Monday, October 29, 2012

SANDY STUFF

FYI
In order to help those who require last-minute computer communications, and to take extra measures of security for the building, the Plainfield Public Library will be open Monday from 9M to 12 or 1pm, depending on worsening weather conditions.  We will be closed all day Tuesday.

Joe Da Rold
Executive Director

Monday, pre Sandy, Get ready as best we can and hope for the best. Sunday; The Giants  (football) won by a finger tip. The Giants (baseball) won in extra innings the World Series. Least set as possible about the Jets the better. As usual I had a good afternoon sleep through two games, especially the Jets.

Baseball season ended last night; pro Basketball begins this weekend. That is for those  who like  a sport where only the last 5 minutes are important.

I expect that we will lose our electricity during the storm and trust that it will be the worst I suffer although have too many tall old trees. Anyhow this most likely may be the last post this week; time will tell.

At this moment my grandchildren in Richmond Va. and Columbus OH just called and they are under similar storm conditions. I doubt that there has ever been one in written records time a storm of this magnitude. Could the Mayan calender be two months off?

Once again best of luck the next 36 hours.

Sunday, October 28, 2012

SANDY AND FORUM

"Health Care' will have to take a back seat for the duration of the storm. Let us hope that no one of us suffers any serious damage. I for one will cross my fingers, my toes (figuratively), my legs, and arms and hope for good fortune- GBW.

Saturday's LWV Candidates Forum was an exercise in logistics which they should be congratulated for doing well. Since with the exception of the BOE elections there are no true contests although the third ward race has all legitimate candidates the party line is too strong for any outsider to9 have an impact. Truly, the Council seats are elected at the primaries.

That said the biggest citizen turnout and interests was for the BOE elections where  in this non political election there are two tickets, one supposedly favored by the Campbells who have controlled the Board the last two years. Remarkably they could only place two candidates for the three three years seats. 

The other full slate is "rumored" to have the blessings  of Jerry Green. Under such circumstances how can any election in which power brokers have an interest be apolitical?

I suppose as usual it matters little, unfortunately, on the qualifications of any of the candidates in this election. The Slam (Campbells) were elected several years ago to rejuvenate a dysfunctional Board. In stead of being open and transparent they have outdone their predecessors in secrecy and manipulation. Once again for better or worse a change is in order.

The fivefour of seven candidates for the charter commission who showed for their forum are all capable people and it will be in good hands if they are all elected.

Saturday, October 27, 2012

HEALTH CARE TODAY-TOMORROW #2



I will post at least three more  documents  relating to my  concerns about health care and the impact of the affordable Health Care Act. None of this is to be construed as an indictment of neither the Obama administration nor an up to blog for Mitt Romney. I will discuss the so-called Romney alternate to the affordable health care act in a subsequent blog.

Instead in the previous blog and this one I am attempting to express my concerns upon the impact of the act upon delivery of quality care to all Americans.

Articles II: Section 8 of the Constitution which defines Congress’s powers does not specifically give it the right to mandate health care for the citizens. Amendment X would suggest that that night could only be exercised by the state however amendment XIV [civil rights] states that “no state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States”.  

I note these quotes from the Constitution because they have the potentiality of making the mandatory provisions of the health care act illegal and unconstitutional. However, that is that problem at this point. I have apparently been told that the health care act not cost us anymore and that there would be no increase in taxes.
THE DOCTOR,
 However there are various fines and penalties in the law some of which are designed to circumvent the contention that there is no mandate to buy insurance. Starting in 2014 and rising every year there is a penalty which will be adjusted for inflation at thousand and 15 failure to buy health insurance.

This June the Supreme Court determined that those penalties are indeed a tax, and therefore the mandate to buy health insurance is perfectly legal under the Congress’s powers of taxation.
Nonetheless, the “penalty” for not being insured is less than any possible insurance premiums and those who are healthy may risk the possibility of their needs health care and just pay the penalty. This penalty of course rises from 1% of income 2014 two $2085 per family were 2.5% of income whichever is higher in 2016. Of course those low income to do not have to file a tax return, never the surgeon religious groups are those of a supreme that would exceed 8% of the family income are not subject to this penalty.

The new health care act also has surtax on Medicare for those whose income is over $200,000 single or if married $250,000 which will be amounting to 0.9% earn income plus a new 3.8% tax portion of capital gains and dividends. That is a top of the 1.45% that is mandatory to be taken out of their wages.

I am not going into the mandates forcing employers to provide health insurance.

There is no estimation on the cost and high premiums that will face the present day insured population.

THE DOCTOR
Let us turn to the other aspects of the Medicare laws and the affordable health care act which I feel will have a negative effect upon the delivery of health care. Aside from the fact that I Medicare payments are determined by two dictated overall known as SGR [Medicare sustainable growth rate] to control spending ties Medicare reimbursement into the growth of the GNP; the intent is to reduce or reimbursement to the providers are.. Because you know it’s every year this is been below the rate of inflation there has been objection from the medical profession so that the changes recommended have been abolished by congressional act. Instead at the end of 2012 827% cut in Medicare part payments scheduled to go into effect on March 1, 2013. Undoubtedly, that will be begin the gated because of enforce responsibility great number of physicians will either refused to accept Medicare patients or entirely leave the profession.

On top of this threat to the practice of medicine; Medicare has instituted a set of requirements which if followed by physicians for the first couple of years includes small increases in reimbursement but if not instituted will end up with a reduction in reimbursement. They are electronic prescription writing, the electronic medical records, and something cool physician’s quality reporting system which requires doctors to report certain activities or data specific to patient encounters.

Initially there is a bonus of 0.5% physician’s total Medicare charges for the year 2012 to be paid by2016. There were supposedly additional bonuses payable for 2000 and on through 2014 after which only penalties will be in play. Those penalties are of course reduction in reimbursement I which can be up to 2%.electronic prescription transmission, 3% for not having electronic medical records and 2% for failure of the PQRS.

There are exemptions to the electronic prescription law as follows:In November 2011, the Centers for Medicare & Medicaid Services (CMS) released the final regulation on the 2013 Medicare e-prescribing penalty program. The penalty for not successfully participating in the program or not filing for an exemption on time is a 1.5 percent payment reduction for all Medicare claims based on the 2013 fee schedule amounts during the year.
Avoiding the 2013 Medicare e-prescribing penalty
Physicians and other eligible professionals who meet the following criteria will not be subject to the 2013
Medicare e-prescribing penalty. If you meet one of the following criteria, you will automatically be excluded from the penalty and no action is required on your part:
• You are not an MD, DO, Podiatrist, Nurse Practitioner, or Physician Assistant as of June 30,
2012.
• Office visits and other services listed in the CMS e-prescribing measure specifications represent less than 10 percent of your allowed Medicare Part B charges in the first six months of 2012 (January 1, 2012 through June 30, 2012) (Link to CMS’ measure specifications at: https://www.cms.gov/ERxIncentive/06_E-Prescribing_Measure.asp#TopOfPage and click on
2012 eRx Measure Specifications, Release Notes, and Claims-Based Reporting Principles [ZIP
475KB]).
• Less than 100 of your claims for Medicare Part B patient services contain visit and service codes that fall within the e-prescribing measure specifications for dates of service between January 1,
2012 and June 30, 2012.
In addition, if a physician (MD, DO) or eligible professional (podiatrist, nurse practitioner, physician assistant) has already taken one of the actions described below, the 2013 e-prescribing penalty will not apply:
• You e-prescribed using a qualifying e-prescribing system or certified electronic health record (EHR) and submitted 10 or more e-prescribing codes (G8553) on your Medicare Part B claim forms from January 1, 2012 and June 30, 2012, and the claims were received and processed by CMS by no later than July 31, 2012.
o Note: Unlike the e-prescribing incentive program and the 2012 e-prescribing penalty program, to avoid an e-prescribing penalty in 2013, you do not have to tie the electronic prescription to a qualifying visit or service when you report on 10 e-scripts during the first six months of 2012. As long as you e-prescribed for a Medicare patient you treated, you can report the G8553 code on the Medicare Part B claim on any Medicare service or visit you rendered for your patient.
• You do not have prescribing privileges and you reported the G-code, G8644, at least one time on a Medicare Part B claim prior to June 30, 2012.”

What a mess! Government and lawyers can never do anything simple.  As a result the physician has to be constantly on guard against inadvertent failure to comply with these laws to avoid financial penalties. None of the laws improve health care; they are just figments of imagination in the minds of those individuals who considers themselves experts, but have no practical concept.

When I started I noted that I was concerned with the quality of health care that we are going to see. I have not said anything about the hospitals, the availability of procedures and restrictions on what may be important tests. More about this later.

If we are not throes of Sandy there will be a continuation tomorrow.

Friday, October 26, 2012

HEALTH CARE TODAY-TOMORROW



As Frankenstorm approaches I am planning to post several comments 0n the "Health Care" issue which will impact all of us. I am beginning with the present Affordable Health Care Act's potential impact. This may take more than one post; if so the next will be tomorrow. I will follow Monday with what I understand the Republican plan(s) represents; conditions and other news permitting.

 One issue in this year’s campaigns that has not received as much attention as it probably should has been the health care issue. There has been sharp division between Republicans and the Democrats but little actual explanation of the pros and cons in each party’s plan; the already in place and to be completely implemented by 2014 “Obama care” and Romney’s “I will repeal Obama care” plan.

There are several prime principles in economics that both sides seem to ignore. Every project  has its own specific economic value and the bottom line cannot be breached without compromising the product. Price controls must not destroy the integrity of the product. There is a question if either group takes these principles into consideration.

Obama care is going to control costs by cutting payments to individuals and institutions that are responsible for delivering such care. At the same time the bureaucracy which is being responsible has instituted more and more restrictive edicts that actually add to the cost of delivering health care without making it better or more readily available. On the contrary; it actually endangers and even can lead to quote is in this delivery of needed care.

There is no proof that the electronic records mandated for physicians to implement or suffer fines by decreases in their Medicare payments if not instituted has a positive impact on a patient’s care. The myth that an electronic record is readily available to all physicians treating a patient and does it contain all the information necessary is just that; a myth.

There are at least 10 popular proprietary programs on the market some more adaptable for a small practice and others to a large clinic type group. Very few have the capability of “talking” to the other systems. Moreover there is an initial installation course which they range from approximately $20,000 to several hundred thousand dollars depending upon the size of the installation. Additionally, all of these systems have an annual upkeep fee. The required items on the records take time to enter and many have really no value in the care of the patient. Some items like ethnic or religious affiliation are only for  statistical control purposes and have no impact on the patient’s care.

 In the hospital or nursing home venue there are many mandatory edicts and reports that must be adhered to and have no value and quality of care.

That said; without artificial restrictions on the type of procedures or tests the methodology of restricting the operating costs in the Medicare program has not been reflected in the “cost” to the patient. As in every insurance program the premium is risk dependent and therefore as one grows older there is an annual increase in the premium which of course impacts more of the elderly when their resources are diminishing.

The same principle applies to those with preexisting or chronic medical problems. If these individuals  are to be insured individually or as a group their premium would be untenably high. If they are to be included in a pool with the “normal” population; the overall cost would have to be higher to cover the carrier’s risk. In the latter case everyone is paying for those at risk.

The effort to increase the availability of health care to everyone through Medicaid and mandatory insurance pools is meritorious. However, Medicaid payments are so minimal (below 50% 0f the “usual and customary fee) l that they cannot manage to cover basic operating expenses much less a profit for the provider. The focus on limiting the collective costs operating the Medicare program has been ill focused since there have been very little actual attempts to limit fraud or an overblown bureaucracy.

And there may still be 15 million left uninsured.

The insurance pools may work and are to be encouraged. Here to there will have to be some legislative restrictions on premiums and a clear outlining of the benefits to be provided.

In both Obama care and in the Romney plans which I will discuss subsequently; the prime principle premiums based on actuarial tables which include risk and age work against the intent of the program. One change to make any of these plans workable especially to those who are elderly or who have a medical and physical condition which increases usage medical resources is to lump everything into one actuarial table can be done and therefore derive a premium which although higher for those who have statistically less use of health care but will make it affordable to those who needed the most.

Premium costs can also be better control by legislating the amount of the premium that can go to administrative costs including salaries as well as promotional [advertising] expenses. This will be the  keystone to make either plan work.

Wednesday, October 24, 2012

THE ELECTORAL COLLEGE VOTE.

A correction of false information about the Electoral College . I stated that Iowa had split its vote in 2008 allocating one elector to the Republicans. The concept was right ; the state  was wrong.; it was Nebraska.

Maine and Nebraska are the only two states that do not  commit their entire electoral college votes to  the state's popular majority. These states allocate two Electoral Votes to the popular vote winner, and then one each to the popular vote winner in each Congressional district (2 in Maine, 3 in Nebraska) in their state. This creates multiple popular vote contests in these states, which could lead to a split Electoral Vote.

It would be more democratic and reflective of how the country felt if every state  acting  as the two non-conformists do in allocating their Electoral College vote.  


A QUIET EVENING

With a peaceful quiet evening. Most of the turmoil from the debate has quieted down leaving the field to the spin makers. No baseball game tonight in a football game to colleges I have no interest. Basketball that is professional basketball College college basketball season will not start for another two weeks. The National Hockey League should have been about the third week of this season is dark and quiet to a block.

I am not an avid TV fan so that does not interest me. There was no news locally that I am aware of.

The problem of being out of limbo was solved by spending an evening reading one of the fiction books I have on hand.

Just a brief commentary about the national presidential race; the latest polls show both candidates to be in a virtual dead heat. The race will depend upon seven states and the candidates will be devoting all their efforts in these states.

Colorado, Virginia, and New Hampshire are the key states which can go either way. The other four states that that have a possibility of going to either candidate are Ohio, Wisconsin, Iowa, and Nevada. These seven states are the ones that are going to elect the next president.

Tuesday, October 23, 2012

ONE MAN'S IMPRESSION



How about that? The third debate has that it says positive and gone; and if there was a winner on this one it was Obama who scored on his “we also have fewer horses and bayonets in the military” retort to Romney’s claim that we have fewer vessels in the Navy..

Statistically Romney failed to point out the age of our Air Force during his argument about why military spending must be increased. According to the Seattle Times: “The current US Air Force fleet, whose planes are more than 23 years old on average, is the oldest in USAF history. It won’t keep that title for very long. Many transport aircraft and aerial refueling tankers are more than 40 years old – and under current plans, some may be as many as 70-80 years old before they retire. Since the price for next-generation planes has risen faster than inflation, average aircraft age will climb even if the US military gets every plane it asks for in its future plans. Nor is the USA the only country facing this problem.

I believe that contracts are on the table  or have been  requested for new refueling aircraft from both Boeing and Air Bus. 

Technically and operationally both our fighter and bomber aircraft are out of date and would present a severe tactical problem in the event of a conflict with a nation who has started to build up a modern Air Force.

On the relationship with Israel; Obama’s position remains clouded although he declared that Israel was our prime friend in the Middle East and we will stand with them. The rest of the debate about the Middle East was probably a non sequitur.

In essence this debate frequently swung back to an argument about the economy and this last four years. Obama still insist on linking Romney with the Bush/Cheney administration. That is as positive an argument as possibly linking Obama was Carter.

In summary Monday night did little to define who would be the best president. Considering that the job makes the man” I am confident that either candidate they at present we can be proud. Obama has already demonstrated that he is a credit to the job, although I feel record much to be desired area of economic recovery.

Romney I am sure is a good organizer and will have competent assistance the mark of a successful leader. He will be no detriment when it comes to foreign affairs. In his domestic policies I am sure that there will not be the radical financial programs that his opponents warn us about. Much of his health care Reformation I find positive. His greatest negative is his ties to the ultraconservative and religious right of the Republican Party. That affiliation is a threat to personal liberties.

I wish I could tell you which candidate I favor; at this point I am still ambivalent. Perhaps it will come down to a flip of the coin on Election Day. I will vote; it may matter.