Health Care Reform S.O.S.

I am a simple physician and family man, trying to make a living and doing the best I can.  I graduated from Texas A&M medical school in 1982, did a three year fellowship in general surgery in New Orleans until 1985 when I moved to Colorado Springs.  I married soon after that and have four children.  I worked in a variety of walk-in urgent care/minor emergency clinics for many years and did physical examinations for life insurance companies.  For the past eleven years I have worked as the Occupational Health & Medical Coordinator for Colorado Springs Utilities.  So I have seen medicine from many perspectives; as a private physician, a patient/consumer and now a municipal government employed physician.  Over the years I have endured the rise and fall of the H.M.O. managed care debacle, saw the boondoggle of Diagnosis Related Groups (DRG’s), observed the decline and fall of the solo practitioner as they have been gobbled up by the behemoth medical corporations and now have seen the greatest insult of all, ObamaScare.  I am not a Harvard educated economist and I don’t have an M.B.A. from Wharton.  I am certainly not a politician (we should all be thankful).  But I do believe that over the years I have seen some things, endured some things and learned some things about health care which I would like to pass along to you.  Of course, this advice is free and may be worth what you paid for it.

Let me begin with a little story.  About a month or so ago, one of my 17 year old twin daughters told me that she had been feeling poorly for a few weeks.  She was tired and had a sore throat.  I looked at her throat, it didn’t look too bad but she did have some swollen nodes in her neck.  I called to get her an appointment with our family doctor (no longer in his own little practice, now an employee of one of the monolithic companies in Colorado Springs).  Being the middle of the week of course they couldn’t see her until the next week.  Well, by Saturday morning she was still complaining so I took her to a satellite walk-in clinic run by one of our local hospitals and on our insurance company approved list.  They weren’t too busy and we got in fairly quickly.  I paid my $40.00 co-pay and we were taken back.  My daughter was seen by a nice nurse practitioner who did a quick history and examination and then ordered a rapid strep test which was negative.  Following that a quick finger-stick mono test confirmed my suspicions that she did indeed have mono.  A prescription for some prednisone tablets for throat swelling and we were on our way.  We had maybe 15 minutes of face-to-face time with the nurse, all that was really necessary.  No problem.  Well yesterday, May 18 I got a bill from the hospital.  The total charge for the visit was, wait for it…$770.00.  After my co-pay of $40.00 was deducted, a $338.00 ‘insurance adjustment’ (read discount, which would still make the total bill $432.00) and an insurance payment of $177.69, my balance remaining is only $214.31!  Now of those charges, $146.00 was for the professional fee (nurse practitioner).  This might be reasonable for a physician exam, but not for a nurse practitioner.  That should be maybe around $50.00.  There was a $242.00 clinic fee, no doubt to cover the overhead of the nice new building they are housed in.  Please note this is not an emergency room, it is a walk-in clinic much akin to your family doctor’s office.  And when you go to your family doctor you are charged only a professional fee, which includes all of the overhead.  You don’t get charged a separate clinic fee.  My doctor is housed in a nice, new, big building with radiology and laboratory services, but doesn’t charge a clinic fee beyond the doctor’s professional fee.  But wait, the final charge was for laboratory services in the amount of $382.00.  This for a rapid throat swab strep test and a finger-stick mono test.  I did some research and found that you can purchase rapid strep tests for $1.82 per test and the mono tests for $4.49 per test.  This is about what I remember from my private practice days.  Each test is quick, simple to perform and only takes about five minutes.  By my calculation this whole visit should have come to around $75.00.  Here then is a microcosm of the problems we are experiencing with the cost and payment for health care around the country.

Let us remember in these discussions that what we are all talking about is cost and payment for health care services.  We have the best health care in the world here in the United States.  This debate is not about health care.  It’s about payment.  The problem with our system now is that the federal government has meddled in the payment system over the past decades and really screwed things up. 

For some reason health care is one of the few, if not the only service we purchase with no idea of what the actual final cost will be at the point of sale.  Doctors don’t know, patients don’t know, the providing institution/company really doesn’t know and the insurance company doesn’t know until the final charge is hammered out weeks or months after the fact.  This is driven in part by the coding and recoding of diagnoses and procedures so to as to maximize the charges by the providers.  This thanks to the ICD-9/CPT coding monopoly owned by the American Medical Association (their primary source of revenue since only about 13% of practicing U.S. doctors belongs to the association) and promulgated by the Medicare system.  We need to divorce ourselves from this byzantine rubric and let doctors and institutions charge whatever they want in a free market where quality and service-level reviews and surveys are available for all to see.  Let insurance companies and patients choose where they want to spend their health care dollars to get what they perceive to be the best bang for the buck.

There are myriad different prices for this insurance company or that insurance company, for cash, for Medicare, for Medicaid; contract prices and discounts.  The providing institution doesn’t really know the price up front.  Frankly, I can’t believe that insurance companies agree to pay some of these outrageous charges.  The complexity of insurance company deductibles, co-pays, co-insurance and knowing where you and your family are in that calculation at any given point in time is impossible, particularly at the time you are receiving service.  Doctors don’t really know the cost of things they are ordering (and thus incurring costs) on behalf of patients.  There is no menu up front, in advance like say, in restaurants.  I recall a conversation in my doctor’s office about a year ago.  I was having my annual physical exam and the doctor ordered the usual annual lab work.  I asked him to make sure that he coded it as annual wellness lab work which is covered 100% by my insurance; otherwise I would wind up having to pay about $500.00 out of my pocket.  He was shocked and frankly in a state of disbelief.  He really thought I was joking.  When I explained that I and my co-workers had all experienced the high cost of these lab tests he honestly related that he had no idea that it was all so expensive.  So to try and put it in perspective, imagine going into Dillard’s (doctor’s office) to buy some jeans.  There are no price tags on the jeans and the store clerk (doctor) has no idea how much they cost.  But don’t worry they tell you, just pay a little bit now (co-pay) and we will bill you in a few weeks if it winds up costing any more.  Well, how much more you ask.  Well, we really don’t know right now.  So a month later you get a bill from Dillard’s for $250.00 for the balance on the jeans.  And oh by the way, it’s too late to return them.  Would you go for that?  Of course not.  If the prices were right on the jeans for all to see you would either buy them or look for a cheaper pair or go elsewhere to look for jeans.  Here is a real life story.  About six months ago on a Sunday afternoon I drove into Jiffy Lube to get an oil change.  You drive right up the garage door and they open your door and tell you to go inside while they drive your car into the bay.  There are no prices posted anywhere outside, they don’t hand you a menu of prices or tell you what the prices are (I know, I should have asked.  But shouldn’t the business tell you?).  Anyway, I got inside and the clerk started ringing up my order while they started working on my car.  The oil and filter change with a tire rotation came to $65.00.  I looked out the window at the Tire World next door and on their sign it read, “Oil/filter change and tire rotation $18.99.”  I instructed the Jiffy Lube clerk to stop work on my car and informed him that I did not want any service.  They sheepishly gave me the keys to my car (I have no idea what they had already done to it) and I drove next door for service.  Why shouldn’t medical care work that way?  One final real life example.  In my capacity at Colorado Springs Utilities I order a lot of MRI scans.  If we do them at the major hospital/medical corporation facilities they run $2000.00 to $2500.00, it takes several days to get one done and then a couple of days to get the results back.  We recently contracted with a small private company that does the same scans for about $700.00 to $900.00 per scan, they often get our employees in the same day we call and the reports are done much quicker.  There is also more personal communication between the radiologists and me, they are much easier to get in touch with and get questions answered.  The quality is just as good as the hospitals’ and the service is much better, not to mention the price!  Isn’t this the way it should be for everyone?  What a wacky system where people are consuming very expensive services, many times on a moment’s notice in difficult and emotionally charged situations and no one knows the cost of what is being purchased at the time.  It is being ordered by a doctor who doesn’t know, on behalf of a patient who doesn’t know, provided by an institution that doesn’t know and paid for by an insurance company that doesn’t know.  There is no direct accountability.  People are spending other people’s money on behalf of someone else.  And its six months before anyone has any idea of what just happened, then shazam!  Look what we just spent!  Oh well, whatever the insurance company won’t pay we’ll just bill to the poor unsuspecting patient.

With health plans paying less and less of the cost lately coupled with the federal government lowering the pre-tax flexible spending account family annual allowed contribution from $8000.00 to $2500.00, individuals are discovering that they are suddenly on the hook for high costs that they never were in the past.  Much of this happens after they have actually incurred the costs and can’t really do anything about it.  One result of this will be that people simply stop going to the doctor and getting tests done, sort of self-selected rationing.  And maybe that’s what the progressives in government want.  But the result will be a less healthy population, less preventative care and ultimately much higher costs down the road for late intervention.

Another problem is the costs created by liability and malpractice litigation and the resulting payments and settlements.  We need meaningful tort reform and perhaps a system like Louisiana where all malpractice and medical liability cases go before a diverse board who rule on the validity and likelihood of success of the case before going to trial or mediation or settlement (at least they did back in the 1980’s, not sure about today).  Sort of like a grand jury.  You can still go to trial with an adverse ruling by the board, but the likelihood of prevailing is very small.  Most don’t.  This weeds out frivolous suits and grandiose settlements.  A cap on payouts based upon reality and common sense would also help, as well as making the loser pay the other party’s legal fees.

With all of the vacant commercial real estate available why do medical companies and clinics need to build fancy new facilities, and then have to pass all of those costs on to patients and insurance companies?  Why not use existing buildings which can be re-finished for far less than new construction?

Get the government less involved, not more involved.  They have already screwed things up and driven up costs enough with Medicare/Medicaid and now ObamaScare.  When the government gets involved they just screw things up, make things too complex, less efficient and effective and increase costs 10-100 times.  Get the government out of the way and let the private sector solve these problems.  The reason we have these challenges in the health care payment/insurance industry in the first place is because of government meddling, regulating and dictating.  To paraphrase Ronald Reagan, in our current situation government is not the solution to the problem, government IS the problem.

Get rid of the electronic medical records requirement!  Virtually every physician I have talked with despises electronic medical records.  They are a disaster.  They are impossible to use, they don’t fit the model of what doctors do and trying to find useful information in them is like looking for a needle in a haystack.  Not to mention the privacy implications and problems.  And I just received a notice from my malpractice insurance carrier informing me of a seminar they are going to be providing discussing the difficulty of defending malpractice lawsuits due to electronic medical records.  Just say no!

And by the way, never, never, never let the I.R.S. get anywhere near health care, health insurance, medical records or anything health or health payment related!  Period.  After the recent scandalous revelations need I say more??

Repeal ObamaScare in its entirety immediately and replace it only with the free market!

Doctors are now talking about and actually are retiring, retiring early, switching professions and jobs to something out of the health field.  They are advising their children not to go into medicine.  All as a result of ObamaScare and the mess the federal government has made of the health care industry.  They are leaving in droves and the projected shortfalls are staggering.  And you can’t make that up with physician assistants and nurse practitioners.  Not that I would want to.

We must begin to look at the opportunity for different ways of delivering health care, such as Indian Reservations, off-shore, cruise ships, concierge medicine, private co-ops, etc.

I know you have heard from many highly placed Ph.D. health care economists with all of their complicated, complex solutions to the problem; many including much more government involvement.  Just take a moment and think that the solution might actually be less, not more.  It might be simpler, not more complicated.  It might be less government, more private sector; less government control and more personal freedom and responsibility.

Well, thank you for the opportunity to bend your ear a little bit from someone in the trenches on the front lines out here in fly-over country.  I hope maybe one little thing I have said might make some sense and spur some further thought and discussion.  Hopefully we can fix this thing before we have to wake up Ralph, because of course he ain’t never seen a wreck like this before in his life (story for another time!).  And I fear the health care industry is headed for a wreck of epic proportions if we don’t do something in a big way and quick.

God help and bless us all and God bless America!

Protect Your Medical Information!

To Any and All Medical/Health Care Providers,

I hereby prohibit you from providing any medical and/or personal information about me and my family in any format to any entity not directly involved in participating in our medical care for a specific issue or to my personal medical insurance company.  No such information may be placed on and/or made available through the internet to anyone or any entity except those above.  No such information shall be made available to any entity of the State of (State) or the United States Federal Government.  Information shall not be made available even if stripped of any personally identifying information.  Any information in electronic format must be stored only on your local premise and computers.  It may not be stored or managed offsite and/or by another entity.

Time to Set Our Compass

All of this talk by RINO's about repealing ObamaScare because it is bad economics or using it as 'foundation' for more tinkering with our health care system totally misses the point and sets us up to be used as 'useful/useless' idiots by the liberal progressives to further their heinous agenda.  ObamaScare must be repealed because it is simply UNCONSTITUTIONAL in toto.  The federal government has absolutely no constitutional authority or power in the arena of health care.  Period.  It's not really complicated.  At this point in time health care policy is strictly a State function.  As it should be.  If the other side wants federal power over health care policy the very first step must be a constitutional amendment.  Let's see them propose that.  And I would throw Medicare and Social Security into the same mix.  I know that the Supreme Court has ruled in that past on those programs, but the court is made of up fallible people, not gods.  And they DO have their own personal political agendas, all of the protestations about objectivity to the contrary not withstanding.  Courts have certainly been overturned by Congress and subsequent courts.  The basis for ruling that these programs are constitutional usually revolves around Congress' taxing authority.  As I have argued prior the power to tax is not synonymous with the power to spend.    The taxing authority is to support the legitimate, constitutional powers of the the federal government.  It is not carte blanche to spend money on anything they darn well desire.  If so, why have Article 1, Section 8 in the Constitution?  This reasoning defies logical thought.  What if Congress raised tax money from all of the citizens and then spent it to hire thugs to break the kneecaps of their political opponents?  They can't do that we would scream, breaking kneecaps is illegal!  Ah, they would reply, we are doing this under our taxing authority.  Say what?!
The Constitution is our fixed point of reference in law and government.  Without it we are not a nation of laws, but rather a nation governed by the whims of men.  This is a recipe for disaster.  And that is where we are headed, and have been for years.  Think of it this way.  In the Christian world the Holy Bible is the fixed point of reference.  It is considered the revealed, inerrant Word of God.  It is not changeable by men.  It is not subject to their interpretation.  If it were, Christianity would not be a religion of God, but rather of pastors.  And that would be a recipe for disasters.  If I can pick up my fixed point of reference and move it, then it's not really a fixed point of reference.  It's not really of much help in troubled times.  What if the North Star kept moving?  How would mariners navigate?  What if the lighthouse on the rocks kept moving?  How many ships would wreck?  When our Constitution is treated like Silly Putty we are adrift in a dangerous sea with no North Star and no lighthouse.  We are rapidly approaching the rocks and don't seem to realize it.
The ends do not justify the means.  We must follow our constitutional dictates if our republic is to survive.  The states are the great laboratories of freedom.  Let them deal with the health care questions and see what works best.  Then other states can duplicate the best programs.
Keep the feds out and freedom and diversity will solve our problems.

Are These Truths Self-Evident?

As I sit here on Sunday afternoon, March 21, 2010 I don’t know if the House of Representatives has voted on the Health Care Reform Bill or not; and if they have voted what the outcome was. The much larger matter is that they should not be voting on a measure like this at all. It is simply far beyond the constitutional constraints of the federal government to be contemplating the complete takeover and control of the nation’s health care system. The Constitution and Amendments do not authorize such power. The only thing that Congress could rightfully be debating about health care would be a constitutional amendment to grant such authority to the federal government. Short of that, the matter resides exclusively with the States and the People. At least that’s how the Framer’s saw the role of the federal government, the States and the People within the framework of the Constitution they ratified in 1789.

Across two centuries I hear the Founder’s cries of alarm, warning us that to ignore the clear and absolute wording and intent of the Constitution is worse than folly, it would be the first step on the path to tyranny and despotism. They knew something about that subject, having just freed themselves from the dictatorial fist of a capricious king in England after a protracted and very bloody war. The horrible price of freedom was forefront in their minds as they began to lay the foundation for a new governmental order to be enshrined in the Constitution. Their words and meanings were unambiguous as they carefully crafted each section. They did not intend to put forth a vague outline to be filled in over time by the whims of this man or that, this group or that, this political party or that. No, they knew the fallen state of mankind, the avarice of people and the nature of power. Men are made lower than the angels and no man is immune to temptation and corruption. If men were angels no government would be necessary. Thus they set out to frame a government not of great power over the people, but one constrained from usurping the rights and freedoms of the people; who were to hold power over the government. Government by the consent of the governed. Of the People, by the People and for the People. Government with a very limited, proscribed list of duties, powers and responsibilities; chief of them to protect the rights of the people which are given by God, not the government. No legislation ever passed by the government has given or granted people a right; that is something that can only be granted by God. The only thing granted by government legislation is an entitlement, giving one group of people power and authority to take the money, time, effort or property of another group of people.

Clearly then, those people whom we place in positions of public service within the government must possess a genuine, healthy fear and respect for the Constitution, an absolute understanding of their role, their authority and their constraints according to the text of the document. This is why our Founders were so insistent that only a moral, religious populous was fit to govern itself in this manner.

The Constitution is meant to be a pillar of marble not a lump of clay on a potter’s wheel. It is the Supreme Law of the Land. To violate its precepts is the highest form of lawlessness, if not outright treason. For if we have no deference to the Constitution we have no country; we have anarchy and tyranny. This idea that the Constitution is merely an outline, a malleable lump of clay to be molded by each generation to suit its fancy is dangerous and subversive. The Constitution can be changed for necessities of the current age, but only by the laborious task of amendment. This is by design. A document so fundamental to the inter-generational structure of our government should not be changed easily or quickly for passing whims of the day.

The Constitution belongs to the People, not the federal government. It was written by the People to create the government. That which is created cannot be greater than the creator. It is not the proper role of government to tell the people what the Constitution means and what it empowers the federal government to do for and to the People. Rather, it is the role of the People to tell the federal government what the Constitution authorizes and empowers the federal government to do on behalf of the People, and, more importantly, what the federal government may not do. The Constitution codifies some of the more important rights conferred by God upon the People and charges the federal government to protect those rights. Furthermore, it recognizes in the Ninth Amendment that the list of God-given rights in the Constitution is incomplete, but that other rights given by God are still maintained by the People and in the Tenth Amendment clarifies that those powers and authorities not expressly awarded to the federal government are awarded to the States and the People. And be clear, the authority of the Congress is limited to Article 1, Section 8. The preamble is only a statement of intent; it is an explanation of why Congress is granted those powers in Article 1, Section 8. There are no powers granted in the preamble. In addition, the Necessary and Proper Clause merely empowers Congress to enact legislation to carry out its enumerated duties in Article 1, Section 8. If the Founders, wary of government to begin with, intended to give the federal government unlimited power and authority, why list a few specifics in Article 1, Section 8? That simply makes no sense. The idea that the Framers on the one hand would take the time to list the specific enumerated powers of Congress in Article 1, Section 8 and then on the other hand would grant unlimited power elsewhere in the Constitution is ludicrous. The words mean what they mean. For instance, the infamous Interstate Commerce Clause was intended to empower the federal government to prevent states from erecting unreasonable barriers to commerce between the various states. It was not intended as a carte blanche for the federal government to regulate, tax and direct every manner of business in the nation. Yet today it does just that. I don’t believe that the Framers ever envisioned a concept of penumbras and emanations.

Those men and women that we place in public office who seek to subvert the true original text and meaning of the Constitution, who trot out complex and subtle twists and turns of interpretation to hold it up as a living, changing document are little different that tyrants of old that our Founding Fathers were well acquainted with. They are the same today as then. Human nature has not changed in the last 100 or 1000 or 2000 years. Thus we must be just as vigilant today as 200 years ago for those who seek to bend the rules for personal gain and aggrandizement by trampling on our freedoms and liberties and eating out the very marrow of our nation’s sustenance.

So what are the People to do when an elected President, an elected Congress and even Supreme Court justices appointed by Presidents ignore the Constitution and impose their will upon the People? The Founders must have thought this eventuality beyond the realm of possibility. Given what they had just come through the idea that a public servant, entrusted with the maintenance of our Republic would ignore the very foundation and origin of that Republic must have seemed unfathomable. Once again we must return to the idea that only a moral people can govern themselves within a system such as this. Our public servants must possess a healthy fear and respect for the Constitution, the States and the People. Lacking this, all sorts and manner of mischief are possible and nearly inevitable. The most obvious solution is to vote the tyrants out and elect better servants. One problem with this method is that there are those politicians who run under false pretenses and become something quite contrary to what people thought they were voting for once in office. This seems to be happening with great regularity. In addition, people elected with good intentions sometimes become twisted by the bureaucratic establishment once they get to Washington and become drunk with power and the lust for money, the mother’s milk of politics. On the far other end of the spectrum is armed resistance which is what our Founders had to resort to in the Revolutionary War to ultimately throw off the yoke of tyranny under King George. We also fought a bloody civil war to try to resolve some of our differences. I pray God that we don’t ever get to that point again. In between these two extremes would be an approach that utilizes established remedies that reside mostly with the People acting through their State governments. It is, after all the People acting through the States who wrote the Constitution and established the federal government. It would seem logical that when the federal government will not right itself or yield to the desires of the People the State governments should step in. They can assert their power through the amendment and convention process. This can be a very dangerous procedure if unfriendly factions gain control of a Constitutional Convention and take it off in directions that would be disastrous for the good of the nation. However, given what is happening now inside the government, this might be worth the risk. Could things really get any worse? Perhaps and perhaps not. But I believe that we have arrived at a crossroads in the history of our nation. These are desperate times and may call for desperate measures if we are to preserve our freedoms and liberties; if we are to preserve our Republic and Constitution and pass on something to our children that resembles the nation that we inherited. Our health care system certainly needs some improvement. Given that, though, it is still the best on the face of the earth. And the fixes should be done at the State level with targeted solutions that preserve our freedoms, liberties and the free market system--which is the best hope for providing the most benefit for the most people without bankrupting the nation.

I pray that this will be our finest hour, that we will act in a manner deserving of the trust placed upon us by the Founders and Framers to guard the Republic and Constitution. They have given us a great gift. The question is can we keep it? We cannot afford to lose it.

The Morning/Mourning After Bill

In mourning,

I renounce my citizenship in this fascist country of Adolph Obama. He, Pelosi and Reid should be impeached for treason and imprisoned for the willful, blatant violation of the Constitution, the Supreme Law of the Land. Then Congress should be dissolved and a new one elected immediately. We can’t wait until November. As a God-fearing, patriotic American I cannot and will not participate in, subject me and family to and obey this illegal, unconstitutional piece of crap legislation; neither as a citizen, taxpayer or physician. Let it be perfectly clear, the federal government has declared war upon the American people. May God have mercy upon us all and may He preserve a remnant of the Constitution and the Republic so that America may be reconstituted for our posterity at some future time.

Lady Liberty Weeps

Tonight the Congress of the United States of America has committed an act of treason, blatantly violating the United States Constitution. I hold all who voted for the Health Care Reform Bill as traitors. The Republic of the United States of America has ceased to exist. I renounce my citizenship in this illegal, extra-constitutional nation. I will not participate as citizen, tax-payer or physician in this heinous action. The federal government by this action has declared war upon the American people. May God have mercy upon us all.

Physician Heal Thyself

In the early 1970's I recall a speaker at one of our PreMed/PreDent Society meetings in college. A physician from Dallas had a warning for we future doctors. He strongly admonished us not to sign contracts with private insurance companies (pre-dates HMO's) or Medicare/Medicaid, not to accept payment from these plans but only direct cash payments from the patients and not to allow these plans to set our fees or demand discounts. We should certainly provide billing statements for the patient to get reimbursed from their insurance providers and for big bills allow them to collect first and then pay us. But our fee is our fee and whatever they can get reimbursed from their insurance plan is what they get. The contract is between the plan and the patient, not the doctor. The physicians should not be parties to insurance payment contracts with patients. Boy was he right! Sadly, because health insurance became tied to employment without the option of portability or the ability to buy across state lines or the ability of small groups to band together to buy cheaper policies; large insurance companies began going to large employers, signing up their huge workforce and then going to doctors demanding contracts with them for discounts and set fees in order for the doctor to keep his patients and the patient to keep their doctor. Nothing more than high-tone extortion of the doctors by the insurance companies. During that time period the American Medical Association represented about 70% of U.S. physicians but was totally ineffective in heading off this bastardization of the physician-patient relationship. It was during this same time that MediCare instituted Diagnosis Related Groups (DRG's) which dictated to doctors and hospitals how they could treat patients for various afflictions and how long they could be kept in the hospital. Again, the A.M.A. was unable to avert this train wreck. This heralded the decline of the influence of the A.M.A. as its leadership was taken over more and more by leftists in bed with the government. Membership began to bleed off to the point today where only about 17% of U.S. physicians belong. Yet the media and government love to run to the 'doctor's union' anytime they want to report what doctors think about this or that. Pure poppycock. It is now a toothless tiger. The fact that virtually all physicians are under contract with myriad insurance plans and with Medicare/Medicaid, that their fees are set by these entities, that they must accept discounted fees to be allowed onto the plans and that many practices are actually owned outright by the plans thus making the physicians merely employees or contractors has totally perverted the cost/price/value equation beyond recognition. This is one factor responsible for ballooning health care costs; the separation of the provider from the consumer in the payment of fees for services rendered. Doctors don't know how much stuff costs and neither do the patients. People don't know if they're getting a good deal or not. All the doctor knows is that many times he has to argue with some non-physician to get a test done. If the doctor and patient know exactly what everything costs they can sit down and discuss the treatment plan and various options that provide the best care for the best price. Giving the patient more choices in the health insurance marketplace by allowing portability from the severing of health insurance from employment, allowing insurance companies to sell across state lines and allowing small groups to band together and buy better priced large policies would be a good start in bringing down the cost of health care and health insurance and making it available to a larger segment of society. In addition, getting the doctors out of the insurance picture by ending physician contracting and fee setting, having doctors be paid directly by the patients who then get reimbursed by their insurance plan at whatever rate they have agreed to would help the cause as well. Also, let individuals set up medical savings accounts similar to their IRA's. Finally, rational tort reform and scaling back onerous taxes and regulations on pharmaceutical and medical equipment manufacturers would complete the reform picture.

Who Says 'A' Must Say 'B' --WFB, Jr.

William F. Buckley, Jr. often admonished people that who says ‘A’ must say ‘B.’ The gist being that ideas and thoughts have logical natural consequences. Sometimes these consequences are not what the person had in mind when postulating ‘A.’ Many conservatives today make the argument (and quite correctly I might add) that the health care reform bills winding their way through Congress are patently unconstitutional. I believe that this position is correct within the scope of Article 1, Section 8 and the 10^th Amendment. The federal government simply lacks the authority and power to engage in these activities and to compel citizens to do or not do certain things relative to health care. The states, on the other hand would be free to pursue universal health care plans within the confines of their borders and according to their state constitutional dictates. Having posited all of this, now who says ‘A’ must say ‘B.’ Under these same U.S. constitutional proscriptions I believe that Medicare and Social Security must also be viewed in the same light; unconstitutional. They simply are not specific enumerated powers of the federal government under Article 1, Section 8. And please don’t bring up the preamble, the general welfare clause, the necessary and proper clause or the interstate commerce clause. These attempts to subvert the clear language and intent of Article 1, Section 8 have been debated to death and handily dispatched. In addition, I realize that various Supreme Courts have ruled several times in the past to uphold the constitutionality of these programs. This merely speaks to the fallibility of the court. The court is composed of mere mortals and numerous courts have been reversed and nullified. I maintain that the court is every bit as political as the executive and legislative branches. Justices are appointed by Presidents to further the administration’s agenda. And over time I believe that justices embark upon crusades for their own personal agendas. To believe that the court is painfully objective and unbiased in its decisions and rigorously faithful to the actual text and original intent of the Constitution is at best laughable and at worst dangerous. Thus, I call upon my fellow conservative revolutionaries to carry our crusade against a federal health care takeover to the next logical step of disbanding Medicare and Social Security (hopelessly bankrupt as they are) and giving the states the opportunity of taking over these types of programs if they see fit.

What We Must Do

Sunday, December 20, 2009

Colorado Springs, Colorado

I believe that the Congress and Obama Administration have profoundly underestimated the groundswell of grassroots opposition to this illegal, unconstitutional monstrosity called a federal health care reform bill. If this bill passes, it may become the proverbial line in the sand, the final straw that breaks the camel’s back, the crossing of the Rubicon, the burning of the ships and bridges, the shot heard round the world. This could be an 1860 moment in history. We are fast approaching a critical mass of opposition to the slide away from our constitutional moorings that began under Woodrow Wilson and accelerated under Franklin Roosevelt. The disrespect and utter contempt that our current ‘public servants’ display for the Constitution, the rule of law and the people who still adhere to the Constitution’s tenets is unparalleled. In my lifetime I have never seen such condescending, flippant attitudes toward our heritage and the body politic. It chills me to the bone.

In short, the Constitution simply does not allow this bill and at least 57% of the American people say they don’t want it. Do our ‘leaders’ give credence to either, much less both realities? No, they spit upon the Constitution and in the eyes of the people they serve, who put them where they are and pay their salaries. Hell must have a special place reserved for such as these. They are not fit to ‘serve.’ They should be removed from office immediately, if not imprisoned for violation of the Supreme Law of the Land. Mark my words, with God as my witness a day of reckoning is coming. A sleeping giant is awakening. We have endured the intentional erosion of our God-given freedoms and liberties by our federal government longer than any people should have to and remain obedient. Our very Declaration of Independence proclaimed that mankind is more inclined to suffer abuses as long as they are sufferable rather than take drastic action to right them and perhaps alter or throw off an abusive government and form a new one. But, it warns that when such abuses become so egregious and long-standing then people have not only a right but a duty to take such action as is necessary to alter or abolish the offending government and institute such changes or new form of government as is necessary to redress the injustices. The patience of the American people is growing strained and thin.

Many pundits tell us that we should direct our remedial anger to the ballot box; throw the bad seed out and replace them with better politicians. Sadly, we have been trying this for over 200 years and the situation only grows more dire with each passing election. The federal behemoth has taken on a life all its own, consuming well-meaning politicians and amassing more power unchecked and unhindered by the tinkering of elected officials who quickly come and go. It overruns checks and balances, ignores constitutional restraints and intimidates the states into submission while it sucks out their very sustenance; bringing everyone and everything under its control. There is hardly any nook or cranny of existence that the federal government does regulate, control or tax. This was explicitly not the intent of the framers. The federal government was to have a few specific enumerated powers necessary for the good of all the people and states, but very limited and constrained by Article 1, Section 8 of the Constitution. The states, on the other hand were to be the laboratories of democracy. They wrote the Constitution that created the federal government for their benefit and to serve their purposes, not vice versa. They are not mere political subdivisions of the federal government. They are the sovereign governing bodies with the most power; being closer to the people they serve. It is ludicrous for the federal government to dare think that it can order them around, trample their authority and direct them to raise taxes and spend money against their will. But that is exactly what has happened. With the clarity of the 10^th Amendment I cannot for the life of me understand why the states have cowered so before the federal altar. No doubt it is due in large part to the boatloads of money (that ironically comes out of the pockets of taxpayers in the several states) that the federal government dangles in front of the states, asking only in return their complicity and acquiescence to unlimited federal power. It is time for the states to reassert their supremacy and return the federal government to its appropriate constitutional role. We must remind those in Washington that they serve by the consent of the governed, not in spite of them. The federal government must once again have a healthy fear of the states and the people it serves instead of the people fearing the federal government. A letter from a citizen to an elected servant should strike infinitely more fear in their hearts than a letter to a citizen from the Internal Revenue Service.

If ballots are ineffective in bringing about the needed change, what other means do we have at our disposal? First of all, surely not bullets as was the case in 1860. Then how about defunding the government? Well, the people lost the power to defund the government by withholding our ‘voluntary’ income tax payments when, during World War II a temporary, emergency process was instituted requiring employers to withhold and send in tax payments automatically on behalf of their employees to insure a continuing stream of money into federal coffers to fund the war effort. Apparently, word of the end of the war in 1945 has not yet reached Washington, as this ‘temporary, emergency’ measure is still in force. Word to the wise, a federal program once begun never ends. The next closest thing to immortality after personal salvation is a federal program. Additionally, I seriously doubt that enough companies would band together and withhold the payments to make any sort of dent in the revenue or statement to the elected officials. And don’t look to the federal courts for any help. In my opinion federal judges, including Supreme Court justices are merely political appointees with personal agendas ensconced for life and accountable to no one. Then what about civil disobedience? Would enough doctors refuse to participate in this health reform fiasco to make a difference? Would enough people or companies or states refuse to participate to make a statement? Would enough companies refuse to participate in Cap &Trade to make it null and void? How would such movements be organized and implemented? What would be the federal government’s response? No one really knows. It would seem that given the history of our separation from England, the writing of the Constitution and the formation of the federal government, we should direct our hope to the states. After all, the 10^th Amendment clearly gives all powers not specifically allocated to the federal government to the states. If the framers had intended for the Constitution to be a blank check of power to the federal government (Article 1, Section 8 notwithstanding), then why a 10^th Amendment? The answer, of course is that they never intended for the federal government to amass such power and control over the day-to-day lives, fortunes and businesses of the American people. They would never have dreamed that the reach of this central government they had created would become so all encompassing. To safeguard any such eventuality they spelled out the specific powers it was to possess in the body of the Constitution and then added an additional safeguard in the 10^th Amendment, ensuring that the states would have the final say in the unlikely event the federal government were to attempt to overstep its bounds. The ultimate expression of state power is the constitutional amendment, the only legitimate path to altering the express or implied meaning of the Constitution. I believe that the framers thought that the federal government would have such respect for the supremacy and almost sanctity of the Constitution and fear of the people that it would never dream of grossly overstepping its authority. This belief was based upon the idea that a representative democracy such as this could only function successfully if the population was informed, engaged and moral. Sadly the liberal control of education over the last 50-60 years has resulted in a pathetic misunderstanding of our nation’s history, heritage, economic and political structure within a large segment of our population. One only has to look at the behavior of our politicians over the last decades to realize that any moral foundation has been utterly lost. In addition, the blurring of lines between political parties and the feeling of a single person’s helplessness in the face of a gigantic federal juggernaut has instilled a pervasive apathy (until very recently) across the electorate.

Is sufficient time left for the people to organize and seize the reins of their state governments so as to reassert their rightful power over the runaway federal government under the aegis of the 10^th Amendment? Or have we already passed the point of no return down the slippery slope to socialism, decay and demise? Only the passage of the next few years will tell. There are signs that people are beginning to awaken to the reality of what is happening. History tells us only about 2% of the American colonists actively supported the Revolution. That would be about 6 million people today, fewer by far than listen to Rush Limbaugh alone in a week. The hope for the survival of the Republic and a future for our children and grandchildren hang on these. We must encourage them to educate and enlist others in this fight. We must peacefully resist the illegal encroachments of the federal government when and where possible. We must organize and move to nudge or take control of state governments to reassert their constitutional power and authority. This is a fight we cannot and must not lose, for as John Adam’s character in “1776” ponders;

“Is anybody there?

Does anybody care?

Does anybody see what I see?”

May God save and bless the Constitution and Republic of the United States of America.