The VA and Liberal & Conservative Fallacies On Health Care

While in general the left is far more reality-based than the right, there are areas where segments of the left are mistaken.As I’ve noted several times in the past, there are some on the left who have been repeating arguments based upon fallacious data to claim far greater quality for the VA system than actually exists.

A problem with those advocating health care reform repeating the fallacious arguments in support of the VA is that those of us who have seen the results of their system know the claims are untrue. Every time there is new information about deficiencies in the VA system the credibility of those who support the VA model is undermined, which also casts doubt upon their legitimate arguments in support of health care reform.

We have another example of problems at a VA hospital with CNN reporting that VA hospital may have infected 1,800 veterans with HIV:

A Missouri VA hospital is under fire because it may have exposed more than 1,800 veterans to life-threatening diseases such as hepatitis and HIV.

John Cochran VA Medical Center in St. Louis has recently mailed letters to 1,812 veterans telling them they could contract hepatitis B, hepatitis C and human immunodeficiency virus (HIV) after visiting the medical center for dental work, said Rep. Russ Carnahan.

Carnahan said Tuesday he is calling for a investigation into the issue and has sent a letter to President Obama about it.

“This is absolutely unacceptable,” said Carnahan, a Democrat from Missouri. “No veteran who has served and risked their life for this great nation should have to worry about their personal safety when receiving much needed healthcare services from a Veterans Administration hospital.”

Conservatives are right that government does not do a good job in managing  health care. A government take over of health care would be a bad thing. Of course health care reform is not a government take over of health care, and government regulation to counter the abuses of the insurance industry is beneficial.

Health care reform has nothing to do with situations such as VA hospitals. Similarly it has nothing to do with Canadian or British health care. If conservatives were really interested in freedom of choice they would be enthusiastically supporting health care reform. Of course the modern conservative movement is an authoritarian movement which has nothing to do with supporting freedom. They are far more likely to support the “freedom” of the insurance industry to limit health care options while ignoring the fact that only the use of governmental power gives people an ability to counter the power of big corporations.

Republicans Not Doing Enough To Weed Out The Lunatics

A couple of weeks ago I cited an article from Playboy on the influence of Republican operatives on tea party groups. One section I didn’t mention previously is about how the party people are trying to  make tea party candidates more electable:

Our candidate-interview process is pretty simple. The candidate is asked two questions:
(1) Are you a birther?
(2) Are you a truther?
If the answer is anything but “no” or “hell no,” the conversation ends right there. If the candidate answers correctly, the conversation continues, looking at viability and whether we can have a worthwhile impact. The reality of this litmus test is as patriotic as practical. Donors don’t contribute to lunatics.

It’s not a bad litmus test to start with, but they really need to do more to wean out the lunatics, such as Rand Paul. There are plenty of other conspiracy theories he subscribes to, such as the NAFTA Superhighway.

The litmus test should also go beyond weeding out conspiracy theorists. For example, anyone who believes in creationism really lacks the understanding of science to hold any position of authority in the 21st century–plus this is a sure sign that they have been brainwashed by the far right. Unfortunately far too many Republicans believe in creationism. Perhaps at very least they could get rid of the young earth creationists. Would they really miss Sarah Palin? How about one-third of Texas? It appears that Rand Paul might also would fail this test (or at least panders to those who would) after having refused to answer a question about the age of the earth. I hope others continue to press Paul to answer this one.

Obama’s Long Term Impact

Peter Beinart, writing at The Daily Beast, points out that “Obama has exceeded in 18 months what Clinton and Carter achieved in a combined 12 years.” His article on Obama’s success concludes:

Unless a policy victory brings political benefits—rising poll numbers, better prospects for the next elections—it is not treated as a big win. Thus, the Tea Party movement is considered an ominous sign for Obama, evidence that the country is turning against him. But the reason that the Glenn Beck and Sarah Palin crowd is so angry is that Obama has expanded the federal government’s relationship with the private sector in fundamental ways. In political terms, the Tea Party movement may be a sign of Obama’s weakened position, but in policy terms, it is a testament to his success. As shrewd conservatives like David Frum recognize, the current mood of Republican optimism is wildly misplaced. When Republicans refused to compromise with Obama on health care, they gambled that he wouldn’t, or couldn’t, push through reform with only Democratic support. Then, when he did, they insisted that he was destroying his chances of passing future legislation. Now he’s proved them wrong again. So what if Obama’s legislative success prompts a backlash that buys the GOP a few more seats this fall? As Frum has asked pointedly, was it a win for the Republicans because after Lyndon Johnson passed Medicare they picked up seats in the midterm elections of 1966?

The larger truth is this: Even as Republicans claim political momentum, the country is in the midst of a major shift leftward when it comes to the role of government. That shift is playing itself out from infrastructure to health care to finance and perhaps eventually to the environment. No one knows whether these shifts will revive the U.S. economy and lay the foundation for stable, broad-based growth, just as no one could predict the impact of the rightward turn in American policy in the early 1980s. Decades later, liberals and conservatives still disagree about whether Reagan’s reforms changed America for good or ill. What they don’t disagree about is the fact that they fundamentally changed America. Those changes made Reagan one of the most consequential presidents in American history. Eighteen months in, it’s a good bet that historians will say the same about Barack Obama.

David Weigle Gets Position At MSNBC

I’m glad to see that David Weigle found another job so soon after leaving The Washington Post (for reasons discussed here). Mediaite reports that he will be working for MSNBC. Keith Olbermann introduced him at the end of Countdown as new a “MSNBC contributor.” Mediaite has a video of the announcement and reports, “Mediaite has confirmed from MSNBC that Weigel’s role will be both paid and exclusive to the network. It’s likely, then that we’ll see Weigel show up on other non-Countdown programs on MSNBC as well.”

SciFi Weekend: “Vincent and the Doctor” and “The Big Bang”

The season concluded for Doctor Who on the BBC with The Big Bang while BBC America aired Vincent and the Doctor. This review contains major spoilers for Vincent and the Doctor (which I previously wrote about here.). I have attempted to keep reviews of episodes which have not aired yet in the United States free of any significant spoilers–as frustrating as it is not to talk more about The Big Bang–but there are a few comments on upcoming events.

Vincent and the Doctor seems to be a stand alone episode which goes back to the original intent of the show to be educational for children, but it does fit well into the season’s overall arc. The educational aspects of the show include both Van Gogh and depression, with the BBC including a pubic service announcement on depression at the end.

The episode took Rory’s disappearance from time into account. The Doctor accidentally referred to Vincent as Rory. Amy questioned why the Doctor was being so nice to her, and even Vincent saw signs that Amy had suffered a major loss despite not remembering it, at least on a conscious level. The episode had the Doctor explaining that “bow ties are cool.” The Big Bang has the Doctor finding something else he considers cool. I did not notice the crack in the wall in this episode, but Vincent does play a role in the two part season finale, along with many other characters from earlier in the season.

The episode included pictures of the first two Doctors and the use of a species identifier, which seemed like a combination of the “Googles” or “Layers” programs on my Droid and a rear view mirror. The rear view mirror allowed the Doctor to see this episode’s invisible monster, who in many ways was just like Vincent. Both are outcasts from their society.

The story involving the monster concluded several minutes before the conclusion of the episode. The Doctor then brought Vincent to the present to see how his work was being appreciated at the Musée d’Orsay. After returning Vincent to his time Amy and the Doctor returned to the museum. Amy believed that having seen how he would be appreciated would make a difference, perhaps keeping him from committing suicide. She expected to see many new works from Vincent. Instead they found two changes. The monster was no longer in the window in the work which first led them to meet Vincent, and a picture of sun flowers now says “for Amy.”

The Big Bang was an excellent conclusion for the season. While it wraps up some of the aspects of the season’s arc, the episode leaves some mysteries open for future seasons, including the relationship between River Song and the Doctor. The episode is extremely “timey wimy” as Steven Moffat would describe it, and shows how Moffat is more interested in writing a fairy tale about the characters than hard science fiction. Steven Moffat discussed the season after watching The Big Bang in the above interview conducted by his son Joshua.

Those who do not want any spoilers might hold off on watching the above interview. Those who have watched The Big Bang and want more might enjoy this link--but hold off if you don’t want any spoilers as to the season finale.

Matt Smith and Karen Gillan were interviewed by BBC Newsbeat, answering questions from viewers in the video above.

Quote of the Day

“Well, folks, Sarah Palin has admitted she tried marijuana several years ago, but she did not like it. She said it distorted her perceptions, impaired her thinking, and she’s hoping that the effects will eventually wear off.” —Jay Leno

David Weigel Leaves Washington Post Following Leaks Of Criticism Of Right Wing

David Weigel provides a demonstration of how nothing on the web is really private–even on closed lists where such privacy is assumed. Weigel is a left libertarian whose views of the right wing seem to be similar to my own. It is not so much their views which repel myself and I believe Weigel, but that their actual policy positions turn out to be quite different from their limited government rhetoric. On top of that, there is the anti-intellectualism, adherence to conspiracy theories and revisionist history, xenophobia, racism, and anti-Semitism which, while not true of everyone on the right, is far too common for comfort.

Weigel was hired to cover the right wing for The Washington Post to some degree  I did question a major newspaper hiring him for such a position, suspecting from the start that his views might give conservatives more fuel for their attacks on the imaginary “liberal media.”

If this was the outcome, it wasn’t because of  any unfair bias being displayed in Weigel’s work. Even some conservatives were supportive of Weigel, such as at The American Spectator:

To start with, it’s important to note that all of the comments at the center of the recent uproar were made on a private email list that was supposed to be off the record. Just for a moment, think of the things that you’d say if you were joking or venting anger among friends, and imagine if they became public with context removed. If everything we said privately were public, I wonder how many of us would be able to maintain jobs or friendships. Weigel is being attacked for writing that the world would be better if Matt Drudge could “set himself on fire.” But people make off hand remarks like that all the time without literally wishing bodily harm upon other humans.

This and other private comments by Weigel have contributed to the charge that he’s hostile toward conservatives and a standard issue liberal, but I don’t think that’s accurate. I could just as easily report on private conversations in which he’s revealed a fondness for Ronald Reagan, a willingness to vote for Bobby Jindal as president, and agreed that Van Jones should have been fired for his 9/11 trutherism. Plus, it should be noted that in the past, he’s even contributed to the American Spectator.

It should also be noted that he went on Keith Olbermann’s show and shot down a story about Sarah Palin committing perjury that had been lighting up the liberal blogs and defended Cato’s Michael Cannon against a “dishonest and unfair hit” by the Center for American Progress.

I’ve disagreed with Weigel on a number of occasions, and have called him out when I’ve felt he’s placed an inordinate amount of focus on fringe characters or extreme statements made by conservatives. But I also know that he isn’t some “drive by” journalist. He knows his subject matter well, reads constantly, goes to lots of conservative events, maintains friendships with conservatives, and talks to a lot of conservatives for his articles and quotes them accurately.

Weigel’s resignation came not as a result of any signs of bias in his work but because of comments written on Journolist, a private email list, which were leaked. Unfortunately Weigel probably saw his comments as being the equivalent of private conservation when in reality any comments made on line can wind up being as public as anything posted on a blog.

It is unfortunate that Weigel is no longer at The Washington Post, but I am confident that he will find other sources to write for. I certainly hope so as we certainly need voices like his to help counter all the ignorance, hatred, and misinformation being spread by the authoritarian right.

Palin Endorsement Found To Be Toxic

Sarah Palin’s support has appeared to have helped some candidates in Republican primaries (although she has generally endorsed candidates who were already in the lead), but Greg Sargent has found that overall she is “toxic.” Reviewing  the internals of the new NBC/Wall Street Journal poll, Sargent came to this conclusion:  “A majority see a Palin endorsement as a clear negative.”

The poll asked people how they’d respond if a Congressional candidate had various hypothetical attributes. Asked how they’d feel if a candidate were “endorsed by Sarah Palin,” the response was….

Enthusiastic about this attribute 8

Comfortable with this attribute 17

Have some reservations about this attribute 15

Very uncomfortable with this attribute 37

It turns out that there were only two attributes worse than an endorsement from  Sarah Palin:  “Supporting Bush’s economic policies; and supporting the elimination of various Federal agencies and/or Social Security.” Of course these things are not mutually exclusive.

Posted in Polls, Sarah Palin. Tags: . 3 Comments »

House Passes Temporary Medicare Fix After Senate Again Fails To Pass More Comprehensive Legislation

Nancy Pelosi’s misguided attempt to use Medicare as leverage to pass the unemployment and jobs measures in the tax-extenders bill failed. Fortunately Pelosi quickly realized there was no point in continuing this strategy when Senate Republicans again blocked passage. Forty Republicans and Ben Nelson voted against the measure, blocking the measure supported by 57 Democrats. Subsequently Pelosi backed down and the House passed the temporary Medicare fix.

While misguided, at least it can be said that Pelosi meant well, motivated by a desire to promote economic recovery, which certainly could not be said of the Republicans. After the Senate passed a Medicare fix as a separate measure, she was under the mistaken belief that she had some leverage over Senate Republicans by blocking a vote on the Senate measure.

I am surprised at how badly Pelosi misread the Republicans. Republicans were willing to vote for the Medicare “doc fix” but certainly would not be heartbroken if it failed and they could blame Democrats for destroying Medicare. Even if they were actually in support of the measure, their opposition to spending money on jobs or the unemployed certainly trumped any such feelings.

Senator Debbie Stabenow of Michigan (where we recently fell to the number two in unemployment, now surpassed by Nevada)  summed  up the Republican mind set here:

It is very clear that the Republicans in the Senate want this economy to fail. They see that things are beginning to turn around. You know the numbers. When this president took office, we were losing 750,000 jobs a month. … Now we are gaining jobs. … Unfortunately, and cynically [on their part], in cynical political terms, it doesn’t serve them in terms of their elections if things are beginning to turn around.

I believe when you look at this bill, which is all paid for — we raised revenues to pay for it — the one piece that is technically not paid for [is the federal unemployment benefit extensions and] that is done in a way that we have always done it, … [those are] always categorized as an emergency. And, frankly, if 15 million people without jobs is not an emergency, I don’t know what is.

Ezra Klein provided this political interpretation earlier in the day when he anticipated the loss on the jobs measures:

And still, it looks like Democrats might lose the vote today. And when I say “lose the vote,” I don’t mean that a majority of the Senate will vote against it. I mean that 58 senators, rather than 60, will support the legislation. All Republicans, and possibly Ben Nelson, appear to remain opposed. And why not? The less that Democrats appear to be doing on jobs — and the fewer jobs that Democrats actually create — the better Republicans will do in November. Substantial compromises on the bill haven’t brought any new votes, and that’s in part because Republicans see no political upside in passing the legislation.

While it made no sense for Pelosi to believe that the threat of not passing the Medicare fix would get Republicans to vote for unemployment benefits, at least she did quickly back down and get the Medicare fixed later the same day.

Getting this passed quickly was important for a number of reasons. After postponing the processing of payments since the beginning of June, Medicare began processing payments with the 21 percent cut. It will now be necessary to reissue these checks with the updated amount. Earlier in the week I saw estimates that this would cost $15 million, and this would increase with every batch of Medicare payments which must be reprocessed. The delay also increases expenses for physicians and undermines confidence in Medicare. This might lead more doctors, who now see Medicare patients at a considerable discount compared to commercial payers,  to decide against accepting Medicare patients.

Now that it is established that both parties agree that this needs to be fixed, hopefully we can also achieve a permanent fix to the Medicare payment formula before the end of the year. Attempts last year failed because the Republicans had wanted to include this cost in the cost of health care reform and use it as another bogus argument against reform. Now that health care reform has been passed hopefully the Republicans will not see further political gain in blocking a permanent fix.

AARP Joins Physician Groups In Blasting Congress For Inaction On Medicare Payment Fix

The failure of Congress to act on the Medicare “doc fix” has led to protests from medical organizations and the American Association of Retired People who have pointed out the harm this will do to the Medicare program and people dependent upon Medicare for their health care. The American Academy of Family Practitioners has called on Congress to stop harming patients and do their job. The American College of Physicians has blasted Congress for causing “Irreparable damage to Medicare” as seniors and military families face loss of access to health care. AARP sent the following letter to every member of Congress urging action on Medicare, warning that their inaction “threatens access to physician services for millions of Medicare beneficiaries.”

On behalf of millions of AARP members, I urge you to immediately pass legislation that ensures seniors have access to their physicians, and provides much needed fiscal relief to the states and to unemployed individuals.

Regrettably, given Congress’s failure to reach timely agreement on a Medicare physician pay package, the Centers for Medicare and Medicaid Services has now been forced to implement a draconian 21.3 percent reduction in their reimbursements.  This cut threatens access to physician services for millions of Medicare beneficiaries – especially those living in rural and other underserved areas.

While Congress continues to debate temporary patchwork solutions, people on Medicare are growing increasingly anxious about whether they will be able to find a doctor when they need one.  Seniors, who have paid into Medicare their entire working lives, deserve the peace of mind of knowing they will be able to find a doctor who will treat them.

AARP urges Congress to act immediately to stabilize doctor reimbursement rates for as long as possible until a permanent solution can be found.   For nearly a decade, Medicare patients and the doctors who treat them have been held hostage by short-term patches to an unworkable Sustainable Growth Rate (SGR) formula.  In the months to come, we look forward to working with Members of Congress from both sides of the aisle to repeal the SGR formula and replace it with a permanent physician payment system for Medicare that rewards value and ends the uncertainty for patients and providers alike.

In addition, enhanced Medicaid funding to states to assist them with the added costs of providing health coverage to low income individuals and for home and community based services must be extended.

Finally, we urge the extension of unemployment benefits for those unable to find jobs during this economic downturn.

AARP members are counting on you to address these critical issues immediately to protect their health and economic security.

Congress Plays Chicken With Medicare

Medical blogs have been protesting the failure of Congress to resolve this problem. For example, Dr. Rob warns that Congress is playing “a great big game of chicken.”

  • The house is playing chicken with the senate.
  • The Democrats are playing chicken with the Republicans.
  • They aren’t in the cars themselves, we are.  Doctors and patients are careening toward destruction in the name of political gamesmanship.

Surely they will flinch.  Surely someone will understand the consequences of the crash.  But you know what?  Sometimes each side expects the others will be the ones who flinch.  Sometimes nobody flinches.  Sometimes the cars crash and people are killed.

There are two potential ways to resolve this deadlock. The quickest would be for Nancy Pelosi to go along with Senate Majority Leader Harry Reid, House Majority Leader Steny Hoyer, and Rep. Robert Andrews (D-N.J.), the Chair of the Education and Labor health panel, and allow the House to vote on the temporary fix passed in the Senate last week.

Nancy Pelosi has been insisting on a different course by attaching the Medicare “doc fix” to other unrelated legislation. The Senate is attempting to pass legislation which includes some of Pelosi’s goals, but it is questionable if the Senate could pass such legislation without watering it down to the point where Pelosi would not find it acceptable.

For Nancy Pelosi to be the one who, at present, is blocking passage of this legislation might be political suicide for the Democrats, risking turning over control of Congress to the Republicans in November. The Democrats are already on shaky ground with seniors. As Ezra Klein pointed out earlier today, health care reform has become more popular since passage–except with seniors. The Democrats cannot afford to further alienate the senior vote, which tends to turn out more heavily in off year elections than the younger voters who are more likely to stick with the Democrats.

American Academy of Family Practitioners Calls on Congress To Stop Harming Patients By Failing To Pass Payment Fix

The American Academy of Family Practitioners has called on Congress to stop harming patients and do their job. The text of their statement follows:

“The House and Senate are pulling the rug out from under millions of Americans who depend on Medicare and TRICARE for their health care coverage.

“This squabbling is intolerable. Political infighting over the Medicare physician payment fiasco has gone on far too long. It threatens access to care for elderly and disabled patients and for members of our armed services and their families. It seriously undermines physician confidence that Medicare will reliably pay for the services already rendered. It undercuts the foundation on which health care reform is to be built.

“For many rural and underserved communities, family physicians are the only health care professionals. They have operated on razor thin margins since Medicare payment stagnated nine years ago. The 21 percent pay cut that went into effect June 1 has pushed their Medicare compensation to levels they haven’t seen since 1994. Now these physicians — often the only source of health care in rural and underserved areas — face the possibility of cutting their staff, missing payroll, and limiting the number of Medicare and TRICARE patients they can accept.

“Congress must stop harming patients and act on legislation that retroactively restores the 21 percent Medicare payment cut with a formula that provides stability to the system. They must stop playing with the lives of constituents with the one-upmanship and political scorekeeping. They must pass legislation that ends these outrageous political games that puts the health and welfare of millions of Americans at risk.”

American College of Physicians Blasts Congress For Causing “Irreparable damage to Medicare”

The American College of Physicians has released the following statement protesting the failure of Congress to continue Medicare payments on schedule in June, blasting Congress for causing “Irreparable damage to Medicare” as seniors and military families face loss of access to health care:

Today,  the  Senate  and  House  remain  at loggerheads on  how to reverse  a devastating  cut  in Medicare and TRICARE payments to physicians.

Today, Medicare  claims are being processed, retroactive  to June 1, with a 21 percent  cut, which is not enough to even begin to cover the costs of delivering care.

Today, tens of thousands of  physician  practices are facing the real possibility that they will have to lay‐off staff, miss payroll, limit how many Medicare and military families they can accept, or even close their doors.

Today, millions of America’s seniors and military families are finding that Medicare no longer is a reliable or stable partner.

And  each  and every day  that the cut remains in effect, more and more seniors and military families will find that they can’t get an appointment with a doctor.

Each and every day  the cut remains in effect, physicians will continue to lose confidence in the ability of Congress, the President, and  both political parties to do the right thing by patients.

This loss of trust in government not only harms Medicare and TRICARE, but threatens to undermine physicians’ confidence in the federal government’s ability to manage health care reform effectively.

It  is past time  for politicians from both political parties and both chambers to stop blaming someone else for the impasse. Physicians and patients don’t want to hear that it is the Democrats’ fault, or the Republicans’, or the President’s, or the Senate’s, or the House’s. They don’t want to hear politicians claim that they are for repealing the SGR, as they withhold their vote from any practical plan to achieve repeal.

They want to hear that the people they elected can work together to solve the problem.

They want to hear that the House and Senate have resolved their differences and enacted legislation to immediately reverse the 21 percent cut and make physicians whole for the damage already done.

They want to hear that  members of Congress, on a bicameral and bipartisan  basis, have agreed on a long‐term solution to replace the unworkable SGR. Such a solution, at a minimum, would provide stable, reliable and positive payments or all services that cover physicians’ costs, provides for higher updates for primary care visits and preventive services, and lead to repeal of the SGR.

Absent such agreement, physicians and their patients will continue  to lose faith  in Medicare and TRICARE, causing potentially irreparable and permanent damage to both programs.

Democrats Split As Nancy Pelosi Betrays Seniors

Nancy Pelosi’s irrational behavior regarding the Medicare “doc fix” is creating rifts between Pelosi and other Democrats. For the past several months we’ve had a repeated pattern of the Democrats taking the lead in trying to fix the problem while the Republicans have blocked passage. Suddenly it is Nancy Pelosi who is jeopardizing Medicare.

The Senate passed a six month temporary fix last Friday which differed from the House proposal. While far from perfect, the Senate bill would have at least bought some time to again work on a long term solution. It was initially assumed that the House would quickly approve the Senate bill but instead Pelosi has insisted she will not act upon a Medicare fix which does not also include the jobs proposals in the House bill.

While fighting for the jobs proposals are admirable, this should not be done at the expense of passing the Medicare fix. Failure to pass the fix endangers the Medicare program and will cause seniors, the disabled, and military families to have difficulty getting access to health care. (Medicare directly covers seniors and the disabled while Tricare, which covers active members of the military and their families, bases its fee schedule on the Medicare fee schedule).

As Nancy Pelosi and Harry Reid took differing positions, Politco reported this morning that  Congress battles as Medicare burns. There even appears to be some disagreement with Pelosi among the House Democratic leadership, as reported by The Hill:

Rep. Robert Andrews (D-N.J.), the Chair of the Education and Labor health panel, tells The Hill that Congress should quickly pass a bill delaying cuts to Medicare physician payments. The comments seem at odds with House Speaker Nancy Pelosi’s (D-Calif.) statement Monday that the House should hold off on taking up the Senate’s Medicare doc fix until the Senate passes a tax extenders bill, which some House members fear might go nowhere if it’s uncoupled from the must-pass doc fix.

“Leverage is less important than ensuring seniors can see their doctors,” Andrews said as he was entering a meeting in the office of House Majority Leader Steny Hoyer (D-Md.). “So I think it’s important to pass it.”

As I said earlier as my Facebook status, also posted to Speaker Pelosi’s FB page (and on Twitter in an abreviated 140 character version):

Nancy Pelosi: We expect Democrats to fight to preserve Medicare, not give Republicans political cover to destroy it. So far it has been the Republicans who have been blocking the payment fix, but if you follow through with threats not to pass the latest temporary fix passed by the Senate the Democrats become responsible for endangering Medicare, and risk losing the senior vote.

Fewer Doctors Accepting Medicare Patients Due To Payment Uncertainties

USA Today reports that “The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program.” There have always been doctors who do not accept Medicare due to lower payment rates compared to private insurance but the number is now increasing due to uncertainty about future payments due to the flawed physician payment formula:

Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill.

• The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.

• The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.

• The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.

The federal health insurance program for seniors paid doctors on average 78% of what private insurers paid in 2008.

“Physicians are saying, ‘I can’t afford to keep losing money,’ ” says Lori Heim, president of the family doctors’ group.

In past years Congress has acted at the last minute to override steep cuts called for under the payment formula but this year there has been increased uncertainty as the Republicans have repeatedly played politics to prevent a long term fix. If the scheduled 21% cut is not reversed it is anticipated that far more doctors will stop accepting Medicare patients. This cut would place Medicare payment closer to the level of Medicaid, which already suffers from difficulties in access to care.

Medicare not only covers those over the age of 65. The program covers many who are disabled, and the Tricare program which covers U.S. military personnel and their families also pays based upon the Medicare fee schedule.

This year, after attempts at a permanent fix were blocked, the fee cuts have been blocked in temporary measures which have only been effective for one to two months. The Senate finally passed a six month fix last week but payments from June were already being sent out at the reduced rates. The fix would restore the cut fees retroactively but now Nancy Pelosi is threatening that the House will not pass this until the Senate also passes a jobs bill. While a jobs bill is also necessary, these are two separate issues and Medicare beneficiaries should not be forced to suffer while Congressional Democrats are fighting to pass a jobs bill.

SciFi Weekend: Doctor Who: The Hungry Earth, Cold Blood, and The Pandorica Opens

On BBC America Doctor Who completed a two part story, The Hungry Earth and Cold Blood, while the BBC began the season ending two part story with The Pandorica Opens. As usual this review will have major spoilers for the episodes which aired in the United States while saying far less about episodes which have only aired on the BBC.

The Hungry Earth and Cold Blood were excellent stories which also left room open for a sequel taking place one thousand years in the future as well as advancing the season’s arc. The Doctor might have an overly optimistic view of humanity in thinking that a legend of the Silurians returning to share the earth in a thousand years will lead to acquiesce as opposed to a preemptive strike (assuming it isn’t one of those periods in which humans are living in arcs off the planet). Some humans just might not accept any deals the Silurians report which were made with a red head in a short skirt negotiating on behalf of humans.

The shocker at the end is that Rory not only was killed but was taken by the crack in time. Anyone think that the dead Rory might have looked a little plastic? Rory’s body didn’t just fall into the crack but tentacles grabbed him and pulled his body in. As we haven’t seen others fall into the crack we do not know if the other people were taken in such a manner or if something was specifically seeking Rory due to his relationship to Amy and the Doctor. Another question raised is how the Doctor managed to stick his arm through the crack without being pulled in. This might become clearer in the season finale when we will hopefully have a better idea of the purpose of the crack.

The first part began with Amy seeing older versions of herself and Rory in the future waving to them from a distance. The reason for this scene became clear at the end. When Rory went through the crack he was erased from time, although it is not clear why Amy could remember the soldiers who fell through the crack in Flesh and Stone but could not remember her fiance. Hypothetically this could set up a dramatic scene should Rory somehow reappear.

The episode ended with Amy seeing an older version of just herself waving off in the distance, although for a moment she thought she had seen someone else. There is also a bit of debris with a portion of the Tardis, as if it had exploded at some point in time.

The Davies season finales were often over the top, and often the set up episode was far better than the conclusion. The Pandorica Opens is Steven Moffat’s first shot at ending a season. The first part was excellent–as big as the Davies finales while feeling more plausible.  I’ll avoid spoiling the details except to note that many characters who appeared in previous episodes return to tie up the season, and Amy gets to meet Italian men. I do have some questions and nit picks but I can also imagine ways in which they will be resolved in the finale.

Next week: The Big Bang on the BBC while BBC America viewers meet Vincent Van Gogh. My spoiler-free comments on Vincent and the Doctor were posted here.