Archive for the ‘Medicare/Medicaid’ Category


Saturday, March 12th, 2016



Saturday, October 10th, 2015



Mass Shootings and a Mental-Health Disgrace

The federal bureaucracy is anti-patient, anti-family and anti-medical care. Reform is essential

ByTim Murphy

Mr. Murphy, a Republican, is a U.S. representative from Pennsylvania and a psychologist in the Navy Reserve Medical Service Corps.
Oct .9, 2015

In 1955 there were 558,000 inpatient psychiatric beds in the U.S. Today there are fewer than 45,000. The severe shortage is due to the decades-long deinstitutionalization that began in the civil-rights era. But it has been exacerbated by a Medicaid reimbursement rule known as the “institutions for mental diseases exclusion,” which prohibits federal matching payments for inpatient care at psychiatric hospitals with more than 16 beds. My bill moves away from the arbitrary 16-bed cap and establishes a clinical standard for patients with serious mental illness.
These past few months have brimmed with tragedy. Americans are struggling to make sense of horrific acts of mass violence like the August shooting on live television in Roanoke, Va., and last week’s college campus shooting in Roseburg, Ore.
We all know how this plays out in Congress: a moment of silence on the House floor and a fraternal feeling of melancholy when the flag over the Capitol is lowered to half-staff. But that moment of silence will not heal the hearts of those who lost a loved one, and it will not stop the next tragedy. Here and now we need action; we need real change.
That’s why I’ve authored the Helping Families in Mental Health Crisis Act. The bill focuses resources and reform where they are most needed: to foster evidence-based care, fix the shortage of psychiatric hospital beds, empower patients and caregivers under HIPAA privacy laws, and help patients get treatment well before their illness spirals into crisis.
As chairman of the House Oversight and Investigations Subcommittee, I led a congressional investigation into our failed mental-health system after the 2012 Sandy Hook Elementary School shooting. What we found was shocking and disgraceful: a wasteful federal bureaucracy that is anti-patient, anti-family and anti-medical care. The federal government has more than 112 programs that deal with mental health in one way or another, yet a person with serious mental illness is 10 times more likely to be in a prison cell than a psychiatric hospital bed.




Tuesday, July 7th, 2015

July 2, 2015



Saturday, September 13th, 2014



Mark Sklar  Dr. Sklar is an assistant professor of medicine at the Georgetown University Medical Center and at the George Washington University Medical Center.
Sept. 12, 2014
It has been four years since the passage of the Affordable Care Act, so I thought it may be useful to provide the perspective of a physician providing daily medical care. I am an endocrinologist in Washington, D.C., and have been in solo private practice for 17 years after seven years at an academic institution. Since 1990, the practice of medicine has changed significantly, seldom for the better.

In the 1990s insurance companies developed managed-care plans that greatly increased their profits at the expense of the physician. With the Affordable Care Act, we are seeing new groups profiting from changes to the health-care system. Entrepreneurs and hospital executives are capitalizing on organizing physicians into groups called Accountable Care Organizations from which they will take a very substantial percentage of collected income. Now that physicians are being required to use electronic medical records, the companies that develop them are harvesting money from physicians’ practices and from hospitals.

The push to use electronic medical records has had more than financial costs. Although it is convenient to have patient records accessible on the Internet, the data processing involved has been extremely time consuming—a sentiment echoed by most of my colleagues. To save time, I was advised by a consultant to enter data into the electronic record during the office visit. When I tried this I found that typing in the data was disruptive to the patient visit. My eyes were focused on the keyboard and the lack of direct contact kept patients from opening up and discussing their medical and personal problems. I soon returned to my old method of dictating notes and pasting a print-out of the dictation into the electronic record.

Yet to avoid future financial penalties from Medicare, I must demonstrate “meaningful use” of the electronic record. This involves documenting that I covered a checklist of items during the office visit, so I spend 90 minutes each day entering mostly meaningless data. This is time better spent calling patients to answer questions or keeping updated with the medical literature.

If electronic records ever allow physicians to obtain data from previous laboratory and imaging testing, it will improve costs and patient care. So far, however, the data in electronic records—like paper charts—can’t be shared unless physicians work in the same health-care system.

My practice quickly adopted the new Medicare requirements for electronically prescribing medications. Yet patients often do not want their prescription sent electronically. They want a physical copy—either because they don’t trust the Internet or because they don’t need to fill the prescription immediately. If I don’t electronically prescribe for a certain number of Medicare patients, I am penalized with a decrease in reimbursement that can rise to a maximum of 5%. Patients should have a choice in how their prescriptions are delivered, and physicians shouldn’t be penalized for how the patients choose. (more…)



Wednesday, April 2nd, 2014
On March 31, 2014,  Senator Richard Burr, Republican, North Carolina, was the guest speaker at a John Locke Foundation luncheon.  The subject of his talk was The Patient CARE Act which was sponsored by Senator Burr,  Senator Tom Coburn, Republican, Oklahoma, and Senator Orrin Hatch, Republican, Utah.   This proposal is a comprehensive alternative to Obama’s Affordable Care Act  aka Obamacare.


Below  you will see photos from the luncheon and  links to a detailed explanation of the Republican  plan plus a video of Senator Burr’s talk.   Many thanks to Becki Gray, Vice President for Outreach of the John Locke Foundation, for providing these links.   

Republicans do have a replacement healthcare plan!   Nancy


Senator Richard Burr, Republican, North Carolina

Conservative Ladies – standing from the left: Mary McKinney, Kathy Arab, Meg Gresham, Dana Postiglioni seated from the left: Laura Cox, Janie Wagstaff, Laura Gutman and Nancy Clark (Lee Green in blue dress standing in background)

Here are two links to good summaries of the Burr-Coburn plan:




Here is the link to Sen. Burr’s talk:  VIDEO OF SENATOR’S TALK







Monday, February 24th, 2014


Feb. 22, 2014

EXCERPT FROM THIS ARTICLE:  The benefits of the digital revolution are large. But we’ll also have to deal with problems and unanticipated consequences, mostly related to privacy, the possibility of misuse, and the concern that patients might be overwhelmed with so much information. The government via the FDA will need to play a role to ameliorate all three of these potential issues. Regardless, digital medicine is coming over the next few years with the force of a hurricane whether we doctors—and we patients—are ready or not.

A sweeping transformation of medicine has begun that will rival in importance the introduction of anesthesia or the discovery of the germ basis of infectious disease. It will change how patients and physicians interact. It will change medical research and therapy. “Sick care”—the current model of waiting for you to get sick and then trying to alleviate symptoms and make you well—will become true “health care,” where prevention is the mantra and driving force. Welcome to the world of digital medicine.

First and foremost, the digitalization of medicine will personalize health care: Treatment will be tailored to each person as a unique individual suffering a unique illness according to his or her genetic makeup. Currently, therapy is based on population statistics. Patients are separated into groups defined in various ways but usually by similar symptoms or by the results of basic lab tests (like cholesterol levels). These groups are then treated with drugs that may help many people, but not all of them, and often only a fraction of them. By incorporating information from an individual’s DNA, the data made available through digitalization will enable clinicians to match individuals with treatments. Only patients who will benefit will get a particular drug.

This is huge. Giving drugs to patients who are not helped has been enormously expensive and often perverse. Particularly with anticancer drugs, it often condemns such patients to horrendous side effects for no benefit.

Second, digitalization will democratize medicine: You will own or control the data about your own medical condition, and you will be able to analyze it instantly by your connectivity to the Web. In many ways, the profession of medicine today is where Christianity was when the Gutenberg Bible put scriptures into the hands of the laity. But the profession is going to change, subtly and not so subtly shifting power away from the medical-industrial complex: doctors, health insurers, hospitals, medical labs and Big Pharma. (more…)



Tuesday, February 18th, 2014


An Obamacare Report Card



Wednesday, February 12th, 2014


The end of government

By , Published: February 9, 2014

Something strange is happening in Washington. We are slowly dismantling the federal government, even as its spending is growing larger. The paradox is that governmental competence is being systematically degraded while the government’s size, as measured by its budget, is increasing. We are spending more and getting less, and — unless present trends are reversed — this will continue for years. It threatens the end of government as we know it.

The cause is no mystery. An aging population and higher health spending automatically increase budget outlays, which induce the president and Congress to curb spending on almost everything else, from defense to food stamps. Over the next decade, all the government’s projected program growth stems from Social Security and health care, including the Affordable Care Act. By 2024, everything else will represent only 7.4 percent of national income (gross domestic product), the lowest share since at least 1940, says Douglas Elmendorf, head of the Congressional Budget Office.

This is the central budget story, and it’s largely missed — or ignored — by political leaders, the media, political scientists and the public. The welfare state is taking over government. It’s strangling government’s ability to respond to other national problems and priorities, because the constituencies for welfare benefits, led by Social Security’s 57 million, are more numerous and powerful than their competitors for federal support. Politicians of both parties are loath to challenge these large, expectant and generally sympathetic groups.

The United States, of course, is not the only advanced society grappling with aging, but it is extreme in its stubborn denial of the obvious. The Pew Research Center recently polled people in 21 countries about whether aging is a problem. The United States ranked 19th in its unconcern, ahead of only Indonesia and Egypt, whose populations are young. Only 26 percent of Americans thought aging was a problem. The share was 87 percent in Japan, 55 percent in Germany and 45 percent in France. (more…)



Sunday, November 24th, 2013


The Wall Street Journal is making it more difficult  to copy  their articles so I am now just providing the links to the articles below.   Nancy
:  – AN ALLY FRETS ABOUT AMERICAN RETREAT – An influential   Saudi royal prince talks about the U.S. debacle in Syria, the Iranian threat, and ‘this perception that America is going down.’ – WHY IT TAKES SO LONG TO BUILD A BRIDGE IN AMERICA – There’s plenty of money.  The problem is interminable environmental review. – WORSE THAN OBAMACARE – Obama’s biggest failure is that he hobbled the U.S. economy   by Daniel Henninger – OBAMACARE FORCED MOM INTO MEDICAID – The authors’s mother preferred to pay for her own health care rather than be on the government dole.  Now she has no choice  – THE GIPPER’S GUIDE TO NEGOTIATING  – The guy who is anxious for a deal will get his head handed to him  – by George  P. Shultz, a former secretary of labor, Treasury and state and director of the Office of Management and Budget  –  YOU ALSO CAN’T KEEP YOUR DOCTOR  –  The author had great cancer care and health insurance.  Her plan was canceled  and now she worries how long she’ll live.  –  NOBODY’S HOME AT HOMELAND SECURITY  –  The man running the inspector general’s office is under investigation;  so is the man nominated to replace him.   –  GREEN ENERGY IS THE REAL SUBSIDY HOG  –   Renewables receive three times as much money per energy unit as fossil fuels. 





Tuesday, October 22nd, 2013



Medicaid in North Carolina

| October 3, 2013 |

Becki Gray      by Becki Gray, Carolina Journal, October 3, 2013.

Before Obamacare, before individual mandates, before exchanges, there was Medicaid. Started in 1965 under President Johnson as part of his War on Poverty, Medicaid extended health insurance coverage to low-income Americans.

Today, Medicaid is the largest publicly funded insurance program in the country. It serves low-income families, the elderly, and disabled. One In five Americans is on Medicaid, more than one-third of the births in the United States are covered by Medicaid, and one-fourth of U.S. children get health care through Medicaid.

Medicaid covers one in nine North Carolinians — 1.6 million of us — and 51 percent of births are covered by Medicaid, the sixth-highest rate in the nation.

Medicaid is funded jointly by the state and federal governments. North Carolina’s share of the program is about $3 billion, while total Medicaid spending in N.C. is closer to $14 billion.

Medicaid spending has grown 90 percent over the last decade and is the fastest-growing part of our state budget, with spending rising by 15 percent in 2011-12; 16.8 percent in
2012-13; and a projected 17.2 percent in 2014-15.

North Carolina’s Medicaid costs are the highest in the South and among the highest in the nation. We have more people enrolled and spend more per patient than neighboring states. Twenty-five percent of the state’s primary care physicians aren’t accepting new Medicaid patients, limiting access, reducing health outcomes for patients, and driving up costs.

Uncontrolled expenses result in consistent budget overruns. Just this year, legislators faced a $400 million shortfall. Since Medicaid is a federal entitlement program, it has to be funded before anything else. Medicaid is the biggest driver of state budget decisions, crowding out other priorities. (more…)

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