Boondoggle?

The Patient Protection and Affordable Care Act (ACA) became law on March 23, 2010. Appearing at a January 2012 symposium, MIT professor Jonathan Gruber stated, “What’s important to remember… if your state hasn’t set up an Exchange, your citizens don’t get their tax credits (that fund their costs of participation in the ACA program), but your citizens still pay the taxes that support this bill.”

Gruber, who advised the Massachusetts legislature when it created Romneycare and the President’s administration when it crafted the Obamacare legislation, went on the explain: “So you’re essentially saying to your citizens, you’re going to pay all the taxes to help all the other states in the country.”

“We just tax the insurance companies. They pass on the higher prices that offset the tax break we get. It ends up being the same thing. It’s a very clever, basic exploitation of the lack of economic understanding of the American voter,” Gruber said in remarks in 2012 that aired on the television show, “On the Record with Greta Van Susteren.” On another occasion, Gruber said, “lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter, or whatever, but basically that was really critical for the thing (the Affordable Care Act) to pass.” At a separate event, while talking about tax credits in the Affordable Care Act, Gruber said, “American voters are too stupid to understand the difference.”

Recently, the Supreme Court has agreed to hear the legal challenge to the ACA legislation that asks if the ACA should be taken literally as outlined in the King v. Burwell brief. The core question raised by the brief is it constitutional for the citizens in states without State run exchanges to be able to use tax credits for payment of their health care fees in the exchanges?

Even though the Supreme Court has ruled that the ACA is constitutional, its ruling was based on the premise that the law was not a mandate, but a tax that is under the constitutional authority of the Congress.  At the same time, the high court ruled that the individual states reserved the right whether or not to establish an Exchange. If not, the law left it up to the federal authority to establish an Exchange in those states. The Supreme Court will hopefully sort out this question.

The important point raised by Jonathan Gruber’s presentation on this and evidently, at least, on four other occasions, was did the President and members of his administration willfully deceive the members of the Congress and certain influential members of the business and medical community into supporting his legislation.

Can patients keep their health plan if they want? Can they keep their doctor? The President told them they could. In the literal sense he was right. If they are willing to pay enough for their coverage, or out of their pocket! It would not necessarily be with their previous doctor or their previous insurance carrier, since some of these plans may no longer be available.

What about the health insurance companies that cannot afford to meet the criteria outlined in the ACA mandates for coverage? Are they being forced to raise their rates to noncompetitive levels, or will they drop out of the health care market all together? Where was that conversation brought into the dialogue before the vote in Congress was taken? Or when eliciting the support of the Board of Directors of the American Association of Retired Persons and the Board of Trustees of the American Medical Association?

Were these the revelations, Congresswoman Nancy Pelosi revealed to the press when she was quoted on Mar 09, 2010,  “we have to pass the  (health care) bill so that you can find out what is in it.”

The questions that should now be asked of our elected representatives in Washington, D.C. are: Do they still feel that they were correct in their support for the proposed ACA legislation, given these new revelations concerning transparency? In retrospect, did they perform their due diligence before they cast their vote in early 2010? After hearing Jonathan Gruber’s presentations, do they feel that the President and his administration knowingly deceived them?

The same questions should be asked of the leaders of two of this country’s largest medical organizations— the American Medical Association (AMA) and the American Academy of Family Physicians (AAFP),* that have supported and continue to support most of the proposed mandates put forth the in the Affordable Care Act.

*AAFP Letter Regarding Support for the Patient Protection and Affordable Care Act, www.aafp org. Mar. 2009, 2010.

‘Working for the Man’

It’s time for a reality check! The independent physicians are rapidly disappearing. Replacing them are contract and salaried physicians, whose income is based on their skill sets, seniority or productivity. In all these employment models, their reimbursement does not come directly from their patients, but from some third party.

In the 1970s, doctors first agreed to accept assignment as full payment for their services. It wasn’t the onset of private health insurance and not the Medicare program, not even when these programs set out the fee schedules that the payers would reimburse their enrollees. It was when the providers of services (doctors) agreed to accept those rates as full payment. That’s the beginning of when doctors started ‘working for the man‘— an often-quoted idiom used when independent decision-making and control of one’s own self interests are subverted to superiors.

Initially, this seemed innocent enough. Patents were being reimbursed by their insurers, and were in turn, supposed to turn the money over to their doctors. Knowing that many doctors were reluctant to rely on collection agencies, a few patients kept the money. Since the practice was becoming more commonplace, in increasing numbers, doctors made arrangements with the insurer for direct reimbursement, feeling that the payers’ reduced payment was better than nothing.

Dial ahead to the advent of managed care health care systems, which linked reimbursement to improved efficiency on the part of the providers— more specifically, the capitation systems that set out total reimbursements to a fixed group of providers for a fixed group of patients over a defined time. Again, the man is setting not only the fees charged, but also the reimbursements that would be accepted.

It is estimated that by next year, about 50% of U.S. doctors will be working for a hospital or hospital-owned health system. A recent survey by the Medical Group Management Association shows a nearly 75% increase in the number of active doctors employed by hospitals or hospital systems since 2000, reflecting a trend that sharply accelerated around the time that Obamacare was enacted.*

Many factors have contributed to this trend: The growing complexities of the rapidly expanding base of medical knowledge, necessitating ready consultations across specialties. The variances in the requirements of the reimbursement models. The changes in attitudes of the emerging physician population that they would give up some of their independence, rather than fight the intrusions restricting their ability to care for patients.

Fearful of being left out of the panel selection with the payer contracts, many doctors are or have joined with other physician groups (PPOs) or have sold their practices to hospital run and owned organizations. As competition becomes more intense with health care carriers, the independent PPOs find themselves, either creating arrangements with the hospitals with respect to revenue distribution or are being taken in by these hospital systems.

With the number of health care payer options narrowing, the providers of health care services concentrate into fewer, but larger and more inclusive, entities. The physician participants within these systems increasing loose control of their decision-making, and also become distanced from the payer. Thus, the increasing control over physicians by these multidisciplinary health care delivery systems— the integrated managed care consortium Kaiser Permanente is an example that was founded in 1945.

Now introduce the Affordable Care Act’s formation of the State and Federal Exchanges. Couple that with Medicare and the expansion of the states’ Medicaid coverage. Allow the Individual Mandate and the Employer Mandate requirements of the ACA to be fully implemented.

What is the future for private heath care insurers in this scenario? Many insurers will find other markets in which to provide coverage. The remaining carriers may consolidate or continue to go it on their own. Because of the mandates set out in the ACA, with respect to what their policies must cover, the private insurers will be increasingly at a disadvantage as they compete with the coverage offered by the Exchanges that are shored up with government subsidies.

If the Employer Mandate and the Individual Mandate clauses of the ACA are fully implemented in their current form, it will totally rewrite this country’s health care payment model. Over time, employers will increasingly dump their employees into the Exchanges as the costs of the private coverage options escalate. With a shrinking patient base and without federal subsidy support to meet the coverage demands outlined in the ACA, the private carriers will not be able to compete. Those individuals who aren’t eligible for Medicaid or Medicare and are not covered by the Employer Mandate provision will be forced to pay the escalating premium costs for private coverage, turn to the Exchanges or pay the fine and go ‘uncovered’.

With the physician population moving voluntarily into a subordinate role in these multidisciplinary health care delivery systems, and the Exchanges poised to squeeze out the remaining so-called private health care payers, the end result seems obvious. Most physicians will be hired, fired and reimbursed by an entity that derives its primary revenue stream from federally funded programs. The owners of the treatment facilities may not be the federal government in the projected United States model, but with the main revenue stream coming from government funding, by default, it becomes a single payer system— just a variant of socialized medicine painted in red, white and blue. **

My physician father warned me in July 1965, when President Lyndon Johnson signed the Social Security Amendments into law creating the Medicare program, that it was only a matter of time that time until socialized medicine would take over.

Physicians should have seen it coming: Accepting assignment, instead of collecting from their patients. Managed care arrangements under a capitation model. Agreeing with the hospital based systems to broker with the payers on their behalf. Willing to give up many of our freedoms to avoid some of the hassles in their practices. Finally, supporting legislation (ACA) that defaults to a single payer, because the law is unsustainable in its current form.

Make no mistake. Within the next decade, our once noble and independent profession will be “working for the man.”

*Graham, J.R., Free of Obamacare Taxes, the Future of Health is Digital, NCPA POSTING, October 22, 2014.

** Socialized medicine is, by definition, a health care system in which the government owns and operates health care facilities and employs the health care professionals, thus also paying for all health care services.

Should Our “Squatters” Get a Free Ride?

This country is utopia to many disadvantaged around the world. When they take up residence in this country illegally, they become squatters that are slowly, but surely, causing irreparable harm to the American dream. 

The number of people residing in the United States illegally is reported to be now well over 11 million, although some estimates range up to 30 million. With the recent deluge across our southern border, that number is increasing by the hundreds to the thousands daily. Although this country has immigration laws to address these individuals once they enter this country, many skirt the system, blending into the community, almost unnoticed. In a very real sense, they are the “squatters” of American society, enjoying the privileges and many of the benefits earned by those who reside here legally — protection from harm, emergency medical care, public education, and automatic citizenship for their children if they are born in the United States.

Traditionally, squatters are individuals that occupy property they do not own, rent, or have lawful permission to use. In many aspects, illegal aliens are this country’s squatters, using the property or resources of others without permission.  While squatters of land usually occupy property of others that is not being used, these illegal inhabitants in the United States are using and consuming resources that could benefit others who have a legal right to those same resources. The incurred costs are then passed on to those legal citizens or added to the debt for future generations to resolve.

According to the National Research Council, the costs, to the American taxpayers of 11 million illegal aliens, is estimated at $346 billion annually. In 2013, the Center for Immigration Studies estimated the medical costs for uninsured individuals at $4.3 billion/year, primarily through emergency rooms and free clinics. This number doesn’t include the billions of dollars more that are being adsorbed by the hospitals for in-patient care. (1)

Reportedly, illegal immigrants, who have not paid anything into the Medicaid program, are receiving about $2 billion/annually in benefits under the Emergency Medicaid program as part of a state-federal health insurance program for the poor. Babies (called anchor) born in this country to non-documented parents are automatically granted citizenship. It is estimated that, through the numerous entitlement programs of which these infants are eligible, they generate costs to the United States at a current rate of $58 billion/year. (2)

In 2012, more than one-fourth of the prisoners in our federal institutions were illegal aliens.  Another 297,000 were incarcerated in state and local prisons. The estimated costs, in a 2010 study, were $7.8 billion annually on a federal level, and $8.7 billion to the state and local governments. Data collected in the State Criminal Alien Assistance Program system in 2009 also suggests that nationally the illegal alien population has a higher criminal incarceration rate at 5.4 percent compared to the overall population at 3.9 percent. In a Congressional Research Service report in 2012, if not deported upon their release, nearly one-sixth of these incarcerated illegal aliens were subsequently arrested again. (3)

Estimates of at least $35 billion of the wages earned by our illegal residents are sent back to their families in their native country and not spent here in the United States. (4) Much of their revenue is through cash transactions and does not move back into the coffers in the form of tax revenue that funds many of the programs that support the public education, highway construction, hospital funding and military protection that shore up their existence here in this country.

The ongoing costs from lost taxes, incarceration expenses, entitlement program payments, education expenditures and medical benefits incurred by illegal aliens are unsustainable. Although almost everyone agrees that effectively closing the border is the only answer, the other concern is what to do with the illegal aliens who have already become a part of the community and those who illegally pour across our border in increasing numbers.

There are two pervious events that have attempted to address immigration reform that should serve as lessons for the leadership in Washington. The first is President Ronald Reagan’s Immigration Reform and Control Act (IRCA) that he signed into law on November 6, 1986. In turn for granting an estimated four million illegal immigrants eligibility for legal status, the new law theoretically required employers to attest to their employees legal status and made it illegal to knowingly hire or recruit illegal immigrants. Although there were rough times getting the final bill to Reagan’s desk, with bipartisan support and no prior legislative experience in addressing immigration problems, he signed the bill into law. Approximately 2.7 million immigrants took advantage of the new law. (5,6)

Most historians consider IRCA a failure. Agricultural employers shifted their efforts to finding alternative sources of foreign labor, through temporary worker programs. Many employers started hiring through subcontractors, which allayed some of their liability since the workers were not their direct employees. The enforcement requirements, such as employer sanctions for violators, were spotty or, in some cases, never materialized. (5,6)

The second event is President Obama’s Executive Order on June 15, 2012 that created the Deferred Action for Childhood Arrivals (DACA) program. According to some experts, the President was chiding Congress for not passing the controversial Dream Act. The program, created by the President’s mandate, allows undocumented youth, who entered this country when they were less than eighteen, to stay temporally, but does not grant them permanent legal status. They are eligible to obtain documents that will allow them to stay and work, but this only applies for a two-year period. At the end of that time, they must re-file for an extension under the program. (7) The consensus, by many in Washington, is that the President’s Executive Order, at the very least, set the stage for the recent deluge of unaccompanied minors and families from Central America that are flooding across our southern border. (8)

Robert Rector, published Heritage Foundation Web Memo #1490 on Immigration on June 6, 2007. Even though the article was created to address the concerns raised in the debate over the Senate Bill: Secure Borders, Economic Opportunity and Immigration Reform Act of 2007 (S. 1348), Rector’s conclusions should give the President and members of Congress reason to pause. Using the demographics of the illegal immigrant population that were being considered for citizenship, he concluded, “the increase in taxes and fines paid by amnesty recipients may initially slightly exceed the increase in government benefits received. In the long run, however, the opposite will be true. In particular, the cost of retirement benefits for amnesty recipients is likely to be very large. Overall, the net cost to taxpayers of retirement benefits for amnesty recipients is likely to be at least $2.6 trillion.”(9)

Our leadership in Washington has reached a stalemate over the illegal immigration issue, not necessarily over what is right, versus wrong, but what is in their particular political party’s best interest— what benefits the Democrats the most in future elections and what hurts the Republications the least. These elected officials might just be pitting the future of our own children against the ‘squatters’ that have taken up residence in our country illegally. Sounds cruel, but that’s the reality!

Follow amnesty to its conclusion. Former ‘squatters’ become legal citizens. As before, they work, but now they will pay taxes and vote. Demographics point out that 49 to 61 percent of adult, illegal immigrants lack a high school diploma versus 9 percent of native-born adults. Additionally, they have twice the poverty rate. (9) How much will they rely on the state and federal entitlement programs? How likely do you think they will be to vote for those who support for expansion of their entitlement benefits?

Those answers could be just an Executive Order away — but that would be after the November election! (10)

“And six years ago, I asked you to believe, and tonight, I ask you to keep believing, not just in my ability to bring about change, but in your ability to bring about change. Because in the end, DREAMER is more than just a title, it’s a pretty good description of what it means to be an American.” *(11)

* Dreamers are young people who were brought to this country illegally as children.

 References:

 

  1. http://www.moneynews.com/NealAshbury/Immigration-healthcare-illegal-emergency/2013/05/09/id/5023579/
  2. Tenery, R., Birthright Citizenship: The Silent Costs, Echos, for the Future December 10,2010.
  3. http://www.fairus.org/issue/criminal-aliens
  4. http://www.renewamerica.com//bb/viewtopic.php?f=5&t=13844
  5. http://wikipedia.org/wiki/immigration_Reform_and_Control_Act_of_1986
  6. http://dailycaller.com/2014/02/06/reagans-amnesty-didnt-work/
  7. http://www.brookings.edu/Reasearch/Reports/2013/08/14-daca-immigration-singer
  8. http://www.ocregister.com/articles/obama-630087-immigration-daca.html
  9. http://www.heritage.org/research/reports/2007/06/amnesty-will-cost-ustaxpayers-at-least-26-trillion
  10. 10.  http://the hill.com/blogs/blog-briefing-room/news/219137-aide-obama-will-make-good-on-immigration-promise
  11. 11.  President Barack Obama, address to the Congressional Hispanic Congress, October 2, 2014.

The Crisis of Truth in the White House

 

In my adult life, I have witnessed four Presidents that, in one way or another, have been involved in situations that have created questions concerning their credibility and that of their administrations.

The first was Nixon and the Watergate break-in at the Democratic National Committee Headquarters on June 12, 1972. Although some may disagree, if it were not for the dogged efforts of investigative reporters, Carl Bernstein and Bob Woodward, at the Washington Post, Nixon’s unlawful act might have gone undetected. The Watergate scandal drove Nixon out of office, not necessarily because of the act itself, but for the cover-up he perpetuated.

Next, was President Bill Clinton and his tryst with White House intern, Monica Lewinsky. Although his escapades with the young intern did irreversible damage to the reputation of the office of the President, it was his lying to Congress that moved the House of Representatives to vote to impeach him.

In March, 2003, President George W. Bush authorized a massive invasion of Iraq that came to be known as Operation Iraqi Freedom. The justification for President Bush’s decision was to wipeout Iraq’s chemical weapon reserves and remove Saddam Hussein from power. Bolstered by Hussein’s history of using chemical weapons on the Kurds in 1988, the dictator’s lack of cooperation with United Nation’s Special Commission (UNSCOM) inspectors and his invasion of Kuwait in 1990, Bush won the overwhelming support of Congress for the United States’ invasion, as well as the support of his predecessor, Bill Clinton. Although no weapons of mass destruction were ever found, based on the best intelligence available, the President believed he was right calling for the invasion. Bush’s intelligence turned out to be wrong, but the President and his representatives did not intentionally mislead the American people and Congress.

On September 11, 2012, the American Ambassador to Libya and three other American citizens were attacked and massacred by Islamic militant terrorists in Benghazi. The initial report, by Secretary of State, Hillary Clinton, was that the attacks were a spontaneous protest, triggered by an anti-Muslim video, Innocence of Muslims.  Witnesses on the ground, as well as those who made up the United States military presence in the area, quickly determined that this was not a spontaneous attack triggered by the anti-Muslim video, but a planned act of terrorism. The Secretary of Defense, Leon Panetta, testified he personally broke the news to the President that the U.S. diplomatic post was “under attack” that night.

A recently revealed email, dated September 14, 2012, by Ben Rhodes, President Obama’s Deputy National Security Director for Strategic Communications, to the United State’s UN Ambassador Susan Rice and other higher ups in the Obama administration, encourages Rice to underscore that “the events in Benghazi were protests instigated by an Internet video and not a broader failure in the President’s policy on Al-Qaeda.” Ambassador Rice then testified on the Sunday morning talk shows on September 16 to that effect.  Two weeks later, the President still referred to the Benghazi attack as rooted in protest to the anti-Muslim video, when clearly all those directly involved in the attack knew that the President’s assertions were not based on the facts.

There is no concrete proof that the close proximity to the upcoming November 6, Presidential election played a role in the administration’s apparently incorrect assertions in the face of conflicting evidence. However, the implications have raised suspicions that, hopefully, will be addressed by the upcoming House of Representatives’ Select Committee’s investigation.  Either the President and his administration will be exonerated or, as with the Watergate scandal that ended Nixon’s tenure, Obama’s continuing influence while he is in the White House could be in question.

Increasingly, the media has exerted its own opinion into ‘reporting’ the news; at least as how they see it.  During President Kennedy’s tenure, his numerous indiscretions barely caused a blip. It was as if the media took on the role of protecting his legacy, like they had for at least several of Kennedy’s flirtatious predecessors. The exposure of Nixon’s attempted cover-up may have been the media’s finest hour, as the disgraced Nixon waved his tearful farewell before boarding the ‘Air Force One’ helicopter, rather than face an almost certain impeachment. Then Clinton came along with multiple tales of infidelity long before he ascended to the Presidency. The press seemed almost numb to Clinton’s escapades, until a confidant of White House intern Monica Lewinsky, Defense Department co-worker Linda Tripp, turned over her secretly recorded tapes of telephone calls where Lewinsky shared stories of her escapades with Clinton, to Kenneth Starr, the Independent Counsel, who was investigating him on other matters. Only when Clinton was caught in a lie over the meaning of having sex, did he face the humiliation of impeachment.

As the first African American to rise to the office of President with an agenda of ‘Hope and Change’ creating new opportunities for the downtrodden and the oppressed, Barack Obama became the standard bearer for the liberal media. To them, his assent to power was akin to the ‘second coming’ after John Kennedy. From the start of his first campaign for the nation’s highest office, the media coddled him. Even today, in the midst of scandals over Benghazi, the continuing flood of illegals across our southern border, the IRS, the NSA and the VA, they faithfully shelter him from the ‘hard’ questions.

The appointment of the House of Representatives’ Select Committee to fully investigate the Benghazi tragedy could be Obama’s day-of-reckoning. If the committee members can put aside their bias, the truth should eventually come out.

If the conclusion of the Select Committee favors the President, the Republicans could lose big time in their fight to regain control of the Senate. Additionally, a win would surely carry on to a Democratic victory in the next Presidential election in 2016.

If the Democrats on the Select Committee try to stonewall the efforts of the committee, their party will be seen as obstructionists. If they willingly participate, and the findings go against the President and his administration, there is a reasonable chance that they will have given up any opportunity for control of the nation’s capital for the next six years.

To echo the ill-fated comment of ex-Secretary-of-State, Hillary Clinton, when she blurted out, “What difference, at this point, does it make how these men died?” before the Senate Foreign Relations Committee in January 2013. The answer is a lot! It matters that the State Department failed to act on Ambassador Stevens’ request for more security for the U. S. Diplomatic mission. It matters that when the attack began, and even when it was continuing throughout the night, no American forces were deployed, until it was too late to save those four American lives. It matters that our President and his representatives continued to call the assault on the mission a ‘random act of reprisal’ because of an anti-Muslim video, instead of a planned terrorist attack, even in the face of overwhelming evidence to the contrary.

Not to take anything away from the importance of the tragic loss of four American lives, the Select Committee will try to determine if our President and his representatives lied to the American people. Secondarily, if the ruse over the inflammatory video was a lie, was it done to protect the President’s claims that he had Al Qaeda ‘on the run’, and thus, hoping to assure him a second term in office?

The ability of the Select Committee to get to the ‘truth’ is not only a referendum on this President, but also a test of the credibility of the media in this country that support him.

 

 

 

A ‘Fox’ in the IRS’s Henhouse

When President Nixon waved goodbye to his staff on the steps of the Marine One helicopter that would carry him off the White House lawn for the final time, it was the culmination of the Watergate scandal. A break-in at the Democratic National Committee headquarters, orchestrated by individuals in the Nixon administration (G. Gordon Liddy, Jeb Magruder, John Mitchell, E. Howard Hunt, John Dean and James McCord), and the attempted cover-up by the President and his staff that resulted in the President’s resignation from office, rather than face almost certain impeachment. One piece of evidence that was central to the case against the President was an 181/2minute gap in a tape recording from the Oval Office, allegedly between Nixon and his Chief of Staff H. R. Haldeman. According to the President’s secretary, Rose Mary Woods, she made ‘a terrible mistake’ during her transcription, resulting in the gap in the recording. It wasn’t what was in the recording, but what was not, that raised the country’s suspicion that Nixon was complicit in the operation and the cover-up— a level of distrust and doubt that ultimately forced him out of office.

In 2013, the Internal Revenue Service (IRS) made public that it had targeted ‘selected’ political action groups applying for tax-exempt status between 2010 and 2012 for ‘intensive’ scrutiny, based on their names or political themes. Appearing before the Congressional House Ways and Means Committee, acting IRS commissioner, Danny Werfel, testified that IRS officials inappropriately flagged progressive groups seeking tax-exempt status, in addition to tea party and conservative groups.

In a letter to Representative Sandy Levin, the top Democrat on the Ways and Means Committee, from J. Russell George, the Treasury inspector general for tax administration (TIGTA), George revealed that there were 298 political groups brought up for a closer review between May 2010 and May 2012. Of the six that had the words progress or progressive in their name, one-third were singled out for further scrutiny. He continued by pointing out “in comparison, our audit found that 100% of the tax-exempt applications with Tea Party, Patriots, or 9/12 in their names were processed during that timeframe.”1

The impetus for this investigation appeared to have had its roots when the U.S. Supreme Court handed down a ruling in Citizens United v. Federal Election Commission on January 21, 2010. It overturned most previous restrictions on political campaign spending and permitted nearly unlimited and usually anonymous spending by corporations and other groups that often influenced election outcomes.

The New York Times reported: Almost all of the biggest players among third-party groups in terms of buying television time in House and Senate races in August, have been 501 (c) organizations, and their purchases have heavily favored Republicans…2

Shortly after the New York Times article was published, Senator Max Baucus, Democratic chair of the Senate Finance Committee, asked the IRS to look at nonprofit organizations’ compliance with IRS rules.

During the review period, the IRS did not deny any applications of organizations with Tea Party, patriots or 9/12 in their names, but only 4 were approved.  During about that same period, several dozen organizations whose name included progressive, progress, liberal or equality were approved. For many of the conservative or Tea party leaning organizations, their applications were placed in an ‘Emerging Issues’ category by the IRS, which was flagged for additional questioning and months, even years, of further delay on their final disposition.

Steven Miller, the IRS’s acting commissioner, and Lois Lerner, director of the agency’s exempt-organization division have claimed that the IRS officials began the scrutiny of these politically leaning groups after they found a surge in the number of applications for status as 501(c) ‘social welfare’ organizations. Both officials claimed there was an increase from 1,500 applications in 2010 to almost 3,500 in 2012. Several points appear to contradict their assertion: First, Lerner originally attributed the increase in reviews to low-level workers in the Cincinnati IRS office, but those workers told Congressional investigators that they “were acting on orders from Washington.” Second, the increased reviews, starting March 2010, began before any significant increase in filings by these ‘social welfare’ groups could have been detected. Finally, the actual number of 501(c) applications was less in 2010 than in 2009.3

Chairman Darrell Issa and his fellow Congressmen on the Oversight and Government Reform Committee are trying to determine exactly who gave the orders for IRS agents to target these groups. Lois Lerner, who retired from the IRS in September 2013, has ended up at the center of focus in the IRS scrutiny scandal. “(Lerner) was in a powerful position and could have been acting alone,” quotes Issa. He further explains that Congressional documents suggest that she was under political pressure to ‘orchestrate’ the targeting.

Lerner admitted, at a legal conference the previous year, that the agency improperly targeted groups to added scrutiny only because they had the words tea party or patriots in their names. In May 2013, Lerner appeared before the House committee and invoked the Fifth Amendment when questioned, but not before giving an opening statement that she “broke no laws.”  In a follow up to the request by the committee for further testimony, Lerner’s attorney, William Taylor said his client would testify on Capitol Hill only if compelled by a federal court, or if given immunity for her testimony. Subsequently, Lerner was issued a Congressional subpoena to reappear before the committee, but, when she failed to comply, was found to be in contempt. Attorney General Eric Holder and the U.S. attorney for Washington will now be asked to refer Lerner to the Justice Department for disposition of her subpoena.

In the spring of 2014, IRS Commissioner, John Koskinen, promised to turn over Lerner’s emails to the committee for their investigation into her involvement. Then came the bombshell early this summer when Lerner’s attorney, revealed to the House Ways and Means Committee, that a ‘trove’ of Lerner’s emails, including those she sent to other federal agencies, were lost when her computer crashed in 2011. Lerner’s losses were not the only ones, when it was reported that six other employees in that department encountered similar problems. Although the extent of their losses was not reported, the revelation, which raises even more questions, was that one of those employees was Nicole Flax, who was chief of staff for the acting IRS commissioner at the time, and a frequent visitor to the White House and the Eisenhower Executive Office Building, The lost emails, reportedly covering from 2009 through mid-2011, closely coincided with the May 2010 to May 2012 increased IRS review period.

Tempers, on both sides, have risen to a fever pitch. The Republicans on the Congressional Oversight and Government Reform Committee feel the IRS Commissioner, John Koskinen, has not been forthcoming with Congress, because it took more than a year after the investigation had begun for the IRS to reveal the loss of Lerner’s emails. They also question Koskinen’s objectivity because it has been reported he donated nearly $100,000 to Democratic candidates and the party’s organizations over the last forty years.4

Representative Issa has made his reservations clear that someone (Lerner), with 30 years of working experience in the federal government, would not know to follow the guidelines that require emails to be printed. “We will probably never know what really happened since the IRS destroyed the hard drive,” he said.

According to Lerner in 2011, communication from the field director for the IRS headquarters’ Customer Support center, as well as, a forensic lab, confirmed that the lost data could not be recovered. “It does seem quite suspicious that these employees engaged in the controversial activities here had computer crashes, as opposed to there being a systemic crash,” said Daniel J. Metcalf, the founding director of the Justice Department’s Office of Information and Privacy. “And it is awfully suspicious that the agency has been unable to reconstruct, through a back-up system, what it says it lost.”

It is clear that Lois Lerner broke the law by not making hard copies of her emails as backup. The IRS leadership also broke the law when it failed to report Ms. Lerner’s broken hard drive and lost emails. “Any agency is required to notify us when they realize they have a problem that could be destruction or disposal,” reported David S. Ferriero, head of the National Archives and Records Administration, when he testified before the House Oversight and Government Reform Committee.

By their own admission, the IRS employees in the Cincinnati office overstepped their authority. The consequences of their illicit activities may have changed many outcomes of the 2012 elections, all the way up the line from the city, county and state house races, to the office of the Presidency itself. Impeding the voices in the electoral process should be held to the same standards as stuffing ballot boxes, or not counting votes, which are Federal crimes.5

It’s hard to imagine that the ‘intensive’ scrutiny and the ‘lost’ emails were not part of an orchestrated effort! There is a fox somewhere in the IRS henhouse, maybe several more, which gave the go-ahead for the agents in the Cincinnati office to proceed with the selective review process. And, like Watergate, possibly a skulk in the White House that was in on it too!

 

 

References:

 

1. http://www.cbsnews.com/news/irs-progressive-groups-flagged-but-tea-party-bigger-target/

2. Luo, Michael; Strom, Stephanie, Donor names remain secret as rules shift, The New York Times, September 20, 2010.

3. http://philanthropy.com/article/IRS-Rationale-for-Tea-Party/1392771

4. http://www.newsmax.com/Newsfront/attorney-lois-lerner-missing-emails/2014/06/27/id/579767/

5. http://soundpolitics.com/archives/008248.html

Houston: We Have Had a Problem!

The Russians are intruding into the Ukraine. The radical Sunni insurgents from Syria and Iraq are forming a caliphate. The injustices of Veterans Administration are just now being addressed. The political subterfuge by the Internal Revenue Service may never be fully known because of the apparent loss of Lois Lerner’s emails. All these problems potentially affect the path this country follows in the future. However, collectively, these untoward events don’t compare to the potential problems that are streaming across our southern border. Unchecked, this deluge of illegals is turning into an invasion, rather than a humanitarian crisis as described by our administration in Washington, DC.1

The players in this battle are the Mexican drug cartels, the gangs and even potential terrorists on one side. Trying to fend off this onslaught, on the U.S. side, are the outnumbered U.S. border patrol agents and the citizens of the border communities whose resources, agencies and health care facilities are being overrun. Surprisingly, it’s been difficult to determine Homeland Security’s position, except as a facilitator for the Obama administration. On the sidelines are the President and the Congress, who are apparently not willing or able to enforce current immigration laws or pass legislation that could resolve this critical situation. The pawns that are being used to wage this war are the children from third world countries to our south, who want nothing more than to grow up in an environment that is not corrupted by violence.

For the most part, this problem is by our own doing. Money has been allocated to build a fence between the United States and Mexico. For a myriad of excuses, from outright dereliction by our current and several recent past Presidents and our Congressional representatives, to political posturing, only 685 miles of this 1954-mile border has been completed. Much of the this so-called ‘fenced’ border consists of barbed-wire, vehicle barriers and inadequate materials that provide only minimal impediment for those who want to enter this country. Properly constructed fencing does work. Israel has proven that a security fence has decreased terrorist intrusions across the Gaza Strip by over 95 percent.

A decade ago, Nobel prize-winning economist Milton Friedman warned, “It’s obvious you can’t have free immigration and a welfare state.”

In 2007, senior research fellow at The Heritage Foundation, Robert Rector, published a further explanation that Friedman’s comment should be viewed as applying not merely to means-tested welfare programs such as food stamps, Medicaid, and public housing, but to the entire redistributive transfer state. “In the transfer state,” he writes, “government taxes the upper middle class and shifts some $1.5 trillion in economic resources to lower-income groups through a vast variety benefits and subsidies.”

Rector goes on to explain that the transfer state redistributes funds from those with high-skill and high-income levels to those with lower skill levels. Low-skill immigrants become natural recipients in this process. Appearing to agree is Julian Simon, the godfather of open-border advocates, who acknowledged that imposing such a burden on taxpayers was unreasonable, stating, “immigrants who would be a direct economic burden upon citizens through the public coffers should have no claim to be admitted into the nation.”

Getting to the crux of the matter, Rector points out that “elections in modern societies are, to a considerable degree, referenda on the magnitude of future income redistribution. An immigration policy which grants citizenship to vast numbers of low-skill, low-income immigrants not only creates new beneficiaries for government transfers, but new voters likely to support even greater transfers in the future.

The granting of citizenship is a transfer of political power. Access to the U.S. ballot box also provides access to the American taxpayer’s bank account. This is particularly problematic with regard to low-skill immigrants. Within an active redistributionist state, as Friedman understood, unlimited immigration can threaten limited government.”2

Looking at the pictures of the thousands of unaccompanied minors crowded into temporary shelters until their fate can be determined, I am reminded of the very effective ads put out by the ASPCA depicting abandoned animals whose only hope is being adopted by a loving owner. The desperate situation and gut wrenching stories of these displaced children tug at our heartstrings.  Looking for new opportunities and unrestrained freedoms, brave souls, not unlike these children, built this country. So why the concerns over the virtual flood of new individuals who want those same freedoms and opportunities? The simple answer centers around affordability and available resources. This country has finally come to realize that we can no longer be the world’s policeman. Now, the social issue that is dividing this nation is this country’s continuing role as a safe haven.

The consensus opinion from Washington feel the nidus for this huge influx arose when President Obama issued an executive order on June 15, 2012, creating the Deferred Action for Childhood Arrivals (DACA) program.3 There are those who feel he was chiding Congress for not passing the controversial DREAM Act.

Apparently, by the time the news of President Obama’s DACA program filtered down to South America, the message took a different twist. Instead of those who were already in this country, Obama’s mandate appeared imply that once minors were able to gain entry to this country by any means available, it was likely that they would be allowed to remain for some indeterminate time. Until the recent uproar, it seems the administration made no or very little attempt to clarify this misunderstanding. Since many of these minors arrive with no papers, it will be up to the immigration courts to determine their eligibility. Additionally, while they are waiting for their court date, they are being placed with relatives, at the government’s expense. It is estimated that between 75-95% of these children fail to show up for their court date and disappear into the existing Hispanic community.

Not everyone agrees with the explanation put out the Obama administration!

“This is not a humanitarian crisis. It is a predictable, orchestrated and contrived assault on the compassionate side of Americans by her political leaders that knowingly puts minor illegal alien children at risk for purely political purposes,” is a quote in a press release by the National Association of Former Border Patrol Officers. Representatives of this same organization went on to claim, “certainly, we are not gullible enough to believe that thousands of unaccompanied minor Central American children came to America without the encouragement, aid and assistance of the United States government.”

Although the effects of the onslaught of unaccompanied minors are rippling across the country, two states in particular are shouldering the brunt of the exodus— Texas and Arizona. On March 7, 2014, Texas Governor Rick Perry said, “We either have an incredibly inept administration, or they’re in on it, somehow or another. I hate to be conspiratorial, but how do you move that many people from Central America across Mexico and then into the United States without they’re being a fairly coordinated effort?” He went on to add that his state has already used $500 million of Texas taxpayers’ dollars to assist with the influx of illegal immigrants.

Controversial Arizona Sheriff Joe Arpaio, already a high-profile critic of the current federal immigration policy, said, “I got my own theory… I think the White House sometimes is incompetent, but I can’t imagine them doing this (transporting many of the unaccompanied minors from Texas to Arizona) without realizing that there was going to be controversy.” He went on to criticize the way the media and some of our elected representatives have been given only limited access to the refugee camps that are springing up to house the children. “Why are they hiding these kids from the media? … Well, I think I have a theory here. I don’t think they’re all young kids. I would bet there are 16-, 17-year-olds. How do we know they’re not members of a gang coming across?”

“It’s time for the U.S. to get serious about immigration,” quoted Zack Taylor, Chairman of the National Association of Former Border Patrol Officers. “We can start by taking away their incentives to be here. All benefits: medical, food stamps, public housing, education, everything… Our government is encouraging foreign nationals to come into our country illegally and stay.”

Recalling his recent experience standing on the banks of the Rio Grande River and witnessing small pontoon boats ferrying load after load of illegals across to the U.S. side of the border, independent filmmaker, Dennis Michael Lynch said, “I just watched our country and the future of our own children officially fall off the cliff, and I don’t know what to do…”

Maybe, the answer to Lynch’s plea of frustration was uttered 44 years ago. Struggling to maintain his composure in the cramped Lunar Module, Apollo 13 Commander James Lovell put out a call for help to the Houston Space Command Center after an explosion crippled his spacecraft.  Although his message, was brief and to the point, it reflected the dire circumstances the Commander and his crew faced if they had any hope of coming back alive. Lovell’s message of controlled desperation endures: “Houston, we have had a problem.”

We can only hope our President and the members of Congress are listening!

 References:

  1. A humanitarian crisis is defined as a singular event or a series of events that are threatening in terms of health, safety or well being of a community or large group of people. Then doesn’t this same definition also apply to the citizens and support systems (law enforcement, health care facilities, welfare agencies, schools, etc.) in those communities where this flood of illegals is occurring? Also shouldn’t the elected officials of these communities have a say in the disposition of these individuals who have entered our country illegally?
  2. Rector, Robert, Look to Milton: Open Borders and the Welfare State, The Heritage Foundation, June 21, 2007.
  3. To be eligible for DACA, the individuals had to be born on or after June 16, 1981, have come to the U.S. before their sixteenth birthday, lived continuously in the U.S. since June 15, 2007 and been present in the U.S. on June 15, 2012 and on every day since August 15, 2012. Those that qualify are eligible to file for a work authorization permit, obtain a social security number or tax ID number and are protected from deportation for two years. There is the stipulation that the status has to be renewed every two years.

The ‘Perfect Storm’ at the Veterans Administration

The VA’s ‘perfect storm’ is the result of the idealists in Washington and the upper echelons of the Veterans Administration imposing their wishes on the pragmatists in the trenches. While the focus of the recent attention seems to be directed toward the VA employees who participated in scheduling infractions, the true blame probably rests in the unachievable obligations of the VA system itself. ‘Heads have already started to roll’, and more are sure to follow. But just because some VA rule mandates that patients have to be seen within a predefined time, doesn’t mean it can be done— at least be done without making sacrifices in other areas.

Now that the issues within the VA have been pushed center stage, it is important to keep the issues of limited access of patients into the system separate from the other concerns such as bloated salaries for VA employees and prioritization of expenditures. These concerns are important and can be discussed in a further posting, but dilute out the importance of fulfilling the acute needs of the eligible VA population.

In an imaginary example, a physician working in a VA clinic regularly sees four patients an hour— the time that physician feels is adequate to take a proper history, perform an adequate physical examination and prescribe an appropriate course of therapy based on any diagnostic results. Because of pressure from the ‘powers-that-be’, that physician is now told his/her new allotment will be six patients per hour. In this scenario, although the physician is mandated to work harder and longer, usually with no increase in pay, it is the patients who suffer. They suffer because they have less time with their doctor to address their unanswered concerns and undiscovered needs when their doctor has to move on to the next patient.

All health care systems have limited manpower and resources. When the patient demands exceed resources, there are only two alternatives that keep the system functioning: decrease the quality of care given to certain or all patients, or decrease access to the system.

The ethical dilemma raised by allocation of limited manpower and resources by the VA hospitals is rationing. The VA has adopted the limiting access position as have Canada and England with their single payer delivery models.

It’s a simple enough question: Given there is a fixed amount of resources, in the short term, how are those resources most ethically distributed? Divide them evenly, so that each party gets the same amount, or give more to some and less to others? Make health care services the limited resource. Does a delivery system then offer less than optimum care to all the eligible patients or does the system give optimum care to some, while delaying or denying access to others?

The U.S. Veterans’ Administration hospitals have a rule that medical care is to be provided to military veterans in a timely manner within 14-30 days. Due to the chronic deficiencies in staffing and inability to always comply with the 30-day rule, certain personnel in some VA facilities sought out tactics ‘to game the system’.  In 2010, then the VA’s Undersecretary for Health Operations and Management, William Schoenhard, released a memo outing the strategies used to get around complying with the appointment rule and ordered them stopped.

These practices were recently brought to light at the Phoenix VA hospital, where allegedly at least 1700 veterans were victims of rigged lists when the wait time for an average appointment was 115 days. Additionally, allegations were levied that more than 40 veterans had died while waiting for their appointment. Allegedly, these practices are not just occurring at one VA facility, but were and are still pervasive in other facilities within the VA system. Due to these recent allegations, Congress has undertaken hearings with much of the attention directed toward Veterans’ Secretary Eric Shinseki, who recently submitted his resignation over the scandal.

Twenty years ago, annual performance reviews were instituted that seemed to have created perverse incentives to ‘cook-the-books’, with respect to the policy scheduling violations. “Fear was instilled in lower-level employees by their superiors, and those superiors did not want long wait times”, said Florida Congressman Jeff Miller, chairman of the House Veterans Affairs Committee. “Bonuses were tied directly to the waiting times of the veterans, and anybody that showed long wait times was less likely to receive a favorable review”.

A review of the inner workings of the VA system sheds more light on the complexities within the Veterans Administration’s health care facilities. The eligible veteran United States population is 21.8 million, with about 9 million enrollees currently in the system. To service the needs of that population, there are 153 VA hospitals, 773 outpatient treatment centers and 260 counseling centers, where 6.5 million patients were seen in 2012-2013. Patient costs are free for veterans with low incomes, former POWs and those with severe disabilities. Veterans who served in combat zones are also eligible for free care for two years after their discharge because of an illness or injury that may have been service related. For the rest, they are responsible for a $15 co-pay/visit and $50 for most visits with a specialist, or for certain tests. Hospital stays can be as low as $236 for the first 90 days.1

Some experts feel that many of the problems arise from an acute shortage of physicians, mostly those in primary care. The VA’s projected needs are 5,500 primary care doctors, and currently they are 400 positions shy of that goal. In the last three years, the VA claims the number of primary care doctors has grown by 9 percent, while the demand for primary care appointments has grown by 50 percent. According to David Cox, the National President of the American Federation of Government Employees, the theoretical responsibility for each primary care VA doctor should be about 1200 patients. In reality, that number is now close to 2000. Although most medical complexes are struggling to find enough primary care doctors, the VA’s problems are compounded by their lower pay scale of $98,000 to $195,000/ year for these positions, while the average was $212,000 in the private-sector in 2012.2

The latest census data for the population in Canada came in at over 35 million. Reportedly, there are 1365 hospitals located that supply care for our neighbors to the north. Similar to the VA system, they function under a single payer health care delivery model. Although there is a great deal of variance across the Canadian provinces, the average waiting time between referral from a general practitioner and the receipt of elective treatment is 18.2 weeks (127.4 days). The waiting time between referral by a general practitioner and consultation with a specialist has risen to 8.6 weeks (60 days).

Britain’s National Health Service (also a single-payer model) has similar problems. In 2010, about one-third of England’s NHS patients, considered sick enough by their family doctor, waited more than a month to see a specialist. Realizing the critical nature of their inefficient system, where the mortality rate from heart disease was 36% higher than in the U.S., the ‘NHS Constitution’ enacted a policy that “no patient should wait beyond 18 weeks (126 days) for treatment after a General Practitioner referral”.

The Fraser Institute, a pro-free market Canadian think tank, reported that even a one-week increase in the wait time from a referral by a general practitioner to the receipt of treatment was associated with an increase of approximately three female deaths per 100,000 population. The report also determined, that over the 15-year period from 1994-2009, increases in the wait times in the Canadian heath care system for cardiovascular care were associated with approximately 662 potentially avoidable deaths. Overall, they projected during that same period, increases in wait times for medically necessary elective treatment may have been associated with 44,273 additional female deaths.3

The acuteness of the shortage of resources, beds and staffing is not new in the VA system. At least several recent administrations in Washington and probably most members of Congress have been aware of these problems for years. Some members of Congress have even advocated for solutions, but to no avail. That was until a number of our veterans reportedly died because of delays in receiving appropriate care. What is new is the awareness of these problems by the public.

Increased morbidity and mortality due to delay of care is a tragedy, no matter the circumstances. Avoidable delay of appropriate care borders on being criminal.

In looking at the big picture, as to the whys, there are at least four significant areas of concern at VA facilities: 1. A system that chronically is pushed to its maximum by unrealistic expectations with its current staffing level and patient load. 2. Very little patient restraint because patients assume little to no responsibility for their ‘first-dollar health care expenses’. 3. Lack of accountability by the VA employees for violations of protocol, or think their work is over when their shift ends, verses the private sector mindset of when the task is completed. 4. Chronically overworking and under-paying their primary care physician staff.

One long-term solution would be to increase the physician staffing and the number of treatment centers within the system. On a more immediate basis, act on the growing call to refer certain patients with acute problems into the private sector for their care (a voucher system). The state Exchanges created by the ACA legislation could be another vehicle. A more radical approach recommended by a few, would be to get the VA out the acute care business altogether and, focus on what they do best— long-term care and rehabilitation.

The American public is shocked and dismayed when they hear about a 115-day waiting period for some of our veterans, while both Canada and England, also with single-payer models, experience almost the same delays on a regular basis.

When Obamacare is fully implemented and if the Exchanges drive the competing private insurers out of the market, only the federal programs will remain. Then those wait times of 115 days for all patients will become the norm!

References:

1.The Associated Press, The Dallas Morning News, May, 31, 2014.

2. Oppel, Jr., R A., Goodnough A., The New York Times in The Dallas Morning News, May 30, 2014.

3. Hospital wait times may have cost 44,273 women their lives over 16-year period: Fraser Institute/ Politics – Yahoo News Canada.

Border Boondoggle

Except for infiltration by terrorists across the Canadian border, the most discussed ‘border’ issues all concern Mexico. With the United States’ insatiable appetite for illicit drugs, and hopes for a better life, our southern border has turned into a virtual war zone. Increasing border patrol presence, construction of a fence in some areas and stepped up surveillance have only made a dent in the flow of problems. Until the root causes are addressed this country will be in a losing battle.

Washington is in gridlock because the Republicans are afraid of losing the Hispanic vote and the Democrats are holding out for more illegals, before the problems are resolved. The flaw in the Republicans’ concern seems unfounded. As an example, even after President Reagan signed into law The Immigration Reform and Control Act in 1986, which granted amnesty to 3 million illegal aliens, George H. Bush still only garnered 35% of the Hispanic vote, when he ran for President in 1989. The problem of foot-dragging by the Democrats is causing an increasing dilution of this country’s identity, spiraling costs of health care incurred by these uninvited residents, escalating violence that have direct ties to Mexican gangs and rampant drug trafficking.

Three areas must be addressed if a solution is to be found: elimination of the ‘anchor’ baby legislation, effectively closing our border and some form of amnesty.

‘Anchor babies’ is a term given to those infants who are born within the borders of the United States and are granted automatic citizenship, even though neither parent is a legal citizen. As background, this automatic birthright citizenship first arose after the Civil War as a Constitutional provision clause of the 14th Amendment in 1868. It was a way to undo the Dred Scott ruling and ensure citizenship for former slaves born on U.S. soil.

Analysis of Census Bureau data reveals that an estimated 340,000 births (‘anchor babies’) in the United States were born to parents of undocumented immigrants in 2008. That extrapolates out to 8 per cent of the births in this country. Carrying the extrapolations of all the costs out further, at an average of $25,000/birth, which also includes prenatal, delivery and post-natal care for both the mother and the newborn child, costs to the health care system would be predicted to be 8.5 billion dollars in 2008. Add to that another $10,000/year for 12 future years of required public educational costs, Medicaid, CHIP, Perinatal CHIP, welfare, Supplemental Nutrition Assistance Program (formerly food stamps), Section-8 housing through Temporary Assistance to Needy Families (formerly AFDC) and the costs generated by those who care for them, the costs rise exponentially.

It is estimated that since The Immigration Reform and Control Act of 1986, at an average of 170,000 ‘anchor babies’/year over those 24 years, adjusting for inflation, have generated costs of $165,000/child or 673 billion dollars total. In more understandable terms, babies born to non-documented parents have generated costs to the United States of over two-thirds of a trillion dollars in the last 24 years and at a current rate of 58 billion dollars/year for just their birth and education.1 These cost estimates only take us through 2008.

Even if a ‘hardened’ fence were to extend from border to border and 100 miles out into the both oceans, there would still be some drugs and illegals that would continue to get through— but a lot less! To be even reasonably effective, the border closure should directly coincide with some form of amnesty. After that specified time, everyone will be sent back with virtually no exceptions.

Realistically, this country is not going to be able to send 11-20 million people back to their home countries. As soon as the anti-amnesty supporters get over this premise, the sooner a solution can be reached. The only REASONABLE solution, mentioned in back corners of the debate, is to give those who are already in this country illegally, before a predetermined date, some sort of legal status. This new legal status would allow them to work, pay and receive benefits from social security, participate in the other entitlements programs and require them  to pay federal and state income taxes. For those who come in after a predetermined date, they go back to their country of origin and fall in line after those who are already in line through the normal immigration practices.

Continuing along this same scenario, the other stipulation would be those, who accept legal status for residency, but entered illegally, will never have the right to vote or hold public office. Controversial, as that might sound, this is the same stipulation afforded in some states to convicted felons, even after they have served their sentence. Looking at it from a more pragmatic way, these uninvited guests came this country or remained here under illegal pretense. Why should they be afforded these same rights of citizens, who are in this country legally?

A caveat, that could be offered to these current illegals, would be for them to voluntarily return to their country of origin and apply for legal immigration to this country. If and when they then return legally, they would have the right to vote and hold elected office.

Until the discordant voices unite and realize that a compromise is vastly better than the status quo, there will be no answer to the subject of illegals. Tina Grego, a journalist for the Denver Rocky Mountain News, published a column in October 2007, titled Mexican Visitor’s Lament that explained the costs incurred by illegals better than anywhere else that I have read.

What Ms. Greco concluded was, with at over a half a trillion dollars a year of incurred costs, this country can no longer turn a blind eye to our ‘uninvited guests.’

1. Tenery, R., Birthright Citizenship: The Silent Costs, Echoes for the Future, http://robtenerymd.com, December, 2010.

2. Grego, T., Mexican Visitor’s Lament, Denver Rocky Mountain News, 10/25/07.

The Reverend Jessie Jackson and Geronimo

What would be the response be from the Muslim community if a health care insurer decided that it would decrease the reimbursement for hospital care of their Muslim policyholders, if they were readmitted for the same diagnosis within thirty days of their last discharge? Incidentally, the insurer did not apply that same rule to their Christian patients. Would not the Muslim clerics loudly protest or worse?

What if only black patients, and not any other patients, who were admitted to hospitals for observation and limited diagnostic studies, had to comply with the ‘two-midnight’ rule for their health care insurance to cover their stay? Would the Reverend Jessie Jackson and other leaders in the black community stage a protest march in Washington?

Would the leaders in the ‘gay’ community be silent if practitioners were reimbursed 25% less when they treated gay patients?

Would the women’s lib contingency stand idly by if health plans that specifically targeted medical issues in females faced disproportionate funding decreases while other plans went untouched?

Finally, what if the patients of the Indian Health Service were forced to use preferred pharmacy networks even though their out of pocket costs would be significantly higher? Do you wonder if the leaders of the Native American Community might consider closing all the roads, including the Interstate highways, through their reservations to public transportation in protest?

Although each of these examples seems farfetched, they are close to the truth. The only difference is that these individuals from the Muslim, black, gay, female and Native American communities are limited to the seniors in their community— the seniors who are enrolled in the Medicare program. For each of them, all of these five scenarios are potentially real. The difference is their needs go almost unnoticed, not because of their religious preference, color of their skin, gender or ethic background, but because they are over 65.

For most senior citizens the Medicaid, Medicare and Medicare Advantage programs are single-payer models that are run by the federal and state bureaucrats under the auspices of the administration through the Centers of Medicare and Medicaid Services (CMS). As the ‘only game in town’, they promulgate these discriminatory rules, because they can.

 Where is the outcry on behalf of the seniors? Where is the Reverend Jessie Jackson, a Gloria Steinem or a Geronimo to come to their rescue?

It’s not AARP! Their members were thrown ‘under the bus’ when AARP’s Board of Directors threw their support behind President Obama’s health care plan. They didn’t seem to care that over $700 billion would be diverted away from projected Medicare funding over the next ten years. To the Board of Directors of AARP, it has always been about the money. Through its subsidiary company, AARP was one of the main suppliers of Medi-gap insurance, a privately purchased coverage that picked up where Medicare benefits left off. The George W. Bush administration passed the Medicare Advantage program that was a lower-cost alternative to the Medi-gap coverage. More than 11 million seniors took advantage of the program that significantly cut into the AARP Medi-gap revenues. President Obama eliminated subsidies for the Medicare Advantage program that made the more-expensive Medi-gap coverage more competitive.

What about the American Medical Association (AMA) and the American College of Physicians (ACP)? Current AMA policy supports adequate funding for the Medicare program and opposes further reductions of current Medicare limiting charges.  However, it seems that both of these influential organizations felt that achieving a permanent fix to the Sustainable Growth Rate (SGR) was more important than fighting to block this diversion of projected Medicare funding away from the seniors and to the ‘newly’ insured under Affordable Care Act. As a side note, have these organizations achieved their goal of a permanent fix for the SGR by throwing their support behind the President’s health care plan? No!

So who fights for the seniors’ interests? The answer is the seniors themselves, who really have no effective organizational model after AARP traded their best interests for company profits. They do have the representatives that they elected to their statehouses and Washington DC— these same representatives that were also elected by and are also beholding to many other interests in the community.

These discriminatory regulations by CMS and mandates under the authority of the ACA are examples of how sectors of underrepresented populations fall prey to the dictates of a few when competition is eliminated from the marketplace. Today, it is the seniors.

Tomorrow, who knows?

The Surgeon General— Where’s the Beef?

The President’s nomination of Vivek H. Murthy, M.D. for the office of Surgeon General reveals how the current administration selects individuals to help run this country. Past Presidents have not always supported the most qualified candidate for a particular position, but one who more closely aligns with their particular point-of-view. Recently, the nomination of Dr. Murthy, a Harvard College, Yale Medical School graduate and residency trained Internist at the Brigham and Women’s Hospital in Boston, has drawn both praises and criticism from differing sectors of the community.

Often referred to as ‘the Nation’s Doctor’, the Surgeon General is the operational head of the U.S. Public Health Service. The person who holds that position is also the leading spokesman on public health matters in the federal government.

After completing his residency in 2006, Dr. Murthy joined the faculty of Brigham and Woman’s Hospital as a Hospitalist and Instructor in Medicine at Harvard Medical School. Despite his pristine academic credentials, it is his activities outside direct patient care that appear to have garnered him the President’s nomination for Surgeon General.

Dr. Murthy’s career in advocacy began when he co-founded and served as president of Visions Worldwide in 1995. It was an organization that concentrated on AIDS education and prevention in the U.S. and India, the homeland of his parents. He went on to co-found TrialNetworks, a cloud-based optimization system that would allow clinical trials to bring new drugs to the market more quickly and safely. In 2008, he started Epernicus, a collaborative networking platform for scientists to improve their research productivity. In that same year, he co-founded Doctors For Obama, which was later renamed Doctors for America, where he served as the national chairman. In 2011, Dr. Murthy was appointed by President Obama to the U.S. Presidential Advisory Council on Prevention, Health Promotion, and Integrative and Public Health within the HHS.

Outside of the medical community, the most controversy with Dr. Murthy’s nomination comes from the supporters of the ‘right to bear arms’. Contained in a Twitter posting in October 2012, the nominee wrote, “Guns are a health care issue.”  With his support for Obamacare (the ACA) and apparently gun control, two of the most controversial domestic issues being pushed by our President, Dr. Murthy’s nomination comes as no surprise.

His academic credentials and interests in improving world health and medical research are laudable. However, the major concerns, voiced by some members of the medical community, are based on Dr. Murthy’s lack of clinical experience— being exposed to and responsible for direct patient care. The experience of titrating oxygen levels in an elderly patient with advanced emphysema or getting up in the middle of the night to comfort a family member who has just lost a loved one to a terminal disease. These are the kind of experiences that earns one the right to be called ‘the Nation’s doctor’.

Even though the main responsibility of the Surgeon General is to be the spokesman for public health and disease prevention, Dr. Murthy’s two plus year tenure on the President’s Council on public health and his early participation in AIDS awareness give him only minimal credentials in this area.

Dr. Murthy’s expertise is in political advocacy, not patient care. He is an idealist, much like our President. Although he should be commended for his medical training and activism, these do not automatically translate into being a good doctor. That comes from ‘being there’!

If he becomes Secretary General, Dr. Murthy rounds out three of the most important members of President Obama’s healthcare team: Ezekiel Emanuel, M.D., PhD, purported to be the leading architect of the Obama care legislation, stayed in academic medicine and held the position as associate professor at Harvard Medical School. Upon entering the public sector, he joined the National Institutes of Health where he was Chief of the Department of Bioethics. Currently, he holds the position of Special Advisor for Health Policy to Peter Orszag, the Director of the Office of Management and Budget. Although she has announced her retirement, current secretary of Health and Human Services, Kathleen Sebelius’ credentials are a B.A. in political science, a Master’s degree in Public Administration, former Governor of Kansas and former lobbyist for the Kansas Trial Lawyers Association.

With these three individuals, that have helped to create, are in charge of implementing and will act as spokespersons for President Obama’s agenda to transform this country’s health care delivery system, there seems to be a pattern— a pattern of exemplary credentials, passionate idealism of what should be, but very little experience in the ‘trenches’ of actual health care delivery— one that appears to closely follow the path of President Obama himself.

The often-quoted line, first appearing in an advertising campaign for a national hamburger chain, seems to succinctly wrap up the concerns of many members in the medical community about the President’s health care team— Where’s the beef?

This country deserves better!