Health care overhaul could include changes to doctor payments

The Wall Street Journal reports that "Democratic centrists said they won a tentative commitment from the White House to back a proposal to curb the growth of Medicare costs. ... One proposal pushed both by President Barack Obama and some centrists is to give the executive branch the authority to implement cuts to Medicare spending that would be recommended by independent experts. Congress could stop the cuts, but only if it acted swiftly. Fiscal conservatives say that under the current system, which gives Congress more power, lawmakers shy away from politically tough votes to restrain Medicare costs."

"After a more-than-two-hour meeting at the White House Tuesday, centrists said they secured a verbal commitment to add such a mechanism on Medicare cost-cutting to the House bill. White House budget chief Peter Orszag ... said 'I think it's probably the most important piece that could be added to the House legislation'" (Hitt and Bendavid, 7/22).

The Associated Press: "With Congress and the Obama administration groping for a way to restrain the skyrocketing rise in medical costs and restore solvency to the health care program for seniors, the Medicare Payment Advisory Commission could be moved into the executive branch, its clout expanded exponentially." 

"The consequences for thousands of doctors, hospitals, nursing homes and other health care providers under Medicare, the government-run program for seniors, would be sweeping. A bill backed by Sen. Jay Rockefeller, D-W.Va., would give MedPAC's annual recommendations, which are advisory, the force of law unless overridden by Congress. That would be a remarkable grant of authority by lawmakers - an acknowledgment that Congress was politically incapable of reining in Medicare on its own - much as legislation a decade ago put the closure of unneeded military bases on autopilot."

But "MedPAC has its critics, and some lawmakers worry that constituents will hold them responsible for future payment cuts made largely without their involvement." In a letter last month, Sen. Max Baucus, D-Mont., explained that even now, lawmakers are 'sure to listen very carefully to MedPAC's recommendations, particularly on provider payments.' Created by congressional Republicans over a decade ago, MedPAC has 17 part-time commissioners, a staff of 35, and a budget of $10.4 million: "almost infinitesimally small in a government that is on track to spend about $3.8 trillion in the current fiscal year." The administration hopes that increasing the authority of MedPAC would help reign in spending by limiting increases to doctor payments (Espo, 7/21). 

Meanwhile, "House Democrats want to give doctors a $245 billion sweetener that helps ensure their critical support for a health care overhaul bill," The Associated Press reports in a separate story. "Next up: Trying to explain how they could do it without breaking President Barack Obama's promise that health legislation won't increase the federal deficit. ... Democrats and the Obama administration argue that the $245 billion included for doctors - the approximate 10-year cost of adjusting Medicare reimbursement rates so physicians don't face big annual pay cuts - does not have to be counted in the overall cost of the health care bill. Their only-in-Washington reasoning is that they already decided to exempt it from congressional 'pay-as-you-go' rules that require new programs to be paid for. In other words, it doesn't have to be paid for because they decided it doesn't have to be paid for."

"Old policy or new, no one disputes that the 'doc fix' does in fact add to the deficit. And the administration's position carried no weight with the CBO when it released its analysis of the House Democrats' bill. The CBO, Congress' nonpartisan budget scorekeeper, said Friday that enacting the legislation 'would result in a net increase to the federal budget deficit of $239 billion over the 2010-2019 period.' The increase is mostly because of Democrats' failure to pay for the 'doc fix,' but CBO didn't even bother to entertain the notion that its cost should be excluded." The change has "been a top priority for the American Medical Association, which cited its inclusion as a key reason in its endorsement of the House Democrats' sweeping health care bill" (Werner, 7/21).

NPR interviewed AMA President Dr. James Rohack. The interview did not address MedPAC or the 'doc fix.' Dr. Rohack said the AMA endorsed the House Democrat's bill because "status quo's unacceptable," and the "political process needs to continue on." Asked why the House bill does not address malpractice concerns, Rohack said that "when President Obama spoke to the AMA house of delegates in June, he recognized that defensive medicine was one of the contributors to unnecessary costs. And so we're willing to work with the White House, the Congress to try and come up with some solutions if we're going to provide what we believe is long overdue fundamental health system reform." He also stressed that the House bill was not the final bill. "We believe, like a baseball game, we're in the second inning" (Siegel, 7/21).

Kaiser Health NewsThis article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


  1. David H. Marshall David H. Marshall United States says:


    The needed for Veteran treatment, U.S. Senate's "experiments that were designed to harm" [9] revealing evidence is: 1. Not in a subject’s Medical History, so that they never the wiser become. And 2. The resulting alerting injuries are not in "The court may not review the schedule of ratings for disabilities..."![5] There is no, "Veterans Right to Know...".[10] After honorable service Congress still has not given back to veterans those rights that convicted rapists and murderers keep![7]

    In honor of those that serve, on 5 May 2009 the U.S. House passed, "Resolved, That the House of Representatives strongly urges Americans and people of all nationalities to visit national cemeteries, memorials, and markers on Memorial Day, where the spirit of American generosity, sacrifice, and courage are displayed and commemorated."[1] Despite the efforts of some members of Congress, do the ignored U.S. Senate proven Department of Defense (DOD) for the greater good of all "experiments that were designed to harm" continue?[9] Under the 2006 established Biomedical Advanced Research and Development Authority (BARDA) "NATIONAL SECURITY MISSIONS", now ongoing are these DOD conducted on "hundreds of thousands" [9] of Veterans lessons learned?[11] In October 1995 is the history of human experiments 15 January 1994 U.S. President’s Advisory Committee on Human Radiation Experiments (ACHRE) Report.[3] On December 8, 1994 is the U.S. Senate REPORT 103-97 "Is Military Research Hazardous to Veterans' Health? Lessons Spanning Half a Century.", i.e., its many "designed to harm" DOD experiments conducted on "hundreds of thousands".[9] The 1987 U.S. Supreme Court STANLEY [4] determined that their 1950 FERES also protects the government from its "designed to harm" acts. The 1950 U.S. Supreme Court FERES Doctrine decided that the U.S. Government can not be held accountable for injuries "incident" to U.S. Military Service.[2]

    "IT WAS NECESSARY "TO CONCEAL THESE ACTIVITIES FROM THE AMERICAN PUBLIC IN GENERAL," BECAUSE PUBLIC KNOWLEDGE OF THE" UNETHICAL AND ILLICIT ACTIVITIES WOULD HAVE SERIOUS REPERCUSSIONS IN POLITICAL AND DIPLOMATIC CIRCLES AND WOULD BE DETRIMENTAL TO THE ACCOMPLISHMENT OF ITS MISSION." Footnote 4, U.S. Supreme Court 1987 STANLEY military experiments case, Page 688.[4] This case confirms their FERES Doctrine [2] decision that correction is through the U.S. Congress. After STANLEY Congress passed the 1988 Veterans’ Judicial Review Act (VJRA). Established was the Legislative, Article I severely restricted, Veteran’s Court with Congress’s, "The court may not review the schedule of ratings for disabilities or the policies underlying the schedule.", i.e., the needed for treatment "designed to harm" evidence.[5] In 2009 the U.S. Congress still has not corrected the U.S. Senate’s 1994 reported 50 years of a DOD "experiments that were designed to harm" policy. The Veterans Court Chief Judge stated, "The Court simply identifies error made below by a failure to adhere, in individual cases, to the Constitution, statutes, and regulations which themselves reflect policy -- policy freely ignored by many initial adjudicators whose attitude is, "I haven't been told by my boss to change. If you don't like it -- appeal it."[8] Given to the Secretary of the Department of Veterans Affairs (VA) is the Judicial Branch’s final authority on "the policies underlying the schedule" questions of law![6] Accordingly a sham, politically correct with ‘no teeth’ Veteran’s Court. The "to harm" experiments were performed under the secrecy cover of our past wars. They were in direct disobedience of the DOD Secretary's 1953 TOP SECRET order. This order was unclassified twenty two (22) years later.[3] In 1953 and since known by the Secretary's of all Services, Joint Chiefs of Staff, the DOD Research and Development (R&D) Board and the U.S. Congress.

    The "Veterans Right to Know Act" to establish the Veterans' Right to Know Commission was proposed in the 2005 and H.R. 4259 [109th] 2006 Congress.[10] A "to harm" subject's right to get the needed for treatment evidence never became law.

    Each deliberate "to harm" project completes the R&D process. Prior R&D is reviewed. The resulting Scope of Work defines what each experiment is "designed" to accomplish. The how, where, when and who is identified. The conducted RESEARCHED cause and effects are closely followed and recorded. From the results are DEVELOPED safe production, use, treatment and protection.


    NOTE: Copies of all documents have been downloaded. If any of the links are not active, on request they are available as PDF or wpd attachments.

    [1] 2009 - U.S. House 5 May 2009 to honor veterans act. H. RES. 360.

    [2] 1950 - Feres v. United States, 340 U.S. 135, 146 (1950). LINK:

    [3] 1953 - DOD Secretary's 26 February 1953 NO non-consensual, human experiment’s Memo pages 343-345. George J. Annas and Michael A. Grodin, "The Nazi Doctors and the Nuremberg Code; Human Rights in Human Experimentation (New York: Oxford University Press, 1992). In REFERENCE [8] as NOTES 72, 168 & 169. The provided Link is to the U.S. President’s established 15 January 1994 Advisory Committee on Human Radiation Experiments (ACHRE) resulting October 1995 Report. Chapter 1: The Department of Defense: Consent is Formalized. Go "Page Down" 15 times to the DOD Secretary's 26 February 1953 Memo. .

    [4] 1987 - U.S. SUPREME COURT, JUNE 25, 1987, U.S. V. STANLEY , 107 S. CT.. 3054 (VOLUME 483 U.S., SECTION 669, PAGES 699 TO 710). In REFERENCE [8] cited in NOTE169.

    [5] 1988 - Veterans’ Judicial Review Act (VJRA), Pub. L. No. 100-687, Div. A, 102 Stat. 4105 (8 December 1988) DVA-Chapter 4 and

    [6] "United States Code (USC) Title 38, 511. Decisions of the Secretary; finality." US CODE: Title 38511. Decisions of the Secretary; finality

    [7] 1994 - U.S. State Dept., "U.S. Report under the International Covenant on Civil and Political Rights July 1994, Article 7". Second and Third Periodic Report of the United States of America ...

    [8] 1994 - Chief Judge and colleague statements, Court of Veterans Appeals, Annual Judicial Conference, Fort Meyer, VA., 17 & 18 October 1994. Chief Judge Frank Nebeker's Statement

    [9] 1994 - December 8, 1994 REPORT 103-97 "Is Military Research Hazardous to Veterans' Health? Lessons Spanning Half a Century." Hearings Before the U.S. Senate Committee on Veterans' Affairs, 103rd Congress 2nd Session. With NOTES 1 to 170. Senate Report 103-97

    [10] 2005 & 2006 - "Veterans Right to Know Act" to establish the Veterans' Right to Know Commission was proposed in the 2005 and H.R. 4259 [109th] 2006 Congress. H. R. 4259

    [11] 2006 - Biomedical Advanced Research and Development Authority (BARDA), Bill S. 3678 2006. Signed into law 16 December 2006. Cloaking BARDA - The Project On Government Oversight (POGO) Blog

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