cast your vote…

Look at the facts…and decide for yourself. No strong-arming on my part.

Comparing Budget Plans
Here’s how budget proposals or campaign promises from President Barack Obama, former Governor Mitt Romney and Rep. Paul Ryan compare…

Individual income taxes
   OBAMA…Raise top marginal income tax rate (now 35%) to 39.6%, limit other deductions for upper-income taxpayers. Raise revenue.

   ROMNEY…Reduce top marginal income tax rate to 28% and reduce other tax rates by 20%. Offset cost by limiting or ending deductions and credit.

   RYAN…Create two new tax brackets, 10% and 25%.

Corporate taxes
  
OBAMA…Lower top rate (now 35%) to 28%, eliminate tax breaks, provide incentives for manufacturers. Revenue neutral.

   ROMNEY…Lower top rate to 25%, shift to make it easier for U.S. firms to limit or avoid federal taxes on profits earned overseas. Revenue neutral.

   RYAN…similar to Romney plan, would lower top rate to 25%, shift to make it easier for U.S. firms to limit or avoid federal taxes on overseas profits.

Medicare
   OBAMA…Keep 2010 tax health law. Change the way the government pays hospitals and other health providers. Raise premiums or copays for some beneficiaries, particularly upper income. Total savings of $248 billion over 10 years.

   ROMNEY…Repeal the 2010 health-care law. Raise enrollment age to 67 (from 65 today). Offer choice of existing Medicare or new program that would provide vouchers to pay part or all of private-insurance premiums.

   RYAN…Slowly raise eligibility age to 67 and give those younger than 55 the option of a privately run plan paid in part by the government or keeping a Medicare-type plan. No change for those 55 or older. Would cost $205 billion less than White-House’s budget over 10 years.

Medicaid
   OBAMA…Proceed with 2010 law expanding Medicaid, rework the formula on how much federal government gives states the program. Save roughly $72 billion, combined with other changes.

   ROMNEY…Turn Medicaid into a federal block grant program, giving control and flexibility to states. Unspecified savings.

   RYAN…Turn Medicaid into a federal block grant program, giving control and flexibility to states. Saves $770 billion over 10 years, compared with White House plan, according to Ryan estimate.

Defense spending
   OBAMA…About $487 billion in cuts over 10 years from Pentagon’s current plan. Appropriate $525 billion for it in fiscal 2013.

   ROMNEY…Reverse planned Obama cuts, commit at least 4% of GDP toward defense, equivalent to $545 billion in 2013.

   RYAN…Reverse the planned Obama cut, appropriate $554 billion for defense in fiscal 2013.

Deficit
   OBAMA…Reduce deficit (now 7.8% of gross domestic product) to 3.9% of GDP by 2014 and 3% of GDP by 2017.

   ROMNEY…Balance the budget by 2010.

   RYAN…Reduce deficit to 4% of GDP by 2014 and 0.9% of GDP in 2017.

(As reported in The Wall Street Journal, 8/13/12.)

cod liver oil?…or amputation?

Interesting choice, Paul Ryan for Mitt Romney’s Vice Presidential running mate.

(Photo credit goes to http://www.salon.com/2012/08/11/paul_ryan_and_the_rights_long_game/ )

Ryan…an attractive, charismatic, 42 year-old man. A self-professed geek, fitness fanatic, pro-life Catholic, embodiment of the values later made popular by the Tea Party, and ardently supported by the National Rifle Association.

While Ryan did not mince words about his opinion of the President, I applaud the candidate for heartily approving a black man occupying the White House. Paraphrasing Ryan’s words…he thinks it’s “cool.” It’s just that Obama’s not the right one. An opinion to which Ryan is totally entitled.

Also of notable interest were the different effects the loss of a parent had upon Obama and Ryan. The former enacted healthcare for all, including coverage for pre-existing conditions, while the latter wants to…obliterate ensured healthcare for all.  

The President and Ryan have already “tangoed” over their visions of America’s future. Their debates would probably be more Olympian than those scheduled between Obama and Romney. Will the candidate speak for himself…or for Ryan?

According to http://www.biography.com/people/paul-ryan-20828085,

Paul Davis Ryan was born on January 29, 1970 in Janesville, Wisconsin. Father Paul Ryan Sr. worked as an attorney, and mother Betty Ryan was a stay-at-home mom. Ryan has one sister, Janet, and two brothers, Tobin and Stan.

After graduating from Miami University in Ohio with a degree in economics and political science in 1992, Paul Ryan began working as a marketing consultant for a family run branch of a Wisconsin construction company. He entered politics a few years later, working as a legislative aide for U.S. Senator Bob Kasten, and later for Senator Sam Brownback and New York Republican Representative Jack Kemp. Ryan became interested in government after reading the literature of Ayn Rand, with whom he disagrees philosophically; Ryan has said that he rejects Rand’s emphasis on an individualist philosophy because his personal beliefs center on collectivism, a group-based philosophy.

And according to  http://objectivism101.com/Lectures/Lecture39.shtml,

There are two basic ways of understanding the relationship between individuals in a group. The first way is individualism, which states that each individual is acting on his or her own, making their own choices, and to the extent they interact with the rest of the group, it’s as individuals. Collectivism is the second way, and it views the group as the primary entity, with the individuals lost along the way.

Of primary concern to some of my generation and those that precede mine, Ryan’s economic proposal as set forth for the RepublicanParty some time ago, proposes to privatize Medicare and do away with Social Security as we know it. While these might be ideal solutions theoretically, those who have paid into the system, but have not yet reaped any benefits…will have to fend for themselves. Who in their late 60’s is adept at wending their way through the minefield that is a health insurance carrier’s bureaucracy?

And those senior citizens who are already borderline impoverished, will most likely sacrifice their health in choosing to put food in their bellies. Vouchers for $5,000, as supported by Ryan, will never cover the escalating costs to cure the aging sick in our society.

 The middle class will join the ranks of the homeless, skyrocketing their numbers into orbit in no time.

 The wealthy need not be overly concerned.

(Photo credit goes to http://www.nationalmemo.com/do-romney-hood-and-friar-ryan-steal-from-the-poor/ )

A youthful 42, the epitome of health, with a lovely wife and 2 young children, Ryan represents the future. His father and grandfather died of heart disease. With their passing, perhaps his personal ties to the older generations are easily severed.

Throwing off the shackles of the past is Ryan’s choice. Start over again. Amputate the body parts to keep the life intact, such as it is. No matter that the “parts” represent millions of people who will likely die in the process for lack of health care, rooves over their heads, food in their stomachs. They should be sacrificed for the good of society. Survival of the fittest, after all.

Ryan will have health coverage for himself and his family. His paycheck will continue…on the backs of those who go without. Some may even sacrifice their lives for this, their fellow man. No matter. The past and present should make way for the future. The aged and downtrodden are already on their way out anyway…aren’t they? Let’s hurry them along.

Better the wealthy spare a few dollars for the less fortunate…than all men, women, and children fending for themselves. Pockets of people collecting to form societies unto themselves.

If Obama is perceived as attempting to drive a wedge between the wealthy and everyonelse, Ryan and his running mate will cement that division as did the Berlin Wall which separated East and West Germany.

Ryan said in an interview when his economic plan was first proposed that it’s better to suffer the consequences now, for they would be much worse if such action was delayed. I wonder if he is prepared for the fallout should it be seismic?

More thefts, more killings, more greed, more disdain for the law.

If those with, have no regard for those without…then why shouldn’t it be just as acceptable…the other way around? Consider this when next you hear of some random killing in the news.

Ryan’s own constituents dispute his premise about economic recovery as exhibited on this youtube video.


Ryan claims to have “given up fear for Lent.” And so he has no fear of the consequences his proposal would effect. Seems to me he needs a little more roughening around the edges…like living outside the box…than what he’s experienced in the last 7 years securely ensconced in Washington politics…with health insurance…and a steady paycheck…and power to write and rewrite our governing laws.

I like to think we’re in the midst of downing cod liver oil…and we’re half-way through the dose. And for rampant inflammation, like what our country is now experiencing economically…swallowing healthful medicine is more productive…and humane…than severing limbs.

“Name your poison,” as is sometimes said. 

…the choice is yours…

………hugmamma.  😦  

BTW…where is Romney in all of this? Backing up Ryan, I suppose.  😦

(Photo credit goes to http://skydancingblog.com/2012/08/10/its-the-granny-starver-breaking-news-on-romney-vp-pick/ )

two housewives, “founders of tea party movement”

I’d always wondered whether or not ordinary housewives could run the country. Looks like last night’s election proved that they can. Evidently we can do the extraordinary, when we decide to put our passion and energies behind a task. I’m sure all women will agree that’s a “no-brainer.” When wives and moms decide to do something, they do it, like Margaret Whitman, creator of the multi-billion dollar business, E-Bay.

Sarah Palin’s first brush with the media was as a beauty queen. Setting her sights on politics, she became mayor of little known Wasila, and then governor of Alaska, and then GOP candidate for VP. While she and McCain lost the presidential election, Palin landed back in front of the cameras. While she may not have been the media’s darling then, mainstream reporters seem to be back pedaling now. This morning on CNN, the political spin-meisters spoke of her as a force with which to be reckoned, especially in the 2012 election. OMG, I thought! Talk about going the “way the wind blows.”

I’m a liberal, too compassionate to turn my back on those needing a “hand-up.” My husband and I, both from large families, 12 and 9 siblings, respectively, are inclined to “give back,” and “pay it forward.” But I do understand the frustration of those on the unemployment lines, those who are barely making “ends meet,” those whose homes are “under water” because of foreclosures next door, those whose businesses are struggling, those who want a balanced budget, those who want less government, and those of us on Main Street who are fed up with the millionaires on Wall Street. Might I just add here, why are we still making millionaires of athletes, and celebrities, and doctors “playing” the Medicare system? I’d just as soon take all the money we’re pouring into these peoples’ pockets, and help the homeless, the abused, those unable to get health insurance.

While I may disagree with conservative efforts to take the country backwards, I have to applaud Amy Kremer and Jenny Beth Martin, Atlanta housewives who are the geniuses behind the Tea Party movement. According to the Wall Street Journal’s  “Birth of a Movement-Tea Party Arose from Conservatives Steeped in Crisis,” on 10/29, both women “were 30-something suburbanites…frustrated by recession, dismayed by the election of Barack Obama and waiting for the next chapter of their lives.” Quitting her career as a Delta flight attendant to raise her daughter, Kremer turned to blogging after becoming an empty-nester, “one on gardening, one on politics. ‘I had this empty space in my life’… Ms. Martin, a software manager by training and part-time blogger, was cleaning houses to help pay the bills after her husband’s temporary-staffing business collapsed. They were in danger of losing their home.” Martin was enraged after Senator Saxby Chambliss, in whose campaign she had been a volunteer, voted in favor of President Bush’s bail out of Wall Street banks. In her estimation, ” ‘Sometimes it stinks when your business goes bad. But it’s part of our system….The government doesn’t need to come in and hold a business up and keep it from failing.’ ”

In the span of a few weeks in February and March 2009, the two women met on a conference call and helped found the first major national organization in the tea-party movement. Within months, they became two of the central figures in the most dynamic force in U.S. politics this year.

Ms. Kremer, 39, currently chairs the political action committee known as the Tea Party Express. It has raised millions of dollars for upstart candidates and engineered the campaign that threatens Senate Majority Leader Harry Reid (D-Nev.). Once shy about public speaking, today she crisscrosses the country addressing thousands at a time. ‘Are you ready to fire Harry Reid?’ Ms. Kremer bellowed to a crowd of 2,000 in Reno, Nev., this month.

Ms. Martin, 40, is national coordinator of the Tea Party Patriots, an umbrella group claiming affiliation with nearly 3,000 local groups around the U.S. Leaving her young son and daughter at home, she is on a 30-city tour, revving up activists for the victory she is counting on next Tuesday.

‘This was something I had to do,’ Ms. Martin says. ‘There were just so many of us who were fed up with the Republican Party.’

 Comprised mostly of middle-aged, middle-class citizens with little political experience, “a braid of many strands of discontent and passion, ranging from opposition to illegal immigration and a national sales tax to support for gun rights. A vocal faction questioning Mr. Obama’s legal eligibility to be president provided another source of grassroots fuel.” If John McCain’s campaign was a “babe” in the internet “woods,” the Tea Party political machine seems hell-bent on giving Obama’s proven internet savvy a “run for its money” in 2012.

Many conservatives felt Sen. John McCain’s presidential campaign had never fully exploited the Internet to raise money and unite disparate activists. The Obama team had proven deft at harnessing technology.

And so the TEA PARTY MOVEMENT was born online, in the internet universe.

  • Michael Patrick Leahy, a Nashville technology consultant,  built a network of like-minded activists
  • Eric Odom, among the above, compiled a large list of activists “through a group working to lift the offshore-drilling ban”
  • Stacy Mott, started a blog for conservative women, “Smart Girl  Politics,” launching a website by the same name which drew in Kremer and Martin from Atlanta
  • Keli Carender, arranged the first protest, drawing 120 like-minded activists, after it was broadcast on a local talk-radio show and written up online by Fox news consultant Michelle Malkin
  •  On 2/19/09, in response to the $75 billion dollar bailout for homeowners unable to pay their mortgages, CNBC financial commentator Rick   Santanelli  started the “rant” when, broadcasting live from the Chicago Board of Trade, exclaimed ‘This is America! …How many of you people want to pay for your neighbor’s mortgage that has an extra bathroom and can’t pay their bills?’ To the cheers of traders behind him, he continued ‘We’re thinking of having a Chicago Tea Party in July’… “The rant went viral.”
  • After massive internet organizing among all of the above parties, 50 rallies occurred simultaneously nationwide. Within a year, 2,000 local tea party groups were formed around the country.
  • Wealthy interests threw their support behind the movement, like Americans for Prosperity and FreedomWorks, “groups born from a conservative think tank formed in the 1980s by members of the Koch family, who run oil-and-gas conglomerate Koch Industries Inc.”
  •  On 4/12/10, Kremer said she wasn’t boasting in claiming ‘I started this’ when she began a social-networking website called “Tea Party Patriots,” the name her husband recommended.
  • Enter the media. Fox TV’s Glenn Beck “launched his own initiative, the 9/12 project,” as well as touted the Tea Party’s 4/15 rallies, as did Sean  Hannity, and blogger Malkin.
  • Hundreds of thousands of “tea partiers” “gathered in city halls, at post offices, at town squares, parks, and along busy streets.
  • The “Tea Party Express” was formed when Sal Russo, Reagan’s adviser in the 60s and 70s, re-energized a 2008 political action committee, Our Country Deserves Better, as a “tea-party-themed group.” With Joe Wierzbicki, a colleague, they spread the word on a cross-country bus tour. In 2 years the newly christened group raised more than $7 million.
  • Tea Party Patriots, among them Kremer and Martin, maintained a nonpartisanship stance, preferring to stand for issues, and not endorsing specific candidates. On the other hand, Tea Party Express “wanted to raise money for candidates and engineer campaigns.”

The break between the two factions of the Tea Party movement, found its momentun when Obama pushed for massive, health-care reform.

  • FreedomWorks, in its “Healthcare Freedom Action Kit,” suggested ways to omit socialized medicine from the budget.
  • A Patriot coached members on how to “Rock-the-boat…’Watch for an opportunity to yell out and challenge’ the representative. ‘The goal is to rattle him.’
  • The Patriots, except for Kremer, declined to participate in the Express’  first bus tour, since the groups had different philosophies.
  • Taking part in the D.C. rally organized by Beck’s “9 1/2 Project,” which drew 75,000, Kremer returned home ” ‘a changed person…I didn’t need to stand in the shadows of Jenny Beth Martin and Mark Meckler (activist and Grass Valley, California Internet marketer and attorney)…I felt good about myself.’ “
  • Prominent Florida physician and tea-party activist David McKalip whipped up a storm when he Googled “a doctored image of Mr. Obama as a a tribal witch doctor with a bone through his nose…” In an email to the Wall Street Journal, he publicly apologized. Kremer defended him, to the dismay of other Patriots. ” ‘David, we all support you fully and are here for you…I can assure you of one thing and that is we will protect our own. We all have your back, my friend.’ “
  • In August 2009, the Tea Party incorporated with a 4 person board, Ms. Martin, Ms. Kremer, Mr. Meckler and Rob Neppell, a conservative blogger. “But relations quickly deteriorated…Ms. Kremer indicated she had hired her own lawyers and might try to claim ownership of the group’s intellectual property, according to an affidavit from Ms. Martin. A few weeks later, she was voted off the board.”
  • Kremer shifted to the Tea Party Express, urging it to back Scott Brown, for the Senate seat vacated by Edward Kennedy.
and as they say…”the rest is history”…hugmamma.
 
 
 
 
 

 

“a fox in the hen house?”

Health care is rampant in the news these days. One article that got my interest in the Wall Street Journal on 10/27 was “Physician Panel Prescribes The Fees Paid by Medicare.” As my husband and I near retirement age, Medicare looms large on the horizon. I’ve already gotten an earful from friends, who gave me one more reason to take care of my health now.

The article, written by Anna Wilde Mathews and Tom McGinty, gives insight into the significant role played by physicians, in determining how much doctors are paid by Medicare.

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars. The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.

Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.

The problem, it seems, other than the obvious one mentioned by Tom Scully, a former administrator of the Medicare and Medicaid agency that “it’s not healthy to have the interested party essentially driving the decision-making process,” is that the committee is “contributing to a system that spends too much money on sophisticated procedures, while shorting the type of nuts-and-bolts primary care that could keep patients healthier from the start–and save money.” Dr. Barbara Levy, Seattle gynecologist and RUC chairwoman has indicated that the committee is aggressively moving “to correct evaluations that lead to higher-than-appropriate payments for some services.” Next month Medicare will render doctors fees for 2011, which should include the committee’s recommendations.

Another inherent dilemma in the assignation of monetary values to medical procedures, is that doctors will be motivated to perform those that pay more. An inevitable by-product is spending growth, since there’s “all the associated costs for hospitals, lab tests and drugs.” Also of great concern are Journal findings that “services were paid too generously in some cases because the fees were based on out-of-date assumptions about how the work is done…more than 550 doctor services that, despite being mostly performed outpatient or in doctors’ offices in 2008, still automatically include significant payments for hospital visits after the day of the procedure, which would typically be part of an inpatient stay.” As an example, is an operation to treat male urinary incontinence which, according to Medicare’s 2008 statistics, were performed as outpatient services or in doctors offices 80% of the time. But because the procedure was last evaluated by RUC in 2003, the service still “wraps in payment for 118 minutes of hospital visit time after the day of surgery.” However, the Journal goes on to say that it’s unclear if the committee will suggest doctors now be paid less for the procedure anyway.

Granted, there’s great debate among physicians as to the value of medical procedures based upon personal experiences. It’s also fair to say that nobody wants to surrender what they’ve already come to expect in financial recompense. Nonetheless, having RUC rely “heavily upon surveys performed by doctor specialty groups, requiring as few as 30 responses,” with the instruction that it “is important to you and other physicians because these values determine the rate at which Medicare and other payers reimburse for procedures,” is an enticement to score high. “William Hsiao, the Harvard professor who led the original physician-work research used to set Medicare fees, argues the approach is almost guaranteed to inflate the values used to calculate fees. ‘You do not turn this over to the people who have a strong interest in the outcome.’ he says. ‘Every society only wants its specialty’s value to go up….You cannot avoid the potential conflict.’”

Medicare requires that out-of-sync payments be reviewed every 5 years. MedPac, a congressional watchdog, reveals that “ in the three previous reviews, the RUC endorsed boosts for 1,050 services, and decreases for just 167.”

Reimbursements for placing cardiac stents in a single blood vessel are based upon a 1994 RUC analysis. In 2008, doctors were paid $205 million for 326,000 such procedures.  Cardiologists suggest that stenting today, as compared to the mid-1990s, “is more routine and may often be less stressful.” According to David L. Brown, cardiologist at SUNY-Stony Brook School of Medicine, ‘The example used to set the code’s value is ‘way out of date,’…’In those days, stents were used when you were having a catastrophic event or thought you might have a catastrophic event.’ Stents and the catheters used to thread them into arteries are now smaller and easier to use, he says. The time varies by patient, but Dr. Brown says he required around 45 minutes on average to perform a single-vessel stenting. The RUC’s valuation suggests a two-hour procedure.”

On the other hand RUC member, representing The American College of Cardiology, and director of cardiology at Geisinger Medical Center, James Blankenship feels the stenting procedure is “ ‘fairly valued’. ” While he agrees that 2 hours may be too long, he “argues that the procedure may be harder because cardiologists now take on challenging patients who might once have gotten bypass surgeries.”

While we may not be inclined to question cardiologists’ fees since they have the power of life and death over us, how about payments for carpal tunnel surgeries. “A study published this June in the journal Medical Care Research and Review found the procedure times used by the RUC to calculate values may sometimes be exaggerated.” While Medicare’s payment of $44 million paid in 2008 was based upon a procedure time of 25 minutes for carpal tunnel surgery, Sullivan Healthcare Consulting Inc, which keeps the hospital database, showed the average time for teaching hospitals, based upon 2,602 surgeries was 17 minutes, and for community hospitals, based upon 4,093 surgeries was 18 minutes. Meanwhile, RUC’s figure of 25 minutes came from “39 surveys of surgeons, out of 150 sent out by groups representing hand surgeons, orthopedic surgeons and plastic surgeons.” Upholding Medicare’s payment, former medical director for the American Academy of Orthopedic Surgeons, Robert H. Haralson III, says the “payment isn’t too high, because the surgery is a more intense procedure than the current value implies.” And RUC leaders wrote to the medical journal insisting that the article was “outdated” and that different standards were used to classify the procedures than that used by the committee. I guess they were suggesting that it was like comparing “apples to oranges.” Hmmm.

It seems we must leave matters in the capable hands of RUC’s head Dr. Levy who assures us that the committee “has reduced values for nearly 400 services in the past and it is now reviewing hundreds more.” And in answer to primary-care groups who are pushing for more representation, we should accept her retort that “ ‘The outcomes are independent of who’s sitting at the table from one specialty or another.’” We should also feel reassured by Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid Services, who “says that for now, ‘we are comfortable’ with the RUC process. The federal health-care overhaul requires the government to insure that the doctor-fee values adopted by Medicare are accurate. ‘We’re not going to rubber-stamp recommendations,’ he says.”

I feel so much better now.

Yeah right!…hugmamma.