Why Most Americans When Polled Believe the New Health Law Will Hurt the Country / Analysis of the Health Care Bill's Process & Substance

There are several reasons why Americans should reject this Health Care Bill, which Obama is pushing furiously to its inevitable deadline on Sunday. It should be noted that Americans do want a Health Care Bill, just not this one. But why isn't this one- the right bill ? There are two salient reasons why the bill is inferior : [ A ] the quality of the PROCESS, and [ B ] the quality of the SUBSTANCE.

In both cases the quality is almost so painfully sub-standard and inadequate, that one could search for days just to find an adequate descriptor for this bill. That most accurate label for this legislative product is that it is simply unacceptable, which also appears to be the opinion of most of the American people.

PART 1-THE PROCESS: IS THIS REALLY A QUALITY PROCESS, OR IS IT INSTEAD A TAINTED NON SALVAGEABLE ONE ?

It is in the last third of March 2010, and Obama, his administration, and Congress have been working on passing this Health Care Bill for 1 1/4 years. But has all that time been directed towards increasing the quality of the substance or the process ?

Sadly, the answer is no. Most of Obama's time has been spent on making seamy deals with Congress, with Senators in Louisiana, Nebraska, and Florida, these being the most famous, and so well known that they are now quoted by every citizen in this country. However, the first 2 mentioned caused such an uproar from the public, that they are being removed from the current bill.

There were also less well known deals made with Senators in North Dakota, Connecticut, Tennessee, Montana and probably even more deals which have been hidden. In fact, yesterday, this Congress announced a cut-off point for any more sweet- heart deals. They did this, since they already placed the final bill on line, and so this edit will prevent anyone from assuming that Congress was still inserting more deals into the final bill, which will shortly become law.

In addition, there were also deals made with physicians, where they will be given Medicare reimbursements to the tune of 200 billion to 250 billion dollars which will be placed into a separate bill, nick-named by critics as the physician fix. In addition, the big pharmaceutical industry crafted a deal where citizens would not be allowed to buy cheap drugs from Canada & and the government would not buy drugs in bulk, and then distribute them to clients, as the Veterans administration has done.

In trade, the drug companies promised to support Obama's Health Care law and reduce an increase in drug costs over a period of 10 years, which they cleverly neutralized, by raising their rates before the deal would go through. This trick in effect, employed an action which would cancel any net gain in savings for the government.

Besides, contaminating the process with unsavory deals, Obama spent his free time going on the stump to campaign to town halls and university colleges filled with the young who still are protected by anxious parents, from the disintegrating economy and its brutal realities of no credit, no house, and no job prospect for them when they graduate. The public is seeing fewer and fewer of those middle aged and older faces in the crowds who have to face the current economic climate.

In the meanwhile, staffers along with lobbyists, are in effect writing the bills. All through this process, Obama has been disengaged; he did not craft any part of the legislation, even a bare- bones outline, until this last month when he wrote a few notes in a ten page paper when the already prepared Senate bill was 2,700 pages long. From the beginning, Obama never bothered to monitor those in Congress who were actually writing the bills. Until recently, Obama has refused to take a definitive stance on what provisions, should or should not be in the final bill, for example, the public option.

In addition, there was not enough effort made to develop bi- partisanship legislation. Some effort occurred in the Senate Finance Committee between Max Baucus and Chuck Grassley, but that process failed, when even the Republican Olympian Snowe, who usually can be counted on signing on to bi- partisan bills, just walked away in disgust. What followed was the carnival side-show, first, a bi- partisanship travesty where Obama had an meeting with his Republican opposition, where he dominated the conversation, and then provided no room for a follow up question, once the initial question was raised.

Next, came a true theatrical production, which both the liberal & conservative press called a " dog & pony show. " The script was carefully crafted, in order for an engaging Obama to get a few Republicans to talk, and then offer up an an idea or two. Obama would then state that he would be including 1 or 2 of their ideas in the final bill. But the ideas he did choose, were nominal and on a small scale, representing a form of tokenism to convince the public that he, was a champion of bi-partisanship.

Obama concluded with this sediment, which can be broadly paraphrased as, " I'll mull this over for about 6 weeks and see if we can forge a bi-partisan bill, and if this does not work out, then I'll have to take another course. " The public who watched it, came away with the certitude that this meeting was only a well scripted performance. Within a day, Obama and Congress were already planning reconciliation, which in the Senate entails that they can win an "up or down vote " with only 51 members voting yes.

Finally, if the public believed that the carnival like atmosphere would end with the Reconciliation Process, then they certainly were in for a big surprise. Since both Houses would have to adopt the Senate Bill as there own, the House wanted to create a bundle of amendments that corrected some of more unsavory deals in the Senate Bill, like the Cornhusker Deal for Ben Nelson of Nebraska. This amendment bill became part of a process called side-car reconciliation. But all amendments in reconciliation must follow strict rules, where their participation in reconciliation rests on the fact, that there must be a budgetary tie with the provision. Abortion does not fit into this paradigm, and thus would not be allowed to proceed under reconciliation.

Therefore, since abortion language in the Senate, specifically pages 2037 & 2071, is repugnant to 12 members of the House, led by Representative Stupak, Nancy Pelosi, came up with a procedural maneuver. This trick allowed those, especially in the abortion coalition, to pass the Senate Bill, without actually passing the Senate Bill.

This procedural device allowed the House to first vote on a procedural rule, called The Slaughter Rule, and then pass the side-car small amendment bill, which made corrections to the Senate language which House members had found disturbing. The bottom line is, if you pass the amendment bill, then DEEM & PASS occurs automatically- which means you have also passed the large Senate Bill. In short, you pass 2 bills with one vote.

Today, the House Whip, James Clyburn, said DEEM & PASS will be used for the vote on Sunday. The House could have used reconciliation with a side car, so why did they stoop to employ the Slaughter Rule & add an extra step ?

It had to be that this procedural rule is the only way the House feels they can get the votes- because they are shielded from accountability, if they don't vote directly on the Senate Bill. This is especially true, if they are concerned about the abortion language, which Representative Stupak insists is in the Senate Bill.

On Saturday, the day before the Sunday vote, Pelosi came out and stated that they would not use " DEEM & PASS " after all. What caused her to really reverse course, we may never know ? Perhaps it was the 100,000 calls per hour to the Congressional switch board, the thousands of voters outside of Congress, or the threat of a constitutional challenge to the new Health Care Law, once the bill was passed ? Should she get a Girl Scout badge for her reversal of the procedural trick, " DEEM & PASS" ? The public doesn't think so.

All of which leads Americans believing, that under Obama's Health Care Bill process, which is seen as an abomination, we are presently living in a banana republic. The threat of the Slaughter Rule, even if were withdrawn at the eleventh hour, was the last straw. All this is really poisoning the perception well ! What's next, a coup in the House if the Energy Bill doesn't pass ?

Finally, this tainted Health Care process makes one pine for living in real democracies, like Iraq and Afghanistan. The collection of abuses, back door deals, outright scams, smoke and mirrors financial maneuvers, creative accounting, unholy alliances, lack of transparency and accountability, crowned with convoluted legislative tricks, which when examining the process alone, have left Americans stunned, dis-oriented, and then out-raged. This is because they are not dealing with a single abuse of process, but multiple insults to that process. They need political therapy which might mean cleaning House ( Congress ) in both 2010 and 2012.

PART 2- THE QUALITY, OR LACK THEREOF, OF THE SUBSTANCE IN THIS HEALTH CARE BILL: IS THERE ANY QUALITY HERE, OR IS THAT GLINT OF SUBSTANCE IN THE DISTANCE, JUST A MIRAGE ?

SHOW ME THE MONEY

Part of any determination of the quality of a product is what does it cost, and can we can afford it ? The C.B.O. has issued a preliminary report, but not the final one. According to this agency, the Health Care Bill, will cost about 940 billion dollars, without factoring in interest. Also, according to the data which was presented to the C.B.O., the deficit will be reduced by 138 billion dollars over the first 10 years, and 1.2 trillion dollars over the next 10 years. But is that really the case ?

1---Were there financial sleigh of hand going on, creative accounting, or juggling of statistics which took place ? This administration and Obama have already promised physicians 1/4 of a trillion dollars which they already plan on placing surreptitiously in a separate bill, so the physicians can be adequately paid for taking care of Medicare patients. Therefore, the real cost of Health Care is now 1 trillion one hundred and ninety billion dollars before interest.

And should they give physicians, a 200 billion raise in funds in the physician fix, which will be hidden in another bill, it will not result in a deficit reduction in the first 10 years, but instead will increase the deficit by an extra 59 billion dollars. Should that fix be 250 billion, then the added deficit burden will increase by 109 billion dollars.

2---Congress also said that they would cut 1/2 trillion dollars from Medicare to shore it up, so it wouldn't go broke, but they are also claiming that this same sum is paying for the enrollment of the new 31 million patients which are being added to the bill. You can't use the same 1/2 trillion dollars twice, unless you are indulging in creative accounting.

3---In addition, one of the biggest sources of lowering the deficit was taxing the Cadillac Health Care Plans, but Obama decided to postpone that tax until 2018 and leave it to another Congress to impose that tax upon the public at that time. This appears unlikely, since it would be both politically unpopular and dangerous for a future president to do so, when Obama doesn't have the guts to do it himself.

4--- Although, most of the benefits will not kick in until 2014, we will be paying taxes for 10 years, while we only receive benefits for 6 years. This is another clever accounting sleigh of hand.

Many are questioning which benefits are available right now ? Are pre- existing conditions covered immediately ? Yes, for children, but they will still have to wait 6 months after the bill is passed to receive any benefits. Adults will have to wait until 2014 to receive this benefit. In the meanwhile, adults with pre-existing conditions can access high risk health care pools.

However, once the bill is passed, there will no longer be annual caps on insurance. Also, college students will be covered until they are 26 years old under their parents' insurance plan. There will be a $250 payment for seniors for drug costs, most likely to draw attention away from the fact that the doughnut hole which Obama promised would be closed, will not happen immediately. This benefit will not begin the process of slowly closing that doughnut hole until 2011. Plus, it will take a period of years for that doughnut hole to completely close.

In 2014, adults with pre-existing conditions will be able toget insurance and there will be tax breaks for consumers who pay for insurance, plus the mandates requiring that individuals buy insurance go into effect during that year.

5---States even now, are required to pick up a great amount of the Medicaid burden of their state. In fact, Medicaid is the second biggest expenditure, after education, for states. States are having a great deal of trouble handling their part of paying for the Medicaid funding for their state's residents.

This bill will add an additional 16 billion new members to the states' roles. Originally, the bill promised to help the states with their Medicaid burden by providing them with a grant of 57 billion dollars, which would have helped them reduce costs until 2016. However, now that amount has been cut to 8 billion dollars, this will place more financial pressure on the states in handling their Medicaid burden. They could begin feeling that pressure as early as 2014.

6---In regard to small business there will be a $2,000 fine on businesses for every employee who is not covered by insurance.

7---Democratic Senator Schumer, on the floor of the Senate, said it would be foolish not to expect that the cost of Health Care Benefits wouldn't go up immediately for consumers, dashing all hope for those consumers who expected premiums to be lower or to stay the same- if the bill was passed.

8---The mandates, regulations, and taxes of the Health Care Bill will destroy all chances of small businesses creating jobs in this fragile economic climate. The large company Caterpillar has released a statement which said, that this Health Care Law will cost them over 100 million dollars a year, therefore how can they be competitive with other countries ?

9--- This bill will add substantially to our deficit, at a time when our relationship with China is precarious, because they are artificially keeping their prices low, making it difficult for us to sell our products. Yet we are inhibited in engaging in a trade war with them, because they hold our debt. That debt will substantially increase because of the cost of this Health Care Bill.

10--- Again, this bill will add to our deficit, and we cannot afford to increase it at this time, because we have been warned by Moodys, the rating agency, that we are in danger of losing our triple A credit rating, which will result in our loss of securing credit, as well as, receiving credit at a reasonable rate.

11---Finally, should the bill be passed, it is so unpopular that Obama will spend months trying to sell it, followed by trying to hold onto Democratic Congressional seats, which this unpopular bill placed into jeopardy. This neglect of job creation, will result in our huge unemployment problem receiving little or no attention for at least the first 2 years of Obama's first term.

12---Furthermore, through this devious process, " DEEM & PASS " which was presented as a solution for passing the bill by the House, and then withdrawn, Obama will have established a precedent for pushing through his massive programs, such as his Energy Program- using the same process. Even if he leaves office, he also has left behind, a template that someone from either party can replicate.

TROUBLE WITH THE QUALITY AND QUANTITY OF THE MEDICAL SERVICES AVAILABLE TO HEALTH CARE CONSUMERS UNDER THE HEALTH CARE LAW

1---If the president told you can keep your own plan and doctor, that was only half true, because the C.B.O. has predicted that many companies won't keep their Health Care Plans, because they find it cheaper to pay the fine. Plus, by 2016 they report that over 8 million people will lose their Health Care Plan and their doctor, if he does not accept their new plan.

2--- This Health Care Bill has been built on the foundation of a flawed study called the Dartmouth Atlas study, which has recently been challenged by Dr. Peter Bach, in the New England Journal of Medicine, in an article titled, " A Map to Bad Policy. '' The Dartmouth Atlas has several mandates which are being incorporated into the bill. This study advises strong "reductions " of any Health Care resource that they dislike because it is expensive and they consider it being over used by patients :

a--- dislike & reduction of specialists, so much so, that they urged that their training in hospitals not be funded by Congress. Recently, the Head of the American Medical Association complained about this situation saying we need more surgeons.

b--- dislike & reduction of teaching hospitals, because they practice expensive innovation techniques using various experimental drugs, practices, and operations which drive up costs. Recently, Senator John Kerry stated that he didn't care if teaching hospitals were expensive, what they accomplished through developing and promoting innovation was worth it. In regard to innovation: teaching hospitals who utilize experimental drugs, new operations and techniques, devices, testing, etc. explain that these techniques extend life and cure diseases; therefore they are necessary, even if they are costly.

In addition, the health industry innovations, as well as, inventions as in the space program which Obama has also de-funded, are fertile ground to develop and expand our economy, unlike green jobs which are mainly temporary. In fact, both industries have been responsible for creating numerous jobs in the private sector.

c---dislike & reduction of expensive drugs for cancer, HIV, and Alzheimer's Disease, etc.

d---dislike & reduction of expensive testing such as CAT-SCANS, MRI-equipment, plus this study even lists any devices, similar to MRI testing imaging devices, that may be invented in the future. Again, there is a strong dislike against innovation, because it is expensive.

e---dislike & reduction of stints, pace-makers, and certain cardiac operations, or procedures.

f---dislike & reduction of hospital admissions, hospices, even home Health Care.

g---dislike & reduction of preventive testing from using sonograms to mammograms for breast cancer.

h--dislike & reduction for knee and hip replacements because of cost.

i---emphasis on rationing- The Dartmouth Atlas, claims that even in the future, and in addition, even if we added 50 million new members to the Health Care roles, we don't need to train and produce any more doctors. I will quote them, " All will have Health Care, just all will have less. "

3--- Over 46% of doctors have considered leaving their profession, if this bill becomes law. You will have trouble finding a doctor who will agree to see you, and long waits to secure even an office visit, as has been experienced in Massachusetts which has a similar Health Care plan. For those funneled into Medicaid, these conditions will be much worse.

4--- The government will provide incentives to doctors to persuade you to accept a standardized formulated treatment plan, where he will be rewarded if he complies- and punished by being barred from treating Medicare and Medicaid patients, if he does not comply.

5--- Over 1/2 trillion dollars will be cut from Medicare, which will result in Draconian cuts for services to the old, poor, minorities, and the disabled who will be denied operations, hip and knee replacements, and expensive cancer drugs, because they have few quality life years left, and the government will perform a cost benefit analysis, to determine if it is worth it, to give you the treatment you need.

6---There will no longer be '' fee for service " payments, but " bundling payments " which pay for episodic care from the beginning of your illness, when you present your problem, until it is resolved. Bundling can't handle determining your fee, if you are a diabetic, or have another illness which presents your doctor with multiple problems which affect multiple organs at once. In addition, bundling cannot handle complications, as there is one fee up front for your original condition. There is no incentive for your doctor to treat your complication- if, in effect, he is not being paid for it.

7--- Within 5 years all insurance plans will be developed by the government.

In conclusion, the Health Care Bill which most certainly will become law, is irreparably flawed on both the process and the product. Americans are finding it disengeuous, that Obama can write off an ugly process as nothing, especially in a city like Washington, where sometimes perception is considered more important than reality.

The fact that Obama is ignoring the significance of process, and denying being accountable for the corruption of that process, which both he and his administration utilize to pass legislation is very trobuling. Even when speaking of living itself, it's the journey and not the destination, which is given the greatest importance, probably because the quality of the destination was determined by the process. Just as the quality of any product, including a legislative one is determined by by the process. In addition, Americans are revolted by the assertion, by this unperceptive president, that after the Health Care is passed, he can begin selling it and its virtues to the American public, and they will readily accept it, thereby implying that the voter is a cretan.

Finally, in this case, the case of the Health Care Bill, all will agree that both the process and the product are gravely sub-standard. But there is something else which this woefully unperceptive president missed, and that is when the American people carefully examine the process that a leader adopts, they find out something more about a man than his style- his character. Unfortunately, Obama did not fare well with the American people in this regard. The public has lost trust, and they will be expressing that loss of trust in 2010. In addition, in 2012, they will be looking for someone with character, something they missed having the last four years.

Obama Says That Process- Using Procedural Maneuvers ( Slaughter Rule ) to Pass Health Care Doesn't Matter, the People Don't Care/ Why He's so Wrong.

This Sunday, Congress will attempt to pass a Health Care Bill, most likely using the Slaughter Rule, which is the coward's way out of passing a bill. Instead of having an "up and down vote " by using reconciliation, where the majority of votes needed to win in the Senate, is a mere 51 votes, the House instead wants to use a procedural trick. This trick involves by- passing the process of having an up and down vote. Instead, it would allow the House to vote on amendments to the Senate bill, and then claim that their vote on this small bill, implied that they also voted on, & passed the Senate Bill. In short, it would be a 2 for 1 vote.

Obama insists that the end justifies the means. That means in the end, he believes it is more important to get Health Care passed and sell its substance, than pay attention to the process that was used in getting this bill passed. Obama's dead wrong, about the importance to Americans that process does play. He is also wrong about the attention which the public will give to this process.

This doesn't suggest that the public won't tolerate what is considered the norm in helping along the "process," such as arm twisting, calling in the undecided House member into the White House, allowing them to accompany Obama on the White House plane, or to stand beside him in the rose garden. But Obama and his administration have gone way past that line in several ways.
How did Obama abuse the process of passing the Health Care Bill, and why does it matter ?

1--- Obama, both when he campaigned as a candidate, and in his first few months as president, promised that he would end business as usual in Washington, bring in a new era of bi- partisanship, and practice complete transparency. In addition, he pledged to put an end to the practice of government, especially Congress & the White House, of making deals with lobbyists. He failed miserably on all accounts. For example, the administration made shady deals with Senators in Nebraska, Louisiana, Florida, and presently with Senators in Tennessee, North Dakota, and Connecticut, as well as, with the American Medical Association, and big pharmaceutical companies.

Obama also promised that every piece of legislation would be on the Internet for 3 to 5 days, so that the Congress and the public could examine any bill before it became law. He continued making these same types of promises while he was president. On almost all of these promises, Obama failed to deliver.

People who practice this type of behaviour pattern are guilty of hypocrisy. Whether the reader will label Obama as such a man is up to each individual reader. It would be horrendous if a president would fail to follow, all of these good precepts of governing which Obama originally promised which were listed above. It is twice as noxious, if someone, sold the country on this list of positive actions as a candidate, in order to have to have the country accept him as president, and then failed to put them into practice. Such a president deserves 2 black marks next to his name.

2---Also, Obama would be wise to heed this advice. When you do abuse "process," don't keep piling on the abuse, or you could end up being that straw that finally broke the camel's back. Obama promised to engage in bi- partnership, and yet, even the 2 female Republican senators who almost always join the Democrats, felt that they could not vote for this bill. Plus, the summit with Republicans that Obama held was a theatrical production, " a dog & pony show " according to almost all members of the press whether they were liberal or conservatives. The public felt the same way.

After that conference, Obama stated that he would see if he could garner enough support for a bi- partisan bill, and that he would take about 6 weeks to make up his mind, about what would be his final course of action. The next day, the administration was already promoting the reconciliation process. It was evident that the summit was a ruse.

However, with a reconciliation process, the Senate would need only 51 votes to pass the Health Care Bill. Yet, even that legislative device was not deemed sufficient enough for Obama, since both Houses had to accept the Senate Bill as the bill that both Houses of Congress would endorse as the final bill. House members were extremely reluctant to do just that. So this administration had to find another avenue to pass this Health Care Bill.

As a solution, the House decided to create a small amendment bill which would clean up the noxious parts of the Senate Bill, which the House detested, particularly the shady deals, and the lax abortion language. Pelosi came up with a procedural trick which Obama has accepted, called the Slaughter Rule- where if the House votes on adopting this procedure, and then passes the amendment bill, it will be " DEEM & PASS, " which means this rule will indicate that the House passed the amendment bill which they voted on, as well as, the Senate Bill which they did not vote on.

3---In addition, Obama should pay close attention to how he is perceived by the public, primarily that he is seen showing the voters enough respect. Presently, he has no bi-partisan support for this Health Care Bill, and the majority of the public are against the bill, not only on its substance but also on its process, especially for the seamy deals that were made in both Congress and with lobbyists representing special interest groups.

In any case, Obama is pushing this bill on Americans in a condescending and patronizing manner, in effect, telling the public that they are plainly too uneducated to understand how impressive the substance of this bill really is. Therefore, he will pass it anyway, because he feels that he is so much more intelligent than those whom he governs, and he has decided that he knows what is best for the country.

Presently, both he and his administration are implying that Americans are even too unschooled to notice that this process, employs a trick called the Slaughter Rule, which ensures that the House members won't have to vote on the Health Care Bill itself, to pass it. House members have embraced this rule, because they don't want to sign on to this Health Care Bill, because some of the shady deals still remain in the Senate Bill, and the language on abortions is more lax in the Senate Bill than similar language in the House. Obama & the House are so enamoured with this maneuver and how it will benefit them both, that they have failed to notice that the Slaughter Rule is also likely to face constitutional challenges, indicating just how desperate this administration is.

4---On the nature of process versus product, it is important to be cognizant of the following facts. Imagine you are in your favorite French restaurant which has a reputation for the finest cuisine, but on the way to a powder room you pass the kitchen and see unsanitary conditions involving food prep. Would you stay or leave ? Would the product be more important to you, than the process of preparing it or serving it, or would the process be at least as important as the product ?

Most Americans realize that the process is just a important as the product. In fact, the quality of the process most of the time, determines the quality of the product, since they are so intertwined. Whether you write a book, build a house, bake a cake, or craft and pass legislation, we all know from the experience of living, that the process determines both the outcome and its quality.

There is even a commercial on television where an angry painter walks out and tracks red paint on a white rug, which later is cleaned up by the crew. The narrator who is hawking a service for reliable contractors, ends by saying the job was done in the agreed upon time frame and at cost, but in effect, the process used insured that the home owner would never call the contractor back. Americans feel nothing but revulsion for this process that the Obama administration has utilized in attempting to pass this bill. Forget for a moment, the sub-standard substance in this bill, and focus on this stunningly flawed legislative process which Americans have been forced to witness as it enfolded for more than a year. The process alone, may well insure, that we don't ask our own legislative contractor back in 2012, and that contractor would be Obama.

Constitutional Challenge to the Slaughter Rule- Deem & Pass/ Desperate Times Call for Desperate Measures or Is It Desperate Men ?

The town of Washinton is buzzing about a arcane procedural rule, the Slaughter Rule, which may well bring the Obama political effort to pass a Health Care Bill to an abrupt halt. " Something is rotten in the state of Denmark, '' the Shakespearean quote that was applied to the political intrigue in the play, " Hamlet, " (Act 1, Scene 1v ), might well be applied to the passing of Obama's Health Care Bill, especially as exemplified by utilization of the Slaughter Rule, to accomplish this goal. This House rule is the procedural maneuver which Nancy Pelosi is using to attempt to garner House votes, to pass this controversial Heath Care Bill.

This circuitous route of shady deals for votes, in the behind, closed doors, secret meetings that Obama and his subservient Congress had taken to pass this Health Care Bill debacle, has all the raw, seamy, theatrical elements that Shakespeare loved: dark political intrigue, hubris so consuming that it rattles the very heavens, and of course, one of his favorite universal themes, which is appearance [perception] versus reality- where who or what appears good is often evil, and the opposite scenario of what appears evil is good. Shakespeare would characterize it as, " fair is foul, and foul is fair, " as he does so eloquently in " Macbeth " in (Act 1, Scene 1.)

The bard would be positively giddy living in Washington D.C. and the ink would flow with characters in the Beltway, such as Nancy Pelosi, who would in the Shakespearean play " Macbeth " ( Act 5, Scene 1) make an incredible Lady Macbeth, who is probably presently whispering in her powder room, '' All the perfumes of Arabia will not sweeten this little hand, " as she invokes the Slaughter Rule with it ?

In addition, there is Rahm Emanuel playing the wiry Cassius in "Julius Caesar," (Act 1, Scene 7 )and as Shakespeare would describe him, " Yond Cassius( Rahm) has a lean and hungry look; He thinks too much : such men are dangerous, " which are probably the very words that the inner cabal of those who ran the Obama campaign, and still sit at his right hand, were probably saying about Emanuel's advice to Obama. His counsel was to pass a modest incremental Health Care Bill, as Bill Clinton did, thus insuring Clinton's re-election. Why else do we have scores of articles defending Rahm Emanuel, but are those articles written by friends or enemies ?

Also, there is our own president, who appears so consumed with power, in the form of establishing historical legacy as well as re-election, that he would sacrifice his country's best interest on the altar of his own self importance, while he postures as the brooding, intellectual, indecisive Hamlet one day, and the ruthlessly driven glutton for naked power, like Macbeth, the next; with nary a pivot or losing a political step in the process.

Meanwhile, as always, Obama has enrobed himself in political subterfuge. However, even Shakespeare could not have envisioned the grasping of this straw of the Slaughter Rule to pass the Health Care Bill, all the while, claiming that the people won't care about the process once this Health Care Bill is passed. As Hamlet would say, " Though this be madness, yet there is method in it. " Hamlet ( Act 1, Scene 3.)

Good luck to the Democratic sycophant who suggested this rationale- the public won't notice - it would be like living across the way from a pig farm and a slaughter house, where it is impossible not to notice. Process does matter when it stinks to high heaven, especially when it follows a trail of malodorous deals in smoke filled back rooms, which were used to induce Democratic Congressmen to vote for his Health Care Bill, when they are growing increasingly reluctant to pass it.

So what is this noxious Slaughter Rule, which is " Deem and Pass ? " It is a procedural rule in the House of Representatives that deems the Senate Bill passed without voting on it. But why was this rule used at this time ? The Democrats turned to the Slaughter Rule because -Plan A- using reconciliation with a side-car proved deficient. The House had already counted on Plan A- reconciliation to solve all of their problems.

The House had already passed their own bill which taxed the rich, those with incomes over $250,000, plus their bill had a public option, as well as, strong language- on refusing to fund abortions in any form with governmental insurance money, which was spelled out clearly in the Stupack Amendment.

On the other hand, the Senate Bill did not have a public option, plus the Senate's Bill had raised money to reduce the cost of the Health Care Bill, in another manner than the one chosen by the House. They accomplished this goal by taxing the Cadillac Health Care Plans of the wealthy, which included a plethora of union employees, who had traded raises for the security of a gold plated Health Care Plan. Plus, there were unsavory deals in the Senate Bill to glean votes, made with Senators in Louisiana, Florida, and Nebraska, as well as, the big pharmacy companies, and physician groups.

In short, there was a battle raging between the House and the Senate that is similar to that of the Hatfields & the Mc Coys. There were also battles in the House between the Conservative Blue Dogs and Progressives. Bottom line is that the members of the House were repulsed by several of the Senate provisions, including taxing union's insurance plans and their lack of strong language on funding for abortions.

In addition, they were also distrustful of the Senate, because the House would be forced to accept the Senate Bill as is, and sign it- as it is. Later, it will be presented to the president as a single bill, who will then sign it into law ? Afterward, both houses of Congress will send in negotiators who will agree to amendments in a new bill, which is a reconciliation bill, with an attached side-car.

This side-car is a separate bill with amendments, most of which are likely to favor the House of Representatives. They will accomplish this task by producing a bill which is designed to rid the final product, the Senate bill, which has been signed into law, of those unsavory deals which were originally included in it.

In this process called reconciliation, the House will approve these amendments which must be related to budgetary matters, for the amendments to be able to participate in the reconciliation process. For example, abortion because it does not pass the budgetary test, could not participate in that process. Next, the Senate needs to pass this new Amendment Bill, but this time, the Senate only requires 51 Senators to vote yes, in order to avoid a filibuster, instead of the usual 60 votes.

Remember, this second bill contains mainly House amendments which were issued to rid the House of passages that they detested in the Senate Bill, which is now the law of the land. Therefore, the House must have complete trust, that after the Senate gets its way, and the Senate Bill is presented to the president and signed into law, that the Senate will return and pass the House amendments included in the side-car. But just where is the incentive for the Senate to do this ?

Consequently, several House members were rightly nervous about this situation, and have refused to commit themselves, because they don't trust the Senate to pass this " side-car." The second problem with side-car reconciliation is this point, because reconciliation can't process abortion issues, since it is an issue which can't be connected to the budget, the House will have to live with the Senate Bill [which is now law ] along with the Senate's less restrictive provisions on abortion funding.

A summary of the steps that are involved in side-car reconciliation are these :

1--- House accepts the Senate Bill as is

2---Senate Bill is accepted as the one bill that both Houses approved

3--- Senate Bill is passed, when signed by the president and becomes Health Care Law

4---Later the House presents amendments of changes to the new law to Senate and both agree to accept them.

5--Both houses of Congress pass them- Senate only needs only 51 votes this time, instead of 60 to avoid the filibuster problem and to pass this reconciliation amendments to the Senate Bil which is this side-car bill.

6---President signs reconciliation amendment bill, and it becomes law.

7--- Note : All provisions in a reconciliation bill must be connected to the budget, and a provision such as abortion, which doesn't qualify- can't be put into a reconciliation bill.

Plan A, as described above, presented big problems for House Democrats. Therefore, Pelosi had a strong incentive to find a way to move those nervous Democrats to vote, by discovering a pathway, to avoid passing the actual Senate Bill, while still passing a Health Care Bill into law.

She chose the Slaughter Rule, possibly because the reconciliation side-car solution, could not amend the Senate's stance on abortion funding, which was more lax than that of the House. The Slaughter Rule is a device, procedure, or phony magic trick depending on which side of the Congressional aisle you are standing on. It is a way for House members to avoid transparency and accountability for their actions, by avoiding the up and down vote in the House on approving the noxious Senate Bill.

The process by which the Slaughter Rule is utilized by the House is :

1-- The House would vote on a rule setting up debate.

2---The House would ignore voting on the Senate passed Health Care Bill

3--- Instead the House would move directly to passing the side- car Amendment to the Senate Bill [ as described above in the side-car reconciliation process, ] and therefore according to the Slaughter Rule it- THE AMENDMENT TO THE SENATE BILL IS PASSED, BUT ALSO THE SENATE BILL WHICH THE HOUSE DESPISES IS ALSO " DEEMED AND PASS "- IN A 2 FOR 1 MANEUVER.

Therefore, Nancy Pelosi, has managed adroitly to shied her members of the House from taking an unpleasant vote which will have enormous negative consequences in their home districts and their careers by protecting them. For example, voting for the Senate Bill will allow the insurance companies to pay for abortions, and to tax union Cadillac Health Care plans which is upsetting to unions workers. Now House members can avoid criticism, and can go home and tell their angry constituents, when questioned about their vote on the Senate Bill which pays for abortions, I just voted for the side- car amendment bill.

But when they voted for the passage of the side-car amendment bill through the Slaughter Rule, it created " Deem and Pass " which passed the Senate Bill too. Again, Shakespeare could make a slew of plays on the "appearance versus reality " theme of this blatant trick by House members to escape transparency and accountability. But his time the public is not being fooled by blatant subterfuge.

It is important to note that the Republicans used the Slaughter Rule several times; however, many of them were on insignificant points. On other issues which were more weighty, they had strong bi- partisan support, while the Health Care Bill has neither of these attributes. This Health Care Bill may be the biggest and far reaching piece of social legislation in this century.

In all plays, especially those which involve Congress, there is often a twist in the story-line. So too, is this the case, there is situational irony. There is a Supreme Court Case which might be used as a precedent to over-turn the use of the Slaughter Rule, to by-pass the normal procedure of actually passing the Senate Bill, by an up or down vote. It concerns a case connected with a Line Item Veto Act of the Balanced Budget Act of 1997, which President Clinton made. Clinton was the husband of Obama's chief primary rival. The Supreme Case is Clinton versus City of New York ( 97-1374) 987 F. Supp.168, affirmed Argued April 27,1998 Decided June 25, 1998.

'' Finding of Court at least one of the plaintiffs that the Act's cancellation procedure violates the Presentment Clause Article1, Section 7, Clause 2. "

2 (c)
Thus, in both legal and practical effect, the presidential issues have amended 2 Acts of Congress by repealing a part of each. Statutory repeals must conform with INS V. Chandra 462 U.S. 919, 954 but there is no constitutional authority for the president to amend or repeal.

The Supreme Court, after a Bill has been passed by both Houses, '' but before it becomes a law " it must be presented to the president, who " shall sign it " if he approves, but returns it, " i.e. veto it " if he does not. "

Bottom line is, the House has to take a bill, in this case the Senate bill, that they are accepting as their own, and it must be presented to the president. It doesn't say take the second small amended bill, which will correct portions of the Senate Bill, once it is passed into law, to the president. You must take the original Senate bill, if you accept it as yours. This would make the Deem and Pass solution, of wholly by-passing the original bill- without having that up and down vote on the Senate Bill- subject to a constitutional challenge under Article 1, Section 7, Clause 2.

What is the significance of this outcome ? It means that there is a possibility that the Supreme Court could actually be ruling that Obama's Health Care Law is unconstitutional, after we have paid for it for several years, but before most of the the benefits kicked in, probably in the year 2014. Now, that would make quite a play to write about- a story of a president and leader who was so hungry for power and historical legacy that he took the easy way out.

Obama then would be known as the man who passed the first historic social legislation in this century that was declared unconstitutional, because he over reached. As the bard in this play, " Julius Caesar " ( Act 1, Scene 111) would say, "... The fault dear Brutus, ( Obama ) is not in our stars, but in ourselves, that we are underlings." But then, those consumed with hubris always fall on their own swords, now don't they ?

Why Democrats Will Lose Big in 2010 & Obama Will Lose His Re-election Bid in 2012/ He Has Lost the Trust of the American People

To understand why Obama will lose a large number of seats in November 2010 and in 2012, and not be re-elected as president in 2012, we need to first look at the '' result, " instead of the cause. We should therefore, not focus first on the cause of his rapid drop in the polls and the antipathy that voters now feel for Obama's Initiatives, which is slowly but surely spreading to the public's approval of the president himself. The "result " which will cause Obama not to be re- elected in 2012, seems to be the salient fact, that more and more Americans have completely lost trust in Obama.

The most important indicator of the quality of the relationship between any leader, for example, a president and his followers is trust. The same is true of the relationship between a C.E.O. and his board of directors, or between himself and the stock-holders of his company. It is also true for the most simple of relationships: an employer and his worker, a husband and his wife, a parent and a child, and the relationship between 2 friends. Loss of trust between 2 parties is almost always irreparable, and if it is ever salvaged- it is at great cost, effort, and time. I am certain that anyone who reads this, believes what is said in this article about the nature of trust.

Therefore, the public's strong distrust of Obama and his initiatives will result in disaster for his party and a Democratic Congress in 2010; and for him, in 2012. But what was it that Obama did, or did not do; or what were the qualities or lack of qualities, that he had, or did not have; that eventually resulted in this " lack of trust ? "

I have written another article that appears in this blog, that describes in detail, all of these qualities and actions that played a part in why this president will not be elected. To access this article, go back into this blog, and find this article dated Thursday, February 11, 2010. The title of the article is, "Analysis of Which Obama Flaw Will Cause a Major Loss of Seats in Congress in 2010 & Failure to Win the Presidency in 2012. "

However, the best way to understand the result or effect of the causes, is to use an analogy. A concrete example in the form of an analogy, may be the best and simplest way to illustrate this salient point of how that trust that Americans had previously felt for Obama was destroyed. Recently in Haiti there was a horrific earthquake, where thousands were trapped under buildings and piles of rubble, where some were dead, and some remained alive- with wounds that required immediate medical attention to avoid death. These survivors also required food and especially water, since without water, a person will survive only about 3 days. Those who were not under rubble also needed food, water, medicine, shelter, and attention to sanitation issues, as well as, the burial of their dead, to prevent the spread of disease.

But there was a major problem with roads in Haiti. There were few roads, and those few were in bad condition. It was a challenge to distribute men and supplies, and most of these were staged at a site far from the rubble, at an airfield. Many of these supplies were air-dropped. Many vowed to concentrate on road improvement in the future, after the disaster was over, as it would be vital if another disaster occurred in the future to have good roads. Plus, a decent transportation system would certainly help this poor economy blossom.

But what if a decision were made by leaders to repair the roads first, in order to have an easier access to the site, and the fact that it would help the economy of Haiti ? If that had been their first priority, all of the money, supplies, food, water, medicine and personnel would have been kept at the airfield and nothing would have been done to extract those trapped under buildings, or villagers who weren't trapped, but who needed food, water, and medicines.

The consequences would have been disastrous, as within 2 to 3 weeks at most, everyone trapped would be dead. Plus, at least 1/2 of the villagers who were not trapped under rubble, would also die from lack of food, water, shelter, untreated wounds, and a lack of sanitation which would rapidly spread disease. But who would be lacking such judgement that he would sacrifice the lives of the villagers, for roads, which if there would not have been a on going crisis, may have been a good idea ?

It is important to remember, that we had a parallel crisis in the economy here in the United States, where are financial house, our economy collapsed. Among those trapped under the rubble, were those who lost their homes through foreclosure, or those who had mortgages which were under-water, or those that lost 30% to 50% of their home equity. There were others who lost 1/2 of their 401k plan, or their jobs and could not find another, or their access to credit to keep open their small business, or to send their child to college. And some lost all of the above.

Although it is already March 15, 2010, Obama is still talking about that Haitian road he is going to build to get out those survivors trapped in the financial rubble, but in this country that road is called Health Care. In our analogy of Haiti with this country, we find ourselves with our own financial earthquake in the United States, but we also find that Obama decided the road to Health Care would be his first priority.

Only right now, that road is not finished, and even if it were sometime this year- there are many in this country who are financially dead, because they came in second when Obama wrote up his " to do list." Still no one can deny that it is nearly spring, and for 1 1/4 years we have not focused on jobs, even after the Massachusetts's Massacre, where the Kennedy seat went to Republicans to send Obama a message of what Americans really thought Obama's first priority should be.

There are 4 breaches where Obama has lost the trust of the public:

1---There may be those that point to the stimulus, and the 787 billion where Obama promised that these funds would keep the unemployment rate at 8%, and that 3 million jobs would be created or saved. Because none of that materialized we have our initial breach of trust. Instead, very few jobs were created or saved, since the stimulus was riddled with fraud, waste, abuse, and the favorite projects of Congressmen for their states. All of which bloated the stimulus.

2---Later, we have a second major breach of trust, when we found that 1/3 of the stimulus went to that road in Haiti- which is the Health Care road and the Energy Bridge to it - Obama's 2 pet projects. Over 36% of the stimulus went to buy the vote of the public, while our pay stubs showed a little over a dollar a day, or about the cost of a cheap cup of coffee, that most of us would surely have given up to create small businesses, or to devote to the building of bridges and roads to create jobs. This is especially true, if we knew Obama allotted only about 1% to create small businesses and about 4% to infrastructure. These last 2 initiatives do create jobs. The last 1/3 went to help the unemployed, while part of it went to help state governments balance their budgets. However, there were no strings placed on that state government money to create or save jobs, and that is why 40 schools are closing in Detroit, and some cities are beginning to have a 4 day school week.

3---The third breach of trust occurred during the State of the Union Speech and the Massachusetts debacle when Obama promised to pivot away from Health Care and to make jobs his first priority, while he still spends all his time, energy, and money on Health Care.

4---A final breach of trust occurred when there was bi- partisan agreement in the Senate on a job's bill which was only 1/2 of what the House Bill allotted, about 85 billion dollars, and the Democratic Senate majority Leader, Harry Reid, butchered it to only $15 billion dollars, stripping out the unemployment insurance section when unemployment insurance would cease in a few days. Later a Senate Republican, Jim Bunning, delayed it further since it as not paid for. But if Reid and his boss Obama had made sure it had already gone through, as a 85 billion dollar bill, there never would have been a Bunning delay. Which leads Democrats wandering- does Obama have their back ? Can they really ever trust him again- after 4 bitter betrayals ?

There may some who ask what was the flaw in this man, or what quality was missing, that caused Obama to make the disastrous choice to leave American bodies dying and rotting under the financial rubble of this country, and instead choose to focus every last resource to be funneled on the road to health care, which even today, is still the road to nowhere. Still, even it is finished, at what price was it constructed, when it made job creation wait behind it in line ?

The best guess of what Obama's flaw might be, that led to lack of trust is: a lack of empathy, emotional intelligence, perception, intuition, and common sense, as well as, his possessing the negative quality- desire, and the hubris to be a transformative president with a historical legacy- even if that outcome came with the price of sacrificing this country's own best interest. All of these are qualities are ones which Bill Clinton had, except thankfully one which he did not have, which is hubris so great that it would put the country second.

It is the lack of these qualities, and the possession of a hubris so great that it would not recognize jobs as a first priority because it clashed with Obama's desire for a transformative legacy, which will, according to Charlie Cook, result in the biggest political miscalculation in this century. This is the assessment of one of the finest political scientists in the country, and it frankly concurs with the opinion of most Americans.

But Americans really don't care why Obama did what he did, they are all believers in the Gestalt theory, where they only care about the perceptual big picture, and where the whole determines the parts, rather than determining that the whole is merely the total sum of its parts. The bottom line is, whatever the cause or cluster of causes- Obama sacrificed jobs so he could focus on health care instead. Consequently, Americans no longer trust him.

At this time, given the uncertain economic climate, most Americans are risk adverse. They are not interested in large, expensive programs which suck up all the time, energy, and money in the political arena when they are concerned with the basics- food, clothing, shelter, and jobs, plus the ability to send their children to college. They are furious that Obama is prioritizing Health Care ahead of jobs and at their expense.

The most risk adverse- seniors- were the last on the Obama bandwagon and now they are the first to jump off. Voters are jumping off that bandwagon, in the reverse order of how they came on, therefore, Obama has lost the cross-over Republicans, Independents, Moderate Democrats, and even now the young voters. Blacks are discouraged and are pivoted to also jump off, with the Black Caucus expressing extreme displeasure that Obama is not addressing the obscene number of blacks who are unemployed which is about 30%.

But the clueless Obama, still naively believes he can sell Health Care once it is passed, and that Americans will forgive him, and all will be well again, in his fairy tale political world. But they won't- as they suffered such financial and personal carnage from this recession, and when they reached out their hands to this leader, he rejected them and turned his back repeatedly on them. Therefore, all trust for Obama is long gone, which will result in the severing of the personal relationship Americans had with Obama. Their first assault will come with the voters depleting the Democratic Congress in 2010, and then they will turn their backs on Obama in 2012. Perhaps then Obama will learn the one political lesson which all leaders and politicians should remember which is, without the trust of the public you have nothing.

Hear Me on PCNTV- on These Health Care Problems, Bundling and the Dartmouth Atlas/ Obama's Cure is Worse Than the Problem Itself

Hear me on PCNTV, a public television channel, on March 11, 2010 at 7:00 Eastern Time. I was the first caller, Peggy. The topic was the upcoming Health Care Bill of President Obama. This site keeps video access for less than 1 week, because they sell their tapes for profit. However, for that one week, you can access those programs which were shown within that week's framework. One guest on the show that I appeared on, was the Pennsylvanian Commissioner of Health Insurance, who was Joel Ario, the other guest was a vice-president for a hospital association, and he was a V.P. of Federal Relations. This show is also recorded and re-broadcast the next day at 9 A.M. and I saw the re-recorded show the next day.

But imagine my surprise when I went into the clip on Saturday, to get the link to it, so I could place it into my blog, and it was not there- in the sense that someone had substituted the tapes. Yes, the title underneath it said Health Care and March 11, 2010, but an election tape with footage from the governor's election and its upcoming race was there in the Health Care video's place. There was a moderator there, and 2 guests, David Latour and Don Connyham, a county executive who discussed the candidates in the 2010 governor's race.

These Call-in Programs have extremely unusual openings, where they have a blue colored screen and distinctive theme music with a picture of a large phone which is being dialed to introduce their program, you can not miss that it is indeed a call-in program. Next a monitor and 2 guests who are introduced, and they speak about the topic with the monitor for 10 minutes before taking calls. This colorful introduction is on all call-in tapes. So even if someone accidentally substituted the wrong tape content wise, there would be no way, that they when they checked to see if they had inserted the tape, and confirmed that it would come up when someone clicked on it, that they could miss the fact that the blue screen and music would not be present. I am also also assuming that they have a back-up tape when they originally taped the video. Therefore, one can ask, was this a mistake, an error, or something else?

I will provide you a brief summary of what questions I asked, and what I said. I commented on the fact that everything about the health care system is discussed, except the Draconian over-haul of the health care delivery system. I asked how would they address the 2 problems of bundling. How then does bundling, a payment method, handle these 2 situations ? :

1--- conditions like diabetes which affects numerous organs in the body,and might involve several different providers- think of a road that might fork into 3 paths.

2--- I also asked how does bundling handle complications ? The answer is it can't in most situations unless the doctor does it for free, which is a disincentive for most hospitals and providers in the United States.

In addition, I stated that The Dartmouth Atlas was the foundation of the health care bill. I pointed out that it was challenged for its validity by Dr. Peter Bach, on Feb.17, 2010 in " The New England Journal of Medicine. " He challenged the main premise of the Atlas, which is that greedy doctors create an over supply of health care resources, like tests and hospital beds, and because those greedy doctors want to fill them up with patients, or take numerous tests like mammograms, this results in outrageous health care costs.

Bach countered this silly assertion with this fact - only 20% of doctors have a financial relationships with hospitals they send patients to. Bach also attacked their definition of efficiency. He illustrated his point with this provocative and colorful example- there are 2 hospitals each with 10 patients. Hospital A gives each patient one $1 pill - their results are 5 patients live with a cost of $5. Hospital B does not give out these pills- their results are all patients, all ten of them die, but they have $0 cost. The Dartmouth Atlas considers hospital B more efficient, because it had lower costs than hospital A. What I gleaned from this example is in the end, it made no difference that all their patients died in hospital B, to the Atlas, the crucial factor was they found a way to cut costs. I finished with this statement. Should we make the Alas the basis to build our Health Care Law on, if there are serious questions about it's validity and its applicability to our present Health Care crisis ?

One of the 2 guests, Joel Ario, said that these 2 subjects which I brought up, were the 2 most important issues in the health delivery system. He is the insurance commissioner for the state.

The other guest who represented hospitals said, and I paraphrase him, that there were things in the Atlas that he did not agree with. My guess is that the theories of the Atlas will penalize the poor and minorities in large urban hospitals. I am happy I brought this controversial topic up and people in my state at least heard a topic that have been held secret for far too long. However, the big mystery is what happened to that controversial tape ? The site can be found at pcntv.com where you can search for their Call-IN Programs.

Addendum:

On Monday, March 15, 2010 they had the call-in line-up for this week, when I checked, and not last weeks line- up which included the March 11, 2010 show. However, I went to PCN and looked on top of their Home Page. When you click on this site, there is a thick blue strip at the top of the page. This strip will have several choices listed across the top of the page horizontally. You need to click on " anytime. " A site will open up with the title, " Watch PCN Live. " Next scroll down until you see a blue colored list, and at the top of this list you will see House and Senate. Scroll down on the right hand side until you find PCN CALL-IN in the middle of the roll. Today on Monday, you could could still see the March 11, 2010 show called health care, which if you clicked on it, you would still get an incorrect tape segment on the 2010 election. Again, there was no opening segment with the Call-in theme music and Logo, on March 11, 2010, which is the norm on all Call-In segments.

Problems with Bundling, Obama's Method to Cut Health Care Costs - the Worm in the Obama Health Care Apple that the Public Never Heard About

There has never been any discussion about the Health Care Delivery System, and for good reason. The Obama administration is performing a Draconian overhaul of that system, which will negatively affect the public. One of the major problems with the delivery system are the problems associated with " bundling, '' which is a plan to eliminate '' fee for service payments, " by paying for each episode of care from your first medical appointment, to your follow -up appointment after your problem has been resolved. What this president doesn't tell you is there are some situations in bundling, where your doctor will have no incentive to solve your medical problems.

The Obama administration has done nothing to resolve this problem, nor has he discussed it with the American public. I have never heard him in a televised address mention bundling, and I've watched most of the televised events where he speaks to Americans. Maybe, there is one public speech out there, perhaps to a specialized group, such as a speech before health care providers, but I've never heard it. I would be really surprised if even .1% of this country even knows what this word, bundling, means.

The second major problem associated with the delivery of the health care system revolves around the Dartmouth Atlas. The blueprint of The Dartmouth Atlas is the foundation of the Health Care Bill, and it is intrinsically flawed because of its promotion of rationing, and its mantra of " cost is the bottom line. "

This study has been challenged numerous times, most recently by Peter B. Bach, in his article titled, " Map to Bad Policy, " written in The New England Journal of Medicine. But the public still knows nothing about it. Obama does not want you to know about the overhaul of the Health Care Delivery System, because frankly you would be horrified. I have addressed the Dartmouth Atlas in several articles in this blog including the most recent one written on March 4, 2010. But even this administration's concept of "bundling " which will immediately affect the Health Care consumer, once it goes into effect, is itself flawed, and this administration shows no signs of repairing it.

Bundling is a single comprehensive payment for a group of related Health Care Services. It is the payment that is reimbursement for an entire episode of Health Care. It entails the doctor and other medical professionals treating you for a medical problem from the beginning to the end of that problem, when your specific medical problem is supposedly resolved. All this use of health resources is done for a set fee, assigned by a medical code, for the completion of this entire process. Bundling is being presented as the panacea of the Obama administration to help solve the cost problems of Health Care, instead of retaining the " fee for service " system you are familiar with.

"Fee for service " is the system in which the health care provider gets paid for each time he provides you with a Health Care service or resource. For instance, you report that pain in your leg to your physician, you will then have a fee for that service. That doctor will then send you to the hospital for a ultra sound of your legs to determine if they have blood clots, and that is another fee. The ultra-sound technician will send the results to a specialist or physician with training in interpreting this test, which will result in yet another " fee for service."

The news turns out to be good, you do not have a clot, but there were 3 separate bills generated in the process. Bundling would have one set fee levied at the beginning for all 3 separate services. However, at this time, it is designed to handle Medicare patients who enter an acute care hospital and the follow-up care they will receive for the next 30 days.

Bundling appears to be quite attractive, doesn't it ? But it has 2 problems that Obama has not addressed. I recently discovered a program from a lab that provides a hospital with bundling codes and fees attached to those codes. This hospital is presently utilizing bundling. I analyzed their description of the bundling process to glean details of how it works. Their site listed the positives of the program but it also listed the problems inherent in bundling.

I will paraphrase what they described as potential problems with the program. One problem they appeared concerned about diseases that involve several organs, as an example, a patient who is diabetic sees a doctor for a medical problem associated with his disease. The specific problem listed was unnamed; however, the agency that handles the bundling codes and attached fees stated that because diabetes involves several organs of the body, the physician would also have to call in a dietitian to attend to the patient's diet, a podiatrist which is a foot doctor to attend to any wounds or infections on the feet, etc.

How would you then code several separate discrete problems, instead of a single discrete medical problem ? The codes and fees and bundling itself is designed to treat a single discrete medical problem and follow its treatment path from beginning to end. Also, because a person had a disease like diabetes which affects many systems in the body, the patient would have multiple problems which would present at once.

Therefore, using the practice of bundling which gives one comprehensive fee for all services rendered, runs into problems when there are several separate and distinct medical problems involving several other doctors, or other health care professionals, because you are experiencing more than 1problem through its episodic journey.

The second problem that bundling presented is, what do you do when a complication presents itself after the hospital has already set in stone your bundled fee and its corresponding code at the beginning of treatment ? According to the program description of the lab that prepares bundling fees, it lists medical complications as a serious problem for the bundling process to resolve.

It also states that if the patient has a complication, there is a distinct dis-incentive for your doctor who was assigned to you at the beginning of your treatment, and paid a straight bundling fee at that time to specifically attend to your original problem, to then handle something that he did not anticipate, and is not being paid for. It went on to say that your physician might not do his best work, if in effect, he was handling your complication for free or for much less. Imagine what would happen if you had a heart attack, and a complication occurred after your coronary medical problem was supposedly fixed. Do you really want to feel that your cardiologist has a disincentive to do his best work on this new coronary complication ?

Presently, Medicare recipients with complex health conditions and who present with multiple diseases simultaneously move between a hospital stay and several post care providers, such as care provided outside the hospital- rehabilitation therapy, a nursing home, home health care, a visiting nurse, etc. Medicare presently, makes separate payments to each of the Health Care Providers for each covered service during the entire period of treatment, from the initial entry into an acute care hospital, to full recovery through their " fee for service payments. "

The Medicare Payment Advisory Commission [ Med PAC ] the agency which determines Medicare reimbursement fees for health care providers, such as physicians which provide health care resources for Medicare patients, is also concerned about bundling. This agency is fearful that health care providers do not have enough financial incentive [money enough to pay themselves, and then all the other providers who participated in taking care of the patient from the beginning of their medical problem to its resolution.]

In addition there might also be a lack of being responsible on the part of the first provider [who will receive the payment and distribute it among the others ] for the quality of care that the auxiliary providers give that patient in the follow-up care phase.

Bundling was chosen as Obama's solution to curb costs, since over 18% of hospital admissions result in re-admissions within 30 days. Therefore, he wants to utilize bundling for the initial admission to the acute care hospital,as well as, all the additional auxiliary providers who provide follow-up care, for 30 days after the patient is released from the first hospital.

These hospitals would not only receive the entire bundling payment for themselves and the other providers who cared for the patient after he was released for follow-up care; they would then also be required to distribute the funds, but once they performed that duty they would also be responsible for the quality of follow-up care which these auxiliary providers gave the patient.

Therefore, these hospitals would either perform all follow up care themselves and be responsible for its quality, or this hospital would have to contract out the follow -up care, pay these contractors, and the original hospital would ultimately be responsible for the quality of work the contractors provided the patients.

In conclusion, the 3 major problems of bundling are:

1--- the bundled payment may not be enough to pay for treatments at the initial hospital and the contracted providers who are supposed to provide quality follow-up care.

2---we have no precedent, no previous medical studies to prove bundling is effective at lowering costs while still providing quality care.

3---there is a problem brewing, that there may not be enough of a financial incentive to prevent the most vulnerable of those patients, with chronic and devastating illnesses, from getting less care, as well as care of questionable quality, because the receiver of the bundled payment, the initial hospital and its doctors, might be reluctant to fairly compensate the auxiliary providers who provide follow-up care.

If you are concerned about yourself, or your parents, being short- changed by this Draconian and untested payment plan of Obama called bundling, be aware that the first phase will take effect in 2014 and the last phase in 2019. Still, it will be too late to fix bundling, if this Health Care Bill passes this year. Therefore, immediately call your Congressman and tell them to fix the problems of bundling before they are placed into a Health Care Law that affects you and your family. Your life and the lives of your family may well depend on it. Count on that !

Obama's Biggest Scam/Tries to Pass Health Care Using Pseudo Medical Blueprint of Dartmouth Atlas/ Validity Disputed in New England Journal of Medicine

THE PREMISE OF THIS ARTICLE CENTERS ON THIS QUESTION, WHY ISN'T OBAMA GETTING A SECOND OPINION- BEFORE HE IMPOSES THE DARTMOUTH ATLAS STUDY, HIS PSEUDO BLUEPRINT FOR HEALTH CARE, ON THE AMERICAN PATIENT, WHEN ITS VALIDITY AND RELEVANCE FOR FIXING THE HIGH COST OF HEALTH CARE IS UNDER ATTACK ?

THIS STUDY AND ITS RAMIFICATIONS ON THE PUBLIC ARE BEING DELIBERATELY HIDDEN FROM THE VOTERS- WHILE THIS STUDY REMAINS THE VERY REAL CORNER-STONE OF OBAMA'S REFORM HEALTH CARE BILL. THE IMPLEMENTATION OF THIS STUDY INVOLVES DECONSTRUCTING OUR HEALTH CARE DELIVERY SYSTEM WHICH PERCOLATES BOTH GOVERNMENTAL AND PRIVATE FUNDS THROUGH IT. THESE FUNDS AMOUNT TO OVER 1/6 OF THE ECONOMY OF THE UNITED STATES SPENT ON HEALTH CARE ISSUES.

PRESENTLY, THIS DARTMOUTH ATLAS STUDY IS BEING CHALLENGED IN THE NEW ENGLAND JOURNAL OF MEDICINE, BY PETER B. BACH, FOR BOTH ITS OUT-DATED METHODS WHICH IMPACT ITS RESULTS AND ITS ERRONEOUS CONCLUSIONS. THE LABEL OF SCIENTIFIC STUDY ALONE DOES NOT INSURE THE VALIDITY OF THE STUDY OR ITS RELEVANCE OR APPLICABILITY TO A PROBLEM.

IN ANY CASE, THERE ARE REPUTABLE CHALLENGES TO THE DARTMOUTH ATLAS WHICH ARE BEING IGNORED BY OBAMA. THESE ARGUMENTS CENTER ON THE VALIDITY OF ITS METHODS AND CONCLUSIONS, AS WELL AS, ON THIS QUESTION- HOW DOES A STUDY ON THE DEAD REMAIN APPLICABLE OR RELEVANT TO WHAT IS HAPPENING NOW ? IN ANY CASE, WHILE THE DARTMOUTH ATLAS IS ALREADY IMPLEMENTED IN SECTIONS OF THE HOUSE AND SENATE BILLS ON HEALTH CARE, THIS STUDY IS BEING CHALLENGED ON BOTH ITS METHODOLOGY, AS WELL AS, ITS RESULTS. AT THE PRESENT TIME, THERE IS AN ALMOST UNSEEMLY RUSH TO PASS THIS BILL, WHICH IS AKIN TO A MASSIVE HOUSE BEING BUILT UPON THE SHIFTING SANDS OF THIS ATLAS.

IT IS ALSO NECESSARY FOR AMERICANS TO UNDERSTAND WHY THIS PRESIDENT HAS NEVER REFERRED TO THIS STUDY BY ITS REAL NAME IN HIS PUBLIC SPEECHES. IT IS BECOMING PAINFULLY APPARENT THAT THIS ADMINISTRATION AND OBAMA FOR THE MOST PART, KEPT DISCUSSIONS OF THE DARTMOUTH ATLAS HIDDEN FROM THE VIEW OF THE VOTERS, BECAUSE IT WOULD CAUSE A PUBLIC OUT CRY, IF AMERICANS UNDERSTOOD THE TRUE MANDATES AND RAMIFICATIONS OF THIS ATLAS.

HOWEVER, OBAMA CONSTANTLY BUT OBLIQUELY REFERS TO THIS UN-NAMED STUDY IN HIS SPEECHES, AS THOSE SCIENTIFIC STUDIES WHICH BACKED UP ASSERTIONS ABOUT THE QUALITY OF HIS HEALTH CARE PROGRAM. HE OFTEN STATES THAT THIS PARTICULAR STUDY ILLUSTRATES THAT YOU CAN PROVIDE QUALITY HEALTH CARE WITH LOWER COSTS IN SOME SECTIONS OF THE COUNTRY, IN CONTRAST TO OTHER GEOGRAPHIC AREAS WHERE THE COST IS HIGHER, BUT WHERE SURPRISINGLY THE QUALITY AND OUTCOMES ARE LOW.

THE BIGGEST QUESTION IS THIS: WHY, AFTER THE METHODS AND CONCLUSIONS HAVE BEEN ATTACKED BY CREDIBLE SCIENTIFIC CRITICS, THE AUTHORS OF THIS STUDY, THE DARTMOUTH ATLAS, HAVE NOT BEEN ABLE TO RESPOND TO THE CRITICS WITH A CREDIBLE ANSWER TO THESE CHALLENGES. FURTHERMORE, OBAMA HAS NOT EVEN ASKED FOR A SECOND OPINION TO QUESTION THE VALIDITY OF THIS ATLAS ?

FINALLY, CAN AMERICA REALLY AFFORD TO BASE I/6 OF OUR ECONOMY ON A POSSIBLY FALSE OR INVALID SCIENTIFIC STUDY, WITHOUT EVEN ANALYSING THE VALIDITY OF THE CRITICISM OF ITS METHODS AND CONCLUSIONS BY RELIABLE SCIENTIFIC CRITICS ?

SO, JUST WHERE IS THE SOCIAL JUSTICE THAT OBAMA SPEAKS OF, WHEN THIS STUDY, IF FALSE OR FLAWED, WILL IMPERIL THE HEALTH AND LIVES OF THE POOR, THE ELDERLY, THE DISABLED, THE CHRONICALLY ILL, MINORITIES AND WOMEN ?

[ TO ACCESS THE DARTMOUTH ATLAS GOOGLE IN DARTMOUTH ATLAS.ORG ] YOU WILL BE ON THE HOME PAGE. SCROLL DOWN UNTIL YOU REACH THE MAP AND CONTINUE DOWN ABOUT 3 PARAGRAPHS ON THE RIGHT HAND SIDE UNTIL THE HEADING OF THE PARAGRAPH READS, " EXPANDING COVERAGE WITHOUT INCREASING SPENDING : DARTMOUTH ATLAS AND WHITE PAPER RECOMMEND COURSE FOR THE OBAMA ADMINISTRATION. " AT THE END OF THIS PARAGRAPH, THERE IS THE TITLE OF THEIR WHITE PAPER WITH " CLICK HERE " TO ASSESS IT. THE TITLE OF THE WHITE PAPER IS " AN AGENDA FOR CHANGE: IMPROVING QUALITY AND CURBING HEALTH CARE SPENDING: OPPORTUNITIES FOR CONGRESS AND THE OBAMA ADMINISTRATION. '' CLICK ON THE " CLICK HERE " DIRECTION TO READ THEIR " WHITE PAPER. "

This President, Barack Obama, is attempting to completely and radically over-turn the delivery system of the American Health Care System, to such a degree that it will be unrecognizable to Americans. Additionally, if Obama's Health Care Bill is passed using this particular Draconian blue-print, the Dartmouth Atlas, [which is presently being challenged for its outdated and ineffective methodology and erroneous conclusions by numerous distinguished doctors and scientists, most recently by Peter Bach, who recently questioned its findings in The New England Journal of Medicine,] then this Atlas, is capable of completely deconstructing the American Health Care system.

Obama has continually cited this questionable study, in all his speeches and meetings, as the way to change our Health Care System by bringing greater Health Care quality care to Americans, while magically lowering costs. Instead, this utilization of the Dartmouth Atlas will completely destroy the American Health Care System.

This is because this Atlas study is so intrinsically flawed, that it will surely eliminate any chance of Americans receiving quality care. Both Americans and their Health Care System will be decimated, by the conclusions & mandates of the Dartmouth Atlas, because of what is becoming increasingly evident, that the Dartmouth Atlas is a self- promoted ideological and poorly executed scientific study, with sub-standard and out-dated methodology and questionable conclusions.

Plus its study of the dead does not deal with the efficiency of the resources to save their lives, but rests solely on the cost of the health care resources; therefore, making this study of little relevance to fixing Health Care, making it in the end- a toxic recipe for disaster.

The damage from using the Dartmouth Atlas as the cornerstone on which to build Obama's Health Care Bill will be catastrophic especially to minorities, such as blacks and Hispanics. It will be devastating to women who consistently out-live their husbands or are divorced or single, plunging them into medical poverty, as well as, monetary poverty. It will especially and cruelly impact the poor, the old, the disabled- the physically and medically handicapped, and those with chronic health conditions. It will be crushing to those who have simultaneous chronic diseases at once, such as diabetes, coronary heart disease, and cancer.

Just what is this controversial study about ? The Dartmouth Atlas is a scientific study that divides the nation into geographic regions where hospitals that have a certain capacity to handle coronary cases and cancer patients, are rated by gathering data from patients who died and determining how much the government spent on these patients during the last two years of their lives. The results of the study are based on the size of the Medicare reimbursements which were paid out by the government to various Health Care Providers who provided care for these patients.

The Atlas which can be accessed by the Internet, compares those hospitals which were paid less reimbursements by the government according to their geographic region, to other hospitals which receive more funds. Receiving more funds is considered and then scored as being a poor reimbursement figure, because the government is paying out more money to providers. According to the Atlas, the hospitals which are paid less, often get the same or better results, than those hospitals which caused the government to pay more for the care of their Medicare patients.

However, it is important to note that the subjects of the study are the dead, and the data was collected from what was spent on them during their last two years of life. This is a very simplistic description of the study. But the conclusion of this study is also simplistic- that the hospitals that get less money from the government in Medicare reimbursements are better, because they reduced the costs for the government. If only this was the case, once you fully analyzed the results.

This study, according to its Home Page on the Internet. was created shortly after Hilliary Clinton announced that she was launching a Health Care Bill during the administration of her husband, Bill Clinton. The Dartmouth Atlas was launched in preparation for Clinton to adopt and place the Atlas recommendations into her new Health Care Bill. Whether Hilliary Clinton even knew this, or would have placed provisions of this study in her Health Care Bill if it were passed, we may never know.

Would it surprise you to know that the sponsors and co- sponsors of the Atlas are major insurance companies who jumped on this study's band-wagon early in the game ? Their names can be accessed on the Dartmouth Atlas Home page under sponsors and co-sponsors. They included: Athem Blue Cross and Blue Shield of Ohio, Blue Cross and Blue Shield of Michigan, Empire Blue Cross and Blue Shield, and Excellus Blue Cross and Blue Shield. These companies were attracted to the Atlas premise, which is that it is the mere availability of drugs, tests, and medical procedures which is driving up health care costs and should be stopped, or to put it simply- less is more. If less utilization of expensive treatment is in the Health Care Bill, than the profits of the insurance companies will go up, which is a net gain for them.

We know that the creation of the Atlas originated because the authors of it had a desire for Clinton to adopt it. What we also know is that the Dartmouth Atlas had an ideological bent- its doctors were indeed hard selling their concept of their scientific results to the government in order for federal agencies to utilize the Atlas on a national basis. This ideological mantra of the Atlas creates a real problem for real scientists, especially as time goes by.

A scientist involved in any scientific study should not have a leaning towards the results that he wishes to occur, because if he does, whether consciously or not, those personally desired results- even if false, can become a self-fulfilling prophecy. We know that the Dartmouth Atlas continues to have this ideological bent toward this type of self- promotion, because on their Home Page they have a "white paper, '' with a title exhorting this president to adopt the cost saving measures which are listed in the Dartmouth Atlas.

Another aspect of the Dartmouth Atlas is that exploits fear- which is unusual in a scientific study, because real science informs- it doesn't use scare tactics to persuade. Instead, this Atlas high-lights all of what it calls the adverse events which may occur in a hospital, such as infections, errors on the part of the doctor, complications of surgery, etc. Then it exhorts the doctors to constantly stress these adverse events to these patients, in order to persuade the patient to avoid the high cost test, the expensive operation or that costly hip replacement.

For this purpose, the authors of the Atlas even advocate the creation of books, pamphlets and visual aids, as well as, extra communication courses for primary doctors to take once they graduate, so they can more fully persuade the patient not to agree to any treatment that might be expensive. This is because there are always some pesky adverse event to worry about. The Atlas forgets that even if you walk across that quiet street in a country town, there is still the chance that you might be killed. For example, the Atlas repudiates mammograms as being unnecessary, in fact, causing harm to women in the form of- women might worry if they have to check out a false positive.

Remember, when this administration floated this trial balloon from the Atlas of " no recommended mammograms for 40 to 50 year old women, " because a false positive could cause them to worry. These women didn't cringe in fear- instead they became angry because they felt patronized by this recommendation. This gem came right out of the Atlas playbook !

The Atlas was eagerly adopted by Obama and his director of the Budget Peter Orzag, who fell in love with the mandate of the Atlas, when they came across it in an article in '' The New Yorker, " written on June 23, 2009 by Doctor Atul Gawande whose article was entitled, '' The Cost Conundrum Redux ." He wrote about 2 Texan cities, one in Mc Allen, Texas with the second highest Medicare reimbursement rate in the nation, $ 14,946 per enrollee and poor health care outcomes; and a nearby town, EL Paso, with lower costs, $7,504 per enrollee and supposedly better outcomes.

Obama was so enthralled with this quick, easy, and cheap solution to his health care program that he made his staff read the Atlas study. The Atlas stated that by carefully following its precepts, you could shave off 30% off of Medicare costs, therefore, we constantly hear the claims this president is making, that he can cut 500 billion dollars from Medicare, because this Atlas promotes the concept that health care treatments, especially expensive ones, are harmful to you, and are unnecessary to solve your Health Care needs; therefore, the rationing of these treatments is wonderful- in the end -it will even save your life.

The chief premise of the article was that it was greedy doctors who wanted to fill up a big supply of empty hospital beds quickly in Mc Allen, Texas that drove up costs there. Critics attacked the methods of the Atlas, for using an old tool, the mean income gleaned from zip codes which comprise an area of about 30,000 people to determine the socioeconomic standing and the economic status of the enrollees, instead of the more modern block or tract numbers that cover an area of 2,000 to 4,000 individuals.

Using the modern methods of blocks and tracts to ascertain the patient's socioeconomic status gives you a more realistic idea of the typical patient's mean income. These critics also contended that the use of the old tool, the zip codes, threw off the numbers in the results of this study, by a range of 30% to 50%. These numbers in effect, negated the original conclusions of this Atlas study.

They also pointed out that the patients in Mc Allen who did cost Medicare more were poorer; they had a history of not having previous Health Care; they had no social support system to help them when they returned home; and they were sicker as they had a greater percentage of serious illness. Also of importance was these patients also had a greater number of simultaneous illnesses presenting, such as a patient with cancer who also had diabetes, and heart disease. In addition, the stage of the illness, for example, in breast cancer was not listed. This factor became important since the mildest form, stage 1, may have greater numbers of patients who have the disease, while the death rate is less; while stage 4- the most deadly stage, has the reverse scenario.

These were just a few variables that seemed to be ignored and not given weight in the discussion by Gawande, the promoter of the Atlas, or the authors of the Atlas itself. These authors included: Elliot S. Fisher, David C. Goodman, John E. Wennberg, Kristen K. Bronner, Johnathan S. Skinner, James N. Weinstein, and Jason M. Southerland.

Why should we be distrustful of this Alas ? Because of claims of over use of expensive treatments, the Atlas is railing against using several types of treatments and operations, especially various types of coronary operations, stints and pace-makers, teaching hospitals, hospices, hospital admissions, expensive drugs for cancer, utilization of services provided by medical specialists, hip and knee replacements, CAT-SCANS, MRI tests, mammograms at certain ages, tests for prostrate disease, etc. These are several reasons why Americans would not want to use this Atlas as the foundation to build our comprehensive Health Care Law upon, without even looking at the criticisms of the validity of the Atlas itself.

But it is almost impossible to ignore this latest and most recent criticism in, " The New York Times, " in the section titled, " Money and Policy " written on February 17, 2010, by Gardiner Harris. The title of this article is, " Report Cited by Obama on Hospitals Is Criticized. " The article points out the criticism of both methods and conclusions of the Atlas by Peter B. Bach who wrote a brilliant analysis of the flaws in the Atlas, in The New England Journal of Medicine on February 17, 2009, in an article sardonically titled, " A Map To Bad Policy. ''

As Doctor Bach succinctly stated it, '' We are about to embark on a huge transformation of our health care system. If we start with a bunch of flawed measures, it will be as devastating as putting in the wrong coordinates before a moonshot. "

Furthermore, Dr. Bach challenged the findings of the authors of the Atlas, among which were Dr. Wennberg and Dr. Fisher, by attacking the very concept of the Atlas, as well as, its methods. The Atlas examined in their Mc Allen versus El Paso study contended that it was the mere availability of hospital beds which greedy doctors attempted to fill, which then determined whether Mc Allen used more Medicare medical resources, which resulted in Medicare paying out larger reimbursements to health providers, than El Paso during the last 2 years of these patients' lives. In addition, the Atlas then looked at that hospital during the last 2 years of a patient's life, holding the assumption that that particular hospital controlled most of that patient's care during the 2 year span before death.

According to Dr. Bach, that assumption is false, because care could occur outside that hospital in another hospital, or outside that hospital in varying situations, for example, at home, or in a nursing home, or in another hospital. Bach also felt that hospitals can influence the follow-up care, but not all of it. This is important, since lack of continuous and effective follow-up care causes re-admission to hospitals and drives up costs. Often frail, elderly patients do not follow a doctor's instructions, nor do they have a living spouse, care-giver, or relative nearby who will insure that they take their meds, or who will call the doctor if a symptom re-occurs or worsens, or makes sure that they follow dietary and exercise instructions.

Bach also challenges the assumption, that greedy doctors, purely for the sake of their own profit, push patients to fill up those empty hospital beds. Bach has estimated that only 2o% of U.S. physicians have a financial connection with a hospital- which leaves 80% who would not have a financial incentive to fill these beds and use other health care resources. Plus hospices, nursing homes, home health agencies, and in-patient facilities that don't handle acute care patients, but service these patients once they are released from acute care hospitals, serve many hospitals, so there is not any singe hospital that can hold a financial relationship over these institutions, or one that would be so powerful, that it would have exclusive control over follow up care of one of their patients.

Bach also challenges the methods of the Atlas. He challenges the concept of efficiency of health care which the Atlas holds. According to Bach, to ascertain true efficiency, one must ask the question, " Are health care resources used to get improved health, weighing both health care resources consumed and outcomes ? Yet the Atlas only uses those health care resources which were used, such as hospital admissions, or cancer drugs to determine efficiency. This boils down to the Dartmouth Atlas expressing concern over cost alone.

Bach uses this example to illustrate his point, 20 patients who are severely ill are divided between hospital A, and hospital B; each has 10 patients. Hospital A gives each patient a $1 pill and these pills save the lives of 5 patients at hospital A. Hospital B does not give out these pills and all 10 patients die, but this hospital has $0 cost. According to Bach, the Atlas would determine that hospital B, the one with 10 dead, was more efficient because it had less cost. Bach's bottom line is both high and low performing hospitals in the Atlas use some health resources wisely and some of them poorly. We should be concentrating on how effective these health care resources are utilized at all hospitals, to determine their efficiency, instead of determining efficiency solely by costs.

Bach also makes a point that some hospitals take sicker patients than others. For example a stage 4 breast cancer patient is sicker than a stage 1 breast cancer patient. On the other hand, a patient with only diabetes, is less sick than one who has that same disease plus cancer, and heart disease. Also, a patient 65 years or older in an average hospital has an average risk of death of 15%. In a hospital with a status better than an average hospital within the 10 percentile ranking, the risk of death is only 6%, but if you jump to the 90 percentile ranking, then the risk jumps up to a 22% risk of death.

In conclusion, looking at the analyisis of the Dartmouth Atlas through the eyes of Doctor Bach and numerous other scientists who have serious misgivings about using this Atlas, as the blue-print for the complete over-haul of our Health Care system, Americans must feel a sense of disbelief, disgust, and despair. It is apparent that the Atlas is inherently flawed, and not applicable to increasing quality outcomes, while lowering costs.

The Atlas is not concerned at determining how to use health care resources in the most efficient manner- it is concerned with butchering costs- and at that, it will suceed, if Obama's health care bill does become law. The people who will be hurt the most are the elderly, the poor, the disabled, women, and minorities. Read the white paper of the Dartmouth Atlas, and the article by Peter B. Back, dated February 17, 2010, in the New England Journal of Medicine titled, ''A Map To Bad Policy. '' Once you are informed about the facts, call your Congressman and demand a second opinion on your Congressman voting yes on passing Obama's Health Care Bill, until every section culled from the Datmouth Atlas is removed from it, which ultimately means starting from scratch. With it's blueprint from the Darthmouth Atlas permeating this bill, if it is passed, it will surely be the biggest legislative mistake in this century, as well as, the greatest medical problem that you and your family may ever face in your lifetime.

How the Job's Bill Was Gutted Deliberately by the Obama Administration while They Spend All their Time & Money on Health Care

After spending an entire year plus 2 months focusing his attention on his first priority, Health Care, Obama is clearly demonstrating that even now, that job creation which is the country and Americans' first priority, is virtually being ignored. Again, this president is sucking up all the oxygen in the room. All of Obama's and this administration's time, energy, focus, and money again are being spent on his massive Health Care Initiative. Yes, there was the 787 billion dollar stimulus, where Obama could check off the " the president created a Jobs Bill, " but the stimulus was deliberately not designed as a job creation tool; instead, it was primarily designed, especially the last third of it, as a separate fund where monies were specifically set aside to carry out his Health Care and Energy Programs.

In effect, the stimulus was gutted to free up the Health Care and Energy Bills from extra costs. This was done by using the stimulus, which was created under the guise of a job creation tool, to absorb part of these programs massive costs, such as those that would be found in the Health Care and Energy Initiatives. These initiatives would be even more expensive - if these Energy and Health Care Programs and their costs were in these massive bills, where they really belong.

We have seen this Obama game played before- when he made a deal with physicians to give them 250 billion dollars for Medicare reimbursements in a separate bill, instead of putting it where it belongs, in a massive Health Care Bill.

Another accounting trick, was to collect taxes or funds for the Health Care Initiative for the first ten years and only deliver benefits for 6 years in order to claim that Health Care was not causing a deficit, when the Congressional Budget Office rated or scored the bill. There are numerous other similar accounting tricks, but the most egregious one, is the deliberate gutting of the stimulus to provide funds for Health Care and Energy Initiatives.

Paul Krugman, the Nobel prize winning economist, insisted that the 787 billion dollar stimulus was too small, when he assumed most of it was going to job creation. He would have been stunned if he knew that large portions of it were being siphoned out for purposes which were not immediately targeted for job creation.

For example, over 36% of the first third of the stimulus, went to individuals in the form of less money being taken out of the weekly pay check, the amount being equal per day, to a cup of cheap, plain coffee in a diner. Americans certainly would have been happy to fore-go that amount, if they knew it instead was going to small business job creation, which is responsible for over 70% of all jobs in the economy. Only 1% went to that small business job creation, and only roughly 4% went to repair infrastructure, a known job creator which also produces corollary jobs in the private sector.

If the first third of the stimulus went to these tax relief measures, and the last third went to provide funds in the future for Health Care and Energy, the second third of the stimulus was at least spent rationally, as it was allocated for food stamps, Cobra medical health insurance, and unemployment insurance for individuals, and help for state governments to balance their budgets.

But what happens when you foolishly fritter away 2/3 of the stimulus ? The answer is simple - it fails to produce jobs, especially created jobs, and jobs in the private sector; or jobs that are permanent rather than temporary. Also, as you only get one [ trillion dollar shot which is 787 billion dollars plus interest] at any program like the stimulus, as the public only allows you one drink at that well.

Therefore, the public are so outraged at the failure of this stimulus, that the administration cannot even name those funds which they are now setting aside for small business and job creation as another stimulus, but are artfully using a synonym, calling the new minuscule program-a Jobs Bill. But this administration is still making the same old mistakes. Again, we are still talking about and focusing on Health Care. Again, we are gutting funds for job creation. Again, we are giving only the crumbs off this nation's table to both the poor and the middle class.

When the idea of a Jobs Bill came up as part of the response to the Massachusetts debacle and the outcries of the public to create jobs in 2010, an effort arose to address the problem. The House reacted quickly with a $185 billion dollar plan to create jobs and help small businesses. The Senate produced a very modest Jobs Bill of 85 billion dollars- less than 1/2 of what the House proposed. However, this relatively small Jobs Bill in the Senate revived a great deal of bi- partisan support in that body and its passage seemed certain, as even Republicans were happy with it.

Then along came Harry Reid, the Democratic majority leader of the Senate, who decided to butcher this bill cutting away not the fat, but unfortunately the muscle of the bill- leaving something less than even bare bones remaining. What did Reid drop ? He removed over 70 billion dollars that were geared to help small businesses hire workers in the form of tax breaks for them.It stripped away unemployment insurance -since it has expired at the federal level- leaving many families destitute. It ravaged extension of Cobra medical insurance for the unemployed. It took away reimbursement dollars for physicians away from these doctors who treat Medicaid and Medicare patients, insuring their are even less of these doctors who be willing to treat the old and the poor.

Evidently, men like Harry Reid and Obama, and this administration thought that these were frivolous extravagances that were being lavished on the poor and needy, because they have a jobs and a gold -plated insurance policy already, plush a cushy safety net to protect them if any trouble in their lives arose. Perhaps Obama, Reid and the Obama administration wanted to spend their time and energy on what was really important to them, Health Care, their ticket to retaining their own jobs in 2010 and 2012 ?

In any case the bare bones Jobs Bill passed in the Senate by a vote of 70 to 28 with the support of a few Republicans, who complained along with many Democrats that it wasn't comprehensive enough. For example, both of these two Republicans, Senator Scott Brown and Senator Snowe stated, " That it didn't go far enough. " The House's take on the Senate Bill said it all, with this descriptor- " puny.'' " Puny " indeed !

This tiny weeny bill had 2 provisions a---exempt businesses when they employ a new worker from paying the 6.2 % Social Security tax up until December, and in addition, these businesses will get an additional one thousand dollars tax credit if the worker remains a year. b--- it also extends a tax credit for businesses buying new equipment. Congress predicted this bill predicted might produce 250,000 jobs.

If anyone wonders what possessed Harry Reid to butcher the Jobs Bill during this time, we can look at his own words for analysis. Reid said he wanted to concentrate on core elements, so obviously he doesn't believe that unemployment insurance and Cobra Health insurance for destitute unemployed workers fit that core element category, when their unemployment insurance has already expired by the end of February.

Reid also said that he wanted to follow this bill with other small bills with unemployment insurance for these unemployed, as well as, Cobra Health Insurance for them. But when was Reid going to do this , since again their unemployment insurance expired the last day in February ? Shouldn't this have been in the first Jobs Bill passed, instead of tax breaks passed for small businesses ? Where was Reid's priorities ? Or shouldn't Reid have kept the first bill of 85 billion dollars intact that included unemployment insurance ? Again, where was Reid's priorities ?

The real reason that Reid and the Obama administration are playing Russian Roulette with the Job's Bill is that these men, both Reid and Obama, are suddenly getting " fiscal religion. " a--- Therefore, they are terrified of being accused of running up huge deficits by the Republicans. This is a ridiculous excuse to decimate the Senate's 85 billion dollar bill to a mere 15 billion dollar bill , because of all of their previous Democratic huge spending bills which have already passed or those that are now a work in progress. It is akin to shutting the barn doors, after all the horses have already fled. So Reid and Obama have obviously short-changed the poor, the middle class, and the unemployed ? Did we ever Obama and Reid see them this concerned, when they gave the big banks 23 trillion dollars in loans and guarantees ?

In addition, this is part of the Reid and Obama strategy which is b--- to put out a few small bills out on "job creation '' every few weeks, so that Republicans, if they don't sign on to them, can be categorized by Democrats as being against the public's interest to create jobs. Obama is either playing with Reid directly on his issue- or he is indirectly involved, because although Obama has insisted jobs is his first priority, he is failing to monitor those to whom he directs tasks, such as Harry Reid. Therefore, the poor, the middle class and the unemployed have to suffer- since they are only political pawns to show up Republicans.

Although Reid had claimed he was going to address the unemployment problem shortly, a vote to extend unemployment insurance for a short time in the Senate was halted by a Republican, Jim Bunning, who is not running for re-election in his home state, Kentucky. He is using a procedural trick, a filibuster, to block this extension because according to this Republican Senator the extension of unemployment insurance is not funded. Bunning wants to use the stimulus money to pay for unemployment insurance. However, those funds are already allotted for Obama's pet projects. Therefore these funds won't be released, since the money has already been committed. This has shocked both the Democrats and Republicans.The Republicans have always considered Bunning a loose cannon and are aghast at this trick he has employed. Bunning deserves all the arrows shot at him.

But the bottom line is, if Harry Reid had left the $85 Billion dollar jobs bill alone, a bill which did include the unemployment insurance for the unemployed, we would not have this problem now. The public should also remember that we, all Americans, are just political pawns in a political chess game Obama & Reid are playing with Republicans. We, the American people, can remedy this parody by making sure that both Obama and Harry Reid lose big in 2010 and 2012. Hopefully, both these men will lose their jobs. But perhaps their sole consolation will be, that unemployment insurance will finally be available for them at that time, when they receive their " pink slip " from the American people.