The High Cost of Free Care

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new-logo25By Marilyn M. Singleton, MD, JD.,


When I signed in for my yearly mammogram the receptionist announced with a wry smile, “No co-pay this time, it’s free!” We both knew that it really wasn’t free.

To understand whether free means free, let’s look at Medicare as an example. Medicare has four parts. Part A (“hospital”) covers hospital admissions, post-hospitalization short-term skilled nursing, and hospice. Part B (“medical”) covers outpatient medical services such as physician ObamacareHurtvisits, lab tests, and outpatient surgery. Parts A and B are called traditional Medicare. Part C (“Medicare Advantage”) is private HMOs. Part D is prescription drug coverage. Technically, all parts are optional.

Medicare is costly before and after we enroll. We pay for Part A through a 2.9 percent tax on earnings, half of which is paid by employers. Thus, an average worker earning $43,500 per year generates $105 every month for the promise of hospital insurance benefits beginning up to 45 years in the future.

Importantly, Part A is mandatory for those eligible for Medicare who receive Social Security payments. If beneficiaries want to opt out of Part A, they must forfeit all of their Social Security payments. More

Obamacare: Sold to the Highest Bidder

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new-logo25By  Dr. Marilyn Singleton,


The Affordable Care Act is like the television show Storage Wars, where unclaimed items in storage lockers are auctioned off after a quick peek through the door. People bid top dollar and hope for the best. Some find a goldmine, but the unseasoned bidders usually receive a Pandora’s Box.

Let’s look at some of the winners. The Center for Public Policy, a non-partisan public interest think tank in Washington D.C., estimated that $120 million was spent lobbying for health reform. Pharmaceutical Researchers and Manufacturers of America (PhRMA) alone spent $26 million lobbying for Obamacare in 2009. And PhRMA has spent well over $100 million on ad campaigns promoting healthcare reform legislation.

Upon passage of the bill, the stocks of some of the largest health insurers, including Cigna, UnitedHealth Group,WellPoint,and Aetna climbed. Major makers of electronic health records (EHR) systems lobbied hard, locking out smaller competitors. Chicago-based Allscripts Healthcare Solutions former CEO Glen Tullman, who had served as health technology adviser to Obama’s presidential campaign in 2008, made more than $200,000 in contributions to the campaign, and was frequent guest at the White House during 2009. With some nudging from the Stimulus mandate for EHRs, annual sales of Allscripts more than doubled from $548 million in 2009 to $1.44 billion in 2012. Cerner, another software purveyor, spent $400,000 lobbying for EHR. During the same three-year period, sales rose 60 percent.

Of course, AARP’s CEO, Barry Rand, wrote that the ACA was “vital” for the nation’s seniors. This makes no sense when the ACA in fact cut a half a trillion dollars from the popular Medicare Advantage program. It seems the ACA’s passage was vital to AARP’s insurance Medi-gap insurance products – which people with Medicare Advantage do not need. More

Obama Appoints Rationing Advocate to Medicare Post

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UPDATE to today’s “CCHC Health Care News”:

President Obama has just announced his recess appointment of the controversial Dr. Donald Berwick, MD as Administrator of the Centers for Medicare and Medicaid Services. Members of Congress, concerned about Berwick’s support of socialized medicine and health care rationing, had delayed his confirmation since April.

Dr. Berwick, CEO and President of the Institute for Healthcare Improvement, has waxed “romantic” about England’s socialized medicine system, supported rationing, and expressed support for England’s rationing-focused, euphemistically-named National Institute for Clinical Excellence (NICE) which issues government treatment protocols for British citizens. Dr. Berwick will hold significant influence over Medicare treatment options and funding during his tenure as administrator. Some call him “Dr. Death,” but the AARP supports him. More

Private Medical Records Can Be Identified and Used Against Patients and Doctors.

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PART 2  from CCHC….Minnesota  mailto:twila@cchconline.org

Private Medical Records Can Be Identified and Used Against Patients and Doctors.

The following is from the Senate version of SF 3099.

RE-IDENTIFICATION – Note that language about de-identification references the so-called federal HIPAA “privacy” rule (§164.514 – line 48.16). This allows the provider of the data to assign an identification “code” that allows the data to be re-identified, meaning that the data is NOT anonymous.

MEASURING DOCTORS – On lines 49.5 and 49.12, it is clear that the data will be used to “grade” doctors and clinics, reporting and measuring doctors by how many services they provide and how expensive they are.

RATIONING CARE – Physician payments will be attached to these report cards, potentially leading to limited services for patients in the near future.


48.1    Subdivision 1. Development. (a) By January 15, 2009, the Health Care
48.2Transformation Commission shall report to the legislature recommendations for advancing
48.3an innovative payment system for the chronic conditions of coronary artery and heart
48.4disease, diabetes, asthma, chronic obstructive pulmonary disease, and depression.
48.5    (b) By January 15, 2010, the Health Care Transformation Commission shall report to
48.6the legislature additional changes necessary to accomplish comprehensive payment reform
48.7designed to support an innovative payment system to reduce costs and improve quality.
48.8    (c) By January 1, 2011, the Health Care Transformation Commission shall develop
48.9rules to implement a comprehensive payment system that encourages provider innovation
48.10to reduce costs and improve quality.
48.11    Subd. 2. Encounter data. (a) Beginning September 1, 2009, and every three months
48.12thereafter, all health plan companies and third-party administrators shall submit encounter
48.13data to the Health Care Transformation Commission. The data shall be submitted in a
48.14form and manner specified by the commission subject to the following requirements:
48.15    (1) the data must be de-identified data as described under the Code of Federal
48.16Regulations, title 45, section 164.514;
48.17    (2) the data for each encounter must include an identifier for the patient’s health care
48.18home if the patient has selected a health care home; and
48.19    (3) except for the identifier described in clause (2), the data must not include
48.20information that is not included in a health care claim or equivalent encounter information
48.21transaction that is required under section 62J.536.
48.22    (b) The commission shall only use the data submitted under paragraph (a) for the
48.23purpose of carrying out its responsibilities in designing and implementing a payment
48.24restructuring system. If the commission contracts with other organizations or entities to
48.25carry out any of its duties or responsibilities described in this chapter, the contract must
48.26require that the organization or entity maintain the data that it receives according to the
48.27provisions of this section.
48.28    (c) Data on providers collected under this subdivision are private data on individuals
48.29or nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary
48.30data in section 13.02, subdivision 19, summary data prepared under this section may be
48.31derived from nonpublic data. The commission shall establish procedures and safeguards
48.32to protect the integrity and confidentiality of any data that it maintains.
48.33    (d) The commission shall not publish analyses or reports that identify, or could
48.34potentially identify, individual patients.
48.35    (e) The commission may publish analyses and reports that identify specific providers
48.36but only after the provider has been provided the opportunity by the commission to review
49.1the data and submit comments. The provider shall have 21 days to review and comment,
49.2after which time the commission may release the data along with any comments submitted
49.3by the provider.
49.4    Subd. 3. Utilization and health care costs. (a) The commission shall develop a
49.5method of calculating the relative utilization and health care costs of providers. The
49.6method must exclude the costs of catastrophic cases and must include risk adjustments
49.7to reflect differences in the demographics, health, and special needs of the providers’
49.8patient population. The risk adjustment must be developed in accordance with generally
49.9accepted risk adjustment methodologies.
49.10    (b) Beginning April 1, 2010, the commission shall disseminate information to
49.11providers on their utilization and cost in comparison to an appropriate peer group.
49.12    (c) The commission shall develop a system to index providers based on their
49.13total risk-adjusted resource use and quality of care, and separately for the conditions
49.14of coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary
49.15disease, and depression. In developing this system, the commission shall consult and
49.16coordinate with health care providers, health plan companies, and organizations that work
49.17to improve health care quality in Minnesota.

The “Super Broker” Bargaining Chip??..CCHC Insurance Exchange Update

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PART 1   CCHC Minnesota  mailto:twila@cchconline.org

Bargaining for Power in Health Care “Reform” Bill

While it is of little use to spend all one’s time at the long
 and long-winded conference committee meetings, it is
good to gather intel every once and awhile as we move to
what will hopefully be a veto of SF 3099 by the Governor.


Health Plan and other lobbyists today told CCHC that the Super Broker is still in the bill, along with myriad other bad stuff, like the bureaucratic, all-controlling Health Care Transformation Commission and payment reform, which is essentially the imposition of price controls. We understand that Sen. Berglin wants the Super Broker for the purpose of transferring subsidy program funds from the State to the health plans.

However, it’s clear that nobody else wants the Super Broker. One lobbyist told me, in so many words (paraphrased): “Nobody wants it. The Chamber of Commerce doesn’t want it, the Governor’s office says they no longer need it, the insurance agents don’t want it. Why is it in the bill still?”

At which point, CCHC suggested that it’s being used merely as a bargaining chip by the Senate author, Sen. Linda Berglin, with the Governor. The lobbyist concurred…perhaps the Senator is using it to get the financial/budget issues to slide in her direction. That’s one good reason the Governor shouldn’t put anything in the bill he might not want to become law.

On the other hand, one seasoned lobbyist said that a policy bill (SF 3099) is unlikely to be signed into law. That would be good news, but there’s no guarantee, so remind your legislators and the Governor what you think of the “Super Broker” proposal. The cast and crew of two off-season committees (the Governor’s Health Care Transformation Task Force and the Legislative Health Care Access Committee) meant it when they proposed these ideas. They want them to become law. Governor Pawlenty is all that stands in the way of the Super Broker and socialized medicine.


Will Your Private Medical Records be “Dumped” into the Hands of Government?

In 2002, the public became outraged when CCHC exposed the Minnesota Department of Health proposed rules to require every health plan and every hospital to ship all the private details of your private medical records to the government. It made front page news, and the rule was dropped several months later after well-publicized legislative hearings. That said, the 1995 LAW allowing Health Department access to all your medical records still exists, a point we’re never going to let be forgotten.

Now, the health care reform bill, SF 3099, proposes to require all health plans to ship your private medical records (right down to all the details of each encounter between patient and doctor) to the Health Care Transformation Commission, a $12 million “super agency”of political appointees, for data mining, analysis, and anything else they choose to use it for…now and in the future.

Proponents of rationing and price controls could use your data to propose certain types of people not receive care, or to propose legislative and other policies that target individuals for intervention strategies, including in the future, genetic manipulation. Don’t forget to sign our petition against Minnesota’s DNA warehouse, genetic registries and unconsented genetic research. (Please do not sign it twice. Thank you.)

Let legislators and the Governor know what you think about SF 3099’s “Data Dump” (the sharing of your private medical”encounter data” with a group of political appointees).


Who to Call – Bill Busters!
1) Contact the Senators and Representatives that represent you.

2) Contact Governor Tim Pawlenty: 651-296-3391; 1-800-657-3717; tim.pawlenty@state.mn.us

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