Republicans Hypocritical Transformation of Medicare into Obamacare

The republicans displayed this Obamacare Rube Goldberg chart when fighting against it. House Republicans just voted to implement this chart for Medicare - Email the Senate and tell them "NO" Obamacare rationing and cookbook medicine in Medicare!

The republicans displayed this Obamacare Rube Goldberg chart when fighting against it. House Republicans just voted to implement this chart for Medicare – Email the Senate and tell them “NO” Obamacare rationing and cookbook medicine in Medicare!

Last Week, House Republicans demonstrated their hypocrisy on Obamacare, bringing nearly every key item of Obamacare into the Medicare. Disguised as a “Doc fix” bill, to correct a pending 21% cut in Medicare Physician payments, the bill actually creates cookbook medicine and outright rationing for Medicare patients. A nearly identical bill has failed to pass twice in Congress since 2013, but was finally passed when Republicans gained control.  Medicare patients will now be subject to doctors who are coerced into following government cookbook and rationing standards to earn a “bonus”. The patient will be pitted against their doctor who will have incentives tied to the profitability of insurance companies and budget needs of failing government programs.  In short, it will be hard for Medicare patients to trust their doctors.


Hopefully the Senate will kill HR2 and go back to the drawing board.  Citizens are encouraged to call or email their Senator to tell them “No Obamacare rationing and cookbook medicine in Medicare: Vote NO on HR2!”.


The bill, HR 2, the “Medicare Access and CHIP Reauthorization Act of 2015”, passed the House with Bipartisan support with a wide margins. However, the bill stalled in the Senate were fiscal conservatives raised concerns about the bill and liberals were worried that the Children’s Health insurance program (CHIP) was only extended for two years rather than four. The main commonality of HR2 with Obamacare consists of the command and control structure becoming more formalized and structured into Medicare as well as new found Republican votes for the Obamacare tools.  This stands in stark contrast to the promise made by Congress when Medicare was originally passed in 1965. The law still stands and states (although is entirely ignored in new Congressional bill):

Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services….”  Section 1801, Medicare Act, 1965

But HR2 does exactly that – creates control over the practice of medicine and methods of paying for it in Medicare.  It creates the exact same sort of financial penalty programs that punish doctors that fail to provide cookbook care and rationing dictated by the government.  Here are the essential ingredients to the “Medicare Access and CHIP Reauthorization Act of 2015” that are also part of Obamacare.

1.  “Secretary Shall” – 105 instances of HHS Power. HR2 authorizes the Secretary of Health and Human Services to make key decisions about actual so-called “best practices” by doctors. The Secretary will be able to determine what “thresholds” must be reached in the population of patients cared for doctors to earn a bonus payment. In fact the term “secretary shall” is mentioned 105 times in the 264 page bill (40% of pages), compared to 1049 instances of the same phrase in the 2409 page bill of PPACA (43% of pages). Thus the number of instances of new Secretary of HHS powers is nearly as high in the Republican supported Medicare/Obamacare bill (HR2) as in the original Obamacare bill (PPACA)!  John Boehner was complaining about transferring Congressional power to the Secretary of HHS more than 1,000 times for Obamacare. But now he is lauding it!

2. Pay for Performance The programs creates payment “bonuses” to doctors that follow government approved medical care in Medicine.  If doctors meet the “threshold” of compliance that the “secretary shall” define, then they will be eligible to receive a 4% bonus starting in 2018 and 9% by 2021. These are really penalties for doctors that refuse to follow cookbooks and instead do what is right for the patient. The bonuses/penalties are for compliance with “one-size fits all”, cookbook protocols creates by bureaucrats during a feeding frenzy of political lobbying by special interest groups.  As recently as January of this year, Senators McCain and Barrasso complained about Obamacare’s “one-size fits all” approach.  The Republican hypocrisy will be revealed if they support this bill in the Senate in two weeks.

3. Cookbook Medicine I – The program creates payments for compliance with “measures” that the government approves.  “Measures” is merely a code word for cookbook medicine. Government panels will create protocols that must be followed to avoid losing the “bonus. For instance, did you doctor deny giving antibiotics beyond 24 hours after surgery. The government thinks this will lower infection rates of “superbug organisms” but it turns out infections have really gone up. Did your doctor give you a blood thinner after hip surgery to prevent clots in your legs? THAT measure led to increased infection rates around artificial hip joints due to excessive bleeding into the surgical site. Did you doctor give you a beta blocker during a heart attack even if you had congestive heart failure. That measure led to cardiac shock and death among many patients. That coerced cookbook practice lasted for four years before the bureaucrats realized their cookbook, one-size-fits-all medicine was actually killing patients. It turns out that none of these “measures” has been linked with actual improvement in patient outcomes, but that is not the point. It is all about control of the doctor – to ensure they can be forced to ration care and save money for insurance companies and the failed government programs. The Heritage institute has long recognized that the Pay for Performance model in Medicare would be dangerous. But this time the Republicans are embracing it. That makes sense since it really got its start under President George Bush – as an Executive Order and through legislation!

4. Cookbook Medicine IIDoctors will be given a bonus if they are in a practice that the government designates as participating in “Clinical Practice Improvement Models”. Is your doctor tracking your weight, smoking habits, gun ownership, blood pressure, glucose and more while you are at home? Do their nurses call you to get all this information?  Are they part of a “patient-centered medical home” to manage your “chronic disease”.  Then they will get a bonus for turning from a medical practice of a social-worker/overlord service for your life. Yet again, these programs have not improved patient outcomes or saved actual costs. But they have created command and control structures for the government to use your doctors to control your life – for the health of the “population”.  As they continue to fail, then more methods of control will be added to “make it work”. Patients should expect ever increasing intrusion in their lives – after all, you are “taking money” from the “system” – and that must be stopped!

5. Rationing – The government will pay doctors less if they spend more money on you than the government wants.  The government will set “resource use” standards as follows for doctor services and medications. Did your doctor exceed the “per patient total allowed charges”? Then they are not denying and rationing care to the government specifications. The Republican/Democrat Obama-Medi-Care bills states that

“In measuring such resource use the Secretary shall use per patient total allowed charges for all services under part A and this part (and, if the Secretary determines appropriate, part D) for the analysis of patient resource use, by care episode codesand by patient condition codes…”.

In 2013, the Republicans refused to appoint people to the Obamacare “Independent Payment Advisory Board” (IPAB) saying:

“Basically, there’s a certain amount of money that’s allocated for Medicare spending each year,” Rep. Phil Roe (R-Tenn.) told the Daily Caller. “Once you hit that amount that’s been appropriated, this board, this bureaucratically appointed board, can then decide, not based on quality or need, but based on strictly cost” whether to pay for a particular treatment.

The Republicans are showing their hypocrisy now in agreeing to the same sort of rationing.

6. Electronic Health Records – Doctors will be denied bonuses if they don’t report all your medical data to the government.  Anthem Healthcare just lost the data of 80 million patients to a hack. Healthcare.gov has been hacked.  Your private medical data must be collected by your doctor via computer and sent to the government.  That data will be used to determine if you need to be targeted for health improvement projects.  For instance, are you too fat? Time to get a government visit telling you to exercise! Do you have a gun in the home? If you have your grandkids over, you may be subject to evaluation since the government is creating measures for “safe environments” in the home including “firearm” safety.

7. Reporting Patient Data to Government – Coerced. Your doctor simply will be paid less by the government (9%) if they don’t report data on compliance with cookbook protocols, rationing protocols, and “improvement models” to the government.

“the Secretary shall provide that in the case of a MIPS eligible professional who fails to report on an applicable measure or activity that is required to be reported by the professional, the professional shall be treated as achieving the lowest potential score applicable to such measure or activity.” (page 41 of HR2)

That will disable the practices of many physicians who are more concerned with the patient wellbeing than with meeting so-called quality and efficiency standards of the government. As if the government ever increased quality and efficiency of anything!

8. Expands deficit.  The new Obama-Medi-Care bill passed by the House would expand the Federal deficit $141 billion over the next decade according to the CBO. No past Republican quotes are needed here. Everyone knows the Republicans opposed Obamacare based on expanding the deficit, but it seems to have disappeared as a complaint in the House now. Perhaps the Senate will be different.

The Republican led house brokered this deal to impose massive Pay for Performance schemes on Medicare patients. They got the Dems to cozy up just BEACAUSE it imposes Obamacare-style rationing onto Medicare (and to fund the Children’s Health Insurance Program for two more years).  If doctors don’t participate in cookbook medicine they will be penalized. If they don’t meet government rationing, they will be penalized. If they don’t give their patients private health data to the government, they will be penalized. This is the 18th time the planned 21% “SGR” (Sustainable Growth Rate) has been used as a stalking horse to impose more onerous provisions on patients and physicians as part of a “doc fix” bill. Senator Tom Coburn has often described this “hostage taking” used in the name of the doc fix to make lives worse for patients and doctors. Now the Republicans are bragging about succeeding in holding doctors hostage so they can create more government control and rationing in health care.

Hopefully the Senate will kill HR2 and go back to the drawing board.  Citizens are encouraged to call or email their Senator to tell them “No Obamacare rationing and cookbook medicine in Medicare: Vote NO on HR2!”.

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