BUCKNACKT'S SORDID TAWDRY BLOG
We should not be a journey to the grave with the intention of arriving safely in an attractive & well preserved body, but rather to skid in sideways, chocolate, bier or wein in hand, body thoroughly used up, totally worn out and screaming "WHOO-HOO, WHAT A RIDE!!!!!!"
verse of the day
You will know the truth, and the truth will make you free.
- John 8:32
voice of the day
You shall know the truth, and the truth shall make you odd.
-Flannery O'Connor
prayer of the day
Lord, may your truth make us both free and odd in a world that breeds bondage and demands conformity. Amen.
OBAMACARE. The very mention of the ACA / Affordable Care Act can set repiglicans and tea-baggers off on a foaming at the mouth, spit flying rampage. While that is all some of their supporters need to justify their voluntary ignorance and racist hatred, others need lies, deception and manipulation to make their voluntary ignorance and racist hatred more acceptable to themselves and those like them. Here are two examples of the continuing lies, manipulation, deception and fear started by greedy fascist pig koch brother's american action forum being spread on the internet by anonymous cowards and the blatantly fascist, racist and hateful karl rove's & ed (lost the VA Senate race) gillespie's american crossroads organization. From +PolitiFact .....
As a result of Obamacare, "California seniors face benefit cuts of over $1,700."
By Lauren Carroll on Friday, October 31st, 2014 at 9:30 a.m.
A recent American Crossroads ad attacks Rep. Ami Bera, D-Calif., for supporting Obamacare.
Even though Rep. Ami Bera, D-Calif., wasn’t in office when
Obamacare passed, a pro-Republican ad in California’s seventh
congressional district is using the law to attack him.
Bera is running against Republican Doug Ose for a second term, and
it’s a tight race. Less than six months into his first term, Bera voted against
repealing the Affordable Care Act, and American Crossroads, Karl Rove’s
conservative political action committee, used this fact to appeal to
California seniors in a recent ad.
"Bera voted to keep Obamacare, which cut $716 billion from Medicare,
slashing Medicare Advantage," the ad’s narrator says. "Now California
seniors face benefit cuts of over $1,700."
Many times, we’ve rated the claim that there are $716 billion in Medicare cuts as Half True. But we hadn’t heard claims about specific benefit cuts by state before, so we decided to check it out.
We found that the claim that California seniors will see $1,700 in
benefit cuts as a result of the Affordable Care Act is misleading. The
statistic comes from a report that ignores critical context and evidence
that the law has expanded Medicare’s benefits packages. Advantages
We should first note that the statistic comes from an April 2014 report by the American Action Forum,
and they have a stake in the election. The American Action Forum is an
arm of the American Action Network, which is a conservative political
nonprofit with financial ties to the Koch brothers. According to the Center for Responsive Politics, the group shares office space with American Crossroads -- the group that produced the very ad we’re checking.
Now to the claim. The ad makes it sound like all California
seniors will face cuts to this degree. However, the report only
addresses Medicare Advantage. About one-third of seniors use Medicare
Advantage, which is a private coverage option.
Medicare Advantage plans are required to provide at minimum the same
array of benefits as traditional Medicare. Many Advantage plans offer
extra benefits -- things like gym memberships, vision exams or generous
cost-sharing -- that have contributed to escalating program costs.
The creators of Medicare Advantage thought that letting seniors
choose plans from private insurance providers would be more
cost-effective than traditional Medicare. But Advantage has turned out
to be more expensive. Medicare paid insurers about 114 percent more for
Advantage plans than for traditional plans, as of 2009 before enactment of the federal health care law.
The law attempted to close that gap in part by gradually reducing how
much Medicare pays Advantage plan providers. It was estimated that its
changes would slow down spending
on Medicare by about $716 billion over 10 years, and Medicare Advantage
cost-saving measures accounted for about one-third of that. (Though the
Obama administration has reversed these cuts for the past two years -- facing pressure from insurance providers, Republicans and some Democrats, including Bera.)
Critics argue that the cuts will force insurance providers to reduce
the benefits they offer to Medicare Advantage enrollees. However,
Medicare Advantage plans are still required to offer, at minimum, the
same level of benefits as traditional plans. And Obamacare includes language protecting that set of guaranteed benefits from shrinking.
In fact, the law expanded Medicare’s required benefits to include
certain preventative services, annual visits, closing a gap in
prescription coverage and more.
Additionally, the law rewards Medicare Advantage providers
with financial bonuses to encourage quality and cost-efficiency.
Providers are required to use the bonuses to offer extra benefits,
attracting more enrollees. Nearly all Medicare Advantage plan providers received these bonuses in 2012, according to the Kaiser Family Foundation. A matter of speculation
It’s possible that Medicare Advantage providers could respond to
their pay cut by reducing benefits, but the only benefits they could cut
would be those extra benefits that go beyond Medicare plan
requirements.
"It's not automatic and won't affect every (Advantage) enrollee or
any of the (traditional Medicare) enrollees," said Dylan Roby, an expert
in health economics at the University of California Los Angeles Center
for Health Policy Research.
Insurance providers could also respond to lower payments by offering
the same benefits while operating more efficiently. They could cut
administrative costs, adjust cost-sharing plans, take in less profit or
drop out of the market altogether.
But, according to the Kaiser Family Foundation, the Department of Health and Human Services
and more, insurance providers’ response to the cuts has been less
dramatic than was expected when Obama signed the legislation in 2010. In
fact, Medicare Advantage enrollment is at an all-time high, and the
percentage of plans with four or more stars in the program’s five-star
rating system is increasing.
"When Congress debated the payment reductions in 2010, forecasters
and analysts also projected that reductions would drive insurers to
raise premiums, cut extra benefits and even pull out of the Medicare
Advantage market," Kaiser experts wrote in May. "Thus far, however, the
response by insurers to the (Affordable Care Act) cuts has been more
muted."
Health and Human Services reported in fall 2013
that "The average number of plan choices will remain about the same in
2014 and access to supplemental benefits remains stable. Since passage
of the Affordable Care Act, average MA premiums are down by 9.8
percent."
Experts also told us that they haven’t seen evidence of reduced Medicare Advantage cuts.
"The evidence is that plan participation has been stable, premiums
have been stable or even a little bit lower, and there are no overall
changes in the benefits provided," said Jack Hoadley, a research
professor at Georgetown University and a member of the nonpartisan Medicare Payment Advisory Commission.
"In my view, the claims in this advertisement are misleading,"
Hoadley added. "Seniors have not faced benefit cuts in Medicare
Advantage, even though the plans (and providers) have to manage with
somewhat lower payments."
So how did the American Action forum report come up with their estimated benefit cut figures?
The American Action Forum report breaks down the reduction in
Medicare payments to Advantage plan providers by state and county. It
says, compared to pre-Obamacare, Medicare Advantage benefits in
California are down $1,718 per beneficiary.
We asked several experts to take a look at the report, and they told
us that it is misleading because it assumes that Obamacare’s spending
reductions directly results in reduced benefits.
Yes, Obamacare reduces Medicare’s spending per Advantage beneficiary,
but this does not necessarily mean fewer benefits for seniors with
Advantage plans. Like we said before, there are multiple ways that an
insurance provider can deal with the spending cuts other than slimming
down its offerings.
"To immediately treat it as a cut to benefits is an exaggeration,"
said Judith Feder, a professor of health policy at Georgetown
University. Our ruling
American Crossroads said that as a result of Obamacare, "California seniors face benefit cuts of over $1,700."
First of all, this claim is misleading because it makes it seem like
all seniors will face these cuts, when the statistic actually refers to
Medicare Advantage enrollees -- only about one-third of seniors.
The statistic comes from a report that assumes all reductions in
Medicare Advantage spending results in fewer benefits for enrollees.
While insurance providers feel the cuts, there are multiple ways for
them to respond other than reducing benefits, such as trimming
administrative costs. We heard from multiple experts and researchers who
said Medicare Advantage benefits have remained stable.
The ad also leaves out the fact that the federal health care law
expanded Medicare’s minimum required benefits and established incentives
for Advantage plans to provide extra benefits.
It’s possible that some Medicare Advantage enrollees could see their
benefits shrink, but this ad blows that possibility out of proportion
and ignores important context. We rate this claim False.
By Steve Contorno on Thursday, November 6th, 2014 at 4:11 p.m.
A chain email
claims more than 200,000 doctors aren't accepting patients with coverage
bought on Affordable Care Act marketplaces.
Are doctors en masse refusing patients who gained health care coverage due to the Affordable Care Act?
That’s the claim in a chain email a reader asked us to check. "More,
truly scary Obamacare news," said the email, sent just before Halloween.
The accompanying story was from CNSnews.com, a site operated by the conservative Media Research Center.
"Over 214,000 Doctors Opt Out of Obamacare Exchanges," read a headline on CNSnews.com.
We found the source of the claim. It was coming from American Action
Forum, a self-described "center-right policy institute." The
organization put out an analysis on Oct. 27 titled: "Health Care
Providers are Opting-Out of Obamacare Exchange Plans."
How many? According to the post, "as many as 214,524 American
physicians will not be participating in any (Affordable Care Act)
exchange products." It went on to list some reasons "doctors are opting
out of the exchange plans."
That’s a lot of doctors. Have that many decided to turn away patients with insurance purchased on the marketplaces?
Let’s take a look. Can doctors opt out of Obamacare exchanges?
The Affordable Care Act requires essentially everyone to have
insurance. To make it easier for people to buy insurance, the government
created federal and state insurance marketplaces, sometimes called
exchanges. The biggest one is HealthCare.gov, but some states elected to operate their own as well.
These marketplace policies are private plans sold by insurance
companies. In some states, just one or two companies are providing
plans; in others, it’s many. Consumers typically have dozens of choices
ranging from bronze policies, which pay 60 percent of health costs on
average, to platinum, which pay 90 percent of costs. (For comparison, a typical employer-based plan covers about 80 percent of costs.)
Can doctors choose not to participate in the networks of policies
purchased on exchanges? Sure. While some states require doctors to
accept any plan for an insurance provider they do business with, in most
cases insurance companies are constantly negotiating with physiciansand hospitals to determine which policy networks they will participate in, experts and industry officials told us.
Some doctors might decide they don’t want to be in the network of
plans purchased on federal or state marketplaces. In other instances,
insurance providers might choose not to include certain doctors or
health groups in policies they created for the marketplaces.
It’s a two-way street, and marketplace policies are just the latest
twist to a contracting process that has always existed between doctors
and insurance companies. 200,000 doctors?
We asked American Action Forum to explain their analysis to us. The
organization based its findings on an April survey from the Medical
Group Management Association, a trade organization for physician groups.
"The survey found that 23.5 percent of doctors said they would not
participate in (Affordable Care Act) exchange plans," said Marisol
Garibay, spokeswoman for American Action Forum.
That percentage was multiplied by the total number of professional
active physicians, which Kaiser Family Foundation estimates is 893,851.
That equals 210,054 doctors, close to the American Action Forum number.
Garibay called it an "upper bound" estimate.
But when we looked at the survey ourselves, we found this to be a pretty dubious figure.
Here’s the rub, from the research: "The survey includes responses
from more than 700 medical groups in which more than 40,000 physicians
practice nationwide."
While there’s a lot of interesting information gleaned from this
survey, the results cannot be extrapolated to represent all the doctors
in the country. Why not? Because the Medical Group Management
Association only represents doctors who are part of medical groups. This
does not include physicians who run independent practices, for example,
and there’s no reason that a poll of 700 medical groups is
representative of all 900,000 physicians in the country.
"That’s a significant difference," said Anders Gilberg, a senior vice
president of government affairs for Medical Group Management
Association. "I wouldn’t generally suggest using it as a proxy for all
physicians."
Let’s put that aside for a second and dig further. The survey found
that as of April, 76.5 percent of respondents were accepting health
insurance sold on a state or federal marketplace.
Of those not participating in marketplace policies, 42 percent said
it was because insurance companies in their area didn’t ask them to
participate in the networks of plans sold on marketplaces.
Meaning, even if this limited survey could be extrapolated to
represent all doctors, not all of them are "opting out" of Obamacare.
Many — almost half — weren’t asked to participate in ACA marketplace
policies.
Why weren’t they asked? One reason is that the insurance companies
want to limit which doctors will serve their customers by creating
narrow networks.Narrow networks are a way for insurance providers to keep costs lower for insurers.
How? If you create a narrow network, it guarantees a doctor will get a
bigger share of your patients, and a doctor would be willing to accept
lower reimbursement rates in exchange for more business.
Narrow networks are also more common on the exchanges because
consumers can pick the plan with the doctors that fit their needs, said
Paul Ginsburg, a professor of the practice of health policy and
management at University of Southern California.
"Employer plans tend to have a broad network because they’re trying
to satisfy everyone (at the company)," Ginsburg said. "On an exchange,
you don’t have to satisfy everyone with one policy, you can offer many,
so you can have narrower plans."
There are plenty of broad plans on the exchanges, they just tend to
be more expensive. According to a May survey of individuals likely to
use the marketplace, 54 percent said they would accept more limited
networks to get a cheaper sticker price. As it is, 85 percent of plans
bought on federal and state marketplaces were the less expensive bronze
or silver plans, according to the Department of Health and Human
Services.
To be sure, it appears some doctors want nothing to do with these cheaper marketplace plans or the customers who buy them.
Among other things, doctors worry that many of the plans on the
marketplace, particularly bronze and silver plans, have high
deductibles. Some patients won’t be able to meet their obligations for
cost-sharing, potentially forcing physicians to eat those costs or shake
down customers.
These are legitimate concerns, and there is reason to believe that
some doctors are choosing not to contract with marketplace insurance
plans. But there is no evidence to suggest the number is anywhere near
214,000. Our ruling
A chain email claimed that more than 214,000 American doctors are
"opting-out of Obamacare exchange plans." That is based on a survey of a
select group of doctors and even the makers of the survey said it can’t
be extrapolated for the entire country. Further, of the doctors
responding to the survey, 42 percent said they weren’t participating in
marketplace plans because they were never asked to, not because they
were "opting out."
The estimate is the result of a flawed methodology and a misreading of survey data. We rate the claim False.
JUST as Tunisian, Egyptian and Libyan exiles returned to help their countries in their struggle for freedom and democracy, so too are Syrians. This is the bloodiest of the Arab Spring revolutions, and the longest lasting, but assad's days are numbered. It is sad for the Syrian people he will not end the violence and leave. It is estimated more than 17000 Syrians have been killed in the revolution and tens of thousands are refugees in Turkey, Jordan and Lebanon. How many more must die? From NPR...
Deborah Amos/NPR Dr.
Yahya Abdul Rahim (left) and Dr. Ammar Ghanem are among the
Syrian-American doctors who have come to the Turkish-Syrian border to
help Syrians wounded in the anti-government revolt. Some work to improve
the flow of supplies; others treat patients in Turkey; still others,
like Ghanem, strap backpacks on and walk across the border to help those
in Syria.
The Turkish border is a key link for the revolt
in neighboring Syria. Turkish ambulances are stationed at border
crossings to cope with the flood of injured Syrians, often as many as 30
a day. And now, Syrian-American doctors are volunteering in a
humanitarian effort to help the wounded and to bring crucial medicines
for field hospitals inside Syria.
A busy
office in the Turkish border town of Antakya represents something new in
the Syrian revolt — a direct link between rebels fighting the regime of
Syrian President Bashar Assad, and a humanitarian network to support
wounded fighters and civilians.
The Union of Syrian Medical Relief Organizations
was founded by an American doctor from Texas. The office in Antakya is
run by a fashion designer from Syria. His managerial skills are crucial
for the work here — for the first time, compiling complete case records
of Syrian patients in Turkish hospitals, with recommendations for
follow-up care.
Across the street, a medical
supply warehouse is run by another Syrian-American, a clinical
pharmacist from Cincinnati, Ohio, named Khaula Sawah.
Sawah, who was born in Syria, is working on a system to organize what has been an ad hoc smuggling operation.
"I am all the time here to organize medical supplies inside Syria, as well as taking care of the injured here," she says.
The
shelves are filled with supplies paid for privately by Syrian exile
groups. It's not nearly enough, says Dr. Ammar Ghanem, from Fort Wayne,
Ind.
"What's going on in Syria is disaster," he says. U.S. Doctors Bring Supplies, Know-How
Ghanem
is one of 30 American doctors who recently arrived in Antakya. They all
came with full suitcases packed with a million dollars' worth of vital
supplies donated by an American medical manufacturer.
EnlargeDeborah Amos/NPR Doctors
treating the injured say the Syrian regime is using more lethal weapons
and targeting specific areas to maximize the damage. As a result, there
have been many amputations, as was the case with this rebel fighter who
was wounded in Idlib province and is being treated in Turkey.
One in-demand supply is a type of gauze that stops bleeding.
"This is very needed. When we come here we brought like 3,000 pieces," he says. "They are gone within one day."
The
clotting gauze went to a field hospital inside Syria. Syrian activists
are stationed on the border now, a stretcher brigade trained to
transport seriously injured cases to Turkey. Ghanem, an intensive care
specialist, says for many, it will take years to recover.
"There
are a lot of complicated spinal cord injuries. And I think that the
regime and their snipers are targeting these areas," he says. "They are
targeting ... the spine, they are targeting areas of the brain, they are
targeting areas that can leave a person with a lifelong disability."
With
so many Syrians dying on the long trek to Turkey for treatment, there
is a race to organize and streamline this emergency operation inside and
outside Syria. Turkish hospitals are overwhelmed by the caseload in
Antakya, a resort town. The Turkish doctors don't have much experience
with battlefield injuries, and have no resources for follow-up care. So
Syrian-American doctors have stepped in to help. Personal Sorrow, Bravery Amid Uprising
Dr. Yahya Abdul Rahim is from Panama City, Fla.
EnlargeDeborah Amos/NPR Abdul Rahim is a Syrian-American doctor from Florida who was among the first to arrive in Syria to help the wounded.
"I feel I am paying back some of duty for my homeland, who has been suffering for years and years, and for decades," he says.
Abdul
Rahim was the first member of the American medical team to arrive. He
organized a rotation of volunteer doctors willing to cross into Syria,
and psychiatrists to counsel trauma victims in the Turkish camps.
"And
some of the psychological scar is going to be a major problem,
especially women who have been raped or children witness the death of
their mother is going to be a major problem," he says.
Despite
all the suffering, Abdul Rahim he says he is optimistic. That was
tested when news from inside Syria interrupted his interview with NPR.
"Just
an hour ago, one of my best friends been shot and killed, and he is one
of the most nice person you can imagine," Abdul Rahim says. "He was big
asset for the medical mission in Syria. Just an hour ago — I just heard
it a few minutes ago."
Then, Dr. Ghanem —
the intensive care specialist from Fort Wayne, Ind. — arrives from a
full day at the warehouse. He straps on a large red medical backpack.
"I'm leaving my family here," he says. "I'm going to go to the inside."
And
with that, carrying a full medical kit for resuscitating severely
wounded patients in the field, Ghanem is on his way — on foot across the
border to Syria.
CHRISTIAN rick perry finds it necessary to lie about the effect tort reform had in Texas. No big surprise there, his campaign is based on lies, distortions, manipulations and propaganda because without all the smoke and mirrors people will see him for what he is, a political whore being pimped by corporate America and tea-baggers...
The Truth-O-Meter Says:
Says Texas gained 21,000 doctors due to tort reform.
Rick Perry on Wednesday, August 17th, 2011 in a speech at "Politics and Eggs" in Bedford, N.H.
Rick Perry says Texas added 21,000 doctors because of tort reform
Share this story:
The doctor-patient ratio in Texas rose faster prior to tort reform.
Ask any Republican candidate about reducing the cost of health care and part of the answer is likely to include rewriting the rules for medical malpractice. In 2003, Texas lawmakers passed a package of changes to malpractice law, plus the state added a few more through a referendum known as Proposition 12.
These turned the state into a beacon of hope among tort reformers and Texas Gov. Rick Perry talks proudly of the good the changes have done.
When he was asked about medical malpractice at the Politics and Eggs Breakfast in Bedford, N.H., on Aug. 17, 2011, he had some precise numbers at his fingertips. "I’ll tell you what one of the results was," he said. "This last year, 21,000 more physicians practicing medicine in Texas because they know they can do what they love and not be sued. Some 30 counties that didn’t have an emergency room doc have one today. Counties along the Rio Grande, where women were having to travel for miles and miles outside of the county to see an ob-gyn, for prenatal care and now they have that care."
For this fact-check, we're examining his claim that that the state gained 21,000 doctors because of tort reform.
First, we found the number is wrong.
Perry’s campaign relies on data from the Texas Medical Association, a physician trade group, which counts the number of medical licenses issued in Texas. The problem is, not everyone with such a license practices in Texas.
The Texas Medical Board issues licenses and tracks whether those doctors actually work in the state. According to their numbers, between 2003 and 2011, the accurate increase is 12,788. That’s about 8,000 doctors fewer than the governor’s claim.
Still, thousands of additional physicians is nothing to sneeze at, and the next question is, can credit be put at the feet of tort reform?
Not much. By far, the biggest driver is population growth. From 2002 to 2010, the population of Texas grew by 20 percent. At the same time, the number of doctors went up 24 percent.
Jon Opelt, executive director of Texas Alliance for Patient Access, a group that supports tort reform and is funded by health care providers, sent us some analysis he had done that filtered out the population effect. Opelt said the higher rate for doctors -- 24 percent -- translates into an additional 1,608 physicians thanks to tort reform.
At least, that’s what he said when we first spoke to him. Later, after we showed him that the growth of doctors increased at a faster rate in the pre-reform years, Opelt sent us new numbers, saying tort reform brought 5,000 more doctors to the state and the ratio of doctors to residents has never been better. (We found those numbers to be a stretch: The upward revision comes from including administrators, teachers and other licensed doctors who don’t actually treat patients.)
In any event, from the pro-reform vantage point, the most accurate figure is 5,000 -- a far cry from 21,000.
But the case for Perry’s statement gets even shakier when you review numbers prior to the new malpractice rules. It turns out that in the nine years before tort reform, the number of doctors grew twice as fast as the population. So Texas did a pretty good job attracting doctors before the law changed.
Tom Banning, chief executive officer of the Texas Academy of Family Physicians, said that back in the early 1990’s the state began passing laws that made it physician-friendly. Among them, a prompt-pay rule to "to ensure that insurers pay physicians promptly and correctly," Banning said, "which creates a very good environment for practices."
Banning said tort reform was more good news for doctors, a sentiment borne out by opinion surveys from the state’s medical association. But he acknowledges that population growth is the biggest force behind the growing ranks of doctors. "It’s like the Willie Sutton rule," Banning said, referring to the famous bank robber. "Go where the money is. From a doctor’s standpoint, you go where the patients are."
Especially patients who can pay. Banning and other observers in Texas note that most of the new doctors are clustered in the affluent, fast growing suburbs around the state’s biggest cities.
This puts a damper on one of Perry’s additional points, that tort reform opens the doors for physicians to practice in the state’s most rural counties. The results here are mixed. The governor is right about emergency room doctors. The state has 60 percent more of them then it did in 2003 and tort reform likely played a major role, experts told us. ER doctors got more protections from tort reform than just about any other medical specialty.
But Perry also boasted that rural counties were getting specialists in obstetrics and gynecology that they never had before. The reality here is murkier. A report from the Texas Alliance for Patient Access says 14 counties (of 254 total) gained an ob-gyn. We looked at one community along the Rio Grande River, Starr County, and found that yes, four years after tort reform, they got one. But the situation has flipped back and forth, and as of May 2011, Starr County had no ob-gyn specialist.
Our ruling
There is no question that tort reform drove down medical malpractice insurance premiums and reduced the number of malpractice suits. And there is no question that most health care providers like the change and say it’s a factor that leads them to practice in the state. But the wholesale transformation that Perry describes is not backed up by the numbers.
Perry said Texas has 21,000 more doctors thanks to tort reform. That’s flat out wrong. Texas has only about 13,000 more doctors in the state and the historic trends suggest that population growth was the driving factor. We rate his statement False. Published: Thursday, August 25th, 2011 at 4:35 p.m. Subjects:Health Care, Legal Issues, New Hampshire 2012 Sources:
New Hampshire Public Radio, Perry claims doctor boom thanks to tort reform, Aug, 17, 2011
The doctor-patient ratio in Texas rose faster prior to tort reform.