intellectual black man having gotten it done on his watch” falls under the category of “crazy talk.” And you were doing so well.
Well, you can forget about civil responses. Those are dead. I’ve been mostly working on the SSM battle since 2009 and having had to deal with the battle scars from that tribe of nutbars on the religious side, my patience has grown far too thin to deal with anything but the facts.
The ACA specifically prohibits rationing to achieve cost reductions. The death panel malarkey is just that – more right-wing Tea Party malarkey which usually is “proven” by references from some obscure right-wing “expert.”
Here’s what the Washington Post Fact Checker had to say on the issue: http://www.washingtonpost.com/blogs/fact-checker/post/sarah-palin-death-panels-and-obamacare/2012/06/27/gJQAysUP7V_blog.html
And, what Politifact had to say: http://www.politifact.com/truth-o-meter/article/2009/dec/18/politifact-lie-year-death-panels/
And, what Snopes had to say: http://www.snopes.com/politics/medical/over75.asp
The video on Obama’s answer that I saw had been clipped. The full-context is here: http://www.coloradohealthinsurancebrokers.com/politics/obama-health-reform-prime-time/
I thought his answer was reasonable. I did not see any indication that grandmother’s pacemaker request would be flat-out denied.
But, I would ask you this – what do you think a private insurance company would have done had this same request been made? I’m sure more than one would say, “she’s too old.”
As far as my comments about being over the cliff? Let me put it this way – Much of the ACA has been endorsed by both parties over the years including Romney who implemented a very similar program in Massachusetts. What I want is an honest, factual critique of ACA. Your mention of “death panels” and your adamant acceptance of these as fact tells me you have not done your homework and you are reacting based upon the vitriol from the right-wing talk radio. You are far from being alone. Do you honestly think that if Reagan, Bush-43, Romney, or a Republican Congress proposed and passed the ACA into law that we would EVER hear this much pushback from the Tea Party Republicans?
I would like to say you were doing so well, but I haven’t seen it yet.
What I’ve learned about Obamacare has zero to do with talk radio. And FOX news…..I don’t get FOX news……I can’t afford the cable rate. What I do know about the ACA is way too long to impose on the comment section but I’ll see if the BDN will allow it. It’s a futile endeavor as far as you’re concerned because you refuse to give any credance to a POV that is not in line with yours. Here’s some of what I know and agree with:
THE TRUTH ABOUT THE HEALTHCARE BILLS
Well, I have done it! I have read the entire text of proposed House Bill 3200: The Affordable Health Care Choices Act of 2009. I studied it with particular emphasis from my area of expertise, constitutional law. I was frankly concerned that parts of the proposed law that were being discussed might be unconstitutional. What I found was far worse than what I had heard or expected.
To begin with, much of what has been said about the law and its implications is in fact true, despite what the Democrats and the media are saying. The law does provide for rationing of health care, particularly where senior citizens and other classes of citizens are involved, (Various panels made up of bureaucrats appointed by the Obama administration will decide health care expenditures under Medicare, and decide what patients will receive specific types of care. They will also choose the doctors and hospitals that can be used by each patient. This is a direct interference with the doctor patient relationship and is clearly rationing.) free health care for illegal immigrants, (millions of dollars have been appropriated to set up clinics in certain states to provide free medical treatment for immigrants. However, employees of the clinics are prohibited from asking patients about their legal status.) free abortion services, and probably forced participation in abortions by members of the medical profession. (Doctors and nurses are not yet being forced to perform abortions, but religious institutions are being forced to finance free contraception, and abortion inducing morning after pills, despite the fact that this violates their religious beliefs and is a direct violation of the 1st Amendment. The next step will certainly be mandating that Catholic hospitals and others provide full abortion services.)
The Bill will also eventually force private insurance companies out of business and put everyone into a government run system. (Although the so called “public option” was removed from the final version of the health care bill it is still alive and well in the minds of most proponents of the legislation. Barack Obama, Nancy Pelosi, Harry Reid, and the mainstream news assured Americans that under Obamacare health care costs and insurance premiums would decline. The exact opposite is true. Health care costs continue to rise and so do insurance premiums. Small businesses can’t afford to provide insurance for their employees and the employees can’t afford it on their own. In addition, insurance companies are being forced to provide benefits that will ultimately force many of them to price themselves out of business.) All decisions about personal health care will ultimately be made by federal bureaucrats and most of them will not be health care professionals. Hospital admissions, payments to physicians, and allocations of necessary medical devices will be strictly controlled. (Under the provisions of Obamacare some 138 new Federal agencies or committees have been established to make many of the decisions on your health care that were previously made by you and your physician. The most heinous of the provisions in the law in this area places a tax on artificial limbs including those being provided to elderly veterans, and our troops that have wounded fighting for our nation in Iraq and Afghanistan. The Veterans Administration will not pay the tax so these heroes and their families will have to pick up the tab. The same is not true for illegal aliens. They can get them at taxpayer expense.)
However, as scary as all of that it, it just scratches the surface. In fact, I have concluded that this legislation really has no intention of providing affordable health care choices. Instead it is a convenient cover for the most massive transfer of power to the Executive Branch of government that has ever occurred, or even been contemplated. If this law or a similar one is adopted, major portions of the Constitution of the United States will effectively have been destroyed.
The first thing to go will be the masterfully crafted balance of power between the Executive, Legislative, and Judicial branches of the U.S. Government. The Congress will be transferring to the Obama Administration authority in a number of different areas over the lives of the American people and the businesses they own. The irony is that the Congress doesn’t have any authority to legislate in most of those areas to begin with. I defy anyone to read the text of the U.S. Constitution and find any authority granted to the members of Congress to regulate health care. (Ironically, the U.S. Supreme Court held that the individual mandate portion of the law passed by Congress was not constitutionally permissible under either the commerce clause or the necessary and proper clause of the Constitution. However, using some bizarre reasoning five Justices found it Constitutional under the taxing power of Congress. They ignored the Constitutional requirement that all tax laws must originate in the House of Representatives, while the final version of Obamacare originated in the Senate. The bottom line is that Congress passed a piece of legislation without reading it and it gave Obama and the Executive Branch the power to make over 4,000 decisions on every aspect of health care without any Congressional approval or oversight.)
This legislation also provides for access by the appointees of the Obama Administration to of all of your personal healthcare information, your personal financial information, and the information of your employer, physician, and hospital. (This is all in the process of being implemented under the rules and regulations being adopted as a result of the law.) All of this is a direct violation of the specific provisions of the 4th Amendment to the Constitution protecting against unreasonable searches and seizures.
You can also forget about the right to privacy. That will have been legislated into oblivion regardless of what the 3rd and 4th Amendments may provide.
If you decide not to have healthcare insurance or if you have private insurance that is not deemed “acceptable” to the “Health Choices Administrator” appointed by Obama there will be a tax imposed on you. It is called a “tax” instead of a fine because of the intent to avoid application of the due process clause of the 5th Amendment. However, that doesn’t work because since there is nothing in the law that allows you to contest or appeal the imposition of the tax, it is definitely depriving someone of property without the “due process of law. (When this original article was written the penalty for not complying with the original mandate was styled as a tax. Then to quell some of the overwhelming opposition to the proposed law, it became a penalty or a fine. Now the Supreme Court has ruled that it is in fact a tax. I personally don’t care what it is called, or what the five Justices on the Supreme Court say, it is still unconstitutional.)
So, there are three of those pesky amendments that the far left hate so much out the original ten in the Bill of Rights that are effectively nullified by this law. It doesn’t stop there though. The 9th Amendment that provides: “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people;” The 10th Amendment states: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are preserved to the States respectively, or to the people.” Under the provisions of this piece of Congressional handiwork neither the people nor the states are going to have any rights or powers at all in many areas that once were theirs to control. (The only victory in the Obamacare court challenge for those who support the Constitution came when the Court ruled that the federal government could not compel the states to put millions of people on the Medicaid rolls without any way to finance it. This was a victory for the 10th Amendment, but what about we the people and our rights under the 9th and 10th Amendments? Apparently those don’t exist any longer.)
I could write many more pages about this legislation, but I think you get the idea. This is not about health care; it is about seizing power and limiting rights. Article 6 of the Constitution requires the members of both houses of Congress to “be bound by oath or affirmation” to support the Constitution. If I was a member of Congress I would not be able to vote for this legislation or anything like it without feeling I was violating that sacred oath or affirmation. If I voted for it anyway I would hope the American people would hold me accountable. (This paragraph is self explanatory and I stand by it.)
For those who might doubt the nature of this threat I suggest they consult the source.Here is a link to the Constitution: http://www.archives.gov/exhibits/charters/constitution_transcript.htmlhttp://www.archives.gov/exhibits/charters/constitution_transcript.htmlAnd another to the Bill of Rights: http://www.archives.gov/exhibits/charters/bill_of_rights_transcript.htmlhttp://www.archives.gov/exhibits/charters/bill_of_rights_transcript.htmlThere you can see exactly what we are about to have taken from us.
Michael Connelly (Retired lawyer and Constitutional Law Instructor)
Oh, yes, the old Connelly speech. Yes, read it before. Here’s something to counter it:
http://www.factcheck.org/2009/10/health-care-overhaul-constitutional/
One thing I’ve notice from the TP crowd is, that if there is a way to find the wrong interpretation of a document, they will find it. The story, “Dog Bites Man,” is construed to be, “Dog Defends himself from vicious Democrat physical attack.”
Now just how did I know that …..”you refuse to give any credence to a POV that is not in line with yours.”
“Pride goes before destruction, And a haughty spirit before stumbling.” You can’t say you haven’t been warned.
More a question of credible sources. I recall one instance on the NOM site where the well-known and well-accepted national divorce rate hovers around 50% statement was questioned. I doubt anyone would disagree with this. It seems plausible, even ancecdotally. But, because that went against her argument, she found a, get this, “assistant sociology professor” from some university in Kentucky who made a statement (with no citations) that the divorce rate in the USA “is nowhere near 50%.” Therefore, in her mind, this was proof enough.
I, of course, provided the statistics published by the CDC.
What axe to grind would the CDC have on divorce statistics? NOM certainly would but the CDC? What dog do they have in the fight?
It is a question of credibility.
Some politicians have tried to scare voters by telling them IPAB will ration medical care. However, the law creating IPAB forbids it from even suggesting rationing of any kind. It cannot cut benefits, raise taxes, increase premiums or co-pays, restrict eligibility, or otherwise do anything that would deprive anyone of care. It most certainly will not reviews anyone’s medical care and decide who gets care and who doesn’t.
Good luck. It’s like talking to a wall.
All socialized and semi-socialized health care systems terminate care at the end of life in some way; since it results in huge savings. Those DEATH PANELS are very real, and exist either via reduced payments or denial of reimbursement. Happens in U.K., happens in Canada, and will happen here to you unless ACC is repealed and reformed.
Sounds more like the for-profit insurance corporations to me…
why don’t they just make the insurance companies become Non-profit organizations? I would think that would go a long way to reducing costs so more people could afford the premiums, the problem I have with Obamacare is that it is Mandatory, and there are real penalties if you don’t comply, that is a problem, in a supposedly free society we shouldn’t be coerced into buying anything and penalized of we don’t. IMHO
How does that work, don’t have money for insurance
and now have to pay a fine. Illegal, otherwise fine people
have having kids without a job.
How about the meds costing$1,200.00 for 28 pills, yet cost $2.00
to make. How about doctors learning to live on a half a million
not 2 million. While we’re at it why has the cancer society been collecting
money since 1860 yet more people are dying from it then ever?
Same goes for all the other diseases some group has been taking
money for an still not cures. When was the last cure found? Penicillin?
In the year 1928?
I think you forgot to take your $2.00 pill today.
If your making fun of my use of my bosses IPOd, enjoy yourself
it gives me a headache. However if your scarasm is directed at my
loved ones need for cancer meds that are $1250.00 a month
which is $50.00 more than our income right now You must be a welfare person
whose taking money out of my pocket so we can’t afford meds
agreed
Just another way to get heathy patients for visits so they can make more money.
I pay a flat rate per month for my insurance which includes healthy-care checkups, vaccinations, blood tests, all other tests, and dental exams – no cost per visit. The goal is to keep me healthy so I don’t run up a huge bill with the insurance company. Preventative care is the name of the game.
Someone is paying they do not work for free
In my case, I’m paying. My $305/month includes all of what I mentioned. I am sure that all the stuff I have done on a routine basis does not begin to cost what I am paying per month. After all, it is insurance and I have it primarily for catastrophic illnesses/accidents where the costs would be very high. But, the more preventative care I receive, the less likely I will need to have catastrophic care.
With the advent of the ACA and where caps on procedures are no longer allowed, it behooves the insurance companies to keep people healthy. In the past, their actuaries could figure in the cost of a $50,000 cap on a heart attack and know they would never have to pay more than that. I don’t think there was any incentive to keep people healthier. That business model is dead with ACA.
So, yes, I’m sure that most of my premiums go into a pool to cover the person with the heart attack. Someday, it might be me. The actuaries can predict that day better than the doctors can. I am very pleased with the care, the cost, and the new rulings handed down by ACA. No caps, no pre-existing conditions, no lifetime limits, and all insurance companies have to comply so the playing field (read: cost basis) is level.
Sounds like your own game plan is to omit preventive care and routine screenings, then head for the ER when you have unmistakable symptoms of a devastating illness that’s now so far advanced it will take millions of dollars to treat.
The headline reads like it is all a success. The story reads like it is all a hope. So our doctors will tell us to get more exercise, eat better, stop sleeping outdoors in the winter, stop drinking a case of beer every night and other such proactive tips to manage our health care proactively. That all sounds nice and it has been tried often with no measurable success. The end of the story quotes the head of Martin’s Point, a great Maine success story who is realistic. The BDN hates realistic when it shades their left wing approaches to managing everyone’s life
Gee, you want them to tell you it’s ok to lay around, eat fast food all the time, smoke, and drink alcohol heavily?
You will still be making your choices, you might just have to pay more to make bad ones.
Subliminal message … Obamacare is good, Governement control is good, we are smarter than you, we can run your life better than you, Freedom isn’t as important as security. Vote for Barrack. Let us control your life.
and make sure you “pay your fair share” so the other half of Americans don’t have to…
Mitt Romney yesterday in Isreal –
“Do you realize what health care spending is as a percentage of the GDP in Israel? eight percent,” Romney told donors at a fundraiser at the King David Hotel in Jerusalem, speaking of a health care system that is compulsory for Israelis and funded by the government. “You spend eight percent of GDP on health care. You’re a pretty healthy nation. We spend 18% of our GDP on health care. Ten percentage points more. […] Our gap with Israel is 10 points of GDP. We have to find ways — not just to provide health care to more people, but to find ways to find and manage our health care costs.”
________________
Israel, like virtually all developed countries, has government run ‘socialized’ health care.
I mean, I thought that Republicans were the “party of personal responsibility. ” But when we put a system in place that acually asks for people to take some responsibility for the amount of money that they cost the health care system, it becomes a “left-wing” thing? “That all sounds nice and has been tried before” is simply not true, not in the systematic way that this plan does it. The current system is untenable, so what is your great idea?
Don’t forget, too, that the whole mandate and the idea behind the ACA was proposed by BOTH parties years ago and Romney himself put it into practice in NH. Now, because a Muslim, foreign-born, radical, socialist, liberal, Democratic, black man’s name is on it, it’s poison.
It is the same monkey math they used to calculate the $84 billion deficit reduction by implementing dingbats afordable helathcare which will cost in th trillions. You know, if you spend $50 bucks you save a nickle kind of thing that the democrats are proficient at.
I’d be happier if Government got out of healthcare.
You want to leave it to the good will of the for-profit insurance companies and the pharmaceuticals?
Nope.
Switzerland does, while compulsory basic health insurance is required — including tourists; there are over 50 companies competing for the business in this market-driven model and Swiss PHARMCO is world renown — their data bases are accessible at even the smallest drug store; enabling pharmacists to prescribe medication without a doctor.
The Swiss only spend 11% of their GDP on Healthcare, while we spend 17%…and guess whose health is better?
I would like to know how many companies would be competing here. Enough to make it competitive enough so that consumers have true choices?
The Swiss also have a much healthier lifestyle than us, so naturally their costs would be less.
Could be an interesting model, I suppose.
Having been passed by a couple in their 80’s or 90’s in lederhosen on a mtn. trail, I can tell you a few of them are in fantastic condition….but then they drink and smoke more than Americans, and eat a lot more cheese, so is that ‘healthier’? …..Swiss white wines and local
Gruyère cheese on fresh whole grain bread is yummy.
Don’t forget much of health care in Europe’s socialized health care is two tier; and private options…for bigger rooms, etc. are the rule. Some of the best clinics in the world are in Europe and they are private and are thriving.
I’ll go for the cheese.
Every morning, fresh whole grain bread and local Gruyere was provided for breakfast at our B&B, along with fruit juice. No wonder they’re so damn healthy! MARCHE…
Is it reasonable to compare the average cost-rate and health status of a country of 7 million (Switzerland) to our country, well over 311 million. There are more people living in New York City than in all of Switzerland.
I have to deal with all the people who go on and on about how wonderful the single payer systems are in Canada, U.K., and others who think we should import Finland’s schools; so I ‘m going to ‘cherry pick’ the Swiss market-driven health care system….and it’s very reasonable to draw comparisons, esp. if you’ve had first hand experience at using the Swiss system.
The Swiss heavily regulate the insurance companies.
I assume you are including Medicare and Medicaid/MaineCare?
I can understand there are ways to objectively measure if patients are healthier. But how do they propose to measure if patients are happier? Are they going to pull out that graphic with the smiley face as #1 and the weepy face as #10 and ask patients to pick a number?
Maine Care running an ACO? Considering the leadership, that’s a scary thought. Oh and by the way, we’re all paying for this Obamacare debacle.
No doctors up here, just P.A`s and N.P`s but they they charge the same then send you to a specialist.
Lindsay wrote this before the NYTIMES story today on how the ACC would create a massive shortage of doctors in many parts of the U.S., and potentially in Maine:
July 28, 2012
Doctor Shortage Likely to Worsen With Health LawBy ANNIE LOWREY and ROBERT PEARRIVERSIDE, Calif.
— In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014.
But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.
Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems.
The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.
http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html
If the ACC stands as written, it will take an Olympic effort to meet the demand for Health professionals…and who better to meet it than someone who ran a successful Olympics?
1) millions of Americans have been having to do without necessary health care due to lack of health insurance.
2) once they have access to health care, more doctors will be needed.
3) Republican leaders say this is cause to resume denying health insurance to millions of Americans.
In Maine, a study by the Muskie Institute revealed that few if any people were denied care at hospitals. At our local one, people are treated first; and then billed.
There are many clinics, esp. for children where services are provided free. Often these are overlapping, so that specific segments of the population may even be over-served. Much of this includes preventive care; free flu shots in the fall for example.
Many people don’t want nor need health insurance, they are healthy or have sufficient resources to pay the lower price for ‘cash’ settlements.
ACC coverage has huge gaps….dental care, eye glasses, hearing aids, etc. must still be covered out of pocket. Aging seniors are finding that these ‘holes’ in Obamacare, need filling!
Repeal and reform ACC.
Everyone needs health insurance, except billionaires. A disastrous accident or severe illness can hit any of us at any time. Medical expenses can go into the millions of dollars.
Anything that Kathleen Sebelius approves of must be wrong for the American people.
Happier now? Well, ignorance is bliss!
Wait until the true cost of Obamatax is levied on everyone, let’s see how ‘happy’ they are then!
The “tax” will be levied on scofflaws who hope to get a free ride at the public’s expense. Is this your preferred type of citizen?
You have a choice–take personal responsibility by purchasing health insurance for yourself, or decline health insurance (on the delusional belief that you couldn’t possibly become ill or have an accident, or else figuring that the rest of us will simply have to pay for your ER visit).
Chose the second one, and you pay the freeloader penalty, aka “tax.”
Ground control to Major Tom… If this wasn’t so laughable it would qualify as one of the BDN’s greatest propaganda schemes to reconcile reality with social Marxism. All that is missing is the sound of a jet swooshing high above and Puffy Pinafore’s smiling face peering out the window, urging everyone “beneath her” to get on board with one big Kumbayah song.
Sounds like a lot of propaganda to me. Then there is Mayor Bloomberg in NYC who now wants to lock up baby formula to coerce women to breast feed. What a nut job. He should just butt out of other people’s lives.