ObamaCare ‘death panel’ faces growing opposition from Democrats

From The Hill

ObamaCare’s cost-cutting board — memorably called a “death panel” by Sarah Palin — is facing growing opposition from Democrats who say it will harm people on Medicare.

Former Democratic National Committee Chairman Howard Dean drew attention to the board designed to limit Medicare cost growth when he called for its repeal in an op-ed late last month.

Dean was quickly criticized by supporters of the Independent Payment Advisory Board (IPAB), who noted his ties to the healthcare industry as an adviser to a major D.C. lobbying firm.

But the former Vermont governor is not the only Democrat looking to kill the panel.

A wave of vulnerable Democrats over the past three months has signed on to bills repealing the board’s powers, including Sen. Mark Pryor (Ark.) and Reps. Ron Barber (Ariz.), Ann Kirkpatrick (Ariz.), Kyrsten Sinema (Ariz.) and Elizabeth Esty (Conn.).

All five are considered vulnerable in next year’s election, highlighting the stakes and the political angst surrounding the healthcare measure.

The four House Democrats faced criticism from their party in July after voting with Republicans to delay ObamaCare's individual and employer mandates — moves widely interpreted as political positioning ahead of 2014.

Two of the lawmakers explained their opposition by suggesting the board would limit care for Medicare patients.

But the National Republican Congressional Committee (NRCC) blasted the four Democrats for “desperately trying to jump off the ObamaCare train.”

The cost-cutting board has been dogged with controversy over the last three years.

Major healthcare interests like the American Medical Association, the American Hospital Association and the pharmaceutical lobby have supported IPAB repeal, saying the panel would cut providers' pay arbitrarily.

Public awareness of the board shot up last year when Palin called it a “death panel,” connecting the IPAB to her previous attacks on a proposal to encourage end-of-life planning in the Affordable Care Act.

“Though I was called a liar for calling it like it is, many of these accusers finally saw that ObamaCare did in fact create a panel of faceless bureaucrats who have the power to make life and death decisions about healthcare funding,” Palin wrote on Facebook.

This claim experienced a revival on the right after Dean published his op-ed, which argued that the board would ultimately ration care for Medicare patients.

“The IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them,” Dean wrote in The Wall Street Journal.

“Getting rid of the IPAB is something Democrats and Republicans ought to agree on.”

The piece quickly went viral, prompting conservative bloggers and Fox News hosts to cheer: “Dean confirms that Sarah Palin was right!”

The IPAB is designed to kick in when Medicare cost growth grows above a specified rate. It is charged with making recommendations on how to reduce Medicare spending, and its proposals are required to be fast-tracked through Congress.

The Affordable Care Act prevents the IPAB from making recommendations that would directly ration care. But critics say reducing provider reimbursements would have the same result by making it difficult for healthcare professionals to make money in Medicare.

While it's unlikely the board will be convened soon, Medicare cost growth is not high enough to trigger its work, and any nominees would face long confirmation fights in the Senate, Dean's op-ed renewed focus on bills to repeal the IPAB.

The Senate and House measures currently have 32 and 192 co-sponsors, respectively, including 22 Democrats in the House. Co-sponsors include lawmakers like Rep. John Barrow (D-Ga.), a longtime GOP target.

But calls for repeal are not taking up the whole debate.

Dean’s piece also drew strong arguments in favor of the panel from supporters like Peter Orszag.

The former White House budget director said the IPAB is necessary in light of Medicare’s transition to new payment models that are meant to lower costs while improving care.

It's preferable to the “old way,” which saw Congress “simply slash Medicare payments” to providers, Orszag wrote in a column for Bloomberg.

“The point of having such a board — and here I can perhaps speak with some authority, as I was present at the creation — is to create a process for tweaking our evolving payment system in response to incoming data and experience, a process that is more facile and dynamic than turning to Congress for legislation,” he wrote.

In the meantime, the Democratic National Campaign Committee (DCCC) is warding off criticism of the anti-IPAB Dems with a push to turn the ObamaCare tables on the GOP.

The committee pointed to evidence Wednesday that resisting the healthcare law could hurt Republicans in the next election.

A new poll commissioned by the Service Employees International Union found that undecided voters prefer an anti-repeal Democrat over a pro-repeal Republican in a generic match-up.

“Instead of fighting old political battles on healthcare, polling shows that Americans want Republicans to work with Democrats to implement Obamacare and move on to focus on creating good jobs,” said Emily Bittner, a spokeswoman with the DCCC.

“The public strongly disapproves of Republicans’ plan to give insurance companies free rein over our health care.”

Me and My Obamaphones

From National Review Online

Not on welfare or below the poverty line? Never mind — here’s your free phone. 

By Jillian Kay Melchior

Confession: You’re paying my phone bill.

In the past month, I have received three shiny new cell phones, courtesy of American taxpayers, that should never have fallen into my hands.

The Federal Communications Commission oversees the so-called Lifeline program, created in 1984 to make sure impoverished Americans had telephone service available to call their moms, bosses, and 911. In 2008, the FCC expanded the program to offer subsidized cell-phone service, and since then, the expenses of running the program have soared. In 2012, the program’s costs had risen to $2.189 billion, up from $822 million before wireless carriers were included. As of June, there were 13.8 million active Lifeline subscriptions.

To be eligible for Lifeline, the applicant is supposed to be receiving some significant government benefit — food stamps, Medicaid, Supplemental Security Income, public housing assistance, etc. But because welfare eligibility has expanded under the Obama administration, more people than ever before are qualified to receive “free” cell-phone service — part of the reason why Lifeline mobiles have become commonly known as Obamaphones. Alternatively, applicants can qualify if their household income is less than 136 percent of the federal poverty line.

But as with any federal program with too much funding, too little oversight, and perverse financial incentives, Lifeline has become infamous for rampant fraud and abuse. There have been news reports about recipients flaunting dozens of subsidized phones. And in February, the Wall Street Journal reported on an FCC audit of the top five Lifeline providers, which found that “41% of their more than six million subscribers either couldn’t demonstrate their eligibility or didn’t respond to requests for certification.”

The FCC supposedly buckled down on eligibility standards last year and established other safeguards aimed at reducing fraud. I was curious about how tough it was to get one of these phones, so last month, I hit the streets of New York. And out of respect for the law and my journalistic integrity, I did not lie to obtain a phone.

Now is the point, I suppose, where I should explain that I really, really shouldn’t have received a single phone. Despite what you hear, not all 20-something writers in the Big City are starving. Given my earnings, even if I were supporting a family of eight, my income would still rule me out. Nor do I receive any type of government benefit. By the Lifeline program’s standards, I am unambiguously ineligible.

My first task was figuring out where to register. The rule of thumb is that wherever you can sign up for food stamps, you can apply for an Obamaphone.

Representatives from SafeLink and Assurance, two of the leading New York Lifeline vendors, stand outside the food-stamp offices, paired like Mormon missionaries, young and polite and earnest. They carry electronic tablets and ask all passersby whether they’ve received their free phone “yet” — as if it were an inevitability.

They approached me for the first time outside the food-stamp office at Tenth Avenue and 216th Street, on the northern tip of Manhattan. The SafeLink vendor, a man probably in his mid 20s, asked me whether I was enrolled in any benefit programs.

“No,” I said, “but I’d certainly like to be. I’m hoping to be.” And indeed, while doing research for another story, I had gone through the motions of applying for New York City welfare, which I also don’t qualify for. I showed him my Human Resources Administration paperwork packet and the case number assigned to me. I reiterated that though I had once applied, I had never been approved for any sort of benefit.

He brought out his electronic tablet immediately to sign me up for phone service. He asked if I had an insurance card, so I pulled out my trusty Blue Cross Blue Shield. He looked at it for a second, puzzled, then asked if I had Medicaid. No, I told him, just private insurance through my work plan.

“Private insurance? What’s that?” he asked, maybe not facetiously. My BCBS card was nevertheless photographed, as well as the first page of my Human Resources Administration paperwork. He asked for my name and my home address, and that was about it. The whole process took less than five minutes, and I had to provide no documentation verifying my income level or (nonexistent) welfare status.

The SafeLink vendor then referred me to his opposite number, a rep from Assurance. She too took down my information, registering me for another Obamaphone.

Traveling to several of the welfare offices in the city, I learned this was common practice. Obamaphone reps come in twos, and both will sign you up if they can.

That’s a very questionable practice, given the Lifeline program’s rules: Each eligible household may receive only one Lifeline subsidy, and obtaining multiple subsidized phones from multiple Lifeline carriers is “a flat-out violation of our rules,” says Michelle Schaefer, an attorney-adviser from the FCC’s Telecommunications Access Policy Division, Wireline Competition Bureau.

Schaefer also tells me that “consumers are, on their applications, required to certify under penalty of perjury that they will only be receiving one Lifeline discount.”

But when I went around New York signing up for multiple phones, I never even saw the applications; SafeLink and Assurance vendors filled out the necessary forms on their tablets on my behalf, clicking through so quickly that it must have been nearly muscle memory. And nobody mentioned perjury.

Granted, the first question the wireless reps asked was usually whether I was already enrolled in the Lifeline program. I told the truth: I had signed up recently, but the phone hadn’t arrived in the mail yet. Almost always, that got me re-entered into the system without hesitation.

When I did receive my SafeLink phone a few days later, I started informing vendors that I did have one Lifeline phone. They assured me that the Lifeline program permitted me to have one phone from each participating wireless provider — which simply isn’t true.

Maybe there’s a disconnect between the corporate offices of wireless providers and their men on the street; a letter I later received from Assurance mentioned that “a household is not permitted to receive Lifeline benefits from multiple providers. Violation of the one-per-household rule constitutes a violation of federal rules and will result in de-enrollment from the Lifeline program and potentially prosecution by the United States government.”

But the wireless providers aren’t doing much due diligence, if my experience is indicative.

At the Union Square location, a SafeLink rep noted that I was already approved for a phone and declined to re-enter my information — but the rep from Assurance, standing only a few feet away, readily signed me up.

At the welfare office on Schermerhorn Street in Brooklyn, a vendor hesitated when I told her that I’d already applied but the phone had not yet been delivered. “Surely your system will catch if I’m actually enrolled,” I told her. She shrugged and signed me up once more.

At the DeKalb Avenue office in Brooklyn, when I told the rep I wasn’t receiving welfare, I was signed up for a phone but cautioned that I might well be denied upon secondary review.

And at one Lifeline location in East Harlem, I walked up to the wireless representative talking very loudly on my own smartphone. I hung up only to answer her questions. Now, keep in mind that the program is supposed to provide cell-phone service to people too poor to afford any phone whatsoever — but my application for a subsidized mobile was happily submitted, even as I dinked around very obviously on my existing smartphone.

So here’s the final count: I was able to apply on the street for one SafeLink phone and seven Assurance phones. I received one SafeLink phone and two Assurance phones, no questions asked. For several other applications, Assurance sent me requests for more financial information.

Finally, I received one other letter, full of grammatical errors, informing me that “there is already an Assurance Wireless account established at this address” and requesting further information about my application. I find it curious that Assurance caught a duplicate only once, considering that I’ve got seven entries in their system, and that they have on file my name, address, HRA case number, and, in some instances, photos of my insurance card and driver’s license. SafeLink was slightly better about catching duplications on the street, but it still gave me a phone when it shouldn’t have.

Since receiving my undeserved phones, I’ve repeatedly tried to reach both SafeLink and Assurance press reps for comment, all to no avail. Their corporate offices have sent me the numbers of their customer-service centers, which are easily accessible and happy to offer plan upgrades to Lifeline clients.

Representative Tim Griffin (R., Ark.) has long opposed the Lifeline wireless subsidies, making it a pet cause. He reiterated the basic point I had learned from this experience: The problems began when the federal government got in the business of providing free cell phones, and the FCC’s recent reforms aren’t sufficient.

“I saw all the horror stories of people getting 10, 20, 30, 40 phones,” Griffin says, “the [wireless] companies not paying a lot of attention and in some cases no attention to who was getting them and whether they were getting duplicates.”

And if you’ve been wondering why the companies are so eager to hand out free phones, the incentive is built into the program. As Griffin explains, “Of course, the way the program was set up, [wireless companies] were getting money for every one they could give out, so they gave out as many as they could.”

And still do.

— Jillian Kay Melchior is a Thomas L. Rhodes Fellow for the Franklin Center for Government and Public Integrity.

College And Your Child

From JewishJournal

BY DENNIS PRAGER

Photo by dny3d / shutterstock.com

The following are some of the basic postulates about America, religion, society, morality, the arts and Israel that are taught at almost every American university.

America:

• The United States is no better than any other country, and in some important ways it is worse than many. 

• On the world stage, America is an imperialist country, and domestically it mistreats its minorities and largely neglects its poor.

•  “American exceptionalism” and overt displays of patriotism are examples of American chauvinism. 

• America is a racist country. You white students are racist — and you either acknowledge this or you are in denial.

• Non-whites, however, cannot be racist — because whites have power and the powerless cannot be racist.

• The South votes Republican because it remains racist, and the Republican Party caters to that racism.

• Women are victims — of men. Blacks are victims — of whites. Latinos are victims — of Anglos. Muslims are victims — of Christians. Gays are victims — of straights. 

• The American Founders were sexist, racist slaveholders whose primary concern was preserving their power and wealth.

• The original meaning and intent of the Constitution are either unknowable or irrelevant to today. 

• The Electoral College should be abolished in order to transform America from a republic to a democracy.

• America’s dropping of the atomic bomb on Hiroshima was racist and a war crime.

Religion:

• God is at best a nonissue, and at worst a foolish and dangerous belief. 

• Only people who reject science believe that the universe was designed.

• Religion has killed more people than any other idea, group or movement in human history.

• Christianity, in particular, has been a malevolent force, its history consisting largely of inquisitions, crusades, oppression and anti-intellectualism. Islam, on the other hand, is a religion of peace. 

• Criticism of Christianity is therefore enlightened. Criticism of Islam, however, is a form of bigotry known on campus as Islamophobia.

• The good done by Christians in forming the Western world is not attributable to Christianity. 

• Evil committed by Christians is due to Christianity. Evil committed by Muslims is not due to Islam. 

Society and Morality:

• The reason for Third World poverty is that Western nations exploited Third World nations through colonialism and imperialism.

• The great moral conflicts are between the rich and the poor and between the powerful and the powerless, not between the good and the evil (that is dismissed as Manichaeism).

• The state is the most effective vehicle to creating a humane society. Therefore the larger the state, the more good it will do.

• Big corporations are bad. Big unions are good.

• Capitalism is rooted in selfishness and is structured to benefit the wealthy.

• Health care for profit is morally wrong.

• War is ignoble. Pacifism is noble.

• Human beings are animals, differing from “other animals” only in having more developed brains. 

• Sexual orientation is biologically determined. Gender is not. 

• Therefore, men and women, including mothers and fathers, are essentially interchangeable. The notions that married mothers and fathers are the parental ideal and that mothers and fathers bring unique things to a child are heterosexist and homophobic.

• The greatest vehicle for women’s happiness is career satisfaction, not marrying and making a family.

• The primary causes of criminal violence are poverty and racism.

• Man-made carbon emissions are dramatically heating up the planet, and this will lead to global catastrophe.

Arts and Literature:

• There is no actual meaning to a text. Texts mean what the reader perceives them to mean.

• There is no better and worse in literature and the arts. The reason universities traditionally taught Shakespeare, Michelangelo and Bach — rather than, let us say, Guatemalan poets, Sri Lankan musicians and Native American storytellers — was not that they were the best but because of Western “Eurocentrism.”

Israel:

• Israel’s settlements on the West Bank are the primary cause of the Middle East conflict. 

• Israel is an apartheid state, morally little different from apartheid South Africa.

Many readers agree and many will disagree with all or virtually all of these propositions. But these are the propositions that almost every university teaches students (outside the departments of business, math and the natural sciences). 

Reporting on one study of college faculty, the Washington Post’s media reporter Howard Kurtz (himself a liberal), wrote: “At the most elite schools. ... 87 percent of faculty are liberal and 13 percent are conservative.” Kurtz went on to note that 84 percent of instructors were pro-choice, 88 percent of professors want more environmental protection “even if it raises prices or costs jobs” and “65 percent want the government to ensure full employment, a stance to the left of the Democratic Party.”

“The most left-leaning departments are English literature, philosophy, political science and religious studies, where at least 80 percent of the faculty say they are liberal and no more than 5 percent call themselves conservative.” 

As Chris Mooney, a left-wing writer, wrote in the HuffingtonPost: “Higher education is a liberal and secular force in our society.”

If you are a parent who agrees with these postulates, you are likely to deem college worth $100,000 or more. You feel good knowing that the university is reinforcing your values and convictions in your child during the course of the four most impressionable years of his or her life. 

On the other hand, if you are a parent who does not hold these positions, you are not merely wasting an enormous sum of money; you are paying an enormous sum of money to have a college inculcate views and values that are counter to your most precious values and ideals. What you can do about it will be the subject of a future column.

---

Dennis Prager is a nationally syndicated radio talk-show host (AM 870 in Los Angeles) and founder ofPragerUniversity.com. His latest book is the New York Times best seller “Still the Best Hope: Why the World Needs American Values to Triumph” (HarperCollins, 2012).

Europe's Renewable Romance Fades

From The Wall Street Journal

High energy bills and threats of blackouts ended the honeymoon. America, take note.

By 
• DAVID GARMAN
  AND SAMUEL THERNSTROM

Europe has bet big on wind and solar energy, and many environmental advocates would like America to follow. Wind and solar have a role in the U.S. energy economy, but we would be wise to see the cautionary tale in the European experience and adjust our plans accordingly.

Wind and solar generate 3.5% of America's electricity today, but Denmark gets 30% of its electricity from wind and hopes to produce 50% by 2020. Germany, Europe's largest national economy, produces roughly 12% of its electricity from wind and solar today, and it wants renewable energy to account for 35% of electricity generation by 2020.

Clean energy powered by renewable resources is understandably attractive. But the honeymoon with renewables is ending for some Europeans as the practical challenges of the relationship become clear.

The first challenge is cost. Germany has reportedly invested more than $250 billion in renewable energy deployment, and its households pay the highest power costs in Europe—except for the Danish. On average, Germans and Danes pay roughly 300% more for residential electricity than Americans do.

Another challenge of Europe's growing dependence on renewable energy is far more serious: the potential loss of reliable electrical supply. It's one thing to ask consumers to pay more for cleaner energy; it's another to force them to endure blackouts.

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Getty Images

Wind turbines near Buetzow, Germany.

Since large amounts of electricity cannot be easily or inexpensively stored, it must be generated and delivered ("dispatched") to meet the constantly changing demand for power. As millions of consumers turn electric lights and appliances on and off, power generators and grid operators must match supply to demand to ensure that current is moving across wires at the proper frequency to avoid power failures, brownouts and other problems.

Normally, this is fairly straightforward. Grid operators generally rely on coal and nuclear plants to meet baseload demand while modifying gas and hydroelectric power output to meet shifting demand. But electricity from wind and solar is variable and intermittent. Nature determines when and how much power will be generated from available capacity, so it is not necessarily "dispatchable" when needed.

When intermittent renewables are small players in the grid, they can be easily absorbed. But as they reach European levels of penetration, the strain begins to show. There are increasing reports of management challenges resulting from wind and solar across the European grid, including frequency fluctuations, voltage support issues, and inadvertent power flows. Anxious operators are concerned about potential blackouts.

In an April 17, 2012, letter to EU Commissioner for Energy Gunter Oettinger, for example, Daniel Dobbeni, the European Network of Transmission System Operators president, said grid operators are "deeply concerned about the difference in speed between the connection of very large capacities of renewable energy resources and the realization in due time of the grid investments needed to support the massive increase of power flows these new resources bring." He also expressed great concern "about the potential destabilizing effect of outdated connection conditions for distributed generation that are not being retrofitted anywhere fast enough."

There are solutions for these problems—upgrades to electricity transmission and distribution and expansions of "dispatchable" generation capabilities, coupled with "demand-response" and other efficiency measures. But the additional cost will be significant. The International Energy Agency has warned that Germany will need to invest between €47.5 billion ($62.9 billion) and €72.5 billion ($96 billion) in transmission and distribution over the next 10 years.

For now, the American picture is different. Unlike Europe, the U.S. has excess generating capacity and generally adequate transmission and distribution systems, so variability in the small amount of electricity produced by wind and solar in most markets is not a significant problem. But renewables are growing quickly. As older nuclear plants are decommissioned and new Environmental Protection Agency regulations shut down coal-fired plants, states such as California that are increasing renewable requirements will start to look more like Europe, with its cost structure and grid-management challenges.

There is also an important lesson in the European experience with energy subsidies: Focus incentives so they reward the right behavior. Lavish subsidies for wind and solar have changed Europe's generation mix, but the costs have been high because the subsidy structure prioritized mass deployment rather than efficiency, reliability and innovation. Even in the U.S., the wind-production tax credit has occasionally produced "negative pricing"—that is, turbine operators pay grid operators to take their power even though it isn't needed, just so the wind generators can collect tax credits.

If Congress insists on subsidizing renewable energy (and to be fair, Washington subsidizes all forms of energy), it should reform subsidies to incentivize innovations that would improve the efficiency and reliability of wind and solar, as well as the development of improved energy-storage technologies.

It is not surprising that many Americans share the European passion for wind and solar. But, as with any relationship, once the initial infatuation fades and difficult issues start to emerge, thoughtful action is needed before the relationship sours. Careful reform of our policies, informed by lessons learned from Europe, could avoid an ugly divorce down the road and help renewables find their place in America's energy economy.

Mr. Garman, an assistant secretary and under secretary at the U.S. Department of Energy (2001-07), is on the board of directors of the Energy Innovation Reform Project. Mr. Thernstrom is executive director of EIRP.

More Doctors Steer Clear of Medicare

From The Wall Street Journal

Some Doctors Opt Out of Program, Frustrated With Payment Rates and Mounting Rules

Ben Sklar for The Wall Street Journal

Juliette Madrigal-Dersch, shown treating a patient in Marble Falls, Texas, is president of a group that advocates private-pay medicine.

Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts.

Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts. Stefanie Ilgenfritz reports. Photo: Ben Sklar for The Wall Street Journal.

The number of doctors who opted out of Medicare last year, while a small proportion of the nation's health professionals, nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services, the government agency that administers the program. Other doctors are limiting the number of Medicare patients they treat even if they don't formally opt out of the system.

Even fewer doctors say they are accepting new Medicaid patients, and the number who don't participate in private insurance contracts, while smaller, is growing—just as millions of Americans are poised to gain access to such coverage under the new health law next year. All told, health experts say the number of doctors going "off-grid" isn't enough to undermine the Affordable Care Act, but they say some Americans may have difficulty finding doctors who will take their new benefits or face long waits for appointments with those who do.

Doctor Goes Off Grid

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Ben Sklar for The Wall Street Journal

Dr. Juliette Madrigal-Dersch's patients pay her directly.

CMS said 9,539 physicians who had accepted Medicare opted out of the program in 2012, up from 3,700 in 2009. That compares with 685,000 doctors who were enrolled as participating physicians in Medicare last year, according to CMS, which has never released annual opt-out figures before.

Meanwhile, the proportion of family doctors who accepted new Medicare patients last year, 81%, was down from 83% in 2010, according to a survey by the American Academy of Family Physicians of 800 members. The same study found that 4% of family physicians are now in cash-only or concierge practices, where patients pay a monthly or yearly fee for special access to doctors, up from 3% in 2010.

A study in the journal Health Affairs this month found that 33% of primary-care physicians didn't accept new Medicaid patients in 2010-2011.

The pullback in Medicare acceptance is being felt in certain quarters. Joe Baker, president of the Medicare Rights Center, said his patient-advocacy group has had an increase in calls from seniors who can't find doctors willing to treat them—mainly from affluent urban and suburban areas where many patients can pay out of pocket if their doctor doesn't accept Medicare. "In most places, doctors can't pick and choose because Medicare is the biggest game in town, or the only game in town," he said.

Some experts attribute the rise in defections to Medicare payment rates that haven't kept pace with inflation and the threat of more cuts to come. Under a budgetary formula enacted by Congress in 1997, physicians could see Medicare reimbursements slashed by 25% in 2014 unless Congress intervenes to delay the cuts, which it has done several times.

"Medicare has really been pushing its luck with physicians," said economist Paul Ginsburg, president of the nonpartisan Center for Studying Health System Change. "By allowing the SGR and its temporary fixes to persist, Medicare is risking a backlash by senior citizens who say, 'Hey, this program isn't giving me the access to doctors I need.' ."

Some doctors say Medicare's reimbursement rates—as low as $58 for a 15-minute office visit—force them to see 30 or more patients a day to make ends meet. "Family physicians have been fed up for a long time and it's getting worse," said Jeffrey Cain, president of the American Academy of Family Physicians. By disengaging with Medicare and other third-party payers, he says doctors can practice based on what patients need, not what insurers will pay.

Other doctors are dropping out of Medicare to avoid deeper government involvement in medicine, much of which is occurring in Medicare. For example, Medicare is now paying incentives to doctors who switch to electronic medical records and who send data on quality measures to the federal government. Doctors who are part of the Medicare program who don't do so will face penalties starting in 2015.

While the leaders of some large doctor groups have endorsed such initiatives, Dr. Ginsburg says, "there are a lot of physicians, particularly older physicians, who say, 'I don't want to do this. Let me run out the rest of my career practicing like I've always done.' "

Some doctors are particularly concerned about patient privacy. Earlier this year, gynecologist Mary Jane Minkin, a professor at the Yale School of Medicine, opted out of Medicare and the Yale Medical Group when she saw that the electronic records system displayed patients' gynecological records to other providers they consulted. "There's no reason the dermatologist has to know about my patients' libido issues," Dr. Minkin said.

All but 10 of the 70 Medicare patients in her practice have continued to see her, Dr. Minkin said, even though they must pay out of pocket to do so.

Doctors have three options for dealing with Medicare. Those who participate bill Medicare directly and must agree to accept its reimbursement rates for all covered services. So-called nonparticipating doctors still file Medicare reimbursement claims but can charge as much as 10% over Medicare's rates for some services, and they must bill patients for the difference. Those who opt out can charge patients whatever they want, but they must forgo filing Medicare claims for two years, and their Medicare-eligible patients must pay out of pocket to see them.

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That prospect rankles many elderly people—in part because they must continue paying their Medicare premiums or risk losing their Social Security benefits. Republican-sponsored legislation in the House and Senate would let seniors use their Medicare benefits to pay doctors privately, but opponents believe that would undermine the entire system, and the bills aren't given much chance of passage.

Doctors who don't take Medicare say they don't necessarily raise rates significantly. Some say not having to submit claims and file mandated reports allows them to keep their overhead low. They can also adjust their fees to fit patients' needs.

"We give discounts to teachers and preachers, and anybody who comes in wearing spurs gets $5 off," said Juliette Madrigal-Dersch, a pediatrician and internist in Marble Falls, Texas. She says she also treats patients who develop cancer free of charge. "I couldn't do that if I took Medicare. It's considered an illegal enticement." Dr. Madrigal-Dersch is president of the Association of American Physicians and Surgeons, a conservative group that advocates private-pay medicine. "It's gone from being a fringy, rebellious thing to a business model," she added.

When the Mayo Clinic's small family practice office in Glendale, Ariz., stopped taking Medicare in 2009, only about 500 of its 3,500 Medicare patients stayed on. Since then, an additional 250 elderly patients have joined the practice, paying between $200 to $575 a visit. Physicians say dropping out isn't easy, and some medical specialties are more dependent on Medicare than others.

Smiley Thakur, a kidney specialist in Seattle, stopped taking Medicare, Medicaid and commercial insurance in 2008 and had to resume two years later, mainly because he stopped getting referrals from other doctors. "Patients weren't interested in how good I was—they only wanted someone who took their insurance," Dr. Thakur said. "It's hard to compete with free."

Write to Melinda Beck at HealthJournal@wsj.com

New Science Standards Put Global Warming at Core of Curriculum

From National Review Online

By  Heather Mac Donald

April 11, 2013 11:48 AM

One doesn’t need to be a global-warming skeptic to be appalled by a new set of national K–12 science standards. Those standards, developed by educrats and science administrators, and likely to be adopted initially by up to two dozen states, put the study of global warming and other ways that humans are destroying life as we know it at the very core of science education. This is a political choice, not a scientific one. But the standards are equally troubling in their embrace of thenostrums of progressive pedagogy.

Students educated under the Next Generation Science Standards will begin their lifelong attention to climate change as soon as they enter school. Kindergartners will be expected to “use tools and materials to design and build a structure that will reduce the warming effect of sunlight on an area” (perhaps this is what used to be known as “building a fort”) and “develop understanding of patterns and variations in local weather and the purpose of weather forecasting to prepare for, and respond to, severe weather.” Things get even scarier by the third grade, when students should be asking such questions as: “How can the impact of weather-related hazards be reduced?” The standards don’t mention protesting the Keystone pipeline as a possible “real-world” answer to the question of how to reduce “weather-related hazards,” but rest assured that the graduates of America’s left-wing education schools will not hesitate to include such hands-on learning experiences in their global-warming-politics — oops, make that “science” — classes. By high school, students are squarely in the world of environmental policy-making, expected to “evaluate a solution to a complex real-world problem based on prioritized criteria and trade-offs that account for a range of constraints, including cost, safety, reliability, and aesthetics, as well as possible social, cultural, and environmental impacts.”

Hard as it may be for the groups such the Alliance for Climate Education, a purveyor of climate-change school programs and — surprise! — an enthusiastic backer of the new standards, there really are other important areas of knowledge and concern. As long as we’re picking and choosing among scientific problems, why not start kindergartners thinking about cell mutation or neural pathways so they can fight cancer and Alzheimer’s disease when they grow up?

But even without their preening obsession with climate, biodiversity, and sustainability, the standards are a recipe for further American knowledge decline. The New York Times reports that the standards’ authors anticipate the possible elimination of traditional classes such as biology and chemistry from high school in favor of a more “holistic” approach. This contempt for traditional disciplines has already polluted college education, but it could do far more damage in high school. The disciplines represent real bodies of knowledge that must be mastered before one can begin to be legitimately interdisciplinary.

The standards drearily mimic progressive education’s enthusiasm for “critical-thinking skills.” Fourth-graders sound like veritable geysers of high-level abstract reasoning, expected to “demonstrate grade-appropriate proficiency in asking questions, developing and using models, planning and carrying out investigations, analyzing and interpreting data, constructing explanations and designing solutions, engaging in argument from evidence, and obtaining, evaluating, and communicating information.” I’d be happy if they knew all the planets, continents, major oceans and rivers, and a few galaxies. Such fancy-ancy cognitive talk gives teachers an excuse to gloss over the hard work of knocking concrete facts into their students’ heads – and ignores the truth that mastering such facts can be a source of pleasure and pride.  

Chinese students are not flooding into American Ph.D. programs because they have spent their high-school years pondering “a technological solution that reduces impacts of human activities on natural systems,” as the standards propose. They are filling the slots that Americans are unqualified for because they have spent years memorizing the Krebs cycle, the process of meiosis and mitosis, the periodic table, and the laws of thermodynamics and motion. The new science standards guarantee that we will look back on the years when Americans made up a piddling 50 percent of graduate-level science students as the high-water mark of American scientific literacy.

25 Facts About The Fall Of Detroit That Will Leave You Shaking Your Head

From Zerohedge




Submitted by Michael Snyder of The Economic Collapse blog,
It is so sad to watch one of America's greatest cities die a horrible death.  Once upon a time, the city of Detroit was a teeming metropolis of 1.8 million people and it had the highest per capita income in the United States.  Now it is a rotting, decaying hellhole of about 700,000 people that the rest of the world makes jokes about.  On Thursday, we learned that the decision had been made for the city of Detroit to formally file for Chapter 9 bankruptcy.  It was going to be the largest municipal bankruptcy in the history of the United States by far, but on Friday it was stopped at least temporarily by an Ingham County judge. 
She ruled that Detroit's bankruptcy filing violates the Michigan Constitution because it would result in reduced pension payments for retired workers.  She also stated that Detroit's bankruptcy filing was "also not honoring the (United States) president, who took (Detroit’s auto companies) out of bankruptcy", and she ordered that a copy of her judgment be sent to Barack Obama.  How "honoring the president" has anything to do with the bankruptcy of Detroit is a bit of a mystery, but what that judge has done is ensured that there will be months of legal wrangling ahead over Detroit's money woes. 
It will be very interesting to see how all of this plays out.  But one thing is for sure - the city of Detroit is flat broke.  One of the greatest cities in the history of the world is just a shell of its former self.  The following are 25 facts about the fall of Detroit that will leave you shaking your head...
1) At this point, the city of Detroit owes money to more than 100,000 creditors.
2) Detroit is facing $20 billion in debt and unfunded liabilities.  That breaks down to more than $25,000 per resident.
3) Back in 1960, the city of Detroit actually had the highest per-capita income in the entire nation.
4) In 1950, there were about 296,000 manufacturing jobs in Detroit.  Today, there are less than 27,000.
5) Between December 2000 and December 2010, 48 percent of the manufacturing jobs in the state of Michigan were lost.
6) There are lots of houses available for sale in Detroit right now for $500 or less.
7) At this point, there are approximately 78,000 abandoned homes in the city.
8) About one-third of Detroit's 140 square miles is either vacant or derelict.
9) An astounding 47 percent of the residents of the city of Detroit are functionally illiterate.
10) Less than half of the residents of Detroit over the age of 16 are working at this point.
11) If you can believe it, 60 percent of all children in the city of Detroit are living in poverty.
12) Detroit was once the fourth-largest city in the United States, but over the past 60 years the population of Detroit has fallen by 63 percent.
13) The city of Detroit is now very heavily dependent on the tax revenue it pulls in from the casinos in the city.  Right now, Detroit is bringing in about 11 million dollars a month in tax revenue from the casinos.
14) There are 70 "Superfund" hazardous waste sites in Detroit.
15) 40 percent of the street lights do not work.
16) Only about a third of the ambulances are running.
17) Some ambulances in the city of Detroit have been used for so long that they have more than 250,000 miles on them.
18) Two-thirds of the parks in the city of Detroit have been permanently closed down since 2008.
19) The size of the police force in Detroit has been cut by about 40 percent over the past decade.
20) When you call the police in Detroit, it takes them an average of 58 minutes to respond.
21) Due to budget cutbacks, most police stations in Detroit are now closed to the public for 16 hours a day.
22) The violent crime rate in Detroit is five times higher than the national average.
23) The murder rate in Detroit is 11 times higher than it is in New York City.
24) Today, police solve less than 10 percent of the crimes that are committed in Detroit.
25) Crime has gotten so bad in Detroit that even the police are telling people to "enter Detroit at your own risk".
It is easy to point fingers and mock Detroit, but the truth is that the rest of America is going down the exact same path that Detroit has gone down.
Detroit just got there first.
All over this country, there are hundreds of state and local governments that are also on the verge of financial ruin...

"Everyone will say, 'Oh well, it's Detroit. I thought it was already in bankruptcy,' " said Michigan State University economist Eric Scorsone. "But Detroit is not unique. It's the same in Chicago and New York and San Diego and San Jose. It's a lot of major cities in this country. They may not be as extreme as Detroit, but a lot of them face the same problems."

A while back, Meredith Whitney was highly criticized for predicting that there would be a huge wave of municipal defaults in this country.  When it didn't happen, the critics let her have it mercilessly.
But Meredith Whitney was not wrong.
She was just early.
Detroit is only just the beginning.  When the next major financial crisis strikes, we are going to see a wave of municipal bankruptcies unlike anything we have ever seen before.
And of course the biggest debt problem of all in this country is the U.S. government.  We are going to pay a great price for piling up nearly 17 trillion dollars of debt and over 200 trillion dollars of unfunded liabilities.
All over the nation, our economic infrastructure is being gutted, debt levels are exploding and poverty is spreading.  We are consuming far more wealth than we are producing, and our share of global GDP has been declining dramatically.
We have been living way above our means for so long that we think it is "normal", but an extremely painful "adjustment" is coming and most Americans are not going to know how to handle it.
So don't laugh at Detroit.  The economic pain that Detroit is experiencing will be coming to your area of the country soon enough.