A Funny Thing Happened On The Way Back From Washington….

Well, not really funny but it did happen.  September 10th, 2012 marked my third meeting with the Physicians Counsel For Responsible Reform (PCRR) which is a physicians caucus to discuss health care recommendations to the (mostly) republican physician congressmen currently in Congress. The physicians attending this small meeting are passionate advocates for patient care as well as advocates for keeping the patient physician relationship at the center of any health care legislation.

A consistent theme I and others advocate is that people need to have the freedom to engage in an economic model that allows choice. We are not in favor of centrally run economics and find the Patient Protection and Affordability Care Act (PPACA) legislation absolutely counter to freedom’s priorities.  I will be the first to state that having monopolized health insurance companies running the show is also not working out.  Nonetheless, asking our government to officiate over this part of our economy is only jumping from out of the pan and into the fire. We need the government to bust up monopoly behavior and advocate for free market principles and choice, not be the dictator of how you and I receive health services.  I recently attended the Florida Medical Association annual delegates meeting (as a Lee County delegate) and the majority of physicians there voiced the same sentiment.

In an ideal world your doctor doesn’t have to get political. Since this situation has turned to crisis mode, yours truly has had to get involved-after all I too am a US citizen. Since it is our government that is trying to solve the problem, we citizens have no choice but to get politically involved; thus my trips to Washington DC. I am pleased to report that after hearing the Senior Healthcare Policy Advisor to Governor Romney, Mr. Matt Hoffman, discuss the (not finished) policy platform for healthcare I can confirm they stand for a 1) consumer choice provision, 2) Market reforms including liability reform, 3) a safety net for the needy,4) state empowerment (rather than federal overtake) and 5) entitlement reform which does mean premium support rather than trying to price fix (the equivalent of putting a square peg into a round hole).  I wrote earlier that Ryan’s proposal misses the point in that the premium support he suggests is attached only to insurance premiums.  I am pleased to report that Mr. Hoffman heard my feedback on that particular snafu and I am hopeful he will take my feedback into consideration.  Medicare premium support should be for all services including insurance.

As to whether entitlement reform is necessary, I would like to quote some lyrics from the great songwriter/performer Neil Young  “out of the blue into the black, they give you this but you pay for that”.  A recent article found that the average Medicare couple pays approximately 1/3 of what they are taking out of the program (114 K in and 355K out).  I would submit that part of the reason there is this discrepancy is precisely because in Medicare there is no free market and also because our government has a penchant (and Fed/government policy) for perpetual inflation.  This means a dollar saved today is guaranteed not to have the purchasing power of a dollar in the future. This disconnect is why we must earn interest on our investments to keep our buying power equal to the saved dollar. Medicare payments are used as fast as they are deposited (no interest earned) and now there are more people in the program than ever. No one could have foreseen how much service and technology would be developed to anticipate the current consumption, hence the crisis. Now to the funny (not really) thing that happened-


Before returning to Fort Myers, I chose to stay the following day (Tuesday September 11th) and visit the Cato Institute. The Cato Institute is a Libertarian think tank who looks at all kinds of government policy. They have been looking at this health care issue for some time and have some very good papers on the topic. Historically their policy analysis is equally used and referenced by both political parties and their positions are rooted in some of the greatest economic thinkers in history. The item I wish to expound on is their June 14th, 2012 policy analysis no. 700 titled The Independent Payment Advisory Board PPACA’s Anti-Constitutional and Authoritarian Super-Legislature by Diane Cohen and Michael F. Cannon. The Independent Payment Advisory Board (IPAB) is an unprecedented but certainly not an unanticipated policy that was bred out of the PPACA legislation. It was historically anticipated by the Nobel laureate economist Friedrich Hayek. He predicted this type of behavior was inevitable in a centralizing planning government.

The republicans have been very clear that removing the IPAB is a top priority-because it runs so counter to our forefathers constitutional intent of federal government. Additionally it is perhaps as far from a democratic body as you can get. This board is PPACA’s answer to getting things done. What they want done is to have the cost of Medicare stop rising faster than general inflation. By the way, I will be happy to go on record to say that wanting the cost of Medicare to stop rising faster than inflation is an absurd policy. No one can force the cost of something to be exactly what we wish it to be, not even the government. Furthermore by not allowing a free market to exist there is no way the government can have this outcome. To believe otherwise is absolute folly. If the government wants to maximize cost containment then they will have to employ all the providers they will need for all the Medicare beneficiaries and allow the beneficiaries to only go to government owned practices. Basically they have to own the cost of all things they will cover and use their large purchasing power to get the best prices possible under such a monopoly environment. Then they have to only allow people to access their system. I would suggest since this is highly an unlikely situation to arise, the government should stop trying to run this beast called health care.

The policy paper states some of the champions of the IPAB  (Peter Orszag for instance) argue we must take some of the politics out of government-run health care.  Wait a second, if this is a government program (Medicare) shouldn’t the government decide on the program?  Now, if we wish to privatize this program that is one thing. To keep it government run but allow an independent board, handpicked by the president/executive branch to decide how things are going to be paid for and what things will be on the shopping list is an abuse of government power.  This board is set up to run with 15 unelected but presidentially appointed (and congress approved) individuals. It doesn’t necessarily require 15 members and in fact through truancy could actually run with only one person. Additionally if that last person is no longer there the default option is to have the Health Secretary function as the IPAB. The IPAB will have the power to create laws without legislation input. It does not need to be bipartisan.  It will have authority not only to set Medicare costs and services policy but the remaining market as well. This is why they changed the name of the board form the Independent Medicare Advisory Board to the Independent Payment Advisory Board. Under IPAB law creation will be done through policy recommendations which if not countered by congress or the president become by default permanent laws.  This is spooky stuff.  The formation of this board actually runs counter to our constitution because it is a formal abdication (transfer of authority) of the Congress to others of its essential legislative duties.  Congress is constitutionally delegated/granted by the people to create laws through a very specific process. By creating the IPAB in the manner it is designed, the congress has transferred this authority. It is specifically stated in the constitution that the Congress cannot do such a thing, yet it appears to have been written into this health care bill.  Congress appears to be derelict in its duty to the people by complying with this aspect of the law.


This is another example (the first being the health insurance mandate) of how the PPACA legislation was an unprecedented executive (Presidential) overreach of our constitutional rights. These kinds of policies are how the executive branch tips the power in such a manner as to be able to dictate to the people.  We all know dictatorial governments don’t serve the general populace well.  What the paper goes on to explain is that the IPAB will become a permanent fixture of our government if it isn’t repealed.  Now that PPACA was deemed constitutional it would appear the IPAB can only be repealed by congress only if it follows some very precise (absurd) steps. The steps are the following:  1. Wait until 2017. 2) Introduce a specifically worded “Joint Resolution” in the House and Senate between January 1 and February 1. 3) Pass that resolution with a 3/5’s vote of all members of each chamber by August 15th 2017. I encourage readers to read the policy paper as it is far too detailed for me to elaborate all the nuances (and might I say truly scary stuff) in this legislation.

So upon learning all this, I guess perhaps it wasn’t such a funny thing that happened on the way back from Washington DC.  I am afraid our voters want to believe that President Obama is such a good guy he is incapable of not standing up for all of us and “do the right thing”. I would suggest by the very fact PPACA was passed under his watch and because this law and other actions(all the other economic Czars for instance) he has taken have been nothing more than power grabs for more presidential authority. By stacking the deck so highly in favor of executive power, how can we trust him to do the right thing? For those who for party affiliations wish to ignore the situation I would ask “what happens when the opposing party is charge, can they too be trusted to do the right thing”? So the way our government is being abused/manipulated, does anyone care to continue to pretend that this November’s election isn’t essential to our and our children’s future, here in the good ole USA?  On unprecedented constitutional grounds PPACA and the IBAP need to be repealed. This only happens with a different president.

4 thoughts on “A Funny Thing Happened On The Way Back From Washington….”

  1. Thanks for taking your own time to work on behalf of is all. I for one recognize the common sense need for some reforms to the medical industry but than I also know we still have the best medicine in the world because of dedicated folks like you Doctor.

  2. Dr. K: I enjoy reading your articles, up to the point that I still understand them! All too soon I reach that point. I sometimes wonder are you really writing them for your patients, or are they really aimed at your colleagues, interested government officials and politicians etc?

    You are a prolific and excellent writer, I suspect that much that you write is way above the understanding of many of your patients who admire you and are delighted to have you as their regular physician and be a credible narrator on these most important issues and that includes myself.

    How about after you have have completed writing an article, such as the one’s that I have just struggled through (it is now 02:39 ….. a.m.), you perhaps also produce a cut down, ‘average patient understanding level ‘ edition.

    Thank-you for your understanding and Regards. John Tilling. Mon 24 Sept 2012. Stryker Orthopaedic facility, Mahwah, NJ.

    1. Dear Mr. Tilling. Your point is noted. I will continue to keep this in consideration. Perhaps what I will do is hightlight points in a more simplistic language as I go through the article. Thanks!

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