A New ObamaCare Horror Story
Rick Manning 4/29/2010

America is discovering in horror just what Nancy Pelosi meant when she famously stated during the health care debate that, “we have to pass the bill so you can find out what is in it, away from the fog of the controversy.”

The past couple of days the news has been filled by reports that the Obama Administration’s own actuary for the Center for Medicare Services estimates that costs of the law are anything but revenue neutral and that they far exceed the ‘estimate’ provided to the public by the Administration. While many are chasing the question of if Obama knew about the higher estimates, when he knew, and if he suppressed them until the vote occurred, there is another massive problem discovered within the law.

Businesses will have to file 1099 forms with both the IRS and send them to the company that provided the services or sold the product for every expenditure that exceeds $600. If you react to this sentence the way my wife, who has run a small business did, you are saying, “that can’t be right, 1099s are only for contract employees.”

Well forget everything you thought you knew about 1099 forms, because Obama’s health care law has changed it.

In practical terms, here is what the new law means. Joe’s Plumbing prints up 100 color presentations at FedEx Kinko’s for a trade show in New Orleans, where they are staying at a Holiday Inn for six days.

At a minimum, Joe’s Plumbing will have to contact FedEx Kinko’s, the airline, Holiday Inn, the rental car company, and the organization sponsoring the trade show and get taxpayer identification numbers from them so they can comply with this tax law. The company will then have to send out 1099 forms to each of these vendors and dozens, hundreds or thousands more vendors, depending upon the size of the company, thus adding significant compliance costs to every business in America. Everyone from a company’s accountant, to building supplier, to carpet cleaner to janitorial service will be trading 1099 forms.

Yes, that’s right, trading 1099 forms, because at the same time, Joe’s Plumbing will also be receiving 1099 forms from every one of their business customers who spent more than $600 with them over the course of the year, which they will be required to keep and reconcile against their books.

Do you have any wonder why Joe’s Plumbing might be more than a tad bit irritated? The new Obama health care takeover just took a guy with a pipe wrench, pvc pipe and a plunger and forced him into Dante’s eighth circle of hell – tracking and filing IRS paperwork.

So, what kind of IRS rules will be put into place to set the framework for how all these tax forms must be filed and stored?

Actually, bombshell number two is that the IRS will not be setting these rules. Instead, those noted tax experts at the U.S. Department of Health and Human Services will be writing and overseeing these tax regulations. Why? Who knows? It is the Alice in Wonderland world of the Obama health care bill.

U.S. Representative Dan Lungren (R-CA) has taken the first steps in alleviating this paperwork chokehold on America’s small business by introducing legislation to repeal this new burden.

Let’s hope that America’s businesses tell their Members of Congress to repeal what Lungren calls the “rat” tax, but what many observers believe should rightfully be called the preparation for the liberal Shangri-la of the VAT tax.

After all, once businesses are tracking every transaction over $600 and filing IRS paperwork on it, how much harder will it be for Congress to just say, add 10% to each bill and send it our way, extending taxation to every level of business unseen to unwary consumers who suddenly just see retail prices rise without knowing the increase is a new, hidden tax.

The requirement goes into effect January 2012. Better get a CPA on retainer. And stock up on toner and paper.

Rick Manning is the Director of Communications for Americans for Limited Government, and the former Public Affairs Chief of Staff for the U.S. Department of Labor.

http://www.netrightnation.com/index.php?option=com_content&view=article&id=1252650:a-new-obamacare-horror-story-&catid=1:nrn-blog&Itemid=7

http://www.getliberty.org/content_images/New%20ObamaCare%20Horror.png

Here are the salient findings of this report:

•  Health care costs will go up, not down. National health expenditures will increase from 17 percent of GDP now to 21 percent under the new law and will be higher than without the legislation. Net federal spending on health care will also increase.

•  Health care shortages are "plausible and even probable." Because of the increased demand for health care, "supply constraints might initially interfere with providing the services desired by the additional 34 million insured persons."

•  14 million employees will lose their employer coverage. Employees of small firms are especially at risk (despite small employer tax credit subsidies).

•  2 million employees who lose coverage will have to enroll in Medicaid.

•  A Medicaid insurance card is not a guarantee of care. An estimated 18 million people will be added to Medicaid. However, because there is no corresponding increase in the supply of caregivers, "it is reasonable to expect that a significant portion of the increased demand for Medicaid would be difficult to meet, particularly over the first few years."

•  One in ten insured workers will see their health benefits taxed. By 2019, more than 10% of insured workers will "be in employer plans with benefit values in excess of the thresholds (before changes to reduce benefits) and this percentage would increase rapidly thereafter."

•  Higher taxes will lead to higher premiums. The new taxes on medical devices, prescription drugs, and insurance plans "would generally be passed on through to health consumers in the form of higher drug and device prices and higher insurance premiums."

•  There are more than one-half trillion in Medicare cuts. The new health law cuts "$575 billion" from Medicare.

•  Medicare cuts would threaten almost one in every seven hospitals. About "15 percent of Part A providers would become unprofitable within the 10-year projection period."

•  Overall access to care for seniors would go down. Because of the law's payment reductions, "providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and, absent legislative intervention, might end their participation in the program.

•  7.4 million people will lose access to Medicare Advantage plans. Enrollment in MA plans will be cut in half (from its projected level of 14.8 million under the current law to 7.4 million under the new law).

•  False advertising: The new "Medicare Tax" doesn't go to Medicare. "Despite the title of this tax, this provision is unrelated to Medicare; in particular, the revenues generated by the tax on unearned income are not allocated to the Medicare trust funds."

•  False advertising: Budgetary double-counting does not improve Medicare's solvency. Medicare cuts "cannot be simultaneously used to finance other federal outlays (such as the coverage expansions) and to extend the [life of the Medicare] trust fund, despite the appearance of this result from the respective accounting conventions."

•  The new long-term care insurance plan (CLASS Act) is unsound. The program faces "a significant risk of failure" because the high costs will attract sicker people and lead to low participation.

•  The promise to those with pre-existing conditions is unfunded. "By 2011 and 2012 the initial $5 billion in Federal funding for [high risk pools] would be exhausted, resulting in substantial premium increases to sustain the program."

•  The law does almost nothing to limit actual fraud and abuse. The fraud provisions in the law will save only about two percent of $47 billion in suspect claims.

http://stickerpatch.blogspot.com/

It is commonly known that there will be a significant shortage of primary care physicians in the future which Obamacare will tremendously exacerbate for myriad reasons. Of course, neither Obama or Congressional Democrats considered this in their reckless haste to ram the healthcare reform legislation into effect. What a surprise – politicians didn’t anticipate something inherently important?

The end result? You will have the “right” of healthcare but you may not have a doctor to provide it to you. If you are ultimately able to schedule an appointment to see a doctor, you may have to wait an excessively long period of time to finally be seen, or be seen by a physician located far from where you live or work, or be herded through like cattle spending little time with the doctor who is massively overworked and overloaded with patients (and over-regulated).

Does the word “rationing” ring a bell? Or decreased quality of care? These were all important issues that were raised by those who opposed the Democrats’ plans but were ignored or denigrated by them and the press.

What is a “brilliant” solution for this problem that is being considered by the government? Have nurses act like doctors. Add a little more training, change some statutes and voila! Doctorlight. Easy! Just don’t be very sick or you might not make it to a real doctor.

And if the nurse gets a PhD, they can officially be addressed as Dr., adding to confusion but subtracting from quality. This proposal would place millions of Americans at unnecessary risk due to inferior training and as a consequence, inferior care.

Furthermore, given the government’s plan to reimburse these nurses the same or marginally less than real doctors, why would any sane person want to become a doctor? After all, for maybe $5 to $10 more per patient that a doctor would be reimbursed versus a nurse, that person would also have to go to medical school and residency for up to 11 or more years, assume debt to pay for school of $250,000 or more and then pay malpractice rates in practice that can exceed $100,000/ year.

This will surely dissuade many including the best and brightest from seeking a career in medicine and don’t we want our doctors to be smart and competent?

Sounds like another government plan causing unintended consequences.

Doctor shortage? 28 states may expand nurses' role
By Carla K. Johnson (AP) – 4/15/2010

CHICAGO — A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."

For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

Those newly insured patients will be looking for doctors and may find nurses instead.

The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.

Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.

"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."

On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training.

Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.

The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning.

States regulate nurse practitioners and laws vary on what they are permitted to do:
_ In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances.
_ In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June.
_ In Montana, nurse practitioners don't need a doctor involved with their practice in any way.
_ Many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor.
_ In some states, nurse practitioners with a doctorate in nursing practice can't use the title "Dr." Most states allow it.

The AMA argues the title "Dr." creates confusion. Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?

The feud over "Dr." is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing.

Many with the title use it with pride.

"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address.

What's the evidence on the quality of care given by nurse practitioners?

The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.

"The argument that patients' health is put in jeopardy by nurse practitioners? There's no evidence to support that," said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health.

Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care.

The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care.

The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do.

"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."

In Florida, a bill to allow nurse practitioners to prescribe controlled substances is stalled in committee.

One patient, Karen Reid of Balrico, Fla., said she was left in pain over a holiday weekend because her nurse practitioner couldn't prescribe a powerful enough medication and the doctor couldn't be found. Dying hospice patients have been denied morphine in their final hours because a doctor couldn't be reached in the middle of the night, nurses told The Associated Press.

Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers.

That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. "That greatly opens up the supply of primary care providers," Hart said.

But it hasn't helped much so far. A study last year by the Massachusetts Medical Society found the percentage of primary care practices closed to new patients was higher than ever. And despite the swelling demand, the medical society still believes nurse practitioners should be under doctor supervision.

The group supports more training and incentives for primary care doctors and a team approach to medicine that includes nurse practitioners and physician assistants, whose training is comparable.

"We do not believe, however, that nurse practitioners have the qualifications to be independent primary care practitioners," said Dr. Mario Motta, president of the state medical society.

The new U.S. health care law expands the role of nurses with:
_ $50 million to nurse-managed health clinics that offer primary care to low-income patients.
_ $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.
_ 10 percent bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.
_ A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.

The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.

"We know we need to get to 100 percent for everybody. This is a crack in the door," said Michelle Artz of ANA. "We're hopeful this sets the tone."

In Chicago, only a few patients balk at seeing a nurse practitioner instead of a doctor, Cockrell said. She gladly sends those patients to her doctor partners.

She believes patients get real advantages by letting her manage their care. Nurse practitioners' uphill battle for respect makes them precise, accurate and careful, she said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment.

Joseline Nunez, 26, is a patient of Cockrell's and happy with her care.

"I feel that we get more time with the nurse practitioner," Nunez said. "The doctor always seems to be rushing off somewhere."

http://www.google.com/hostednews/ap/article/ALeqM5jCB6VTbMN12zQSwafnZfBJovMseAD9F2CK880

We all know that the political rhetoric which was employed for the bill’s passage was not merely disingenuous but overtly and despicably dishonest and criminal. As stated in a previous post, these politicians see themselves as elitists, members of a privileged class much as was extant in Russia in the 1970’s and early 1980’s – the nomeklatura.

As their employers (at least on paper), we must now revoke their privileges, limit their unrestrained actions, mandate that they abide by the same laws as the rest of us, and vote the offenders out of office.

No Obamacare for Obama
THE WASHINGTON TIMES     March 23, 2010

President Obama declared that the new health care law "is going to be affecting every American family." Except his own, of course.

The new health care law exempts the president from having to participate in it. Leadership and committee staffers in the House and Senate who wrote the bill are exempted as well. A weasel-worded definition of "staff" includes only the members' personal staff in the new system; the committee staff that drafted the legislation opted themselves out. Because they were more familiar with the contents of the law than anyone in the country, it says a lot that they carved out their own special loophole. Anyway, the law is intended to affect "ordinary Americans," according to Vice President Joe Biden (who - being a heartbeat away from the presidency - also is not covered), not Washington insiders.

Mr. Obama frequently tossed around the talking point that the new law gave people the same type of coverage as Congress enjoyed. In his March 20 health care pep talk to wavering Democrats on Capitol Hill, the president said one of the advantages of the health care legislation was that "people will have choice and competition just like members of Congress have choice and competition." At yesterday's signing ceremony, Mr. Obama said Americans will be "part of a big pool, just like federal employees are part of a big pool. They'll have the same choice of private health insurance that members of Congress get for themselves." But the American people will have a public pool; the executive branch and congressional staffers kept their country-club pool private.

Last year, Sen. Charles E. Grassley, Iowa Republican, spearheaded efforts to have all Americans included in the plan, but he ran into heavy opposition from unions representing federal workers - the same unions that were pro-Obamacare stalwarts. In September, the Senate approved a scaled-down amendment that covered members of Congress and their staff. When this provision later emerged from Senate Majority Leader Harry Reid's office, the leadership and committee staff loophole had appeared. A move in December by Mr. Grassley and Sen. Tom Coburn, Oklahoma Republican, to close this loophole and to extend the law to senior members of the executive branch - including the president, vice president and Cabinet members - was blocked by Senate Democratic leaders.

Mr. Grassley has introduced an amendment to the Senate health care reconciliation bill that also will apply the law to the upper tier of the executive branch and all Capitol Hill staffers, but it remains to be seen whether Democrats will let this measure move forward.

The special exemptions slipped into the health care law are another example of how those statists who rule consider themselves a privileged class, imposing burdens on the country that they will not accept themselves. Candidates for office in 2010 should pledge to close these and other loopholes in the law that impose unequal burdens and create exclusive privileged classes in America. Meanwhile, we await Mr. Obama's explanation why if his "historic" health care law is so great for America, it's not good enough for him and his family.

http://www.washingtontimes.com/news/2010/mar/23/obamacare-for-everyone-but-obama/

The rest of America won’t – we will either have to wait for it or die waiting.

And Obama doesn’t intend to end his pursuit of increasing control and domination by the Federal Government over the lives of us Americans.

America's New Nomenklatura
Investors Business Daily       03/29/2010

Government: With the passage of health care reform and the ongoing boom in federal hiring, it's becoming increasingly clear that America is now run by a new, privileged class of bureaucrats.

For those who remember the old Soviet Union, it was a grim place — at least for average citizens. But not so for those in government. Contrary to the official ideals of equality and a classless society that the ruling communist regime espoused, the USSR created a privileged class of party members inside government — the nomenklatura.

This semipermanent bureaucracy earned higher incomes, got better health care, ate better food and had greater job security than average Russians, the much-despised proletarians. Today, our bloated federal government seems, in significant ways, to be creating this same dynamic.

Take the just-passed health care bill that carefully excluded the White House, congressional leaders and their staffs from having to live under the reforms' restrictions.

"President Obama will not have to live under the Obama health care reforms, and neither will the congressional staff who helped to write the overhaul," said Iowa Republican Sen. Charles Grassley. "The message to the people at the grass roots is that it's good enough for you, but not for us."

The hypocrisy of these officials and the contempt they show for average Americans is bad enough. But Mr. and Mrs. John Q. Public can also go to jail or be fined up to $250,000 for not buying insurance. And the government is spending $10 billion to hire 16,500 new IRS agents to make sure they don't escape the new system.

Under current budget plans, this won't end soon. With $45 trillion in new government spending planned over the next decade, this new privileged governing class can only grow.

Today, as we witness a massive shift of resources from the private to the public sector, the only place adding jobs is government. Since the start of last year, the federal government has added 81,000 jobs. By contrast, private-sector payrolls have shed 4.71 million.

Big government is the place to be these days. Federal workers are some of the country's best-paid, earning far in excess of their counterparts in the private sector. A recent report in Politico.com, for example, noted that 2,000 congressional staffers now have incomes in excess of $100,000, and that 43 make the $172,500 maximum.

But the bureaucrats — that silent, permanent government that now exceeds 2.8 million in number — make out just as well.
USA Today recently looked at federal pay vs. private pay in 2008 for specific occupations ranging from airline pilot and cook to computer manager and registered nurse. What they found was more than a little disquieting for those in the private sector.

The average federal worker that year took home on average $67,691 in salary, compared with $60,046 in the private sector — a difference of $7,645. Not that much, you say? Well, that was before benefits are factored.

The average government worker gets a whopping $40,785 a year in health care, pension and other benefits compared to $9,882 for a private worker. The difference in total compensation widens to $38,548 a year — for the same job with the same duties.

Anyone who has visited the slow-moving Post Office, talked to the surly and often hostile IRS agent or even gone to the local DMV to spend time in waiting-room hell can tell you that pay gap doesn't represent productivity, training or ability.

What it does represent is the new Nomenklatura — the privileged apparatchiks who now run our government and with it, sadly, much of our lives. This is very much a result of years of "progressive" thinking that has pushed the Democratic Party sharply leftward across the political spectrum.

Since the Civil War, the so-called Progressive Movement's dream has been to exalt bureaucratic expertise and control over free-market efficiency. With the new administration, their dream has become our nightmare.

http://www.investors.com/NewsAndAnalysis/Article.aspx?id=528809

This was one problem and one disease not an entire healthcare system. Just another example of why Americans don't want government run healthcare.

Report: More Than 70 Million Doses of H1N1 Vaccine May Have to Be Discarded

House Majority Leader Steny Hoyer, D-Md., warned that politicians should “be very careful ... that our rhetoric doesn’t incite to violent...

Health Reform: Should Americans feel ashamed for being angry that those who rule Washington thwarted the popular will? No more than colonial Americans at the trampling of their freedoms.

If the president and the leaders of his party in Congress think the American people are going to roll over and play dead after the biggest government power grab in history, they don't know this country.

And if they think those on the side of economic freedom will be intimidated by their attempts to caricature them as a bloodthirsty mob of Timothy McVeighs, they underestimate the powers of a free people.

A new CBS News poll finds that 62% of Americans want Republicans to keep fighting the Democrats' health legislation even now that it has passed.

Only 16% believe the new law will "mostly help" them.

Democrats are portraying that majority as a violent minority, being inflamed by the speeches of GOP congressmen and Sarah Palin. House Majority Leader Steny Hoyer, D-Md., in an appearance on the CBS "Early Show" on Thursday, warned that politicians should "be very careful ... that our rhetoric doesn't incite to violent acts."

Does that include the rhetoric of former House Energy and Commerce Committee Chairman John Dingell, D-Mich., who this week told a Detroit radio show that "it takes a long time to do the necessary administrative steps that have to be taken to put the legislation together to control the people"?

Control the people?

This is a country that went to war over onerous taxation by the mother country. We took up arms and sacrificed our sons "to dissolve the political bands" that attached us to King George, and "to assume among the powers of the earth, the separate and equal station to which the laws of nature and of nature's God" entitled our Colonial forebears.

Dingell has again earned his longtime nickname, the Truck. But it will take more than a couple of hundred congressional eighteen-wheelers to turn the Spirit of '76 into roadkill.

Where were Hoyer and his colleagues, now so concerned about inflammatory rhetoric sparking violence, a couple of years ago?

As Victor Davis Hanson points out, "write a book in which you muse about killing George Bush, and its Knopf imprint proves it is merely sophisticated literary speculation; do a docudrama about killing George Bush, and it will win a Toronto film prize for its artistic value rather than shock from the liberal community about over-the-top discourse."

Knopf's defense was that it was "not the first time a novelist has chosen fiction to express their point of view about American society or politics." Newmarket Films' defense of its computer-rejiggered news footage depicting Bush being assassinated was to call it "quite a compelling political thriller. In many ways it is sympathetic to George Bush."

Nor do you even have to go back years ago.

Washington Post columnist Courtland Milloy on Monday said of the Tea Party protesters: "I want to spit on them, take one of their 'Obama Plan White Slavery' signs and knock every racist and homophobic tooth out of their Cro-Magnon heads."

Politically motivated violence is to be condemned as long as America can peacefully be kept free.

Our bet is that as Americans increasingly feel the impoverishing effects of last Sunday's big step toward socialized medicine, they will indeed repeal it — without firing a single shot.

http://www.investors.com/NewsAndAnalysis/Article.aspx?id=528481

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