Disappearing Hospitals - Imploding Under Reform

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Dr. Robert Pearl writes about how health care reform will bring about changes in how hospitals deliver acute care and many will go out of business or change.

Pearl writes: Last week’s (Forbes) article discussed the “strategic inflections point” as that defining moment in any industry when the rules of the game begin to change. In the era of health care reform, hospitals across this country are now experiencing a time of transition.
Pearl writes: We can predict that the first hospital CEO who suggests closing down a cardiac surgical program will be fired on the spot. The doctors and local community will do everything in their power to stop it from happening.

Consolidating or closing entire hospitals will be even more painful. Regulators would likely intervene. Change will be resisted and delayed.

But, if there were fewer hospitals with higher volumes, quality would rise and the overall spend on hospital services would decrease. We should not underestimate how difficult this process will be or how long it may take. But once it is complete, patients will barely miss the old hospital down the street.

Pearl speaks about volume, but there's more to this story. Obviously, volume drives profit margins, regardless of what proceedures are performed. Also, volume is positively correlated with quality outcomes. In other words, those hospitals where volume of services are high report better patient outcomes.

Nevertheless, insurers must agree to pay for these procedures and there's a limit to what's covered. 

Hospitals are also in decline because the cost of keeping them modern (like hotels), fueled for temperature control and germ free have exceeded the reimbursement received for providing care. Some hospitals are booking post operative patients in real hotels rather than absorb the expense of keeping their in-patient facilities staffed to licensing requirements. For example, hospitals can only charge so much exuberant costs for simple wound dressings to compensate for the cost of care. Frankly, it's cheaper to send patients home with an instruction sheet about how to change bandages. 

So, just how can hospitals bring down the cost of care and create profit margins? It seems like small hospitals will need to merge with health care systems where high volume services can be performed, like MacDonald's produces hamburgers. It's a harsh analysis but describes the way it works. Some hospitals will become centers for volume in heart care, others for orthopedic care and some for cancer care. This means the local community hospitals will become outpatient emergency centers and feeder systems for the larger volume facilities.   

Patients will be focused on managed care organizations rather than their hospitals. In the future, it makes sense for people to live in places where their managed care plans provide coverage because, otherwise, receiving care will require paying large co-pays. Also, advanced practice nurses will become integral to every primary care practice, to provide access to growing number of patients who will buy coverage through the health care exchanges.

Here is more of Pearl's interesting Forbes article:

What first comes to mind when you hear the word “hospital”?

Your reaction may depend on your past experiences. You may feel gratitude for the birth of a child or the treatment of acute appendicitis. You may feel sorrow, remembering a loved one who passed away on a hospital bed.

Regardless of our experiences, many of us assume the closer our hospital is to where we live, the safer and better off we are. But that assumption is wrong. Fewer hospitals with increased volumes would lead to higher quality of care and better clinical outcomes.

Some hospitals were born to fail

In the early 1700s, hospitals provided little medical care. Instead they served as isolation facilities for those with contagious illnesses, as shelters for vagrants and those with mental illness, or as almshouses for the poor. Those who could afford medical care (middle- and upper-class families) received it in their own homes, including surgery.

By the end of the 19th century, medical care was becoming too complex to be delivered in the home. As a result, care shifted to centralized facilities where patients benefited from the latest medical advancements and around-the-clock physician and nursing availability.

A century ago, traveling even moderate distances was incredibly slow and expensive compared to the cost of hospital care. Therefore, building a hospital in every town made sense. Hospitals became a source of great civic pride for community leaders who comprised the governing boards. And so the “community hospital” was born.

Founded by physicians, religious groups and public municipalities, the number of U.S. hospitals grew exponentially from 178 in 1873 to 4,300 in 1909 to 6,000 in 1946. The passage of the Hill-Burton Act in 1946 helped further expand that number to 7,200 by 1970.

With the introduction of the publicly funded Medicare and Medicaid programs in 1966, the number of individuals with health insurance skyrocketed – as did the demand for inpatient services, as did hospital costs.

By the 1990s, high-margin procedures such as heart bypass surgery and total joint replacement were performed in (and advertised by) nearly every hospital. But the demand for inpatient services sharply declined in the 1990s with the introduction of managed care, the expansion of outpatient alternatives, and the mounting costs of a hospital stay. During that decade, some hospitals were forced to merge or shut down.

Since 2000, the number of acute-care hospitals has held steady at around 5,700. However, the push to limit utilization at these high-cost facilities continues while low-volume hospitals across the country are struggling to survive.

Hospitals are facing a strategic inflection point

Last week’s article discussed the “strategic inflections point” as that defining moment in any industry when the rules of the game begin to change. In the era of health care reform, hospitals across this country are now experiencing a time of transition.

The reduction in their volume, revenue and margin threatens their independence and even their existence. Over the past decade, 16 percent of hospitals have consolidated by joining a health system. That trend is accelerating in the context of the Affordable Care Act, also known as Obamacare.

And there's more of this article at this link: 

http://www.forbes.com/sites/robertpearl/2013/11/14/hospitals-may-be-disappearing-in-the-era-of-health-care-reform/2/ 

Therefore, what's going to happen to closed hospitals?

They'll become relics like empty textile mill buildings, inner city schools and underutilized churches. Self care will trump hospital admissions. Moreover, insurance companies will gain from profits once absorbed by acute care hospitals because they'll reap an incentive for keeping people well, thereby saving the cost of paying for expensive sickness care. 

All of the above information, of course, can be turned upside down as people live longer and require more chronic care. I haven't read Pearl's analysis of how to pay for the care of an aging population. 

Stay tuned.  

Obamacare is an Insurance Plan - Republicans Should Support the Reforms

With 48 million Americans uninsured, meaning they don't have any health insurance to cover the cost of illness care, it seems to me there's an exclusive market to sell coverage to those eager to have coverage. Indeed, this is a marketing dream. Put up affordable health care plans and allow the uninsured to pick an affordable product.What's wrong with this idea?  

Absolutely nothing. It should work because people will pay for it.

What's wrong is how the Obama administration allowed this missed opportunity, to sell health insurance to the uninsured through "exchanges", to become a communications glitch and a political conundrum. In other words, Republicans quickly took advantage of the public's general misunderstanding about health insurance to cast mistrust on President Obama's credibility. Meanwhile, the insurance reforms provided by Obamacare (funny how the media is suddenly calling it "health care reform") are overlooked, while Republicans create a frenzy about the flawed sign-on website.

In fact, health insurance exchanges offer affordable plans to the uninsured, whereby the beneficiary can shop for coverage, even for pre-existing conditions, like diabetes or heart disease.

Healthy people can buy insurance with high deductibles and thereby pay lower premiums.

In fact, the point is, everyone who qualifies and needs health insurance can buy an affordable product in an insurance exchange.

Republicans should support the insurance reforms required under the Affordable Care Act, because the law requires people to pay for their coverage.  

Obviously, Republicans created an Obamacare "red herring", a diversion. Rather than support health insurance coverage for everyone, Republicans would rather create mistrust. Nevertheless, Medicare is a federal health insurance plan and very few people complain about their coverage.

Moreover, Republicans have no plan to cover 48 million uninsured.

Unfortunately, in the Obamacare debacle, Republicans think they've found a mythical "silver bullet" to recover from their low approval ratings post the disasterous government shutdown. 

In my opinion, this tempest in a tea pot about Obamacare won't change public opinion about Republicans, regardless of how it negatively impacts the President's credibility. Republicans need an alternative plan, but they don't have an idea to offer.

The fact is, Republicans should support Obamacare because it provides health insurance for people who will pay for their coverage. It's the Republican thing to do.

Rather than degrade Obamacare, Republicans must find a way to cover 48 million people who want to pay for coverage.

Republicans Obsessed with Obamacare and Wasting Time

House to waste more money voting to delay Obamacare.

This obsessive compulsive voting to deter the implementation of Obamacare is a total waste of taxpayer money. 

Moreover, if Republicans put the money wasted on repeal of Obamacare into productive time, our nation might see progress toward approving a budget, elimination of the stupid fiscal sequester and, of course, lifting the nation's debt ceiling. 

Instead, Republicans obsess over Obamacare. They even want to vote, yet again, to delay the implementation of the law. This is another wasted effort by a Republican party, ironically, built on a mission of austerity. 

Too many people and insurance exchange systems are invested in the implementation of health care reform to delay the implementation of Obamacare. To do so will incur a lost opportunity cost, because the delay would inevitably postpone expensive systems already in progress.

What makes sense regarding health care reform is doing what works. Americans already have health care reform that works called Medicare.

Medicare isn't free. Working people and their employees pay for Medicare through payroll deductions. Even when beneficiaries are receiving Medicare benefits, they continue to pay for the program with copays and through Social Security deductions. Everyone who pays for Medicare should have access to the benefit.

Republicans must stop wasting time and money to denigrate the human condition by voting to repeal Obamacare, frightening Americans by threatening to cut Social Security and medical coverage provided by Medicare. Instead, Republicans should focus on immigration reform, creating jobs by supporting the American Jobs Act and supporting investment in eduction for all American children, beginning with pre-school.  They must stop obsessing about Obamacare, Medicare, Medicaid, Veterans Benefits, Children's Health Insurance Programs (CHIP) and income security programs.

Nevertheless, Republicans are fighting among themselves about the nature of what it means to be right wing, conservative, neoconservative, Tea Party or libertarian. Meanwhile, obsessive Republicans are damaging America's reputation as a beacon of freedom to the world. America has earned a reputation for a country embroiled in so much partisanship that we can't get anything done, rather than a beacon of progressive idealism. 

Let's face it, the Republican Party has completely lost its way. In so doing, they're dragging the respectable and thoughtful people into their obsession with ideology over reason. Worse, Republican organizational chaos and disorganization is costing Americans time and money as the obsessive votes to repeal and delay Obamacare continue to consume their taxpayer paid time.

Republicans should obviously be fired for incompetence. This can't happen soon enough, as Americans must vote every one of them out of office and the sooner the better.

Republicans Offer No Alternative to Obamacare - Pointing Fingers Without Solutions

Republicans are masterful at pointing fingers but rarely do they offer solutions. This is clearly the situation with their compulsive political obsession against the health care reform law known as Obamacare.

Some 48 million Americans were uninsured in 2012, which was not statistically different from the prior year.

http://www.kaiserhealthnews.org/stories/2013/september/17/census-numbers-uninsured-numbers-remain-nearly-unchanged.aspx

Republicans circle their political wagons around their fanatical opposition to Obamacare. Nevertheless, they don't offer an alternative to how our US health care system can afford to pay for 48 million uninsured, if they don't have insurance coverage.

When 48 million people are uninsured, they use the expensive hospital emergency departments for illness care. These bills are seldom paid. Hospitals are required to treat everyone who presents in an emergency department but they're unable to recover the cost of providing this "charity care". Therefore, hospitals pass the cost of caring for uninsured over to those who pay for their care in a very clever formula known as "cost shifting". In other words, a small percentage of every charity care bill is passed on to everyone else who pays their bills. Republicans offer no solution to this dynamic. Apparently, Republicans like cost shifting. If they don't like it, they'd do something to prevent the practice. This "something" could be "insurance exchanges." 

There's a well established precedence for insurance exchanges already working in Massachusetts. Republican Governor Mitt Romney designed this law. Governor Romney's support for the health care reform law, that later became the model for Obamacare, is working in Massachusetts and it was a Republican governor who put it in place. Now, this same law is not worthy of helping all Americans.

Therefore, if Republicans want to repeal Obamacare, just because they don't like it, they must find an alternative to replace it.  

Otherwise, 48 million Americans who are waiting to sign up for Obamacare insurance coverage, so they'll be able to pay their hospital bills, won't have any alternative but to continue to use emergency care if Republicans have their way. This is very bad for protecting the health of our Americana workforce. Americans must be healthy to be productive. Furthermore, the cost shifting of charity care becomes impossible to fund because this add-on drives up the cost of all health care.

America has an enormously successful health care system.This sytem is imploding in may places because the cost of providing care isn't being recovered through reimbursement. Republicans don't seem to think the benefits of our nation's world renown medical science is worth protecting, by allowing people to buy health insurance to pay for care. They don't like Obamacare but won't offer any alternative.

Until Republicans provide an alternative to Obamacare, those among them who screech, like Senator Ted Cruz and Congesswoman Michele Bachman, should be prevented from pointing fingers, when they offer no solutions.

Link to Affordable Care Act:  http://www.hhs.gov/opa/affordable-care-act/

Republican Government Shutdown is a Nightmare - What Would President Romney Do?

It's obvious Republicans in Congress don't believe in Democracy because, otherwise, they would figure out, with basic arithmetic, how their party lost the 2012 Presidential election. 

In other words, there won't be a President Mitt Romney because he and the Republican Party lost the presidential election.  

One reason the Republicans lost is because Mr. Romney said the first thing he'd do would be to repeal the health care reform law called "Obamacare". 

It was one of Gov. Mitt Romney's favorite pledges on the campaign trail: "If elected, I will repeal Obamacare on day one."  However, even as Romney ranted on this theme, a range of analyses by political and healthcare think tanks suggested it would be difficult for Romney to erase the landmark Affordable Care Act.

Nevertheless, Tea Party Republicans don't pay attention to much of anything the experts say. Right wing zealots are so narcissistic they just love to listen to themselves. Now, they're frenzied in an obsessive-compulsive disorder about repealing Obamacare, regardless of whether or not they can really do it, or not.

Tea Party zealots are in a psychotic denial about their candidate Governor Romney losing the election to President Obama, whose signature legislation, of course, is Obamacare.

These Tea Party zealots are a minority of dangerously misguided miscreants who hold fast to their entrenched hostage taking approach to governing, because they don't like Obamacare.  

They're allowed to do this. In our Democracy, where protests are allowed, Tea Party zealots are determined to abuse their right to free speech, causing harm to the entire nation because of their terrorizing tactics. In their demented thinking, it's fine to abuse the right to free speech, even if a majority of the nation voted against conservative Romney. Their arithmetic is screwed up, because Tea Party zealots act like they've contracted a Napolean syndrome, whereby their minority position takes on visions of grandeur. 

Maybe, if Romney had received the most votes and won the 2012 Presidential election, our nation would conceivably be controlled by these zealots and, thereby, this current shutdown would be a non-issue. They would probably have selectively shut down government and repealed Obamacare immediately. No democratic government would have prevented them from a takeover of government, on day one, of a Romney administration.

It's likely a Romney presidency would have jump started a national shut down by simply closing the government, piece by piece, including repeal of Obamacare. In the current preventable shutdown, we see Romney's goals, including the repeal, being driven by a minority, who are doing what their candidate was unable to do in the Executive branch of government. 

It's absolutely frightening to consider how Romney would have governed. Imagine if Democrats in the Senate tried to obstruct a Romney agenda with a simply majority vote?  There's no way Republicans would have tolerated this behavior. 

It is obvious the Republicans are driving this government shutdown because they are miffed about the outcome of the 2012 election whereby President Obama won and Obamacare moved forward.
These same right wing Republicans would never tolerate similar bully behavior if Romney were president.

Tea Party zealots clearly use our Democracy to their advantage but they don't believe in it unless it serves their selfish ends.

A Tea Party run government would be like living under tyranny.
Therefore, the majority of people in our Democracy can't allow this take over of government to succeed, regardless of the consequences.

In a democracy, a majority sets the agenda. Tea Party zealots are the enemy within us and they must be removed from office for practicing sedition. 

Moreover, these zealots must never be voted into power because, frankly, their bully tactics are tyrannical and their approach to politics is to create fear rather than trust in government.

Republicans Need to Serve in the Military Before Holding Servicemen's Pay Hostage to Misguided Ideology

Texas Senator Ted Cruz never served in the US Military. Nevertheless, his right wing Tea Party misguided political ideology is holding hostage our nation's military pay. He's taking this terrible anti military position because he doesn't agree with implementing the federal Health Care Reform law. Shutting down government will freeze military pay, for the sake of not implementing a duly passed heath care reform law. Meanwhile, Texas has much to gain from health care reform, because the state has the highest percentage of uninsured people in the nation. Health care reform, aka "Obamacare" will offer Cruz's constituents the opportunity to finally buy affordable coverage.

How to solve getting the military paid, now and in the future?

It's simple. All US legislators, especially those who serve in the federal government, should be required to serve in the US Military. Like magic. Presto! Serving in the military will teach our lawmakers how vitally important it is for the military to be paid. It's horribly wrong to withhold military paychecks, because it's families that truly suffer. Military personnel don't live in a cocoon. They have families to support. Freezing military pay hurts the families of our nation's defenders.

Incredibly, first person accounts written by US Navy Seals tell how they carry money on their persons to pay off informants and to help bribe clandestine operations.So, how is it these same heroic Seals are now at risk for not being paid, because right wing Republicans in Congress don't like Obamacare? Let me get this straight. Navy Seals can pay informants but can't, themselves, get paid? Oh paleeze! Obstructionist Republicans who hold military pay hostage are stupid and unpatriotic. 

Worse, to a right wing person, these extremists are unqualified to hold military pay hostage, because they happen to hold an ideological opposition to the federal health care reform law. Right wing Republican obstructionists, like Senator Ted Cruz and his Tea Party followers, have never put on a uniform to serve our country. It should be against federal law for anyone who never served in the US armed forces to hold hostage military salaries.

Senator Cruz and his misguided political ideology must be cruised out to sea. He and his extremist followers should be re-settled on some remote island where they can do no more harm to our nation with their extremism. 

All military personnel should promptly be paid. Nobody, especially Senator Cruz, should be permitted to make unqualified judgement about the timeliness of defense department paychecks.

Republican Alert! Government Shutdown Costs Money: Ronald Reagan Quote on Ideology

Republicans usually tremble, tremble, tremble at the mention of President Ronald Reagan. 

So, here's a quote, they'll likely faint after reading:

"No mother would ever willingly sacrifice her sons for territorial gain, for economic advantage, for ideology." Likewise, I doubt any sane son or daughter would willingly sacrifice their mother for ideology, either. http://www.brainyquote.com/quotes/keywords/ideology.html#2VCPIelLyRqxOd8H.99
Okay, Republican ideologues, how do you justify sacrificing our US government operations, the "mother" of our nation, for the sake of your minority opinion ideologies (there are too many to mention)?

Honestly, I don't know whether to be angry at the Republicans or at the American people, in general, for putting up with idiots who somehow get elected to Congress and then want to shove their right wing ideology down our throats. Now, these obsessed politicians want to dismantle our government. 

Hello? Our US Constitution wasn't written to fly in the face of voters only when right wing zealots want to protect Second Amendment gun rights!

Congress is supposed to to support all the laws.

Now, a minority of right wing Congressional Republicans are intent, like Kamikaze Pilots, to shut down our government, rather than to uphold the law passed in health care reform. In my mind, this is seditious behavior and they should be punished.

Moreover, Republicans have shamefully failed arithmetic, yet again. GOP right wing zealots are earning their labels as the "stupid party" by continuing to act dumb, because shutting down government wastes money. By the way, the GOP doesn't deserve to be called Grand Old Party, anymore. They've earned the title of Grumpy Old Party, instead. They want to shut down government, harming hard working people as a result, just because they can. They're the spoiled bully thugs hiding behind their mommies skirts in the school yard. Their "mommies" are House Speaker John Boehner, a puppet of the Tea-Party and Texas Senator Ted Cruz. Surely, these idiots must not understand how much their zealotry is costing taxpayers. "Wonklblog" pundit Ezra Klein and others are reporting how the suicidal launch to obstruct government, by shutting it down to prevent implementation of Obamacare (health care reform) will cost taxpayers billions of wasted dollars.

A government shutdown will cost us billions

By Ezra Klein, Published: September 23 at 12:37 pmE-mail the writer 

To understand what Congress is risking every time it nears a shutdown, consider what the past ones have cost. In 1996, the Office of Management and Budget tallied the two major shutdowns of the decade at about $1.4 billion. Adjusting for inflation would bring that total to more than $2 billion in today’s dollars.But as an analysis (pdf) by Roy Meyers, a political scientist at the University of Maryland, found, that estimate left out a lot. It didn’t account for the lost value of work that wasn’t done or the $300 million the federal parks would have taken in or the reduced pace of IRS audits. And then there are the less visible consequences. Meyers suggests that contractors might start charging the government a premium after shutdowns to compensate for the uncertainty of their payments. And a large body of work shows that unstable budget processes at the state level raise borrowing costs, meaning some of the costs are permanent, or at least long-lived.

Even getting near a shutdown costs money. The government must prepare, and that means a lot of hours spent on nothing useful. “You have to pull people off whatever they’re doing to inform employees about what they can do and when they can come in,” said Stan Collender, a budget expert at Qorvis communications. “You have to prepare to change the Web sites with new information about what to do during the shutdowns. You have additional security costs for the buildings because you have to lock them up so no one can get in. You have additional maintenance costs in terms of heating and cooling. And let’s say you’re a supplier who is supposed to deliver parts to the government on Oct. 2. What do you do?”

Okay, Ezra, I'll tell you what to do.

These contractors and everybody else negatively impacted by a government shut down (nearly everybody in America) must vote these stupid GOP party people out of office. If a government contractor can't deliver parts, then the person making the products obviously won't be paid, either. In my mind, that's illegal. Moreover, ask the government contractor to tell his/her suppliers to join in a rebellion, call a special election or another Constitutional Assembly in Philadelphia - (the building is still open, isn't it?) for the purpose of removing every dumb and dumber government ideologue out of office!


Even worse than being dumb is not knowing how to solve a problem. Dumb and dumber Republicans are carrying on like cats in mating season about Obamacare and the cost of government, but offer zero solutions. They're completely void of ideas. Their misplaced energy is engulfed in unfounded zealotry.


Try asking a Republican what they don't like about health care reform, aka "Obamacare" (if they'll let you get a word in edgewise) and they're likely to say they don't want anymore government run programs. Then, after they've predictably said that, ask them to tell you where they earn a living? There's a better than 50/50 chance these zealots earn money off the same government they want to shut down.

Hypocrisy 101 is a subject wheres stupid Republicans might get a passing grade.

President Obama once taught college courses in Constitutional law at the University of Chicago law school.

Surely, Obama knows how his executive leadership is essential at this time, when a government shutdown is looming, because some in Congress won't enforce the Federal Law in Obamacare. President Obama must lead Americans out of this ideological sea of right wing extremism and enforce the Obamacare law without holding government operations hostage to do so.


Meanwhile, Americans may not be able to wait for the next election to rid ourselves of seditious members of Congress who want to bring down government, because they want to break the law. They must be removed for violation of their oath of office, which is to uphold the US Constitution, including Federal Laws. Maybe, President Ronald Reagan's quote on ideology should be included in this solemn oath, presuming the dumb and stupid Republican can read, understand and remember it.

Republicans Can't Keep Railing Against Obamacare- They Need to Provide an Alternative

It's wonderful to see Ed Shultz back on TV weeknights, at 5 PM on MSNBC.  His "take no prisoners" progressive broadcast style sure knows how to get liberals emotionally fired up, on the left side of important issues.  

"The Ed Show" is back, just in time to educate Americans about the reason Republicans are obsessed with opposing Health Care Reform, aka, the Affordable Care Act, commonly called "Obamacare". 

"Republicans...spent their summer running around the country at town halls lying about Obamacare," said Shultz, "(but), I'm not going to let them off the hook."

Shultz says the reason Republicans, like Texas Senator Ted Cruz and Congresswoman Michele Bachman are obsessed about eliminating Obamacare, even supporting 40 separate votes in the Congress to repeal the law, is because they're afraid to run a campaign, in 2016, against the success of this important health care reform.  Therefore, they're determined to try to destroy the law, rather than risk seeing it successfully implemented, beginning in October 2013.  

Ahhhhh, now I get it!  Republicans aren't opposed to Obamacare because they hold a fundamentally philosophical disagreement against everybody having health care coverage. Rather, they're opposed to Obamacare because it might be successful!  Maybe, Obamacare will really provide millions of Americans with access to healthcare insurance coverage and Republicans don't want to deal with campaigning in a year when the health care reform law will be touted as successful.

Are we shocked-shocked(!)? Indeed, Republicans don't really care about people having access to health care insurance, at all.  Instead, they want to claim a hallow power victory, by infecting their right wing followers with a zeal to defeat health care reform.  

Thank you Ed Shultz for de-mystifying the Republican anti-Obamacare obsession.

Nevertheless,  I'm cautious about whether or not Obamacare will be as successful as Ed Shultz would like us to believe.  Ideally, at the outset, Obamacare had the potential to be enormously successful- until the US Supreme Court supported states having the right to "opt-out" of the Medicaid expansion. This optional exclusion to the law has effectively blocked coverage for millions of Americans who, otherwise, are unable to afford the insurance coverage provided through "exchanges", as authorized by Obamacare.  

Some states, like Maine, for example, have already (unfortunately) opted out of the Medicaid expansion.  As a result, on January, 2014, an astounding 70,000 Maine people will have no health care coverage because Governor Paul LePage vetoed the bi-partisan law, passed by the state legislature, that would have expanded Medicaid coverage, under Obamacare.  So, those people left uncovered on January 2014, will certainly not see Obamacare as being successful.

Yet, the success of Obamacare is already experienced by certain elements of the law already in effect:

1. Illegal to discriminate against beneficiaries who have pre-existing conditions - like diabetes or cancer.

2.  Eliminating caps on coverage for care.

3.  Allowing children to remain on their parents health insurance plans until they are 26 years old.

4.  Providing insurance coverage for dependent children without regard for pre-existing conditions.

5.  Providing wellness care coverage for Medicare beneficiaries.

A repeal of Obamacare will eliminate the partial list of benefits as described above.

To sustain any appearance of credibility regarding health care reform, the Republicans obsessed with eliminating Obamacare must find a suitable replacement for the law. Rather than run around the nation, wasting tax payer money to destroy health care reform aka Obamacare, they should be selling Americans an alternative plan.  But, the truth is, they simply don't have one.

Therefore, although I don't necessarily share the enthusiasm Ed Shultz professes in support of Obamacare. I fully realize how our nation simply can't go backwards on health care reform. President Obama successfully put health care coverage at the forefront of domestic public policy and Americans must rise to the challenge of fixing what might be wrong with the law, while saving its assets.

If obsessed Republicans want to continue railing against Obamacare, they must provide Americans with a viable alternative or forever hold their piece.

Meanwhile, those who intellectually realize how important health care reform is to our nation's well being must stand together in support of the Affordable Care Act until the last obsessed Republican is finally voted out of office.

Remember, Obamacare will cover mental health care; and obsessive-compulsive disorder (OCD) is coded in the Psychiatric Diagnosis and Statistical Manual of Mental Disorders (DSM), making condition reimbursable by health care insurance.  

Polarized Government While Fighting the War on Terror - Speaker John Boehner Must Stop the October 1, Quagmire

Speaker John Boehner may shut down the American government on October 1, 2013, because he wants to waste more time to force a repeal of President Obama's Health Care Reform. 

Indredulously, the threat of a government shut down on October 1st, is real. Government services could stop, all the while our state department personnel and US military are in harms way, prepared to defend our nation against renewed terrorist threats. A government shutdown, by the way, means these people probably won't get paid. 

U.S. officials have emphasized they have been watching growing threats emerging from Yemen for weeks.

An intercepted Al Qaeda message has startled Americans, once again, about the dangers of living in a world at war with terrorists.
Extremist warriors with the Al Qaeda network are continuing to plot attacks to kill Americans, especially in areas of the Middle East, where some populations are easily intimidated to become complicit with terrorist groups.

Extreme caution against international terrorism is the new normal, but especially so since we're coming up on one year since the deadly September 11, 2012, Benghazi attacks, when Ambassador Stevens was killed in fiery street demonstrations.

Terrorist "chatter" threats, combined with the coming end of the month of Ramadan, plus the concern over several major prison breaks in the region, all contributed to the U.S. decision to shut down diplomatic installations.

Nevertheless, while our nation faces renewed terrorist threats, our government is nearly paralyzed by political polarization that takes only a majority vote to fix. While our state department and the military fights, putting their lives on the line, to defend us against perceived and actual terrorist threats to national security, by groups hell bent on killing us, our government is entrenched in a difficult to explain political quagmire.  

Imagine how history will judge our priorities during the war on terror?  Congress can't pass immigration reform, won't repeal the stupid budget sequester that's hurting our economic recovery, refuses to take action on the President's Jobs Act and repeatedly wastes time voting to repeal Health Care Reform.  Yet, somehow, we're supposed to win the war on terror, being fought by brave state department and military personnel, although a polarized government may cut their salaries. Incredulously, these brave people could see their salaries frozen if Speaker John Boehner shuts down government on October 1st, just to prevent Health Care reform from moving forward.

It can't escape terrorists, who obviously watch CNN or the BBC news networks, that the American Congress can't even vote to build roads and bridges, advocated by the President's Jobs Act, never mind, unite to fight terrorist attacks.  

Although American vigilance has spared us many potential attacks, our luck could run out at any time. 

Republicans are clearly engaged in dangerous reasoning. Their priorities are screwed up. 

Congressional Republicans are willing to put state department and military personnel in harms way to defend us against terrorism, but won't vote to support economic security in programs for our citizens, like Social Security, Veterans Benefits, Unemployment Insurance, Medicaid, Head Start, Food Stamps or Meals on Wheels programs, to name a few.  

Rather, Congressional Republicans could soon waste more time to vote to shut down government, just because they can.  

A polarized government is no way to win the war on terror. This war defines our 21st century. Americans must find a way to win this war, just like we won the Cold War, regardless of how much money it costs.  It's time Republicans, who take an oath to protect the United States Constitution, show patriotic dedication by solving our nation's resolvable problems and winning the war on terror, too.

Let's vote out of office the Republican obstructionists, like Speaker John Boehner, and others who can't share the vision of a world at peace, where our people share in the wealth of a successful democracy. 

Speaker Boehner has the power to dredge our nation out of the quagmire of a government shutdown. Moreover, he has an obligation to put our national priorities in the right order.

Paid Not to Work - Taxpayers Funding an Absentee Congress

The Senate did not have a single five-day work week in Washington for the first seven months of the year.

Our US Congress is elected to represent the American people, but lately they're spending too much time away from the job.  Rather than deal with important issues like supporting immigration reform or recalling the stupid budget sequester that's harming our economic recovery, post the 2008 recession, Congress has decided to take more time off and, thereby, work less.  Still, Congressmen, and Congresswomen and their staffs are continuing to be paid, regardless of how little work they're doing.

A CNN analysis of reports that the 2013 Congress has worked less than during any of the previous 5 years.

House members have been in Washington for 56% of all non-holiday weekdays -- essentially, fewer than three days a week. Senators have walked into the Capitol for 61% of weekdays.

The weeks are not just shorter, but consistently so. The Senate did not have a single five-day work week in Washington for the first seven months of the year. The House had two.

Moreover, even when the Congress and Senate are supposed to be in the Capitol, it's like searching for "Where's Waldo" to find them.  Where they hang out is a mystery. Clearly, most members of the House  and Senate only show up when they know they must be seen.  Often, it's their staffs who monitor what's going in Congress.  Just walk into any Congressional office, pick one at random, and you'll see staff people monitoring the goings on in Congress.  The elected representatives themselves are never there.

Most members of the House/Senate only show up "when it counts", meaning. most show up for votes, although their pre-determined head count is simply a made for TV formality.  Nearly all voting outcomes are known before the tally is counted.

It's high time Americans fire this do nothing and absentee Congress, especially the Republicans who are obstructing governmental progress.  American didn't elect Congressional obstructionists who don't show up for work.  Our democracy elected people who should represent our best interest, like:

1.  Help to create jobs,

2.  Improve our economic recovery

3.  Uphold laws like the implementation of Health Care    Reform, and

4.  Create progressive laws like immigration reform

Instead, Americans are paying mega millions for the Republicans in Congress to (a) stifle job creation by holding fast to the stupid budget sequester (b) wastefully taking votes to recall Health Care Reform and (c) obstructing immigration reform including a compassionate path to citizenship for illegal immigrants. 

There's no employer I know who pays employees who don't work, yet Americans are funding an absentee Congress. 

Republican obstructionists in the Congress would be fired if they were employed in a private company. Instead, they're soaking up taxpayer money not to work. They should be fired as soon as possible and replaced with a government that shows up to represent the people who elect them.

Obamacare Poll- Americans May Finally "Get It"; But Republicans, Ahhh, Not So Much

Republicans quickly misrepresented a popularity poll recently reported about how Americans perceive the health care reform called "Obamacare".  

Probably, the poll was taken, because the US House recently wasted even more time and money to vote to repeal the health care reform law - an obsessive compulsive reaction to the law . 

CNN commissioned a poll to determine if this repetitious waste of time is somehow gaining traction with the public.  What's evident in the poll is that the public has not moved on this issue.

Nevertheless, it turns out, Republicans jumped to the conclusion that Americans oppose the health care reform law. In fact, a break down of the data shows how those who oppose the law say it's because they actually want an expansion of the benefits.  

Health care colleagues I know say people who oppose "Obamacare" do so because they prefer a single payer system.

(Dateline) Washington (CNN) - CNN's latest health care poll, released Monday, is in the political crossfire. Conservatives say it's proof the Affordable Care Act (ACA) is unpopular. Liberals, on the other hand, say it's a call for more reform and an aggressive policy to develop national health care.

As mentioned at the time, the national survey found that "a majority of Americans still oppose the nation's new health care measure, three years after it became law."

But, as was pointed out immediately in the second paragraph of the CNN story, " a CNN/ORC International poll released Monday also indicates that more than a quarter of those who oppose Obamacare, say they don't support the measure because it doesn't go far enough."

As you can imagine, after the poll went up online, opponents of the Affordable Care Act highlighted the first number in the survey, that 54% of Americans say they oppose the law.

But it's far from the whole story.

Supporters of the law point to the second number in the survey: That 35% oppose the health care law because it's too liberal, with 16% saying they oppose the measure because it isn't liberal enough. Add that 16% to the 44% who say they favor the law and that means that six in ten either support the law or don't think it goes far enough.

"It's sometimes difficult to remember, but at the start of the health care debate in 2009, many Democrats wanted nothing less than a single-payer system and were extremely disappointed when that approach was not part of the new law. That disappointment seems to have persisted among some groups," says CNN Polling Director Keating Holland.

CNN has been asking the "support/oppose" question and the "too liberal/not liberal enough" breakdown since March 2010, before the bill was passed by a then Democrat controlled Congress and signed into law by President Barack Obama. The responses to both questions have stayed pretty much in the same ballpark over the three year period.

CNN Political Editor Paul Steinhauser contributed to this report.

Rather than assist Americans with legislation to streamline the implementation of Obamacare; or educate providers about how to help the uninsured obtain access to health insurance coverage, the Republicans, instead, just want to cause trouble.  

A Republican misinformation campaign about Obamacare is intended to stir up fear and mistrust, two smear tactics they've certainly mastered, through their years of experience. 

Those who figured out how Obamacare might become a better benefit if it "morphs" into a national health plan, are on the right side of this issue.  Hopefully, these advocates will "get it" enough to vote the obstructionist Republicans out of office. In so doing,  Americans might be able seek a health care reform law the public can understand and support - in a single payer system. 

Let's get the polling data right and push harder for the health care reform Americans really want to support.

Catholic Nuns Speak Truth to Power on Health Care Reform and Abortion

American women religious in concert with the Catholic Health Care Association were the coalition the US Conservative Democrats in the House of Representatives eventually listened to when they voted on March 23rd, to pass the long overdue health care reform legislation.

An April 16, 2010 article in the National Catholic Reporter (NCR) tells the story about how the Catholic Health Care Association aligned with women religious and lay groups to educate the US Congress about the need to pass Health Care Reform.

Meanwhile, the American Bishops appeared fixed on including the most restrictive anti-abortion language imaginable in the bill. Rather than focus on the bill's badly needed reform measures, the Bishops pushed, instead, for even more restrictive language than is already included in federal Medicaid law.

Thankfully, the voices of persuasion and reason prevailed with the Conservative Democratic legislators who were ultimately convinced to vote in favor of the reform. This Catholic coalition victory also puts women religious into the arena of being politically influential. These intelligent women rose above the useless bickering about how restrictive the "restrictive" abortion language should be, while keeping their focus on supporting the common good in the bill.

A quote in the NCR from a "prominent theologian" said the Bishops thought the health bill should be defeated because they wanted to be the sole moral arbiter on complex legislative issues. They did not appear to be so worried about the common good.

A coalition of Pro-Life Women Democrats who proved they were able to work collaboratively with Pro-Choice legislators is really good new-news. These women added clout to their spiritual and political networking. By combining their compassion with their life experiences, they convinced the word-smithing skeptics of reform to think less about abortion language and more about the needs of the uninsured, the under-insured and those whose lives depend on receiving quality care, regardless of their abilities to pay.

Meanwhile, American Bishops continue their focus on the Republican party as the only way to reliably enforce the government's policy position against funding abortion.

Women religious like Sister Simone Campbell, a Sister of Social Services who is a member of the National Catholic Social Justice Lobby, spoke truth to the power of the American Bishops. It was the right thing to do.

Campbell is identified as a long time legal advocate for the poor. She and the coalition prevailed in the health care reform vote. They are to be congratulated for standing tall, by supporting the common good.

American Bishops should also congratulate the coalition, but I have not heard a peep out of them. Nonetheless, in their positions, they don't worry about where their personal health care insurance is coming from. They don't pay emergency room bills if their children become critically ill in the middle of the night. Bishops have never turned away from a drug prescription counter because they couldn't afford to pay the price of the medication. Our American Bishop's should take every opportunity to become attuned to the needs of common people.

Whether one is pro-life or pro-choice, health care problems are faced by thousands of Americans during every hour of every day. Abortion is the not our nation's biggest health care problem. Yet, access to quality and affordable care is a right we all deserve.

I hope the Catholic Coalition who helped pass health care reform keeps on growing. There are certainly hundreds more problems in the world to fix for the common good.

American Bishops, on the other hand, need to be non-political and more collaborative. It's how Health Care Reform, with politically astute Catholic Nuns in support, finally became law.

Comment from Caroline in Virginia: This article is good Julie. If ever there was a group of women held down by a male organization, these nuns have finally added their influence to health care. Caroline

Let the Shouting Stop and the Health Care Relief Begin

Comment to this blog posted at the end:
Isn't this outrageous shouting campaign the ultimate right wing irony? These recent "drown you out rather than talk", orchestrated demonstrations targeted at Democratic Congressional town hall meetings for the purpose of opposing health care reform, are acts of political desperation. The right wing is fabricating lies about your grandmother's right to hospice care, while throwing in evil and wrong minded references to Nazi Germany, just to get attention, like a child having a tantrum.

Radical right wingers who oppose health care reform are the first ones to point fingers at left wing liberals who acted out against the War in Iraq. Now, the shoe is on the right wings' foot. How dare they steal the liberal's techniques? They are imitating, in lemming-like droves, the progressive demonstrations they abhor in liberal activism.

This is the ultimate hypocrisy. Right wing nuts are throwing out deliberate misinformation for the sake of obstructing free speech for those who know better, derailing discussion and obstructing legitimate debate.

Right Wing nuts and Left Wing liberal nuts are falling out of the same tree when it comes shouting matches at public rallies, replacing civil discourse with ear piercing rhetoric.

If right wing shouters want to run our free government by noise levels, then we truly need a US Constitutional amendment to ban public debate exceeding ear damaging 100 decibels.

As for the Democratic Congress people exposed to this extremism, please hold your anger and just consider the source. It's of utmost importance for you to listen to reasonable debate while turning off the noise made soley for the sake of squelching the health care reform debate. Try using ear plugs.

Most important, stay the course and vote to support what's right for Americans who deserve 100 percent coverage and access to quality health care at affordable rates.

Call me if you need someone to shout louder than the crazy right wing obstructionists. Good luck.

Comment from Caroline Hartzler of Virginia:

Hi Julie,

I am appalled by all these ranting people. They haven't noticed that within the last 40 years the Republicans managed to strangle all efforts to improve their quality of life. These "conservatives" don't want big government but they certainly can't take care of themselves as they age. Those who stir this anger enjoy the "people power" they have unleashed; but, they do not reveal their own health insurance plan and how much they pay for it. Just like they don't reveal all the funding they receive from insurance companies and all other corporations liked to the medical industry.

They are screaming about socialistic medicine but they didn't notice that most of the large corporations have eliminated all the benefits from their pay packages and they have been left to fend for themselves.
Perhaps this is why corporate managers have larger salaries and bonuses than ever before.

And pray tell, these same ranting people have not heard about Advanced Medical Directives before??? Obviously, they aren't tuned to the level of sanity that has been advising us about the advantages of forethought.

Another topic dear to my heart-- gun control. It is so safe now in the U.S., that we should allow people to carry concealed weapons, even across state lines. It seems that no matter what the next newscast brings about random shootings, communities think it is happening far from them so there should be no gun control.

I become dismayed by the unhealthy American attitudes encouraged among all age groups. It is truly sad that the free American education promulgated through high school has not produced enquiring minds.

Ciao,
Caroline