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Title: Blog by Novelist William S. Frankl, MD

Archive for August, 2012

The Top Three Small Business Struggles.

Wednesday, August 29th, 2012

Another terrific short essay from The Heritage Foundation’s “Morning Bell,” 8/29/12

Small businesses are getting a lot of focus from politicians, because they are a key engine of job creation—which has stalled in the U.S. economy. A Republican National Convention theme of “We Built It” continued the political debate over the economy yesterday.

A survey by the National Federation of Independent Business (NFIB) in July revealed that small businesses’ top three concerns were taxes, regulations, and poor sales. A quick look at these top three small business struggles shows they have every reason to be demoralized.

1. Taxes

Small businesses are under enormous threats from looming tax hikes. President Obama is advocating a tax hike on the country’s job creators—the at least 1.2 million small businesses that employ workers and make more than $200,000.  Known as flow-through businesses, these entrepreneurs pay their taxes through the individual income tax. A study by Ernst & Young estimates that this tax hike would kill about 710,000 jobs and cause real wages to drop.

This tax hike, however, is just a portion of the Taxmageddon crisis scheduled to hit the country on January 1. The Congressional Budget Office has left little doubt that unless Congress and the President prevent Taxmageddon, the country is headed toward a fresh recession next year.

And Taxmageddon includes only some of Obamacare’s 18 new tax hikes, several of which don’t kick in until 2014 or later. The tax landscape is truly bleak.

2. Regulations

Heritage’s James Gattuso and Diane Katz have documented the sea of new regulations that continue to drown America’s businesses. In their detailed report, “Red Tape Rising,” they note: “During the first three years of the Obama Administration, 106 new major federal regulations added more than $46 billion per year in new costs for Americans. Hundreds more regulations are winding through the rulemaking pipeline as a consequence of the Dodd–Frank financial-regulation law, the Patient Protection and Affordable Care Act, and the Environmental Protection Agency’s global warming crusade, threatening to further weaken an anemic economy and job creation.”

The cost of these regulations strangles economic growth and job creation.

3. Poor Sales

In an economy with 8.3 percent unemployment, consumers have to cut back. Struggling sales are no mystery. Higher fuel prices are also hurting small businesses, which must make the no-win decision of passing these costs on to consumers or absorbing the costs themselves.

Heritage’s Nick Loris explains the impact of fuel costs on the economy : “In a recent poll by the Small Business & Entrepreneurship Council, 40 percent of small businesses responding said they have had to increase their prices. But that approach has a distinct downside. When consumer demand is already down, passing higher costs on to consumers suppresses demand even further, causing lower output, lower income and higher unemployment.”

To all of this, President Obama has said, “We tried our plan—and it worked.”

It’s not working for small business owners or for nearly 13 million jobless Americans.

Congress and the President need to stop Taxmageddon, open access to our energy resources, and reduce regulations that cost more than the benefits they deliver. America needs jobs, and small businesses need relief.

How Obamacare Robs Medicare and Hurts Seniors

Tuesday, August 28th, 2012

Nowhere have I seen the Medicare debate ––––Obama vs Ryan and the Republicans ––– than in this short essay by the Heritage Foundation’s “Morning Bell” on 8/28/12. It should be widely distributed and discussed on the stump as the presidential election battle really heats up after the conventions are over.

The rhetorical Medicare wars have heated up this week, after President Obama declared in his Saturday radio address that his proposed reforms “won’t touch your guaranteed Medicare benefits. Not by a single dime.”

This is incorrect. Obamacare cuts $716 billion from Medicare over the next 10 years, according to the Congressional Budget Office (CBO), and uses these “savings” from Medicare to fund other entitlement expansions mandated by Obamacare. Medicare becomes a cash cow for Obamacare, and the Medicare “savings” from payment cuts are not put back into making Medicare solvent. Such massive payment cuts do impact Medicare benefits, as well as seniors’ access to those benefits.

Heritage’s Alyene Senger explains how this hurts America’s seniors:
The impact of these cuts will be detrimental to seniors’ access to care. The Medicare trustees 2012 report concludes that these lower Medicare payment rates will cause an estimated 15 percent of hospitals, skilled nursing facilities, and home health agencies to operate at a loss by 2019, 25 percent to operate at a loss in 2030, and 40 percent by 2050. Operating at a loss means these facilities are likely to cut back their services to Medicare patients or close their doors, making it more difficult for seniors to access these services.

The President also said on Saturday, “As President, my goal has been to strengthen these programs now, and preserve them for future generations.” But Obamacare imposes new taxes on present and future generations—including a new Medicare “payroll tax” that doesn’t even go toward Medicare. Senger details:
The payroll tax funds Medicare Part A, the trust fund that is projected to become insolvent as soon as 2024. Obamacare increases the tax from 2.9 percent to 3.8 percent, which is projected to cost taxpayers $318 billion from 2013 to 2022. However, for the very first time, Obamacare does not use the tax revenue from the increased Medicare payroll tax to pay for Medicare; the money is used to fund other parts of Obamacare, much like the $716 billion in cuts are.

The same set of dollars “saved” from Obamacare’s massive across-the-board Medicare payment cuts cannot be used to enhance Medicare solvency, reduce the federal deficit, and fund Obamacare’s entitlement expansions all at the same time. This is only a fraction of the dishonesty and budgeting shell games surrounding Medicare.

The Heritage Foundation advocates reforming Medicare into a premium support plan. What does that mean? Seniors would be given a choice between the fee-for-service Medicare of today or private plans. “Premium support” simply means that the government funding that goes toward their traditional Medicare plan now would be transferred directly to the plan of a senior’s choice, just as it is today in the Medicare drug program that already serves most senior citizens.

Not only would this change stimulate intense competition to control costs among private health plans, as well as the traditional Medicare program, but it would widen the scope of seniors’ options and give them greater control over their own health care.

Two important things to note:

Under all of the major premium-support proposals unveiled on Capitol Hill, traditional Medicare would remain. Seniors would have the right to stay in traditional Medicare or pick a better plan if they wished to do so. To quote President Obama, “If you like your plan, you can keep it”—truly.

Shifting to premium support would not take away seniors’ benefits. All major versions of premium support guarantee beneficiaries at least the Medicare benefits or the level of benefits they get today. In addition, they would have access to new plans with even higher levels of coverage at competitive prices tomorrow.

Some liberal opponents of Medicare reform pretend that reforms would suddenly bring private insurers into the mix. In fact, private health plans have been part of Medicare since the 1970s. The New York Times did a good job of explaining that private insurers are working very well within Medicare today—and they are playing a role in expanding benefit options while controlling costs. On August 25, the Times’s Robert Pear reported:
Even as President Obama accuses Mitt Romney and Representative Paul D. Ryan of trying to privatize and “voucherize” Medicare, his administration crows about the success of private health plans in delivering prescription drug benefits and other services to Medicare beneficiaries.

More than a quarter of the 50 million beneficiaries receive coverage through private Medicare Advantage plans, mostly health maintenance organizations, and Medicare’s drug benefits are delivered exclusively by private insurers, subsidized by the government.

Obama administration officials, lawmakers from both parties and beneficiaries have generally been satisfied with the private plans.

Medicare must be reformed. President Obama has a very different vision of what “reform” means.

Lots of Insurance Cards But No Access

Thursday, August 23rd, 2012

With the appearance of Rep. Paul Ryan as the vice presidential candidate on the Republican ticket, Medicare has come front and center where it should have been from the get-go. The hot air, the distortions, the lack of clarity and understanding of health issues ––– feeding into a media generally acting as lap dogs for the Democrats ––– has resulted in much noise but little appreciation of the real, front-line issue in health care. And both the Democrats and Republicans have generally failed to highlight this issue.

The fact that healthcare is so muddled is that proposals to fix it are devised by individuals who have never worked in healthcare and do not understand how it is ideally provided. In other words ––– bureaucrats, bean counters, politicians, sociologists, political scientists, all with a collective age under 30.

The Affordable Care Act (ObamaCare) is not affordable. Let’s start there. Some of the bureaucrats involved in creating ObamaCare must have been brain dead. Take out $716 billion from Medicare and use it to fund the 30 or 40 million without insurance and put the majority of these individuals into Medicaid ––– a dismal failure, an ineffective, poorly run, underfunded program.

Now what happens? Most of the 30 to 40 million will not see a doctor. The reimbursements for care in the Medicaid system are so poor that many physicians, in increasing numbers, have refused to see patients covered by this system. So, lots of patients who now have the cherished insurance card are unable to find a doctor and will ending up in emergency rooms for their care. And, as everybody knows, emergency room care is extremely expensive. Wow! What a great plan!

Now what about the Medicare patients? With $716 billion taken out of the system, and with the promise that the recipients will not need to pay more into the system for their care, and that the major savings will come out of the reduced reimbursements to doctors and hospitals more and more physicians and hospitals will refuse to see Medicare patients (the reimbursements have already been falling yearly). So, lots of Medicare patients (growing every day as more and more boomers reach 65) will be clutching their Medicare cards but with long, long waiting periods to ever see a doctor (if they can find one still in the Medicare program). Therefore, off to the emergency room (if they can find one that is still open for them) for their care. Wow! Another great plan!

But this is typical of bureaucratic thinking ––– the important thing is to  create an expensive program with a catchy, inappropriate name, a director who doesn’t understand the program, and lots of bureaucrats getting fat paychecks to run the program. Who cares whether it works? Right?

Now, I admit that I’ve used a bit of hyperbole in writing this post. But it’s not far off the mark. In summary, not nearly enough doctors to see burgeoning numbers of patients who have insurance that isn’t sufficient to pay for their care.

As I have proposed for years, we need to create a blue ribbon panel made up of doctors and nurses who work in the “trenches; ” academic physicians who work in the medical schools and who teach medical students; and a group of interested citizens; all of whom recognize where the problems in healthcare exist and how to best reform the medical care system. What I’m proposing is that we need to give healthcare back to the doctors, nurses, and patients. Give them a full year or two with unreserved support from the Congress and the president (whoever that might be). Allow the committee to call in experts as consultants in every field they feel  necessary to get the job done. Get the lawyers (especially the malpractice lawyers) out of the way. Get the medical administrators out of the way. Get the bureaucrats out of the way. And perhaps we can reform a healthcare system that will serve as a more appropriate and financially solvent approach that will result in the delivery of high quality, caring, cutting edge medical care for the public.

An Intriguing Sociopolitical Medical Story

Tuesday, August 14th, 2012

A front-page story in the Philadelphia Inquirer today, August 14, 2012, detailed the case of a young man, 23 years old, who was turned down for a heart transplant at the University of Pennsylvania. The young man has “Noncompaction Cardiomyopathy” (NCC), which is often associated with other congenital lesions and symptoms of shortness of breath, fatigue, limited exercise capacity and the presence of edema. To complicate the NCC, the patient has a form of autism called “Pervasive Developmental Disorder Not Otherwise Specified” (PDD-NOS). This form of autism is characterized by difficulties with social interaction skills and communication. These people are eager to interact with others but act socially different from their peers and can’t effect genuine connections ––– often the closest connections they make are with their parents.

Now initially, I could understand  why he might be turned down for cardiac transplantation ––– namely the difficult post operative and long-term medical problems after transplantation and whether the extent of the cardiac disease warrented transplantation. However, I am a bit skeptical about the non-medical reasons for turning down this patient, i.e. the recent appointment of Ezekiel Emanuel as vice provost for global initiatives at the University of Pennsylvania. Emanuel is an oncologist, bioethicist, philosopher, author, and columnist. He was one of the major architects of ObamaCare. Now at Penn, he chairs the department of medical ethics and health care policy at the Perlman School of Medicine at Penn. He has written about the increasing scarcity and limitation of medical resources and questions whether the very young, the disabled, and the elderly should be provided with high tech cutting edge treatments, rather than providing scarce resources to those who are more likely to contribute to our present day society.

Here is an excerpt from one of his papers:

“Without overstating it (and without fully defending it) not only is there a consensus about the need for a conception of the good, there may even be a consensus about the particular conception of the good that should inform policies on these nonconstitutional political issues. Communitarians endorse civic republicanism and a growing number of liberals endorse some version of deliberative democracy. Both envision a need for citizens who are independent and responsible and for public forums that present citizens with opportunities to enter into public deliberations on social policies.
This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason. Clearly, more needs to be done to elucidate what specific health care services are basic; however, the overlap between liberalism and communitarianism points to a way of introducing the good back into medical ethics and devising a principled way of distinguishing basic from discretionary health care services.”
(Emanuel, E. J.  “Where civic republicanism and deliberative democracy meet.” Hastings Center Report. 26(6): 12-14, 1996

So, was the young man discussed at the beginning of this post really not eligible for the transplant OR has Emanuel’s views played some role in the decision-making?  I guess we’ll never know.

Whose Climate Is It?

Monday, August 13th, 2012

Well, here we go again. Into the realm of science climate fiction/or truth. Who knows? As everyone who lives on the East Coast of the United States, the winter of 2012 was mild, and this summer is a swelter. Apparently (I have not personally checked this out) the National Climatic Data Center has released the following: the average temperature in the United States during July, 2012 was 77.6°F, which was 0.2° higher than the level set in the Dust Bowl era in 1936. And about 80% of the lower 48 states have some level of drought according to the United States Drought Monitor. Nevertheless, global temperatures obtained from satellite data indicated that this was the coolest July worldwide since 2008.

So what? I’ll tell you what. The heat, drought, and heavy rainfall (ironic, isn’t it?) in the United States will cause the climate change debate to heat up –––– those who blame the world-wide climate change to humanity’s proclivities; those who deny any global warming (whoops, we don’t call it that anymore it’s now “climate change” ); and those who say it’s climate change, the Earth is warming, but not due to human activity. Thus, “Much sound and fury signifying nothing.” For the present we will all continue to perspire, shiver, get wet, and go about our daily tasks while the big business of “climate” carries on publishing its dueling views.


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