Wednesday, July 14, 2010

Obamacare Begins -- In Idaho

When the Regime sets prices, this is called "applied compassion."

When producers organize to complain about price controls, and then freely decide not to offer their services at the artificially low price, this is called "a criminal conspiracy to fix prices."

This is the central claim of the "consent decree" inflicted, at gunpoint, on a group of Idaho orthopedic surgeons by the Obama Regime -- with the eager collaboration of the Idaho State Attorney General. Under the terms of that extorted agreement, it would be tantamount to a criminal offense for a doctor to complain to his peers about regulatory actions that may drive accomplished medical specialists out of business.

This is just one aspect of the multi-faceted ugliness inflicted on the medical profession through the federal crackdown on a group of Idaho orthopedic surgeons who rebelled against government-imposed price controls on medical treatment.

The Idaho Industrial Commission imposes the "fee schedule" for worker's compensation claims. Rather than permitting the market to set prices for various treatment options, prices were set according to an abstruse formula called the "Resource-Based Value System" (RBVS). 

As the Justice (sic) Department explained in a May 28 legal filing, the RBVS "uses a `relative value unit' and a `conversion factor' to determine physician payment. The relative value unit measures the resources necessary to perform a medical service.... The conversion factor is a set dollar amount, say $100. A physician's payment for any medical service is generally calculated by multiplying the relative value unit by the conversion factor. For example, a physician would receive $500 for a medical service with a relative value unit of 5 and a conversion factor of $100."

Collectivist demi-gods assemble: A WWII-era rationing Soviet.
As an assembly of quasi-divine bureaucratic beings,  the Idaho Industrial Commission apparently determines the "relative value unit" and "conversion factor" of medical procedures through direct revelation.

In 2006, the Commission's Olympian deliberations yielded a "conversion factor" of $88 for many of the common orthopedic procedures covered by government-mandated worker's compensation insurance. 

The revised fee schedule was to go into effect on April 1 of that year -- appropriately, given that the date is the symbolic birthday of anybody who believes government to be a necessary and useful enterprise. It would have resulted in sharply reduced reimbursements to orthopedic surgeons. 

Predictably, a group of specialists in that field failed to appreciate the supernal wisdom contained in the Commission's freshly minted revelation: Betrayed by their faithless eyes, the physicians noticed that new fee schedule would probably put more than a few of them out of business. They compared notes and decided to organize an effort (coordinated through the Idaho Orthopedic Society) to change the government-imposed fee schedule.  

Enemies of the state: Wartime rationing convictions in the UK.

Through meetings, phone conversations, and e-mail messages, a group of orthopedic surgeons agreed to withdraw from the workman's compensation insurance program, and to urge the Commission to revise the reimbursement rate to a more realistic figure. 

No doctor was coerced or otherwise pressured into opting out; in fact, specialists continued to provide treatment to emergency room patients under the new, lower rates. 

In February 2007, amid widespread defections of orthopedic specialists from the workman's comp program, the Commission consulted its Urim and Thummim and revised its fee schedule again, enacting a 61% increase over the artificially low rate it had set a year earlier. Satisfied, doctors rejoined the program -- even as Leviathan quietly prepared to punish them for their impudence. 

In the American political lexicon, the activities in which the Idaho orthopedic surgeons engaged are described as petitioning government for redress of grievances, a civic function explicitly protected by the Constitution. 

According to the Obama Regime -- and, let us not forget, the Republican-dominated Idaho state government, which collaborated in this totalitarian initiative -- this is "a combination or conspiracy in restraint of trade or commerce" under the detestable Sherman Act. 

Under the government's conspiracy theory, every meeting or communication among the defendants was transmuted into an "overt act" in the furtherance of that supposed criminal design. The terms of the settlement imposed on the surgeons by the "Justice" Department are designed to criminalize the exercise of constitutionally protected rights. Enforcement of the settlement will require Stasi-grade intrusive surveillance.

As described in the "Final Judgment" announced on May 28, "Prohibited Conduct" on the part of the defendants includes any communication among orthopedists -- whether direct or indirect -- regarding any government-mandated insurance fees or contract terms, or decisions by any health care providers to withdraw from those programs. 

A list of "Permitted Conduct" -- remember, in a totalitarian system, government specifies what subjects may do -- graciously informs the victims that they are "free" to consult with their peers about matters of patient care. 

Interestingly, they are also permitted to discuss "legislative, judicial, or regulatory actions, or other governmental policies or actions," pursuant to "the Noerr-Pennington doctrine." This provision complicates matters considerably, given that the federal crackdown against the orthopedic surgeons violates that doctrine, under which the actions of the Idaho physicians were entirely appropriate. 

In United Mine Workers v. Pennington (which built on an earlier ruling in Eastern R. Conference v. Noerr Motors), the Supreme Court held that "Joint efforts to influence public officials do not violate the antitrust laws even though intended to eliminate competition." 

The behavior of the Idaho Orthopedic Society was far more innocuous. They weren't enlisting government aid to eliminate competition, they were simply trying to get a regulatory body to remove its boot from their necks.  However, in the proto-fascist system now afflicting us, the former is entirely acceptable, and the latter is considered a grave offense against the "common good." 

Accordingly, the Idaho physicians to whom the Final Judgment applies are explicitly authorized to carry out "joint efforts to influence public officials," while at the same time expressly forbidden to do so.

How are the doctors supposed to comply with the Final Judgment, given that its guidelines distinguishing "Prohibited" from "Acceptable" conduct make no sense? This is where the Regime engages in its preferred form of job creation -- that is, creating invasive busywork for state-employed commissars. 

The task of "determining or securing compliance" will be assigned to "authorized representatives of the United States Department of Justice or the Office of the Idaho Attorney General (including their consultants and other retained persons," explains the Final Judgment. 

These zampoliti (the Soviet Russian term for "political officers") will be given the supposed authority "to require that each defendant provide hard or electronic copies of all books, ledgers, accounts, records, data, and documents ... relating to any matters contained in this Final Judgment; and to interview, either informally or on the record, defendants and their officers, employees, or agents, who may have their individual counsel present, regarding such matters."

In addition, the victims in this arrangement "shall submit written reports or a response to written interrogatories, under oath if requested, relating to any of the matters contained in this Final Judgment...."

The "Consent Decree" will be in effect for ten years. To understand what this would be like, it's helpful to imagine enduring a decade-long IRS audit, with the Feds reserving the option to prolong the torment as they see fit. 
Dry gas pumps yesterday, "death panels" tomorrow.

All of this is merely a grace note to the symphony of suffering called "Obamacare." 

It's important to recognize that although Obama may be waving the baton, the score he's conducting is a thoroughly bipartisan composition, building not only on New Deal and Great Society themes but also the corporate socialist HMO system developed under Richard Nixon. 

Also worthy of note is the contribution made by the loathsome Senator John Sherman, the Republican author of the corporatist Sherman Antitrust Act -- a supposed monopoly-busting act that actually enables the Regime to wage war against any business interest that is not part of an officially protected cartel.

Idaho's Republican Attorney General -- a putative hero in the struggle to interdict Obamacare -- eagerly collaborated in the persecution of Idaho's renegade orthopedists.   And someone in the Republican-dominated Idaho political establishment carefully shepherded the physicians into the embrace of Mark J. Botti, an attorney from Akin, Gump who until recently worked for the same section of the Justice (sic) Department that staged this pogrom

Notes antitrust law commentator Skip Oliva:

"Botti ran the exact same section that prosecuted his clients; he drafted a report that affirmed the exact same policies used to prosecute his clients; and he also advises an international antitrust group whose stated purpose is to expand the power of national antitrust regulators. Something tells me Botti wasn’t exactly the most zealous defender of his clients’ interests — at least not the clients who are currently paying him."

As "defense" counsel in this matter, Botti's role was exactly the same as that of a defendant's advocate in the Cardassian court system: Collaborate with the prosecution to validate the infallible wisdom of the state through a pre-ordained guilty verdict, and help the defendant accept that verdict with proper submissive humility. 

The Federal jihad against Idaho's rebel orthopedic surgeons is a field test for the coming regulatory and legal assault on physicians under Obamacare. One eminently predictable -- and most likely intentional -- result of that onslaught will be health care rationing as the pool of health care providers is depleted. 

The next logical step would be to criminalize a doctor's decision to leave his profession because of price controls. After all, if a doctor can't withdraw from a government-mandated health coverage program, why should the government permit him to withhold his services by choosing another profession?

Of course, at the rate the Regime is destroying the economy, in short order there won't be any other professions to choose from, or any wealth to plunder in order to fund grandiose social engineering schemes.

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Dum spiro, pugno!


name is inserted here said...

Bureaucrats who will decide who gets healthcare in the messiahcare plan how lovely. Since we are mere mortals compared to the Messiah® it is only fitting. That hopey changey is not all its hyped up to be.

Anonymous said...

Will wrote:

"As "defense" counsel in this matter, Botti's role was exactly the same as that of a defendant's advocate in the Cardassian court system: Collaborate with the prosecution to validate the infallible wisdom of the state through a pre-ordained guilty verdict, and help the defendant accept that verdict with proper submissive humility."

This has been the norm in the kangaroo family courts for a long long time. Family law attorneys don't represent the clients who are paying them - they represent the court's interests.

As far as Lawrence Wasden goes, he's as two faced a double talking pol as there is. Then again so is the that is no different from any of the inbred good-ole-boy bureaurats in this state. Hopefully one day we can openly hang them all . . .

In Male Fide
Sic Semper Tyrannis

liberranter said...

As far as Obamunistcare goes, I'm sure you've seen this LRC blog post today (7/15/10) that touches on this source article on North Korea's rapidly collapsing "health care" system.

Of course this is the deliberate goal of our Criminal Overlords: to destroy every last vestige of the free market in their quest for total power and to use "health care" as a bludgeon to keep us all in line. They'll almost certainly succeed too, given that the average Amoricon sheep is programatically incapable of distinguishing "capitalism" from "state corporatism" and vilifies the former (which they wouldn't recognize if it kicked them in the crotch) while suffering under the latter.

God help us, although if He doesn't, it's because we've shown ourselves to be undeserving of His help.

Dedicated_Dad said...

The blood - it boils.

What F***ing country **IS** this again?

It sure as aytch-eee-double-hockey-sticks ain't Our Founders' Republic.

How much more will we take before we decide it's time to refresh the tree of Liberty with its natural manure?


liberranter said...

What F***ing country **IS** this again?

The toxic residue of the republic that, as Benjamin Franklin predicted, we couldn't keep.

liberranter said...

By the way, the fact that Idaho's Rethuglican establishment is eagerly implementing this Marxist travesty should serve as a wake-up call to the state's Republican-registered votards (but won't, of course).

TMLutas said...

The end result is that doctors will just withdraw to cash only practice or they will withdraw from medicine entirely. The consequences of that are excess mortality or, dead bodies.

There will not be much talk about it. There will be general bewilderment why it is happening. The doctors won't tell us. They very well will understand after the first few examples are set.

The bodies will just pile up without much comment from the political class.

Anonymous said...

How sad. To squawk about ones own rape, theft, and murder, is to invite a tax-fattened finger of rebuke from the hand of Leviathan.

Anonymous said...

I hate to tell you this but health care is highly rationed in the US now. The people who are complaining are those with the better government plans and medicare that fear they are going to lose out. Guess what too bad.

"doctors will just withdraw to cash only practice"

Some maybe, but most are not good enough and need to work in a government system.

DPirate said...

Love your site.

As you know, doctors are the beneficiaries of a state-derived monopoly on many forms on necessary health care. As such, I fail to see how they can have any expectation of a free market. A sick person in America is generally forced by law to see certain individuals, or face punitive measures. Given these facts, I find this article to be somewhat off. Unlike other trades, we are not allowed to DIY.

William N. Grigg said...

Thanks, DPirate!

You're entirely correct about the medical cartel, of course. There are more than a few conscientious medical practitioners who are fully accredited within that cartel who hardly consider themselves "beneficiaries" and would much prefer a legitimate free market in medicine. I think their situation is roughly comparable to that of genuinely accomplished teachers frustrated to be trapped in the government's education matrix.

hope is for children change is for pennybanks said...

Government Wants Your Individual Obesity Rating By 2014
Published on 07-17-2010

Source: HULIQ

All Americans, by 2014 will be required to have an individual obesity rating electronically recorded. It has been determined that under the new health stimulus law passed by President Barack Obama recently, that all Americans, by 2014, will be required to have electronic health records which will include their height, weight and body mass index (BMI).

BMI is a formula that calculates ones body measurements, including height and weight, in order to come up with an individual obesity rating. Calculation of BMI is the preferred method of the Centers for Disease Control and Prevention (CDC) for measuring obesity and coming up with an obesity rating, which is the measure of a person’s body fat percentage.

Regina Benjamin, the U.S. Surgeon General stated that according to the CDC, “BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.”

America has been criticized for being a nation that actually promotes obesity and hence leads American's to have health issues. The new health regulation also stipulates that the electronic records, including BMI will be able to quickly send individual health records as public health data to state and federal health agencies such as the HHS and the CDC.

The new obesity-rating regulation will be enforced in every American's electronic health record. The regulation states that it must, “Calculate body mass index. Automatically calculate and display body mass index (BMI) based on a patient’s height and weight.” In addition, these electronic health records will be available for viewing on a national exchange. Seems a bit invasive, say many, but there will be security measures in place on these electronic records to try to help with privacy.

The 2009 economic stimulus law, already in place, has made some additions. The most major; this new regulation and requirement for obesity ratings within electronic records. This is the government's first step towards adopting a new universal requirement for electronic health records (EHRs) by 2014.

Secretary Kathleen Sebelius and Dr. David Blumenthal, the National Coordinator for Health Information Technology for Health and Human Services (HHS), shared on Tuesday that under the stimulus law, health care providers, including doctors and hospitals, must establish "meaningful use" of EHRs by 2014 in order to qualify for federal subsidies. If they do not comply, they will risk getting penalized in the form of diminished Medicare and Medicaid payments.

As outlined in Section 3001 of the stimulus law, it reads, "The National Coordinator shall, in consultation with other appropriate Federal agencies (including the National Institute of Standards and Technology), update the Federal Health IT Strategic Plan (developed as of June 3, 2008) to include specific objectives, milestones, and metrics with respect to the following: (i) The electronic exchange and use of health information and the enterprise integration of such information.‘‘(ii) The utilization of an electronic health record for each person in the United States by 2014."

DPirate said...

Your picture ID has this information. Height/weight, that is all. Not that it isn't ridiculous or anything...

alpholive said...

As an abstainer from all commercialized medical practice my health is mine to manage. I did yeoman service in the taxpayer economic system and am about to have cuts in SS payments for medical treatment I live without. If the ss checks stop I will go back to work if I can find it but only to sustain this house of flesh. If no work is offered I will attempt to procure sustenance wherever and by every means to keep the house "Open". But I will not allow a unionized health professional to even know my name. I have selected a secret location where I will not be disturbed until all that remains is these bones. Except for the last fifty years it has been a suitable life. I'm optimistic about eternity. aleph

Anonymous said...

"As an abstainer from all commercialized medical practice my health is mine to manage."

I agree with you on that!

More of us will need to be 'abstainers' in order to insure individual health. hmmm

Over a 4 year period of dealing with a supposedly serious auto-immune disorder of the thyroid by means of my own research & self-treatment, a recent thyroid function test revealed all thyroid levels 'normal'.

We need not lay down our lives before the state healthcare committees & pharmaceutical company trained 'doctors'.

Trust the Lord and allow promptings of the Spirit to guide you in how to stay healthy and how to treat maladies when they occur.

I raise several species of livestock. The Creator leads them to what they need to remain healthy. Why wouldn't He do the same for us?

Anonymous said...

Referencing "Anonymous the Abstainer":

I was a self-treating abstainer, too, until I shipped a strep bacteria that flourished in my blood, on my liver and caused the lung above to react in hysteria. I also follow God's lead, and this time He led me to the medical "system." Death was only a day or two away, otherwise. So, I came to realize that the established medical system is useful in some very critical ways. I wouldn't want to throw the baby out with the bath water. Of course, when Obamacare takes off running, we're all totally screwed.

But now that my three weeks in the hospital are over, I have bills that I'd love to trade for a mortgage. What I'm finding most interesting about this system now is that the first thing the hospital wanted to do is stick the taxpayers with the bill since I'm uninsured. How's that any different from Obamacare which hasn't even been implemented (openly) yet? But since I also don't have a social security number, no robbing the taxpayers will happen in my name.

And the charities set up, obstensibly, for these types of things? Haven't heard back from them.

Linda June

David said...

The problem is not that the doctors opted out of the pricing agreement, the problem is that they communicated and agreed to do it together.

That kind of activity is prohibited under anti-trust laws. If they just did it on their own then it would not have been a problem.

Also, when dealing with white collar crime sometimes the best you can do is realize when the prosecutor has your client behind the 8-ball and the best thing to do is to go along with it and avoid jail time if possible.

I am not sure about the exact fact scenario here, but the defense attorney could face disciplinary action from the Idaho State Bar if they were acting against their clients' interest.

Maybe it was a clear cut case of actions violating an unjust law but the doctors did not want to fight that hard and just take the punishment.

Price fixing by agreement in any measure (by discussion what prices to not accept) is prohibited by Anti-Trust laws.

Cheers. I just started reading your blog last week and love it.