I'm hoping, for your sake, that you didn't spend your Saturday night as I did: watching the House debate health-care reform on C-SPAN.
Pathetic, I know. The outcome wasn't in doubt, and the arguments were as familiar as an old pair of slippers. Moral imperative! Government takeover! Long-overdue protections! Crippling mandates!

I'm not a huge fan of the House measure, but I was glad to see it straggle across the finish line, if only to keep the process going. And, by the end of the long debate, I was cheering for it even more because of the appalling amount of misinformation being peddled by its opponents.

I don't mean the usual hyperbole about "a children-bankrupting, health-care-rationing, freedom-crushing, $1 trillion government takeover of our health-care system," as Texas Republican Jeb Hensarling put it. Or the tired canards about taxpayer-funded abortion or insurance subsidies for illegal immigrants.

Or the extraneous claims about alleged Democratic excesses, as in this from Georgia Republican Jack Kingston: "Let's remember the Pelosi plan for jobs: an $800 billion stimulus plan that caused unemployment to go from 8.5 percent to over 10 percent."

Caused? We can debate whether the stimulus was effective, although the best evidence is that it prevented things from being even worse. No rational person believes the stimulus "caused" unemployment to rise.

I mean the flood of sheer factual misstatements about the health-care bill.

The falsehood-peddling began at the top, with Minority Leader John Boehner:

"If you're a Medicare Advantage enrollee . . . the Congressional Budget Office says that 80 percent of them are going to lose their Medicare Advantage."

Not true. The CBO hasn't said anything of the sort. Boehner's office acknowledges that he misspoke: He meant to cite a study from the Medicare actuary estimating that projected enrollment would be down by 64 percent -- if the cuts took effect. Choosing not to enroll in Medicare Advantage is different from "losing" it.

But Boehner wasn't alone.

Kentucky Republican Brett Guthrie: "The bill raises taxes for just about everyone."

Not true. The bill imposes a surtax on the top 0.3 percent of households, individuals making more than $500,000 a year and couples making more than $1 million.

Georgia Republican Tom Price: "This bill, on Page 733, empowers the Washington bureaucracy to deny lifesaving patient care if it costs too much."

Not true. The bill sets up a Center for Comparative Effectiveness Research "in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically."

Are Republicans against figuring out what works? There's nothing in there about cost, and certainly nothing about denying "lifesaving patient care."

Price, again: "This bill, on Page 94, will make it illegal for any American to obtain health care not approved by Washington."

Not true. The vast majority of Americans get their insurance through their employers. The bill envisions setting minimum federal standards for such insurance, in part to determine who is eligible to buy coverage through the newly created insurance exchanges. This is hardly tantamount to making it "illegal" to obtain "health care" without Washington's approval.

Michigan Republican Dave Camp: "Americans could face five years in jail if they don't comply with the bill's demands to buy approved health insurance."

Not true. The bill requires people to obtain insurance or, with some hardship exceptions, pay a fine. No one is being jailed for being uninsured. People who intentionally evade paying the fine could, in theory, be prosecuted -- just like others who cheat on their taxes.

California Republican Buck McKeon: "I offered two amendments to try to improve this bill -- one to require members of Congress to enroll in the public option like we're going to require all of you to do."

Not true. No one is required to enroll in the public option. In fact, most people won't even be eligible to enroll in the public option or other plans available through the exchanges.

Florida Republican Ginny Brown-Waite: "The president's own economic advisers have said that this bill will kill 5.5 million jobs."

Not true. Christina Romer, chair of the Council of Economic Advisers, has estimated that the bill would increase economic growth and add jobs. Republicans misuse Romer's previous economic research on the impact of tax increases to produce the phony 5.5 million number.

You have to wonder: Are the Republican arguments against the bill so weak that they have to resort to these misrepresentations and distortions?

marcusr@washpost.com

From the Washington Post:

I am talking about the absolute total BS that the repubs are spreading to induce fear and panic in the citizenry with the hope that it will result in the GOP taking back control in the next election.

I think everyone should read this healthcare bill cover to cover before making any decisions. Did you know you go to jail if you decide not to buy healthcare ins.?

Not true. The bill requires people to obtain insurance or, with some hardship exceptions, pay a fine. No one is being jailed for being uninsured. People who intentionally evade paying the fine could, in theory, be prosecuted -- just like others who cheat on their taxes.

Bullshit, how many people have gone to jail for not complying with the Mass. State Law which is the prototype for the current Healthcare Reform? Answer: 0. I quote again from The Washington Post, and had you bothered to read the article, you would have read the following:

Obama & Pelosi both said there would be consequences for non compliance.

I think everyone should read this healthcare bill cover to cover before making any decisions. Did you know you go to jail if you decide not to buy healthcare ins.?

Rochelle - I'm really glad you have your passport ready. I hope you get to use it REAL soon.

B.D.
No worries. Tiger's Mom is on board.
She has researched the issue and has re-assured everyone
that we are over reacting.
She cited the Massachusetts plan as a guideline
for things to come..

B.D.
No worries. Tiger's Mom is on board.
She has researched the issue and has re-assured everyone
that we are over reacting.
She cited the Massachusetts plan as a guideline
for things to come..

Doctor Shortage to Spur Delays, Crowded ERs in Health Overhaul

By Pat Wechsler

Nov. 13 (Bloomberg) -- President Barack Obama’s health overhaul, aiming to add 36 million Americans to the insurance rolls, will worsen a family-doctor shortage, triggering longer waits for office visits and crowded emergency rooms.

“This is already a catastrophic crisis,” said Joseph Stubbs, president of the Philadelphia-based American College of Physicians, the second-largest doctor’s group in the U.S. “Now we’re talking 30 million more people who will want to see a doctor. The supply of doctors just won’t be there for them.”

Underserved areas in the U.S. currently need 16,679 more primary-care physicians to reach a “medically appropriate” target of 1 for every 2,000 residents, U.S. data shows. The health-care overhaul bills before Congress would raise pay for family doctors, increase residency training and forgive school debt to help meet that deficit. Those measures, though, will take years to make a difference, said Stubbs, who also works as an internist in Albany, Georgia.

More family doctors are needed to cut health costs through early diagnosis and prevention, and increase access to medical care, Obama said in a June 15 speech to the American Medical Association meeting in Chicago. The Massachusetts health-care initiative shows what can go wrong if the primary-care system isn’t fixed simultaneously with the start of universal coverage, said Allan Goroll, a professor of medicine at Harvard Medical School in Boston.

Massachusetts passed a law in 2006 that has increased the percentage of insured to 97.4 percent of its population, the highest in the U.S., from 93.6 percent.

Waiting Times Rise

The average waiting time to see a family-medicine doctor in Boston, a city with 14 teaching hospitals, is 63 days, the most among 15 cities in a 2009 survey by Merritt Hawkins & Associates, a recruiting and research firm in Irving, Texas. People in Los Angeles waited 59 days, while those in Miami saw doctors in 7 days, the survey found.

Boston’s longer wait was “driven in part by the health- care reform initiative,” the report said.

Even before the initiative, there was a shortage of primary care doctors in Massachusetts, said Harvard’s Goroll, who is also an internist at Massachusetts General Hospital in Boston. As many as half of doctors in the state have closed their practices to new patients, forcing many of the newly insured to turn to emergency rooms for care, he said.

“The primary lesson of health-care reform in Massachusetts is that you can’t increase the number of insured unless you have a strong primary-care base in place to receive them,” Goroll said. “Without that foundation of primary care, Massachusetts has ended up with higher costs and people going to emergency rooms when they can’t find a doctor.”

Spending to Double

Per-capita health spending is projected to double in Massachusetts by 2020, according to a June report by the state. Insurance premiums rose 10 percent this year, Massachusetts Health and Human Services Secretary JudyAnn Bigby wrote in an Oct. 21 New England Journal of Medicine article.

There were 303,749 primary-care doctors in the U.S. at the end of 2007, according to data in a 2009 American Medical Association report. That number rose 11 percent from 2000 to 2007, falling behind a 13 percent jump among other doctors, the Chicago-based group said.

The shortage in primary care isn’t uniform across the nation, according to U.S. Health Resources and Services Administration data from all 50 states, which shows 6,215 designated shortage areas. In general, suburban and wealthier urban areas tend to be well stocked with family doctors, and rural areas and inner cities are short.

Underserved Communities

The federal government designates regions as being underserved based on per capita numbers. To be designated, a region needs to have less than one family doctor per 3,500 residents. Using just this ratio, the communities have 7,413 fewer primary-care doctors than they need, the HRSA said.

An adequate level -- established by public health clinicians and staff as affording “appropriate” access to health care -- is 1 for every 2,000 residents, according to the HRSA, which gathers the data. That brings the deficit to 16,679.

In most industrialized nations, including Germany and the U.K., there is one primary-care physician for every specialist, according to the Organization of Economic Cooperation and Development in Paris. The U.S. ratio is closer to one to three, according to the AMA.

The U.S. will need another 35,000 to 46,000 primary-care doctors within 15 years as the population ages, the American College of Physicians said in a 2009 report.

Living Longer

“We are living longer and living more often with chronic disease,” said Cathy Schoen of the health-care research group the Commonwealth Fund in New York. “Someone needs to be in the center of care and know the whole patient if care is to be coordinated and efficient.”

Becoming a family doctor -- once the icon of U.S. medical care, from Norman Rockwell paintings to TV’s Marcus Welby -- has lost its luster over the past decade, primarily because these physicians earn, at most, half of what specialists make, Harvard’s Goroll said.

In the late 1990s, Medicare and Medicaid changed the reimbursement system to compensate medical procedures at a higher rate than management and evaluation of patients, something family doctors focus on in their practices.

The emphasis on procedures and technology led many prospective doctors to choose careers in higher-paying radiology, orthopedic surgery, anesthesiology and dermatology, according to Goroll.

Average Salary

The average salary for family physicians grew 18 percent over five years, or about 3.6 percent annually, according to data from Merritt Hawkins, the recruiting firm. That compares with a 46 percent increase, or 9.3 percent a year, for orthopedic surgeons.

Family practice pays an average of $173,000 a year, a 2009 survey by Merritt Hawkins shows. This compares with $391,000 for a radiologist, $481,000 for an orthopedic surgeon, $344,000 for an anesthesiologist and $297,000 for a dermatologist.

Given that the typical medical student debt is about $140,000, the income disparities prove to be “strong disincentives for younger physicians,” according to a 2009 report from the American College of Physicians.

In a 2008 survey of third-year medical residents, 21 percent said they planned to pursue careers in general internal medicine, the equivalent of primary care, according to the American College of Physicians. That’s down from 54 percent in 1998. The rest were headed to subspecialties, such as oncology, gastroenterology and infectious disease.

Medical-School Changes

Medical schools at Duke University in Durham, North Carolina, and Johns Hopkins University in Baltimore are attempting to change the trend by creating primary-care residency programs that let students work with families outside the hospital setting.

At Duke, a family medicine leadership residency was started three years ago to let students practice “21st-century primary care,” working in outpatient clinics and in communities, said Lloyd Michener, who is the chair of the department of community and family medicine at the medical school.

“It brings in an element of public health since residents are assessing both the needs of the patients and the community they are working in,” said Barbara Sheline, the school’s assistant dean for primary care.

A four-year urban health residency that begins in July 2010 at Hopkins combines medicine and pediatric training at community clinics and in schools.

Students in the Community

Duke also has approved a new primary-care curriculum for its medical students, allowing up to nine to choose work in community clinics during their four years.

The university will offer the program to three or four students this year on a pilot basis, then accept applications for the slots in the 2010-2011 academic year. The program will offer scholarships to give students the option of choosing a career in primary care without worrying about a large educational debt, Sheline said.

“For most of us, primary care is a calling,” Michener said. “But I see medical students turn down the idea of primary care for very thoughtful reasons about wanting a family themselves and not wanting to work all the time.”

Hopkins’ medical school also converted to a curriculum this year emphasizing “individualized medicine, based on genetic makeup and history, environmental influences and lifestyle,” said Charles Wiener, director of Hopkins’ residency programs and vice chairman of the department of medicine.

‘Knowing the Individual’

“Primary care knows the individual best,” Wiener said. “I’m hopeful this will spark more interest among students.”

Health-care overhaul legislation in the U.S. House and Senate offers medical school debt forgiveness for those who choose primary care. The bills also call for a redistribution of unused residency spots to primary care and general surgery.

They also attempt to redress the pay inequity between primary care and specialty medicine by giving family doctors a payment bonus of between 5 and 10 percent annually for at least the next five years. This is on top of a restructuring of Medicare payments beginning in 2010 by the Centers for Medicare & Medicaid Services.

The agency is taking money away from specialists such as cardiologists and radiologists to fund a 6 percent to 8 percent increase in reimbursement for office visits to family physicians phased in over four years. The House version would also provide federal funds to increase Medicaid primary-care payments.

Medicaid Expansion

By allowing those living at 150 percent of the federal poverty level to qualify, the overhaul would expand the ranks of Medicaid by more than 10 million people in 2015.

These are populations that typically don’t have family doctors and frequently have been living with untreated chronic illness, said Lori Heim, president of the Leawood, Kansas-based American Academy of Family Physicians, representing 94,000 doctors and medical students.

Heim, who is also a family doctor at Scotland Memorial Hospital in Laurinburg, North Carolina, said she cared for a man in his 40s with untreated high blood pressure. Although the patient had a full-time job, he had no health insurance and no primary care doctor. He was already suffering from permanent liver and heart damage, and had to be admitted to the intensive care unit, she said.

“Instead of a family doctor putting him on generic blood pressure pills years ago that would have cost less than $100 a year, I had to put him in the ICU, which alone will run several thousand dollars,” Heim said. “Down the road, he may need dialysis. This is a working example of why costs keep going up and what happens when there aren’t enough family physicians.”

To contact the reporters on this story: Pat Wechsler at pwechsler@bloomberg.net.
Last Updated: November 13, 2009 00:00 EST

If T.M. has read that whole bill she is the only one in the world who has.I think she gets most of her talking points directly from the Democratic Party LOL.

And what passes for YOUR opinion has been dictated by Glenn Beck, POX News, etc., so I guess we are even.

I forget who did the news special that I watched last week, but they looked at healthcare systems around the world and compared.
The Japenese system was remarkable. No waiting, almost no cost to the patient and no gate-keepers between patient and specialist.Doctors were not getting rich, and were paid a salary that the gov decided. Not poor but not wealthy.
The American system was by far the most uncontrolled and costly. Also the best as far as treatment options, but not accessable to everyone.
When an MRI only cost $90 in one country, and here cost $1200+...
whats wrong with that picture?

The best guess is overbilling by dr's and hospitals because they know that the thieving insurance companies will short-pay most billed charges.And when underpayment becomes the norm, over-charging becomes the normal reaction.

If Insurance companies were cut out of the loop or tightly regulated, THAT alone would solve most of the problems that we have today.

Regulation of insurance companies was what all all other affordable healthcare systems had in common.

Some places there were no insurance companies, rather co-ops or gov secured (taxed) agencies that collected, paid, and regulated the system. Private insurance was still available, but for what? Those people that needed a place to throw money?

Healthcare is one of those things thats a basic right. Not based on social status or income.

The quality here is fine, its the access thats the problem.
Quality did not seem to be an issue in Japan...

I believe in thinking for my self

The Japenese system was remarkable. No waiting, almost no cost to the patient and no gate-keepers between patient and specialist.Doctors were not getting rich, and were paid a salary that the gov decided. Not poor but not wealthy.