WASHINGTON, D.C., Monday, May 23, 2011 — National Federation of Independent Business (NFIB) president and CEO Dan Danner and small business owner Earl Hall joined U.S. Senator Jon Kyl (R-AZ) today to unveil a bill that will address some of the most costly and egregious mandates in the new health care law. The bill, called the Small Business Health Relief Act, will make health care coverage more affordable for small businesses, which, according to NFIB research, is a top priority for small-business owners.

“The policies in the health care law will crush small businesses with new costs and uncertainty. The small-business community would like to thank Senator Kyl for introducing the Small Business Health Relief Act to help fix some of the worst parts of the law,” said NFIB president and CEO Dan Danner. “This bill addresses the top concerns of small businesses, and it will help them get back to creating jobs and investing in their businesses.”

The bill eliminates a new tax on health insurers that will drive up the cost of coverage and will repeal the employer mandate, which not only requires small businesses to buy insurance, but dictates how much they must purchase.  These repeals will lowers costs for small-business owners and provide Americans more choices and freedom in their health care coverage.

“It’s a day-to-day struggle to survive against competition from the big box stores regardless of the economy,” said Earl Hall, owner of Hometown Printing and Office Supply in Bordentown, N.J. “It’s been even more difficult in a weak economy that experts don’t see improving anytime soon. The health care law imposes heavy new costs on my business that we may not be able to absorb.”

U.S. Senators John Barrasso (R-WY), Richard Burr (R-NC) and Tom Coburn (R-OK) co-sponsored the Kyl bill, introduced on Monday.

The businesses that face potential penalties are those with 50 or more full-timers or full-time equivalents (FTEs) as well as owners with multiple businesses totaling 50 or more full-timers or FTEs

The penalties are steep.  For employers that do not provide health insurance coverage, the penalty is $2,000 per year per employee (minus the first 30 employees).  For employers that do provide coverage, if one or more of its employees receive insurance subsidies, then the business will pay $3,000 per subsidized employee or $2,000 per employee (minus the first 30) – whichever is less.

Readers of this site know that we always look at incentive structures.  We know that changing the rules of the game, the rewards and the punishments, will change economic behavior.

NFIB economists predict that the mandate will affect the economy in the following ways.

Businesses will spend real resources determining how many employees they have with respect to the employer mandate. They will face time-consuming, arbitrary administrative burdens associated with employees seeking insurance subsidies in the new insurance exchanges.

The mandate makes it extremely expensive to cross the 50-employee threshold. For example, a mid-sized restaurant that goes from 49 to 50 employees will face a $40,000 per year penalty. A business can avoid the penalties by firing employees, by not hiring new ones, or by outsourcing. Estimating the costs of hiring and expanding will be complex and confusing.

Businesses subject to the employer mandate will receive monthly government reports on subsidized employees that inadvertently reveal personal financial data on employees’ spouses and families. This raises discomforting privacy concerns and exposure to liability for employers.

For some firms, the employer mandate will result in large fines when there are private changes in their employees’ households. For example, an employee’s spouse losing a job or an employee’s spouse’s elderly relative moving into their house could trigger thousands of dollars in annual penalties. Employers will not be entitled to know the details of what caused their penalty – unless they challenge the employee’s honesty before a government agency.

The employer mandate will increase costs, and producers will pass them along to consumers.

Health Care Funding Reform – A Proposal

ObamaCare really does nothing to correct the underlying problems in our health care delivery system.  In fact, the new regulations will make problems worse.  Most of the current problems are actually the result of government intervention in the system we had before the mandate for “managed care.”  It is not really managed care, but managed cost to 3^rd party payer.  The result is higher cost to consumer.

I would like to begin with a hypothetical.  If I sold a card, on an annual contract, for $500 a month that allowed the holder to shop and buy almost anything for a $20 co-pay, it would be heavily used.  Next year, I would have to increase the cost of the card.  That is where our health care system is, today.  It is the Federal Government which caused our current problem when “managed care” was mandated in about 1984.

I propose:

Save money – increase the efficiency of health care utilization:

1. Have people pay for a percentage of whatever health care they consume, up to a predetermined maximum, when insurance will cover expenses at 100%.  Before “managed care”, patients were wise shoppers when purchasing medical tests or treatments.  Not now!

Save money – reduce the number of tests:

2. Tort reform is essential.  It works fairly well in Texas.  Texas caps awards on non-economic damages at $250 thousand.  Perhaps, the loser should also bear legal the expenses of the winner.  The necessity of practicing “defensive medicine” is expensive and inhibits good medical judgment.

Incentivize purchase of health insurance:

3. Give employees a tax credit for what they spend on health insurance premiums.  That way, the employee is revenue neutral and has insurance.  Also, the employee owns the policy and is not dependent on an employer.  Also, if younger healthy people have an incentive to join the risk pool, insurance companies have no great excuse to increase premiums because they are only insuring sick people.  If this were the law, who cares if an illegal alien has insurance.  He paid for it.

Provide portability:

4. Bar employers from buying health insurance, but give employers a tax deduction for whatever they give employees for the employee to purchase health insurance.  The employee needs to own the policy.  Portability is achieved.

Make health insurance premiums competitive:

5. Require health insurance carriers to publish an audited report as to what percent of the premium dollars are actually spent on health care.  Clinical audits are not health care.  Help purchasers see what they get for their money.  I am aware of one HSA policy that only spent 9% of the premium income on health care and still demanded a double digit increase in the premium payment the following year.

Make health insurance premiums competitive:

6. Allow sale of health insurance across state lines.  That will increase the risk pool for insurance companies, and make it more profitable to lower their premium rates.  In return, they must be required to pay a “clean claim” within 30 days, and not hold on to the payment for several months.  Penalties for not paying claims in a timely fashion should be significant.  In Texas, the insurance company which delays claim payment loses part or its entire “negotiated” discount from billed rate.  Physicians should not be forced to provide interest free loans to multi-million dollar companies.  Prompt pay works in Texas where a “clean claim” is defined by law.  Also, deny insurance companies the ability to wait more than 180 days to demand repayment of what they perceive to be an over payment or in appropriate payment.  There is no way for a physician to recover a loss and the insurance companies can surely discover their own mistakes before that time expires.

Assure availability of health insurance coverage:

7. Prohibit denial of coverage on pre-existing conditions and cancellation of a policy for illness.  The larger risk pool will help decrease the risk of coverage.

Provide for the few who still cannot afford health insurance premiums:

8. Provide Federal subsidy for free or part pay clinics for the indigent, and those who still do not have health insurance.  If someone makes enough money to buy insurance and does not, he/she pays more than someone who still cannot afford the premiums. Provide tax deductions or credits for hospitals, imaging centers and laboratories which donate facilities to provide care for the indigent.  We had a system similar to this before “managed care”.  Most hospitals were operated by local government, under terms of a bequest with charitable contributions, or faith based organizations.  Give the same inducements to pharmaceutical companies to provide medications.  They already provide samples of newer medications and have programs for those who cannot afford to pay for prescriptions

Provide for those who still cannot afford health insurance premiums:

9. Give physicians who volunteer time to work in the clinics described in item 8 a tax deduction or tax credit for their services.  The amount of the tax break should be the average billed rate for the service in the area being served.

Protect physician-patient relationship:

10. Remove third party intrusion into the physician-patient relationship.  Today, when people call to potentially schedule a new patient appointment, they do not ask about training or experience of the physician.  They do not ask about cost or fees.  They ask, “Is the doctor on my plan?”  If they do not have to pay more than a small co-pay, all that matters is the insurance coverage and not value of service rendered.  To repeat, patients need to be wise shoppers for health care, like everything else they buy.

Give volume buying power to reduce premium rates for individuals:

11. Allow membership stores like Costco and Sam’s Club to become outlets for health insurers.  Insurers should bid for the right to market to club members.  The result is expected to be rates for individuals in line with what large corporations currently pay for their employees, and attract more members to the stores.

In closing and summary, instead of using a stick to try to beat the American public into submission, use a carrot as an inducement.  Taken as a total package, the above recommendations seem to address the problems existing in our current health care funding.  Don’t cripple health care delivery to attempt to accomplish that goal.

The Republican party has no alternative.  For those of you who missed the original post, or have forgotten it, I have repeated it.  If you agree with the proposals, PLEASE contact your Representative and Senators.  Urge them to bring it before the Congress for debate and possible approval.

Dr.  Barry Jacobs is a Reproductive Endocrinologist, practicing in Carrollton, Texas, a northern suburb of Dallas. He completed his residency training in obstetrics and gynecology at Baylor College of Medicine in Houston, and remained at that institution to become its first fellow once Baylor achieved accreditation for an advanced training program in Reproductive Endocrinology and Infertility. Dr. Jacobs has served on the faculty of several medical schools and was director of Reproductive Endocrinology at Texas Tech Health Science Center in Amarillo. Currently, in addition to his clinical activities caring for infertile patients and those with recurrent pregnancy loss, he is Chairman of the IVF committee at Baylor Medical Center in Carrollton.

Also contains information on Cap and Tax and Labor Law changes being pursued.

This Administration is BAD NEWS for Small Business.  Get informed by reading the report.  And then please share it with at least 5 other Small Businesses you know.   If we work together, we can push a lot of this stuff way back.  But we have to be willing to share, to talk, to raise our voices and speak out and educate.

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Justice Department declares war on doctors

In a landmark Idaho case, the Justice Department forced a group of doctors to accept government price controls.
Attorney General Eric Holder testifies before the House Judiciary Committee’s oversight hearing on May 13. In a landmark action against Idaho physicians, the Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal price fixing.
(Haraz N. Ghanbari/AP/File)

posted May 31, 2010 at 8:15 am EDT

As I’ve long suspected, “health care reform” has emboldened the Justice Department to take a more active role in enforcing government price controls against physicians. Today the Antitrust Division, joined by Idaho Attorney General Lawrence Wasden, forced a a group of Boise orthopedists to accept price controls for worker’s compensation and HMO contracts as part of a settlement accusing the doctors of “price fixing”:

According to the complaint, the conspiring orthopedists engaged in two antitrust conspiracies, which took place from 2006 to 2008. In the first conspiracy, through a series of meetings and other communications, the orthopedists agreed not to treat most patients covered by workers’ compensation insurance.

They entered into a group boycott in order to force the Idaho Industrial Commission to increase the rates at which orthopedists were paid for treating injured workers. The Idaho Industrial Commission sets the fee schedule that determines the amount that orthopedists and other healthcare providers usually receive for treating patients covered by workers’ compensation insurance. The boycott resulted in a shortage of orthopedists willing to treat workers’ compensation patients, causing higher rates for orthopedic services.

In the second conspiracy, all of the defendants, except [one], and other conspiring orthopedists agreed to threaten to terminate their contracts with Blue Cross of Idaho. They jointly threatened to terminate their contracts to force Blue Cross of Idaho to offer better contract terms to orthopedists.

The proposed settlement prevents the Idaho Orthopaedic Society and the named orthopedists from agreeing with their competitors on fees and contract terms. The settlement also prohibits them from collectively denying medical care to patients, refusing to deal with any payer or threatening to terminate contracts with any payer.

This case is a watershed for two reasons:

First, until now the Federal Trade Commission, not the Justice Department, has taken the lead in prosecuting physicians. Since 2000, the FTC has brought about three dozen cases against physicians (all but one of which settled without any trial). But the FTC only has civil and administrative jurisdiction; the Antitrust Division has civil and criminal jurisdiction. The Sherman Act makes no distinction between civil and criminal “price fixing,” so in a case like this, it’s entirely a matter of prosecutorial discretion whether to charge the doctors with a civil or criminal offense.

Based on the descriptions in the Antitrust Division’s press release, there’s certainly no reason they couldn’t have prosecuted the doctors criminally and insisted upon prison sentences — and there’s little doubt such threats were made or implied to obtain the physicians’ agreement to the proposed “settlement.”

The second reason this is a landmark case is that the Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal “price fixing.”

The FTC has hinted at this when it’s said physicians must accept Medicare-based reimbursement schedules from insurance companies. But the DOJ has gone the final step and said, “Government prices are market prices,” in the form of the Idaho Industrial Commission’s fee schedule. The IIC administers the state’s worker compensation system and is composed of three commissioners appointed by the governor. This isn’t a quasi-private or semi-private entity. It’s a purely government operation.

What’s more, the Antitrust Division has linked a refusal to accept government price controls with a refusal to accept a “private” insurance company’s contract offer. This lives little doubt that antitrust regulators consider insurance party contracts the equivalent of government price controls — and physicians and patients have no choice but to accept them.

Despite this, Antitrust Division chief Christine Varney, an Obama political appointee, insists she’s trying to protect “competition”:

The orthopedists who participated in these group boycotts denied medical care to Idaho workers and caused higher prices for orthopedic services. Today’s action seeks to prevent the recurrence of these illegal acts and protects Idaho consumers by promoting competition in the healthcare industry.”

The Idaho attorney general compounds the lie:

The free marketplace works best when there is fair competition. Anticompetitive activity harms the marketplace, businesses and consumers. Enforcement of the antitrust laws restores competition to the marketplace to the benefit of businesses and consumers and the marketplace as a whole.

But what “competition” do they refer to? The IIC fee schedule is set by government fiat. There’s no “competition” among orthopedists — or any other physicians for that matter. Everyone gets paid exactly the same “acceptable charges” based on the schedule. Even in the case of the Blue Cross contract, the physicians weren’t “competing” on price; they were simply told to accept the reimbursement levels proposed by the insurer.

And as much as the government would tout the “conspiracy” among physicians, as I said yesterday, we’re basically talking about people having conversations with one another. The truth is the antitrust regulators don’t need much to establish a Sherman Act “conspiracy.” Even if there’s no evidence of direct communication between physicians, if a large number of physicians in a given market individually reject a government price control scheme or insurance company contract, the Antitrust Division can simply “infer” the existence of a conspiracy.

This is another reason why the DOJ’s presence in a physician case is more disturbing than the normal FTC case. The DOJ has a number of “tools” the FTC does not, including the self-granted power to award amnesties from criminal prosecutions to the first “conspirator” to step forward and provide evidence against one’s competitors.

A doctor that feared prosecution could seek amnesty — and provide the Justice Department a blank check to rummage through his files and private communications. And if that doesn’t work, the DOJ can always seek wiretaps of physicians’ phones and computers, a power awarded the DOJ during a 2006 renewal of the PATRIOT Act. The potential exposure of your physician’s confidential records — including your medical records — is limitless.

And while I usually caution against reading partisan political motives into an antitrust case — and I’d note the Idaho attorney general is a Republican — it’s hard to segregate today’s action from the larger political context of “Obamacare.” Christine Varney is an Obama political appointee, and if the Idaho case is an indication her Division plans to take a more hands-on approach to dealing with local physician groups, this policy will quickly degenerate into political demagoguery. It’s just too easy to label physicians “price fixers” and scapegoat them for the failure of government planning of the healthcare industry.

UPDATE: The DOJ has released the proposed order and other documents. It’s a naked censorship order that restrains the physicians from

(A) encouraging, facilitating, entering into, participating in, or attempting to engage in any actual or potential agreement or understanding with, between, or among competing physicians about:

• any fee, or other payer contract term or condition, with any payer or group of payers, including the acceptability or negotiation of any fee or other payer contract term with any payer or group of payers;
• the manner in which the defendant or any competing physician will negotiate with, contract with, or otherwise deal with any payer or group of payers, including participating in or terminating any payer contract; or
• any refusal to deal or threatened refusal to deal with any payer;

or

(B) communicating with any competing physician or facilitating the exchange of information between or among competing physicians about:

• the actual or possible view, intention, or position of any defendant or his or her medical practice group, or any competing physician concerning the negotiation or acceptability of any proposed or existing payer contract or contract term, including the negotiating or contracting status of the defendant, his or her medical group, or any competing physician with any payer or group of payers, or
• any proposed or existing term of any payer contract that affects:
• the amount of fees or payment, however determined, that the defendant, his or her medical practice group, or any competing physician charges, contracts for, or accepts from or considers charging, contracting for, or accepting from any payer or group of payers for providing physician services;
• the duration, amendment, or termination of any payer contract; or
• the manner of resolving disputes between any parties to any payer contract.

The order also illegally legislates through the courts by requiring the physicians to adhere to the 1996 Department of Justice and Federal Trade Commission Statements of Antitrust Enforcement Policy in Health Care, which is not law but merely the subjective opinions of unelected government antitrust lawyers. The order also requires the physicians to make “all books, ledgers, accounts, records, data, and documents,” available for government inspection at any time in the next ten years.

Since this is an DOJ case, it is subject to final approval by a federal judge in Idaho. There’s a mandatory 60-day public comment period, after which the judge will almost certainly rubber stamp the order as being “in the public interest.” Still, there’s at least an opportunity to express some serious dissent to what’s transpired here.

2ND UPDATE: It turns out the Idaho physicians hired the guy who used to run the Antitrust Division’s litigation department — and developed the government’s anti-physician antitrust rules — to represent them. No wonder they settled without a fight.

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Dr. Jacobs is a Reproductive Endocrinologist, practicing in Carrollton, Texas, a northern suburb of Dallas. He completed his residency training in obstetrics and gynecology at Baylor College of Medicine in Houston, and remained at that institution to become its first fellow once Baylor achieved accreditation for an advanced training program in Reproductive Endocrinology and Infertility. Dr. Jacobs has served on the faculty of several medical schools and was director of Reproductive Endocrinology at Texas Tech Health Science Center in Amarillo. Currently, in addition to his clinical activities caring for infertile patients and those with recurrent pregnancy loss, he is Chairman of the IVF committee at Baylor Medical Center in Carrollton.

1) the person who has the need is able to communicate that need to someone who can provide for that need.
2) the person who has the means to meet the need is able to communicate that fact to those who have the need.
3) the need provider and receiver have the freedom to agree to the terms under which that need will be met.
4) the absence of interference in the above process
5) the absence of interference in the subsequent delivery of all provisions necessary to meet the need

A very good reason to be pro-small-government and anti-bureaucracy is because of the destruction wrought by bureaucrats that so gum up the works in the above process that even though there are needs in the world that could be met, the cost of meeting those needs is so high that need providers don’t get into business.

Nowhere is the risk of bureaucracy so great than is small markets, which are most often filled by small businesses.

Why?  Because the cost of complying with regulation is the same whether an enterprise is large or small.  The regulatory cost of setting up a business (licensing, permits, etc) is the same for a large or small business.

The greater the burden to set up a business, relative to the opportunity of setting up such, the less likely the business will be set up.  Because targeted problems usually have small markets, and because small markets are often best served by small businesses, when regulatory costs are high these businesses don’t get started and these markets don’t get served.

Well, what happens when regulatory and compliance costs massively rise across the board for ALL small businesses?  We’re about to find out.  From Cato:

The health care bill that the Democrats rammed through Congress at the end of March seems to be the gift that keeps on giving.

The latest surprise is Section 9006(b)(1) — come on, I know you’ve read it — which requires that businesses provide a 1099 form to every vendor with whom they do more than $600 worth of business over the course of a year. A 1099 is similar to a W-2 form, but for income other than wages. Businesses will also have to file a copy of the form with the IRS.

Of course businesses already have to file 1099s for outlays on items like consultants.

But the new rule will mean that even the smallest of businesses will have to issue a form — and file with the IRS — for virtually every purchase or payment.

This is a very, very big regulatory expense.  What will happen is that many people who could start small businesses won’t start small businesses.  Other small businesses who are in operation today will add this to the number of burdens laid on them by government, and they’ll shutter.

*Shudder*

Big Government, the Grinch that keeps on Giving.

So, what to do?

Lobby your congressional representatives like mad.  Call and let them know that if they do not repeal this portion of the health bill, the regulatory requirement could put your small business out of business.

1.  ObamaCare means a harder economic climate for Small Businesses

At core ObamaCare is a mandate.  It is a requirement that people purchase health insurance.  This means that more dollars that were available for other purposes in the past, will now be directed to health care in the future.  Unless your small business serves the healthcare industry, these dollars are not headed your way.   Also, since nothing in the bill actually reduces heathcare and heath insurance costs, but actually increases them, an additional amount of dollars will flow into healthcare just to meet the rising costs.  These are dollars your businesses will not see from your customers because they are required to divert them elsewhere.

2. ObamaCare means higher health insurance expenses for Small Businesses

As noted above, nothing in ObamaCare reduces expenses.  The only way to reduce cost is to increase supply or decrease demand.  ObamaCare increases the demand for health care while doing nothing to increase the  supply of health care.  You will see your premiums increase if you provide healthcare to your employees or yourself.

3. ObamaCare means penalties and fines

For some small businesses, you’ll pay a penalty (fine) if you don’t provide health insurance for your employees.

4. ObamaCare means that part-time workers will become a dying breed

The penalty for not providing health care to employees is the same for part-time and full-time employees.  Since this penalty is part of the overall compensation expense for employing someone, it doesn’t make sense to employ part-timers.

While a simple analysis of the bill would lead any dispassionate analyst to conclude this, we also have empirical proof.  This approach to healthcare – the health insurance mandate – is currently being tried in Massachusetts and has failed.

None of these developments is good for business or good for job creation.  The US was headed toward bankruptcy before ObamaCare.  It’s just headed there faster, now.  The only way out is to (a) cut spending, (b) raise taxes, (c) print money, or (d) default on the debt.

It’s your guess as to which is our fate.

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Related Entry: This is Gonna Hurt: The Pain for Mandatory Health Insurance

There were many lessons learned (not least of which that there’s no such thing as a “pro-life” Democrat, Harry Reid and Bart Stupak taught us this), but this is what we learned most:

In the battle for the hearts and minds of Americans, we won.  When this vote was finally taken, only 35% of American’s wanted it.  One in five Democrats voted against it.

And we defeated the “public option” and that was the most vital part of the battle.  In the end, what these so-called progressives got was a massive handout to insurance companies and a crazy plan based on the already-failing Romney-care in Massachusetts whose entire substance is pointing a gun at people and demanding that they buy insurance.  (By the way, don’t forget in 2012 that Romney was no friend on this health-debate, even penning an op-ed in USA today advocating for a plan very similar to the one just passed.)

The way forward will be multi-faceted, but never forget, in the battle for the hearts and minds of America, we defeated them.  Unfortunately, their power and corruption were too much to overcome, this round.

Make no mistake, overcoming this will be very difficult – but keep in mind that NJ and VA kicked out their Democrat Governers, Ted Kennedy’s seat was lost to a person whose primary platform was anti-healthcare, and the Democrats who voted for this are headed for a slaughter in 2010.

What we have going for us right now is that the full program does not take effect for four years.  In that time, this legislation will be bombarded and attacked non-stop.

The place that this legislation will be best challenged is not in the federal executive and legislative branches (at least not initially).  It will be challenged in court on constitutional grounds (where our case is very strong), and it will be challenged by the states themselves (particularly by pissed-off Attorneys General who may just have the numbers to push a constitutional convention if necessary – it’s more possible than you think since this Bill assuredly bankrupts states which are already on the verge of insovency).

Do not lose hope.  The fight was worth it.  The momentum is still with us, and these Democrats will rue this day which will live in infamy.

Cry your tears tonight if you must, but get some good sleep and let your heart be at peace – then wake up tomorrow and sharpen your knives.  We’re going right back at them.

Why is the financial scam of Managed Care not being exposed?

I cannot understand why the media and we docs are not exposing the financial scam of Managed Care. Readers need to google “Bill McGuire” the former CEO of United Health who was given a $1 Billion benefits package. Read the front page Wall Street Journal and New York Times Articles from December 7, 2007 highlight the $660 million fine McGuire had to pay for back dating stock options and the $800 million in stock options he had left over.

Do you recall when United Health held news conferences and was on all the networks a few years back?  United Health announced it was no longer going to require prior authorizations and then not so publicly instituted a policy of not guaranteeing payment. The standard Managed Care practice now is to deny 30% of physicians billings because Managed Care has calculated that Docs will simply not take the time to appeal as much as 1/3 of denials.

Do we not realize that we are paying an ever increasing ”tax” in effect to Managed Care Executives?  Last year 3 of the largest Managed Care companies raised premiums 26 % while only increasing payments 6% for services. On average the highest paid CEO’s are Managed Care CEO’s. When the Catholic Nuns ran the largest health care system Sister Mary CEO did not get paid a salary. There is a calcualtion called dollars lost from actual provision of healthcare and supposedly Medicare loses $6 for every $100 and Managed Care loses nearly $30 for every $100 with most of this $30 going to Executive compensation. Additionally 6.9 % of healthcare dollars are lost to the time doctors spend on dealing with Managed Care authorization paper work.

Is anyone questioning how 80% of Americans are supposedly happy with their current health care? Since 20% of Americans do not even have health care coverage this means that there is 100% satisfaction of those who do have coverage. This makes no sense. Any of us who have a health plan have watched the increasing portion of our pay check going to managed care. My first employee health plan many years ago cost me nothing and had no copays. Gradually I have paid larger and larger portions of the premiums and the copays have escalated and the coverage shrank.

If Americans are happy it is because they do not look at their pay check and are not realizing the “tax” they are paying to Managed Care CEO’s. The flattening of incomes and the declining of purchasing power is directly related to the thievery of Managed Care. Doctors salaries have been stagnant by and large since 1992 yet we have allowed ourselves to be scapegoated in this process. If we do not disclose the evils of Managed care we are doomed.

Managed Care lobbyists are going to be succesful in maintaining their strangle-hold by getting a mandate for insurance and a mandate for more employer sponsored care. If Americans are happy it is because doctors are fighting the denials and doing all the authorizations and doing all the care free by phone and employers are doing all the leg work arranging the plans and American industrial production and workers are economically suffering as a result.

The only ones ‘doing well” in this system are the Masnaged Care executives and perhap Managed Care shareholders. This needs to stop. Healthcare needs to be disconnected from employment, and patients, not doctors, need to deal with insurance denials then there will be true competition because patients will not put up with what doctors have put up with from Managed Care. We need to call upon the media to do its job and expose Managed Care for what it is a profit scam for its own Executives.

Dr.  Barry Jacobs is a Reproductive Endocrinologist, practicing in Carrollton, Texas, a northern suburb of Dallas. He completed his residency training in obstetrics and gynecology at Baylor College of Medicine in Houston, and remained at that institution to become its first fellow once Baylor achieved accreditation for an advanced training program in Reproductive Endocrinology and Infertility. Dr. Jacobs has served on the faculty of several medical schools and was director of Reproductive Endocrinology at Texas Tech Health Science Center in Amarillo. Currently, in addition to his clinical activities caring for infertile patients and those with recurrent pregnancy loss, he is Chairman of the IVF committee at Baylor Medical Center in Carrollton.

The Senate health care bill crucial to saving President Obama’s signature domestic initiative will hit the wallets of a quarter of all Americans making less than $200,000 per year, according to an analysis by the nonpartisan Joint Tax Committee that assessed the way the bill would hit taxpayers directly through new taxes and fees and indirectly through taxes levied on health care providers and passed on to consumers.

The committee also determined that the bill would subsidized insurance premiums for 7 percent of taxpayers — about 13 million people — while some 73 million people would face higher costs from the new fees and taxes.

“For every family that gets some benefit from this program, in other words, a premium subsidy, three families are going to get a tax increase and those three families obviously include the bulk of people you’d call middle class America,” Sen. Chuck Grassley, R-Iowa, told Fox News.

Watch the words directly from the Dissembler-in-Chief’s mouth.

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[A] new provision in the health care bill will require businesses to count part-time workers when calculating penalties for failing to provide coverage.

As we warned in in October of last year measures such as these hurt small businesses and part-time workers (particularly students, working mothers, and people who work for companies with a seasonal bent), leading to more unemployment and more mis-allocated resources in the economy.

Ed Morrissey from Hotair.com issues his analysis and warning today, too.  He’s spot on.

This change in the parallel bill would have a big impact on small businesses, who already have trouble competing with their larger competitors.  It will force businesses into either paying for benefit packages that they can’t afford with their current staff levels, pushing them either into cutting staff to recoup the costs or shutting their doors altogether.  It will have a major impact on the part-time labor market, which supports student workers and second earners in families under normal economic conditions.

Today Rasmussen reported that 57% of American’s think that ObamaCare will damage the economy.  They’re right.

How can the president claim such things?

Well, he can’t.

That is, not if he knows how to do math (or tell the truth).

The big problem is that all of his claims count 10 years of taxes but only 6 years of spending.

Paul Ryan, in last week’s health care summit, exposed this lie (and others) by doing the math for the president.  He pointed out that the real cost over ten years is $2.3 trillion – and even that is on the “low” side since lots of people will want the “now-free” health care and lots of businesses will drop coverage.

The President claimed that costs are $100 billion per year, but he’s not telling the truth (or can he just not do math?).  The truth is that costs increase each year.  And bringing down the deficit?  No, it won’t.  Deficits are going to be at least $460 billion over the first 10 years.  The ten after that?  $1.4 trillion.

Watch Paul Ryan take the president to Math (and Truth) school.

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But what about others who will have access, legally, or otherwise?  Even if you are not worried about “Big Brother”, are your medical records in a central data base truly safe?  Are Pentagon files safe from hackers?  I think you already know the answer to that.  Last year, there were over 50 breaches of computer data bases by hackers.  Approximately 43 million Americans had their personal information compromised in the past 12 months.  One and one half million credit cards were stolen on line in the past 2 years, as well as social security numbers.

As a physician, I would love to have instant access to my patients’ records from other physicians, but I absolutely do not want that information compromised.  We do not need to have all those records in a central data base.  Other than requiring a patient be responsible for those records, there is no reason that all of the individual’s information cannot be recorded electronically in a small portable system, like a flash drive.  The patient can take the entire record to the physician’s office for both review and to be updated.  Oh, I forgot, our Government doesn’t think we, the public, can be trusted with our own medical records.  The Government feels the need to be the ultimate custodian.  George Orwell was off a few years, but we are approaching 1984.

Dr.  Barry Jacobs is a Reproductive Endocrinologist, practicing in Carrollton, Texas, a northern suburb of Dallas. He completed his residency training in obstetrics and gynecology at Baylor College of Medicine in Houston, and remained at that institution to become its first fellow once Baylor achieved accreditation for an advanced training program in Reproductive Endocrinology and Infertility. Dr. Jacobs has served on the faculty of several medical schools and was director of Reproductive Endocrinology at Texas Tech Health Science Center in Amarillo. Currently, in addition to his clinical activities caring for infertile patients and those with recurrent pregnancy loss, he is Chairman of the IVF committee at Baylor Medical Center in Carrollton.

(Scroll down for the URGENT ACTION ITEMS.)

US News & World Report is reporting that Democratic Leaders are planning secret health reform deliberations.

Despite their claims to the contrary, the way that House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid have handled the healthcare bill has been anything but transparent. And, if the left-wing blogosphere is to be believed, the two congressional leaders intend to keep the deliberations secret as they try to merge the House and Senate versions of the legislation into something that will pass both chambers.

C-SPAN has challenged the President and Congress to open Health Care talks to TV coverage, writing:

President Obama, Senate and House leaders, many of your rank-and-file members, and the nation’s editorial pages have all talked about the value of transparent discussions on reforming the nation’s health care system,” he wrote. “Now that the process moves to the critical stage of reconciliation between the chambers, we respectfully request that you allow the public full access, through television, to legislation that will affect the lives of every single American.

And then C-SPAN reminded the president that he “pledged during the campaign to open up health care talks to C-SPAN’s cameras”.  In fact, what Obama said was:

That’s what I will do in bringing all parties together, not negotiating behind closed doors, but bringing all parties together, and broadcasting those negotiations on C-SPAN so that the American people can see what the choices are.

Today Pelosi responded to C-SPAN’s request that the reconciliation process not be hidden from the American People.  Her reply?

There has never been a more open process for any legislation.

Quite a bold statement.  Never.  Never, ever has any other bill had a more open process than this one that has been totally conducted behind closed doors.  She must have sensed the absurdity of her statement because she then added

We will do what is necessary to pass the bill.

That’s more like it.  A little truth, finally.  And if what is necessary means dissembling, hiding, breaking campaign promises, and shutting out the public, then she’s willing to do it.

We don’t have to stand for it.

Step one is to let everyone we know that this is going on.  If we can inform enough people that this is going on, we can encourage a groundswell of opposition and force the legislative process into the open.  Remember, it was President Obama who promised transparency and televised broadcasts on C-SPAN, and we are demanding that he and they keep this promise.

What can you do?

URGENT ACTION ITEMS:

1. Please go right now and join the Facebook group “We Demand Congress Televise All Health Care Legislation Deliberations” (just click on the link) and then invite all of your Facebook friends to join, too.

2. Then sign the petition at Letthecamerasin.com and encourage your friends to do likewise!

You can also forward this blog post along to them.

If we can get this information to spread quickly, we can force their hand.  But we must act quickly and decisively!

1. Cash For Clunkers is a Modern-Day Version of the Broken Window Fallacy

2. The Two Biggest, Fattest Lies In The Health Care Reform Debate

3. Anatomy of a Trojan Horse: How Big Government Plans to Take Over Private Health Care and What We Can Learn From Arizona To Stop It

4. The Power of Language: How to expose BIG GOVERNMENT with our words

5. This is Gonna Hurt: The Pain of Mandatory Health Insurance

(As a side note, one of the most searched-for terms in search engines that led people to SBABG was “Ben Nelson Traitor“; we think his goose is cooked and we’re glad to do our little part to try and ensure it.)

Clearly, and unsurprisingly, the impact of Proposed Health Care Legislation dominated Small Business interest this year, and likely will in the coming year.

We hope you found our information and analysis helpful this year.  If there’s anything you’d like to see more of in the coming year, let us know in the comments below or at the Facebook update related to this blog entry.

We look forward to hearing from you in 2010.  Keep in touch by signing up for our RSS feed and becoming a fan of our Facebook Page!

Judas got 30 pieces of silver. Esau got a mess of pottage. Benedict Arnold offered to sell out his countrymen for cash. And now joining the long line of the imbecile pansy squishes is Big Ben Nelson. And for what did he sell his soul? Medicaid subsidies for Nebraska … all paid for by the other states he just foisted this monstrosity upon.

This one is making the rounds, forward it along to all Nebraskans you know.  They must be so proud right now!

Page 22 of the HC Bill:  Mandates that the Govt will audit books of all employers that self-insure!!

Page 30 Sec 123 of HC bill:   THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.

Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!!

Page 42 of HC Bill:  The Health Choices Commissioner will choose your HC benefits for you. You have no choice!

Page 50 Section 152 in HC bill: HC will be provided to ALL non-US citizens, illegal or otherwise.

Page 58 HC Bill:  Govt will have real-time access to individuals’ finances & a ‘National ID Health card’ will be issued!

Page 59 HC Bill lines 21-24:  Govt will have direct access to your bank accounts for elective funds transfer.

Page 65 Sec 164: Is a payoff subsidized plan for retirees and their families in unions & community organizations: (ACORN).

Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for private HC plans in the ‘Exchange.’

Page 85 Line 7 HC Bill:  Specifications of Benefit Levels for Plans–The Govt will ration your health care!

Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services. (Translation: illegal aliens.)

Page 95 HC Bill Lines 8-18: The Govt will use groups (i.e. ACORN & Americorps) to sign up individuals for Govt HC plan.

Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans. (AARP members – your health care WILL be rationed!)

Page 102 Lines 12-18 HC Bill:  Medicaid eligible individuals will be automatically enrolled in Medicaid. ( No choice..)

Page 12 4 lines 24-25 HC: No company can sue GOVT on price fixing. No “judicial review” against Govt monopoly.

Page 127 Lines 1-16 HC Bill: Doctors/American Medical Association – The Govt will tell YOU what salary you can make.

Page 145 Line 15-17: An Employer MUST auto-enroll employees into public option plan. (NO choice!)

Page 126 Lines 22-25: Employers MUST pay for HC for part-time employees AND their families.  (Employees shouldn’t get excited about this as employers will be forced to reduce its work force, benefits, and wages/salaries to cover such a huge expense.)

Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option will pay 8% tax on all payroll!  (See the last comment in parenthesis.)

Page 150 Lines 9-13:A business with payroll between $251K & $401K who doesn’t provide public option will pay 2-6% tax on all payroll.

Page 167 Lines 18-23: ANY individual who doesn’t have acceptable HC according to Govt will be taxed 2.5% of income..

Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.)

Page 195 HC Bill: Officers & employees of the GOVT HC Admin..  will have access to ALL Americans’ finances and personal records.

Page 203 Line 14-15 HC: “The tax imposed under this section shall not be treated as tax.”  (Yes, it really says that!)

Page 239 Line 14-24 HC Bill: Govt will reduce physician services for Medicaid Seniors.  (Low-income and the poor are affected.)

Page 241 Line 6-8 HC Bill: Doctors: It doesn’t matter what specialty you have trained yourself in — you will all be paid the same! (Just TRY to tell me that’s not Socialism!)

Page 253 Line 10-18: The Govt sets the value of a doctor’s time, profession, judgment, etc.  (Literally — the value of humans.)

Page 265 Sec 1131: The Govt mandates and controls productivity for “private” HC industries.

Page 268 Sec 1141: The federal Govt regulates the rental and purchase of power driven wheelchairs.

Page 272 SEC. 1145: TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!

Page 280 Sec 1151: The Govt will penalize hospitals for whatever the Govt deems preventable (i.e… re-admissions).

Page 298 Lines 9-11: Doctors: If you treat a patient during initial admission that results in a re-admission — the Govt will penalize you.

Page 317 L 13-20: PROHIBITION on ownership/investment. (The Govt tells doctors what and how much they can own!)

Page 317-318 lines 21-25, 1-3: PROHIBITION on expansion. (The Govt is mandating that hospitals cannot expand.) Page 321 2-13: Hospitals have the opportunity to apply for exception BUT community input is required.  (Can you say ACORN?)

Page 335 L 16-25 Pg 336-339: The Govt mandates establishment of 2 outcome-based measures. (HC the way they want — rationing.)

Page 341 Lines 3-9: The Govt has authority to disqualify Medicare Advance Plans, HMOs, etc..  (Forcing people into the Govt plan)

Page 354 Sec 1177: The Govt will RESTRICT enrollment of ’special needs people!’   Unbelievable!

Page 379 Sec 1191: The Govt creates more bureaucracy via a “Tele-Health Advisory Committee.”  (Can you say HC by phone?)

Page 425 Lines 4-12: The Govt mandates “Advance-Care Planning Consult.”  (Think senior citizens end-of-life patients.)

Page 425 Lines 17-19: The Govt will instruct and consult regarding living wills, durable powers of attorney, etc.  (And it’s mandatory!)

Page 425 Lines 22-25, 426 Lines 1-3: The Govt provides an “approved” list of end-of-life resources; guiding you in death. (Also called ‘assisted suicide.’)

Page 427 Lines 15-24: The Govt mandates a program for orders on “end-of-life.”  (The Govt has a say in how your life ends!)

Page 429 Lines 1-9: An “advanced-care planning consultant” will be used frequently as a patient’s health deteriorates.

Page 429 Lines 10-12: An “advanced care consultation” may include an ORDER for end-of-life plans.  (AN ORDER TO DIE FROM THE GOVERNMENT?!?)

Page 429 Lines 13-25: The GOVT will specify which doctors can write an end-of-life order.  (I wouldn’t want to stand before God after getting paid for THAT job!)

Page 430 Lines 11-15: The Govt will decide what level of treatment you will have at end-of-life!  (Again — no choice!)

Page 469: Community-Based Home Medical Services = Non-Profit Organizations. (Hello?  ACORN Medical Services here!?!)

Page 489 Sec 1308: The Govt will cover marriage and family therapy.  (Which means Govt will insert itself into your marriage even.)

Page 494-498: Govt will cover Mental Health Services including defining, creating, and rationing those services.

Here is the link to the .pdf of the bill that accompanied Dr. Frazer’s letter to Bayh which he forwarded along …

http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf

Be alarmed!  This so called “health care reform” is actually a bid to remove the Constitution as our governing law and establish rule by fiat.  Hitler, Stalin and Mao would be proud.

Again, please share this article with everyone you know.  We must get the word out.

–

Dr. Barry Jacobs is a Reproductive Endocrinologist, practicing in Carrollton, Texas, a northern suburb of Dallas. He completed his residency training in obstetrics and gynecology at Baylor College of Medicine in Houston, and remained at that institution to become its first fellow once Baylor achieved accreditation for an advanced training program in Reproductive Endocrinology and Infertility. Dr. Jacobs has served on the faculty of several medical schools and was director of Reproductive Endocrinology at Texas Tech Health Science Center in Amarillo. Currently, in addition to his clinical activities caring for infertile patients and those with recurrent pregnancy loss, he is Chairman of the IVF committee at Baylor Medical Center in Carrollton.

U.S. employers who tell workers to stay home when they are sick will have to give them paid time off for up to five days under new federal legislation proposed on Tuesday.

Is this a good idea?  Let’s look at the incentives.

First thing that really jumps out is that you’re now incentivizing businesses to NOT tell workers to stay home when they’re sick!

Next thing that jumps out is that if companies somehow overcome this incentive to not send sick workers home but are going to be forced to pay for all non-work from sick employees, guess which kinds of people aren’t going to be able to find work?  Right.  Those more prone to sickness, i.e. the weak and poor.

Just another example of how a government program will hurt the very people it purports to help.

By requiring payment for sick leave, you introduce discrimination against the weak and incentives to invite more illness into the workplace.  Let the market work this out, not bureaucratic central planners.  Employers know they have to strike a balance with their employees, their workplace, their customers, etc.  By mandating a certain, somewhat arbitrary course of behavior that the people involved have not contracted, the government creates perverse incentives that really do nothing to remedy the underlying concerns.

Also, if you’re not careful, you’ll get people faking illness (claiming they have symptoms that they don’t), or not taking precautions against exposing themselves to illness.  If you know you’ll lose pay if you get sick, you take precautions to avoid illness.  However, if you know that if you’re sick you’ll get paid anyway and can sit at home and watch TV, you’ll be less inclined to take close care of your health.  Think not?  Then you don’t understand people and their economic calculations.

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Not only was it not bi-partisan, it wasn’t even close to unanimous within the Democratic Party.

Divisive.

Toxic.

Political Suicide.

Nearly 20% of House Democrats refused to stand with Pelosi and Obama.

Or did Pelosi and Obama refuse to stand with their party?

Simply. Amazing.

If you want to know what’s in the 2,000 page bill, and just how it will affect your small business, read this.

Please subscribe to our RSS feed and join our Facebook group to stand with other small business people against Big Government.

We’ve bolded a few items in the email that we think this member did very well – we particularly love how he used his association with SBABG to send a message.  We encourage you to do the same.

From: XXXXXXXXXXXXXXXX
Sent: Friday, November 06, 2009 2:23 PM
To: sbabgorg@gmail.com
Subject: Healthcare – I made a difference today

Yesterday, I got so fed up with the congress, Pelosi and the health care nonsense that I finally boiled over, picked up the phone and called Harry Mitchell’s (Arizona Democrat in the House of Representatives) Washington D.C. office and asked to speak with the legislative director. Rep Mitchell has still not publicly tipped his hand on how he will vote on this bill and I wanted to voice my opinion and wanted to make sure my voice was heard.

When I called I identified myself as a local small business owner and a member of an organization of 8,000 small businesses allied against big government policies.  I had a 25 minute conversation with the legislative director about why I oppose the proposed legislation and what it means for me, my family, my business and my employees. After finishing the conversation, I felt like I had truly made an effect on the legislative process and clearly explained why I am so opposed to it. If you’d like, you can pass on my experience to your readers so that they can also call their representative’s offices and tell them strongly how they feel.  After speaking for nearly a half an hour and clearly explaining why I strongly oppose this legislation.  I used one statement that I believe made a big difference.

“If Mr. Mitchell votes for this legislation, I will make it my personal mission to do everything in my power to make sure that he does not get re-elected. I will give my time, my money, my support and I will enlist other small business owners from our organization to campaign against him.”

This really seemed to resonate and I could tell he was taken aback. There was a long pause and then he said “wow… ok… I will make sure Representative Mitchell knows how you feel.”  At that moment I realized that this legislative director will also be out of a job if Mr. Mitchell does not get re-elected, so I think it sunk in right then that I would be campaigning to put him personally out of a job.

He was cordial, bright and well-informed so the conversation was actually quite interesting and informative and non-confrontational. He did try and cite some incorrect figures about certain things and about the bill, but I was able to correct him and he seemed to defer on those points.  I was expecting to get a fire-breathing Pelosi clone on the phone for some reason, but was pleasantly surprised and impressed with how receptive he was and with the fact that he told me he would take my thoughts and speak to Mr. Mitchell about them. I almost felt bad for – in effect – telling him I was about to do everything I could to get him fired.

I hope other members are calling their representatives, too, and speaking with their staff members about how we will oppose them if they continue to pursue policies that hurt our businesses and communities.  I know it makes a difference.

—-

That was a cool email to get today.  We’ll get to see how Rep. Mitchell votes on the bill very soon (too soon!), but whether he votes yes or no the approach this member took is very effective and serves as a case-study in how to call a representative.

First off, this member spoke to the right person. The legislative director is key to the process.  He or she monitors the legislative agenda and makes recommendations to your representative regarding issues.  If we can influence the legislative director, we will likely influence the politician.

Remember that when we talk to the staff of a politician and you tell them that if the politicians votes a certain way that we’ll draw upon all resources we have and organize a campaign against that person, and we are credible, we can influence that person to influence the candidate.  It’s often very effective to target the people around a primary target.

Second, this member was well informed, civil and talked for a long time about the whole issue in depth, registering opposition by explaining why he was opposed to the bill and who would be victimized by this bill (note – we have a future post forthcoming about “pleading on behalf of the victim,” which is a technique this member provided).  By doing so, the member’s threat to oppose the politician was credible.  Also, long conversations are good.  The legislative director has only so many hours per day.  If those hours are filled with conversations from people like us, carefully and rationally explaining our opposition to this bill, that is what will dominate the director’s day.

Third, the member identified himself as a small business owner. This is vital. Whereas left-leaning politicians love to bash big business and “the excesses of capitalism,” they are usually very sympathetic to small businesses, which they often identify with “the working man.”

Fourth, the members used his association/affiliation with outside groups to communicate the reality that there are many more people like him who the legislative director might not be hearing from, but who are none-the-less real and who feel similarly. Use your associations with various groups to your advantage and feel free to use your association with SBABG in your conversations.

Do not give up the fight.  Now is the time (NOW is the time) to pick up the phone and call the legislative directors of your representatives!  Please email us (through the contact form above) with your experience.

Also, please subscribe to our RSS feed and our newsletter, and join our Facebook group so that we can keep you informed about how you can fight against Big Government.