In the final hours of December 31, 2012, congress and the democrats agreed on a deal in the White House that averted the fiscal cliff in the US and saved the economy from slipping away into darkness. But for how long?

According to Forbes magazine, income tax rates up to $450,000 (for married couples) will be subject to older tax rates, but income above $450,000 will taxed at 39.6%. Tax-rates on long term capital gains and dividends will be hiked from 15 percent to 20 percent only for those taxpayers above; for everybody else it will be the same 15 percent.

Further, according to Forbes, the deal is composed of an extension of exemption on estate taxes at $500,000, but rates have been increased to 40 percent from 35 percent.

It seems rather uncomfortable to say that President Obama achieved victory on tax code debate since democrats were pushing top tax rates for income just above $250,000; nevertheless, tax revenues have been made somewhat stronger.

As reported in my last article, updating tax rates for the rich may strengthen the revenue part of the budget. Perhaps it is a good sign, but the deal barely mentions anything about chronic deficits.

Perhaps the most pivotal portion of budget is spending. Because spending and taxes are branches of the same tree, and there is a threat that the tree might lean to one side if the other branch grows too heavy.

According to the Heritage Foundation report, “Federal spending by the Number 2012,” federal entitlements are driving this spending growth, increased from less than half of the total federal outlays some 20 years back to nearly 62 percent in 2012.

Further report says that three major programs (Medicare, Medicaid, and Social Security) eat up about 44 percent of the budget. Other programs such as anti-poverty program increased by 49 percent in the last 10 years, food stamps tripled since 2002, and housing assistance rose by 48 percent since 2002.

Debt Facts

The year 2012 marked $1.1 Trillion of deficits, the fourth consecutive year the deficit exceeded 1 trillion.

The 2012 Deficit. was estimated to be 7.3 percent of the GDP.

Over 2 decades, spending grew 71 percent.

In 2012, spending on entitlements was nearly 62 percent of total spending, while defense expenditure was 18.7 of the budget.

The US economy is drifting towards deeper deficits for two principle reasons: a dramatic shift in spending on the outset of recession, and a large chunk of financial resources diverted towards a host of social programs.

What’s happening in the US economy can be summed up as a fiscal fiasco. It is also economic uncertainty and political confusion over the fate of the tax code, massive spending and mountainous federal deficits, since this deal focused extensively on one side of the budget.

Ironically, what remains to be the most awful aspect of the deal is the extension of rapid spending cuts, generally known as sequester. The sequester problem should have been solved under this deal.

According to the Christian Science Monitor, ‘sequester’ is composed of mandatory spending cuts, hammering down $600 billion in defense and $600 billion in domestic programs, which have been extended to March 1, 2013.

Are we going to experience the same kind of frustration and confusion again in March as we did prior to this deal? Fiscal deficits are a jinx to growth and the whole of the economy because it forces us to cease off-spending.

But again a question arises whether welfare policies sometimes ask for more than what the economy can produce? Is this too much welfarism?

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There is a new kind of economic disorder in the United States taking roots in their fiscal policy. It has emerged in the system foreshadowing an economic apocalypse of the US economy, and is known as the Fiscal Cliff.

The implication of the Fiscal Cliff, if left unchecked, will be devastating in nature and highly toxic for the US and global economic stability. The term ‘Fiscal Cliff’ refers to a package of tax increases and spending cuts that may take place due to the expiration of certain laws dealing with tax code and state spending.

In other words, it refers to a stage where economic fortunes may slip down under a deep no-growth trajectory because of laws which will get activated automatically in January.

According to the BBC, on 31 December, a raft of temporary tax cuts is due to expire just as huge automatic spending cuts are introduced. Individuals and companies will be hit simultaneously with tax rises and reductions in government contracts, benefits and support.

BBC further says that some $607 billion of cuts and tax rises are planned, including reductions in the defense budget, the end of an employee tax holiday, changes to Medicare allowances and higher personal taxes.

The ideology of both Republicans and Democrats is asymmetrical when it comes to resolution of the fiscal mess: President Obama proposes a tax increase for the households that earn more than $250,000 per year, but Republicans tend to repeatedly torpedo that proposal. Republicans seem to favor a “no tax rate increase policy,” with some adjustments and corrections in spending programs.

According to Boston.com, Republican Senator Lindsay Graham of South Carolina said “No republican will vote for higher tax rates… We will generate revenue from eliminating deductions and loopholes, but we will insist our Democratic friends reform entitlements – something we’ve never done, and that’s where the big money is at.”

According to CBS News, about $1.2 trillion in federal spending cuts are scheduled to take place next year, and some state-run health care programs for the elderly, such as Medicare, will be affected by a 2 percent reduction in payments.

There come questions about how to jump-start job creation and fuel economic growth while still slashing away at federal deficits. Tax hikes to annihilate deficits may plunder the economy itself; tax increase arrests spending and investment but can positively correlate with a deficit reduction scheme.

Ironically, it all depends on how much importance we attach to ballooning deficits and interest service and how we see growth. If spending is slashed through different programs, like Medicare, it will adversely affect savings among the elderly as it will wipe-out state help, leaving them to rely on whatever means they have.

On the other hand, even if Bush-Era Tax Cuts were to be extended for the next two years, will they be helpful in opening the door for faster economic growth? For the last few years Bush-era tax cuts were in place in the economy along with the low interest rate policy adopted by the US Federal Reserve, but the economy is still coughing. What is needed is to increase taxes if deficit reduction is primary for the economy.

The argument is that it might drag the economy back into a recession, but again a question arises. Are these tax-cuts helpful in getting the economy back on a stable surface?

There is no magic wand that can drain out the federal deficits and growth rate with the same pattern of spending and bush-era tax cuts in place.

Ultimately what can be done to avert the crisis, to shield the US economy falling over the cliff? The resolution is in striking a deal that limits spending (to some extent) and increasing tax rates on households earning more than $398,350. Spending on defense should be lowered dramatically; further laws with sunset provisions must be avoided.

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Tucson, U.S.A. — The United States is forfeiting a half century of leadership in medical care and medical research and development, writes orthopaedic surgeon Lee Hieb, M.D., in an article in the winter issue of the Journal of American Physicians and Surgeons.

“We are rapidly throwing it all away as we spiral ever downward into a “vampire economy”—an economy so overtaxed and overregulated that it is sucking the lifeblood out of its productive citizens, she writes.

Hieb undertakes a diagnostic examination of the medical economy, and features the following findings:

• There are 140,000 pages of regulations pertaining to Medicare, compared with a “mere” 82,000 in an impossibly complex tax code.
• Today, 49 cents out of every dollar is spent by government. In 1920, only 10 cents was spent by government, and 90 cents privately. Even in 1947, after World War II and the Marshall Plan, only 20 cents of every dollar was spent by government.
• Businesses are organized into cartels. Some are favored by government, so that profits are retained privately, but losses are shared by taxpayers.

The diagnosis, Hieb writes, according to the Austrian school of economics, is that we have a classic fascist economy. According to Lwewellyn Rockwell, “Fascism is the system of government that cartelizes the private sector, centrally plans the economy to subsidize producers, exalts the police state as the source of order, denies fundamental rights and liberties to individuals, and makes the executive state the unlimited master of society.”

Hieb’s description of the economy comes from the title of Guenther Reimann’s 1938 book, The Vampire Economy: Doing Business Under Fascism.

“The frontispiece of Reimann’s book is a pictorial representation of what it took a car manufacturer to get 5,000 tires for his autos. After 6 months and numerous encounters with boards, chambers, secretaries, ministers, councils, and commissars, the company received 1,000 rubber tires and 4,000 ersatz tires, at a 200% increase in price.”

Hieb compares this with the U.S. Food and Drug Administration (FDA), although the FDA takes 15 years to approve a drug, not just 6 months.

When F.A. Hayek wrote The Road to Serfdom in 1928, 55 percent of the German economy was controlled by the government, and their military expenditure was 10 percent of their budget. Today in America it is estimated that 45 percent of our economy is controlled by the government, and our military consumes 21 percent of the national budget.

Hieb explores the moral hazards of dependency on government money, and warns physicians: “We must never put ourselves in such financial dependency on the government that we are willing to compromise Hippocratic principles of ethical patient care.” Independence, she writes, is the “garlic necklace.”

The Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties, founded in 1943, publishes the Journal of American Physicians and Surgeons.

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During this electoral campaign, Medicare has been in the center of the political debate. The Democrat ticket (Obama-Biden) is accusing the Republican ticket (Romney-Ryan) of planning to end Medicare as we know it, and Republicans are accusing Democrats of taking money out of Medicare to fund Obamacare.

According to a new ad released by Romney’s campaign, the Obama administration has cut $716 billion from Medicare to pay for Obamacare. The ad tries to convince voters that the money they have paid to guarantee their healthcare goes to a massive new government program that is not for them. Romney and Ryan are trying to convince the public that they are the ones that would save Medicare benefits from Obama’s cuts; if they win, Medicare benefits will be assured for future generations.

On the other hand, President Obama, during a speech in Iowa, said the Republicans are being dishonest about his Medicare plan. Obama assured the public that he has strengthened Medicare, and that his reforms have saved millions of elderly people millions of dollars on their prescription drugs. The president added that he has made reforms that will not touch Medicare benefits and stated that Romney and Ryan want to turn Medicare into a voucher system.

With this method, seniors would not have health care guaranteed; instead, they would receive a voucher to buy private insurance. According to Obama, this would make seniors pay extra money every year.

Romney’s campaign has accused President Obama of failing to fix Medicare, which they claim is broken. The Republicans claim Obama promised he would fix Medicare in his first term in office, and he has failed.

A NY Times Editorial on August 15 defends President Obama and claims that the Republican’s attacks on Obama’s plans for Medicare are getting more “heated and inaccurate.” It explains that the Republicans are criticizing Obama for taking $716 billion out of Medicare to a new government program that does not benefit the seniors, but the Republicans are not saying that the “the budget resolutions crafted by Paul Ryan and approved by the Republican-controlled House retained virtually the same cut in Medicare.”

The Editorial also explains that “the Republicans imply that the $716 billion in cuts will harm older Americans, but almost none of the savings come from reducing the benefits available for people already on Medicare.”

After all the controversy, a legitimate question would be: what is Medicare? Basically, it is a Federal insurance program that covers the medical services and hospitalizations of some elderly and disabled people. This is not to be confused with Medicaid, which was created to provide medical care to those in poverty.

The health plan is divided into two main parts and two additional ones. The first part, Hospital Insurance, helps to pay hospital stays and other additional health services such as physical therapy. This first part is available for the people  almost every time without having to pay a monthly premium, because they have already paid it through their payroll deductions.

The second part of Medicare, Supplementary Medical Insurance, covers other additional services like blood transfusions or renal dialysis. This part requires a monthly premium, which currently is $99.90 (higher-income consumers have to pay more).

The third part of Medicare has the advantage that it allows the users to design their own medical plan according to their needs. These plans may enlist some private insurance companies to provide some of the services.

In 2006, Medicare expanded to a fourth part of the plan, which covers prescription drugs. This last part, administered by a private insurance company, offers different plans and prices depending on the plan you choose and of the drugs you use. It  requires a payment of a deductible and a premium.

To be eligible for Medicare you have to be at least 65 years old, less than 65 but disabled, or have permanent kidney failure that requires a dialysis or a transplant. The other requirements are that you must be a citizen or a permanent legal US resident for more than five continuous years, and have ten years of contributing into the system.

Medicare basically funds from the payroll taxes and the Self-Employment Contributions Act. Any additional Medicare funding comes from premiums, deductibles, etc.

A key aspect to consider is that according to a new Quinnipiac University/New York Times/CBS News poll, Medicare is the third-most crucial issue to likely voters in Florida, Ohio and Wisconsin, just behind the economy and healthcare.

The future of this program could be decided with this election. Now it is time for the Republicans to convince the voters that, under Obama, Medicare would go bankrupt. Or, the Democrats must convince the voters that if Romney wins, Medicare would turn into a voucher system.

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Las Vegas, U.S.A. — Nevada nursing homes and the patients under their care face $20 million cumulative reduction in Medicare funding in 2013-14 as a result of several different federal budgetary actions and regulatory payment changes made by Congress and the Centers for Medicare and Medicaid Services (CMS) since 2009, a new 50 state data analysis projects.

Nationally, nursing homes and the patients under their care face nearly $4 billion in reductions in 2013-14, and a staggering $65 billion reduction over 10 years, according to the independent health policy advisory firm, Avalere Health. Nursing homes, technically referred to as skilled nursing facilities (SNFs), are Nevada’s second largest health facility employer.

In differentiating the impacts of different budget cuts and regulatory payment changes that result in less cumulative government funding, the Avalere analysis, funded by the Alliance for Quality Nursing Home Care, will be utilized to help inform Nevada policymakers how the successive battery of federal funding reductions undermine facility operations, disrupt staffing, and threaten seniors’ care amid the growing influx of older, higher acuity patients – increasing numbers of whom are able to return home after successful rehabilitation.

The Avalere analysis, the first retrospective national and state-by-state look at recent reductions in Medicare payments to facilities, projects the 2013-14 budgetary impact on Nevada based on the following major government actions since 2009: Affordable Care Act (ACA) productivity adjustment ($7 million cut in 2013); Case-Mix Adjustment in FY 2010 CMS Rule ($7.3 million regulatory reduction in 2013); Forecast Error Adjustment in FY 2011 CMS Rule ($1.3 million regulatory reduction in 2013); Sequestration provision of Budget Control Act ($4.3 million cut on January 1, 2013 ); Bad Debt provision in March 2012 Middle Class Tax Relief and Job Creation Act ($2.1 million cut 2012-14 beginning October 1, 2012 ).

Alan G. Rosenbloom, President of the Alliance, said that with approximately 70 percent of facility expenses related to staffing, the impact of federal Medicare cuts combined with a fragile state Medicaid system causes significant difficulties in regard to hiring and retaining the direct care staff that help make a significant difference in care quality and patient outcomes.

“More Medicare cuts from Washington – which are imminent — undermine Nevada facilities’ ability to continue sending more and more patients home as quickly as possible. The unintended consequences of these cuts and regulatory payment changes will affect patient access, quality and require that care increasingly be rendered in settings that actually increase the cost to government.

This makes no sense, and is wrong for seniors, providers, taxpayers and the future of our entire U.S. health care system. We respectfully urge Nevada candidates for federal office to address how they would help stop more Medicare cuts for the state’s skilled nursing facilities and the seniors under their care.

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The most popular buzz in the political world this weekend has to be the revealing of Governor Mitt Romney’s Vice President pick, Paul Ryan. Ryan, Wisconsin’s representative, has been one of the many who were being vetted for Romney’s VP in the past few months. People and the media have been wondering who Romney would pick, whether it would be Paul Ryan, Tim Pawlenty of Minnesota, Marco Rubio of Florida, or Rob Portman of Ohio. In the end, on August 11, Romney tweeted:

“I am proud to announce @PaulRyanVP as my VP. Stand with us today. http://mi.tt/Romney-Ryan #RomneyRyan2012″

Ryan, also know as the chair of the House Budget Committee, is known for his fiscal policy. His personal website says that “He is a senior member of the House Ways and Means Committee, which has jurisdiction over tax policy, Social Security, health care and trade laws.” With a strong background in economics and budget plans, he is a smart addition for the Romney team.

However, the media has much to say about Romney’s decision. Obviously, not everybody is going to love Paul Ryan. Some are saying Ryan is good for the Democrats, that he is “bad for women,” and hates medicare. Many Americans are worried about Ryan’s Medicare plan. Ryan’s budget plan, which is somewhat controversial, intends to to make Medicare something called “premium support,” meaning that the government will offer seniors a set amount of money to spend in a health insurance exchange. This would allow seniors to choose their own private insurance, or use the government-run insurance. Once the senior has a plan, they would have to pay more out of pocket.

Current Vice President, Joe Biden, recently said that “Ryan’s plan to privatize Social Security was irresponsible.” Along with this, CBS news said that, “Ryan, a seven-term congressman and chairman of the House Budget Committee, wants to slice away at Medicare, food stamps and virtually all domestic programs, with military a notable exception.”

Besides fiscal policy, budget plans, and Medicare ideas, the media has also been showing another side of Ryan. Ryan is young, smart, and apparently a fitness buff. The ever so popular internet meme of Ryan has gone viral. Based off of the Ryan Gosling meme, that often starts off with “Hey Girl..” to melt women’s hearts, the Paul Ryan meme is very similar, having some that say “Hey girl, unlike the debt, our love will never hit a ceiling.” The memes have gone viral, and are the topics of many Ryan headlines.

Also headlining for Ryan, is his physique. Politico recently published an article called, “Forget the budget, Paul Ryan is hot.” It details how Ryan is included in the Hill’s top 50 Most Beautiful List and one of the top suggestions for google when one types in Paul Ryan, is “Paul Ryan shirtless.”

Romney’s decision has caused a spark in the political world. Paul Ryan’s budget plan, fiscal policies, internet memes, and pictures of him shirtless will definitely keep him in the media for a while. The question is if his budget plan and six pack will help Romney win the election in November.

Image Courtesy of  monkeyz_uncle (Flickr: DSC_6842) [CC-BY-2.0], via Wikimedia Commons

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Vice president Joe Biden has two main things in common with Paul Ryan, the person who is trying to substitute him. Both are Catholics and both suffered terrible loses when they were young. Ryan lost his father and Biden lost his wife and daughter in a crash in 1972. Also, both men have clear differences in the way they plan to run the country and Biden recently called Ryan’s policies “irresponsible.”

In a political rally in Durham, N.C. Biden said that Romney and Ryan are decent men, but they have very different values from him and Obama. He said their main differences are in education policies, tax issues and government spending. Both Republican and Democrat tickets have very different points of view on how these issues should be handled.

Also, Biden referred to Ryan’s plan to privatize social security as irresponsible. The vice president criticized that Ryan wants to end Medicare and give tax breaks to millionaires and billionaires.

Obama, who has been campaigning in the swing state of Iowa, criticized Ryan for blocking a farm bill that could help the farmers get the resources they need. President Obama during a rally in Iowa stated: “If you happen to see Congressman Ryan, tell him how important this farm bill is to Iowa and our rural communities,” Obama added “we’ve got to put politics aside when it comes to doing the right thing for rural America and for Iowa.” The Democrats are trying to deflect all the positive attention Ryan could get by making hard accusations on him and trying to prove his budget plan would only favor the wealthy.

On the Medicare issue Romney has defended his running mate, saying that what he intends to do is to preserve Medicare. Romney added that Ryan has different ideas than Obama, and added that “the president’s idea, for example, for Medicare, was to cut it by $700 billion. That’s not the right answer.”

Ryan has also defended the accusations that he would turn Medicare into a voucher system. He said that his mother is a Medicare senior in Florida, and criticized the government by saying that the government made promises to the elderly community, promises with which they have organized their retirement. He added that if the government wants to fulfill those promises it needs to reform Medicare for the younger generation, and that is what he intends to do in order to guarantee a secure future for the elderly.

Romney said that the only president in the nation’s history that has robbed Medicare is Obama. He stated:  ”There’s only one president that I know of in history that robbed Medicare,” and added that it was going to cost $716 billion to implement his own risky program commonly called Obamacare.

Image Courtesy of  Jason and Bonnie Grower / Shutterstock.com

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Washington, U.S.A. — A Romney-Ryan White House would be a dream for the richest 1 percent of Americans who are millionaires, but an economic nightmare for the vast majority of middle-class and lower-income Americans, according to Americans for Tax Fairness Action.

“A Romney-Ryan White House would be Robin Hood in reverse, and that’s not the kind of America we want to live in,” said Frank Clemente, campaign manager for Americans for Tax Fairness Action. “Both of their budget plans would lavish the richest 1 percent of Americans who make over $1 million with yearly tax breaks of at least $250,000, while raising taxes on 95 percent of Americans who make less than $200,000. Politicians stacking the deck in favor of their wealthy campaign contributors and sticking the rest of us with the tab is not right.”

“We need to overhaul the tax code so that it reflects our values, and so everyone plays by the same rules and pays their fair share,” added Clemente. “That’s why we should end tax breaks for companies like those that Bain Capital invests in that ship jobs overseas, and level the playing field for small businesses that create jobs in America. We should end tax breaks for the rich like Mitt Romney who use offshore tax shelters in places like the Cayman Islands to avoid paying the taxes they owe, so they can pay a lower tax rate than the teachers who educate our kids.”

Romney’s tax plan, which would make the Bush tax cuts permanent, including for the richest 2 percent, and cut the top income tax rate by another 20 percent, would give people making over $1 million in 2013 a net tax cut of over $250,000, according to a new analysis by Citizens for Tax Justice. Romney’s tax plan would increase taxes by an average of $2,000 on families making less than $200,000 a year, according to a new report by the Tax Policy Center (see page 6 ).

Ryan authored the House budget t hat also wou ld make the Bush tax breaks permanent, including those for the richest 2 percent, and cut by 30 percent both the corporate income tax rate and the top tax rate paid by the wealthiest Americans.

It would give the richest Americans a tax break of nearly $300,000, while raising taxes on a typical household earning between $50,000 and $100,000 and filing jointly by over $1,350, according to the Joint Economic Committee. It also would end the Medicare guarantee and requires seniors to pay $6,000 more per year for fewer benefits than they get now, according to the Kaiser Family Foundation Program on Medicare Policy.

Americans for Tax Fairness Action is a 501c4 organization that is separate from the Americans for Tax Fairness coalition, which is a 501c3 organization The 140 organizations that comprise the ATF membership are separate and distinct from Americans for Tax Fairness Action. Any references to ATF action should not make any association between the coalition that comprises ATF and ATF Action

Image Courtesy of  Gage Skidmore

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Ann Arbor, U.S.A. – The Center for Healthcare Research & Transformation (CHRT) released a policy paper that shows how the Patient Protection and Affordable Care Act (ACA) in 2014 will streamline eligibility categories and may also help between 400,000 and 500,000 citizens to become newly eligible for Medicaid coverage. Currently, there are at least 40 different ways — each with varying eligibility requirements—to qualify for Medicaid in Michigan.

Whether or not Michigan decides to expand coverage for Medicaid, the paper shows that enrolling in Medicaid and maintaining that coverage should become easier for Michigan residents starting in 2014, when the ACA requires states to eliminate asset tests — a review of an individual’s assets to ensure they do not exceed certain limits—and consolidate existing eligibility categories.

“Many changes were included in the ACA that go beyond the Medicaid expansion. These changes were designed to make enrollment policies and processes simpler for those who have existing Medicaid coverage, and enable those newly eligible to go through an easier enrollment process than exists today. These enrollment changes alone should help ensure that more people have access to the affordable care when they need it,” says Marianne Udow-Phillips, CHRT’s director.

Under current federal rules, the Medicaid program provides coverage to those at or below a certain income level who also fit within certain categories, and states can opt to expand Medicaid eligibility.

In 2014, all existing eligibility categories—mandated or optional—will be simplified and consolidated into three categories:

• Parents and caretaker relatives of dependent children under 19.
• Pregnant women.
• Infants and children under age 19.

Additionally, those who receive Supplemental Security Income (SSI) or qualify as “medically needy” will remain Medicaid eligible to avoid gaps in coverage.

For states that opt to expand Medicaid, all non-elderly citizens and eligible resident immigrants with incomes at or below 138 percent of the federal poverty level will become Medicaid eligible, even if they are not categorically eligible.

While the Medicaid expansion is optional for states, streamlining eligibility criteria and simplifying enrollment processes is still required.

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Dr. Gary A. Puckrein, President and CEO of the National Minority Quality Forum, on March 1 released the following statement of concern regarding the Independent Payment Advisory Board (IPAB):

“In our increasingly diverse society, it is important that we have an honest and open discussion about the investment required to enable an American healthcare research, delivery and financing system that will support the provision of the highest quality care to all Americans. Unfortunately IPAB, a cost-containment mechanism that is a provision of the Patient Protection and Affordable Care Act, will stymie that essential national conversation.

“The 15-member Independent Payment Advisory Board (IPAB) will develop specific proposals to contain the growth rate of Medicare spending if it is projected to exceed targets also established by the law. These proposals are transmitted to Congress in the form of legislative proposals that must be enacted or substituted on a legislatively mandated basis. Once it is in place, IPAB can be discontinued only by a joint resolution that must be introduced in January 2017.

Since IPAB is not a government agency, and is not promulgating regulations, it is subject neither to open meetings or public comment requirements. There are no options for appealing the IPAB recommendations. The provisions for judicial review appear to be limited to the recommendations issued by IPAB based upon deliberations that are not open to the public. Judicial or administrative review of the Secretary’s implementation of those recommendations is prohibited.

“The clear intent of the law is to insulate IPAB and its decisions from the full range of traditional democratic checks and balances. This is unwise and unwarranted. Instead of this draconian measure, we must pursue an integrated and practical approach to improving our nation’s healthcare system that will assure that the improved health status of the consumer of those services is the primary measure of success.

“The National Minority Quality Forum urges Congress to abolish the Independent Payment Advisory Board and to engage in the constructive deliberations that are necessary to protect the health of the people they were elected to serve.”

About the National Minority Quality Forum

The National Minority Quality Forum (The Forum) is a Washington, DC-based not-for-profit, non-partisan, independent research and education organization dedicated to improving the quality of health care that is available for and provided to all populations.

The Forum develops user-friendly, web-based disease indices that provide a unique two-dimensional view of the prevalence and impact of diseases by ZIP code, including diabetes, kidney disease, heart disease and HIV/AIDS. Visit the website at www.nmqf.org. Look for National Minority Forum on Facebook , and follow on Twitter (http://www.twitter.com/NMQF).

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The 60 Plus Association (60 Plus) on February 07, 2012 sent a letter asking the Federal Trade Commission (FTC) to block the proposed merger between Express Scripts Inc. (ESI) and Medco Health Solutions, two pharmacy benefit managers (PBMs) that administer prescription benefits for many health plans, including some Medicare Part D plans. 60 Plus is a non-partisan seniors advocacy group, with over 7.1 million supporters.

In the letter, 60 Plus detailed the group’s concerns about the impact of an approved merger on our nation’s seniors, in particular.

“Seniors tend to have more chronic conditions and take more medication than other age groups, and are especially sensitive to changes in the pharmaceutical-drug sector of the health market,” the letter states.

“When seniors lose access to community pharmacies because they are no longer part of a PBM network or go out of business, or when they are forced into a mail-order program, their health and safety is at risk. Seniors rely on local pharmacists for information, advice and counseling about their medications and possible side effects and drug interactions. Without this one-on-one counseling from a trusted pharmacist, some seniors will experience adverse drug reactions and health complications.”

If the merger is approved, the combined ESI/Medco will control prescription drug benefits for more than 100 million Americans, and more than 50 percent of several important components of the pharmacy market, including specialty pharmaceuticals and mail-order. According to 60 Plus, this level of monopolistic control will eventually result in higher prices for all consumers.

“For seniors, the ESI/Medco merger will mean higher prescription prices, fewer choices in pharmacy care, and lower-quality health services than are currently available,” said Jim Martin, 60 Plus Association Chairman. “This merger is anti-competitive, anti-consumer and anti-senior, and should not be allowed to proceed.”

The 60 Plus Association strongly supports free enterprise, consumer choice and the well-being of seniors.  Unfortunately, the ESI/Medco merger gives two players in the PBM industry an unfair advantage in market share and setting prices. The result: higher prices, loss of pharmacy choices and lower-quality services for seniors.

The 60 Plus Association is a 20-year-old nonpartisan organization working for death tax repeal, saving Social Security and Medicare, affordable prescription drugs, lowering energy costs and other issues featuring a less government, less taxes approach as well as a strict adherence to the Constitution.

60 Plus calls on support from over 7 million activists.  60 Plus publishes a newsletter, SENIOR VOICE, and a Scorecard, bestowing awards on lawmakers of both parties who vote “pro-senior.”   60 Plus has been called, “an increasingly influential senior citizen’s group.”

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Six national aging groups filed a friend of the court brief with the Supreme Court last Friday, January 27, saying that there are extensive provisions in the Patient Protection and Affordable Care Act that are of “vital importance to the health and well-being of people 65 and older” and that Congress did not intend for any of them to be contingent on whether or not the minimum coverage provision (also called the individual mandate) was constitutional.

“The health and quality of life of many older Americans are already improving because of the health reform law,” says National Senior Citizens Law Center Executive Director, Paul Nathanson. “We don’t believe Congress intended to let the elderly poor languish in nursing homes or be subject to abuse if the individual mandate was found unworkable.”

The amicus brief was filed in the National Federation of Independent Business et al v Kathleen Sebelius et al and the State of Florida et al v Department of Health and Human Services et al cases which challenge the constitutionality of the health reform law. In those cases, the petitioners contend that all of the ACA should fall if the minimum coverage provision is invalidated by the Court.

The brief states that a “careful review” of policies Congress sought to enact shows that the provisions affecting people aged 65 and over “can be effectuated without any reliance on the minimum coverage provision.”

The brief also highlights the parts of the ACA that greatly benefit people aged 65 and older that should not be affected if the Court decides to invalidate the minimum coverage provision, including the following:

• Reduced cost-sharing for Medicare beneficiaries for prescription drugs by substantially reducing the coverage gap or so-called donut hole
• Elimination of cost-sharing for annual wellness visits and other screening services
• Medicare Advantage plans are prevented from charging higher cost-sharing for chemotherapy and dialysis than permitted under traditional Medicare
• Decreased unnecessary institutionalization of Medicaid beneficiaries
• Improved coordination of care for people receiving both Medicare and Medicaid (dual eligibles)
• Improved quality and safety in nursing homes, and prevention of abuse and neglect of elderly and people with disabilities in nursing and other residential facilities.

The brief states that the only provisions that should be affected by the constitutionality of the minimum coverage provision are the pre-existing condition, the community rating, and guaranteed issue provisions.

“The rest of the ACA, including, but in no way limited to the provisions highlighted in this amicus brief, should remain intact,” the brief concludes.

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The Federal Trade Commission issued a complaint to block Omnicare’s hostile acquisition of rival long-term care pharmacy provider PharMerica Corporation, alleging that the combination of the two largest U.S. long-term care pharmacies would harm competition and enable Omnicare to raise the price of drugs for Medicare Part D consumers and others.

In its complaint, the FTC charges that a deal combining Omnicare and PharMerica would significantly increase Omnicare’s already substantial bargaining leverage by dramatically increasing the number of skilled nursing facilities, known as SNFs, that receive long-term care pharmacy services from the company.  Due to its substantial market share, the FTC alleges that the combined firm likely would be a “must have” for Medicare Part D prescription drug plans, which are responsible for providing subsidized prescription drug benefit coverage for most SNF residents and other Medicare beneficiaries.

According to the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services, the proposed acquisition “appears likely to result in higher reimbursement rates . . . and thereby to increase the cost to CMS (and therefore the U.S. government and U.S. taxpayers) as well as any individuals who pay out-of-pocket costs in connection with such services.”

“If Omnicare is allowed to purchase its biggest and only national competitor, it will diminish competition and raise health care costs – leaving taxpayers and patients to foot the bill,” said Richard Feinstein, Director of the FTC’s Bureau of Competition.  “The Bureau will continue to be vigilant in our efforts to prevent these sorts of anticompetitive deals.”

The FTC’s administrative complaint is part of the agency’s ongoing efforts to maintain competition in the U.S. health care sector, which benefits consumers by keeping prices low and quality and choice of products and services high.  This year, more than 1.6 million Part D Medicare beneficiaries are expected to require long-term care while living in an SNF, and about 1.1 billion prescriptions per year are processed under Part D on behalf of approximately 29 million beneficiaries.

Long-term Care Pharmacies.  Unlike traditional retail pharmacies, long-term care pharmacies do not provide medications directly to “walk-in” consumers from nearby homes.  Instead, long-term pharmacies work with SNFs and other institutional providers to arrange for the delivery and administration of prescription medications to the SNF’s residents.  Most SNF residents need help with the ordering, delivery, and administration of their drugs, and a majority of them get prescription drug coverage from a Part D prescription drug plan.

To protect this fragile population and ensure they receive the Part D benefits they are entitled to, CMS requires Part D plans to provide SNF residents with “convenient access” to a network of long-term care pharmacies, such as Omnicare and PharMerica.  This ensures that SNF residents can get their prescription drugs from a long-term care pharmacy that contracts with the residents’ chosen Part D health plan.  Health plans that cannot provide their beneficiaries with “convenient access” to long-term care pharmacies risk being barred from offering Medicare Part D health plans.

Omnicare, headquartered in Covington, Kentucky, owns and operates approximately 204 long-term care pharmacies in 44 states.  In 2010, Omnicare had revenues totaling about $6.1 billion.  PharMerica, headquartered in Louisville, Kentucky, owns and operates approximately 97 long-term pharmacies in 43 states.  In 2010, PharMerica had revenues of approximately $1.8 billion.

The FTC’s Complaint.  According to the FTC’s complaint, Omnicare’s proposed acquisition of PharMerica, the second-largest long-term care pharmacy in the United States, would be illegal and in violation of Section 5 of the FTC Act and Section 7 of the Clayton Act.  The acquisition would combine the largest and only two national long-term care pharmacies in the country.  The FTC alleges that the combined firm would serve approximately 57 percent of all licensed SNF beds in the United States.

Under the Merger Guidelines used by the FTC and Department of Justice, a transaction that leads to that much market concentration would be presumed illegal.  After the acquisition, the merged firm’s only competition for inclusion in Part D plans’ long-term care pharmacy networks would come from small, regional and local long-term care pharmacies, none of which currently operates in more than a few states.

The FTC charges that, even before the transaction, Omnicare has been able to use its size to exert bargaining leverage over Part D health plans, by threatening to terminate contracts if its terms are not met.  A firm that combines the largest and second-largest long-term care pharmacies in the country would have the unique ability to exert even greater bargaining power to raise the price of drugs to Part D health plans.

Due to its substantial market share, the combined firm likely would be a “must have” for Part D health plans, the FTC contends.  Losing contracts with a combined Omnicare/PharMerica would put the Part D health plans at serious risk of failing to meet CMS’s “convenient access” standard.  This increased risk would provide the combined firm with an anticompetitive advantage in negotiating prices it charges Part D health plans for long-term care pharmacy services.

The Commission vote to issue the administrative complaint against Omnicare was 3-1, with Commissioner J. Thomas Rosch voting no.  The case will be heard before an administrative law judge at the FTC in June 2012.

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After a two-day meeting of government leaders and private sector experts that focused on the proposed framework of an historic national plan to defeat Alzheimer’s disease, Eric J. Hall, founding president and CEO of the Alzheimer’s Foundation of America (AFA) and a member of the Advisory Council on Alzheimer’s Research, Care and Services established by the National Alzheimer’s Project Act (NAPA),on January 19 released this statement:

“Our nation is placing an intense and unprecedented focus on Alzheimer’s disease right now, giving hope to Americans that the bold recommendations and thoughtful discussion that emerged during his meeting of the Advisory Council and ongoing will result in a powerful plan that turns the tide of the disease.

“In the year since NAPA was passed by Congress and signed by President Obama, the Alzheimer’s Foundation of America has consistently sought input from family caregivers, clinicians, researchers, healthcare professionals, policymakers and the general public about their personal and professional experiences with Alzheimer’s disease, their recommendations for change and their hopes that the NAPA process goes beyond a ‘check the box exercise.’

Their voices formed the basis of AFA’s report ‘No Time to Waste,’ which provides hard-hitting recommendations that align with the draft plan being discussed by the Advisory Council. “Never before has our nation been poised like this to pursue and achieve what Americans facing this devastating brain disorder demand and deserve.

We are at a pivotal juncture to alter the current course of Alzheimer’s disease, and we must act aggressively yet realistically in order to carry the momentum forward.

“Since fiscal concerns and the growth of the Alzheimer’s population cannot go unnoticed, it is critical that we design this plan with incremental, fundable and attainable goals, which include substantially increasing our scientific knowledge surrounding the disease; preventing, delaying and slowing progression of symptoms; researching and implementing best practices of care; providing much-needed support services for families; and ultimately obtaining the cure we are all waiting for.

“There’s no doubt that we have no time to waste, but it will be vital to engage Congress and sustain their commitment in order to achieve a national plan to defeat Alzheimer’s disease and help countless families now and in the future. Much work lies ahead, but I am confident that we are on the right path toward the resolution of this crisis.”

The Alzheimer’s Foundation of America (AFA) released its “No Time to Waste” report in October 2011 in response to the mandate by NAPA for federal officials to develop an integrated national plan to defeat Alzheimer’s disease.  AFA’s report urges wide-scale public awareness campaigns, including messaging to drive earlier detection and to “shift the focus from fear to acceptance of the disease.”

Other calls for action include: a substantial investment in research toward the prevention, treatment, care and cure of Alzheimer’s disease; additional dementia training and reimbursement for primary care clinicians; and greater training and support for family caregivers of all demographics, including teenagers and ethnic populations, across the continuum of care.

At the Advisory Council meeting this week, Hall further recommended family-friendly workplace policies; tax breaks for expenses related to care giving of loved ones with Alzheimer’ disease; and Medicare-provided support services, such as respite care, that can greatly benefit both individuals with the disease and the health and well-being of family caregivers.   Image Courtesy of   https://www.facebook.com/AlzheimersFoundationofAmerica

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Health care was a major issue at the November 9 Republican presidential debate hosted by CNBC titled, “Your Money, Your Vote: The Republican Presidential Debate.” With each Republican presidential candidate stating that they would repeal ObamaCare, the debate gave them the opportunity to address the steps to reform health care once elected to office.

Ron Paul, who has had previous experience in the medical field as a doctor, addressed the issue by stating that the solution to heath care was to get the government out of the business altogether. He stated that there should be the right to “opt out of ObamaCare,” as well as any health care program to bring health care back to patient-doctor relationships.

Paul also discussed the need for patients to have medical savings accounts, which would drive down the prices on major medicines. Rick Perry believes that Medicare should allow more options for people to choose from. He also said that the best solution was to send money to the states and have them decide on what program fits best for their state.

Mitt Romney, who is currently taking the lead in recent polls, has received criticism in the past on his stance on health care. His plan is often referred to as “RomneyCare” because of its similarities with ObamaCare. During the debates, he responded that he would appeal ObamaCare and the solution would also be to send money to the states and allow them decide which health care plans are best for their state.

Romney also stated that Americans should be allowed to purchase their own insurance, instead of being forced to receive it through their company. He also agreed with Paul, saying that health care should work like a market so that Americans have a stake in the quality of their insurance. Michele Bachmann also held the same stance. She also maintained her true “malpractice liability reform” stance.

Newt Gingrich stated that there was a need to restore patient-doctor relationships, as well as turn over the funds to the state level so that they can craft a plan, similar to what John Huntsman indicated. Gingrich then stated that there has to be more concentration and funding for research on brain science.

By finding cures for many leading diseases and illnesses, people wouldn’t have to pay for such federal programs. Senator Rick Santorum thought that many other candidates lacked his experience in the health care field, and that other candidates such as Romney were not consistent in their plans.

He stated, “I was always for having the government out of the health care business and for a bottom-up, consumer-driven health care, which is different than Governor Romney and some of the other people on this panel.” Though each candidate has different plans for repealing ObamaCare, health care will continue be a hotly debated topic in future debates.

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Republican and Democratic lawmakers have been engaged in intensive negotiations for weeks to figure out how to lift the $14.3 trillion debt limit but a devastating default looms as the two parties have yet to reach agreement. President Barack Obama addressed the nation with his frustration over the deadlock: “Once again, the economy will be held captive unless they [Republican lawmakers] get their way. This is no way to run the greatest country on earth.”

“Every day that goes by without a deal will see investors become a bit more defensive,” said Omer Esiner, chief market analyst at Commenwealth Foreign Exchange in Washington to Reuters. The stalemate has shook the American position in global markets and experts say that failure to reduce the government deficit by $4 trillion over the next 10 years will downgrade the United States.

President Obama said in a televised address on Monday “I have told leaders of both parties that they must come up with a fair compromise in the next few days that can pass both houses of Congress – a compromise I can sign. And I am confident we can reach this compromise.” Leaders of both parties have insisted that they will not allow the United States to default but so far, demands from both sides have been irreconcilable.

Republican lawmakers say the lift of the debt ceiling must be accompanied by even larger reduction in spending, reflecting the Tea Party line to shrink government. Meanwhile, the Democrats want to shield Medicare and Medicaid to secure old and poor Americans — they want any cuts in the healthcare system to be balanced by changes in the U.S. tax code, something that Republicans in the House of Representatives have staunchly refused.

Because of the division between Republican control in the House and Democratic sway over the Senate, it seems unlikely that their competing plans will win bipartisan support by August 2, when the US ‘runs out of cash to pay its bills’.

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In case you haven’t been paying much attention, and I don’t really blame you if you have kept your eyes closed, Rep. Paul Ryan may singlehandedly be responsible for the impending self-implosion of the Republican Party.  Less than six months after Republicans had their sweeping midterm election win, the tables have turned yet again. Republicans have steadily been losing ground with the majority of voters.  After promising to create jobs, they have instead focused on cutting programs in an attempt to “balance the budget.” They have teleported us back to the mid 90’s and focused on legislating morality.  You know abortion, gays, prayers, that kind of useful stuff.  Then Ryan’s Medicare plan.  It is just politics 101, you don’t piss off seniors.  Senior citizens vote in droves and they like Medicare.  Really.  They enjoy having a low cost government run insurance.  Sounds unbelievable right?  No person in their right mind wants to shop around private insurance companies, with a little coupon, to find the best deal.  Especially a senior citizen.  This is my version of hell.  And the costs will be astronomical.

Many pundits point out that the Medicare problem needs to be “fixed.” And how do these same pundits propose we “fix” the problem?  As usual on the backs of elderly and the poor.  Cut programs.  It is always a spending problem and never a revenue problem.  Guess what?  If we didn’t extend the ridiculous tax cuts to really really rich people, we would not have a freaking Medicare problem.  Common sense.  But, no…we have far too little of that.  Instead the Republicans are jumping on the doomed ship that is Ryan’s Medicare privatization plan.  And the sink is already sinking.  It is plummeting fast to the bottom of the ocean since the shocking victory in upstate New York on Tuesday night.

Despite Paul’s significant contribution to the demise of the GOP, Republican insiders are now trying to draft him to step into the ring for the presidential race in 2012. House Majority Leader Eric Cantor is the latest leader in the GOP party to endorse Ryan.

“Paul Ryan is about real leadership,” he told reporters at a weekly press briefing. “I think what this public so desperately wants to do right now . . . [is] see a Washington that will lead. They don’t want to see individuals that dismiss the current problems as something that we can just sweep under the rug.”

Ryan, however, has stated he has no interest in running.. “I’ve been very clear about this, I’m not running for president,” he said on NBC’s Meet the Press last week. “If you’re running for president, you’ve got to do a lot of things to line up a candidacy. I have not done any of those things.”

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It has been a rough first week for Newt Gingrich and his presidential campaign. The Republican candidate believes that because he is calling for “real change,” he will cause controversy.   The controversy that Gingrich is talking about includes his own party.  His comments earlier in the week about U.S. Rep. Paul Ryan’s (R-Wis.) dramatic Medicare overhaul caused outrage among Republicans, suggesting that Newt may be running against President Obama on his own.

On Sunday, Gingrich created the controversy on NBC’s “Meet the Press.” “What you want to have is a system where people voluntarily migrate to better outcomes, better solutions, better options, not one where you suddenly impose it,” he said. “I am against Obamacare imposing radical change, and I would be against a conservative imposing radical change.”

The House GOP plan, proposed by Rep. Ryan would turn Medicare into a voucher system.  Seniors would be given money to purchase private insurance. Gingrich said he prefers the current Medicare program in addition to a private alternative.  “I don’t think right-wing social engineering is any more desirable than left-wing social engineering,” he said. “I think we need a national conversation to get to a better Medicare solution for seniors.”

Following the comments, the backlash was fierce from all directions. Democrats have since launched a website thanking Newt for pointing out that Rep. Ryan’s plan is radical. Gingrich was forced to apologize to Rep. Ryan for his comments.  He also retracted the remarks and told Fox News that any news outlets that quote those statements from him would be misquoting him.  “Any ad which quotes what I said on Sunday is a falsehood, because I have said publicly those words were inaccurate and unfortunate,” he said. “When I make a mistake — and I’m going to on occasion — I’m going to share with the American people that was a mistake, because that way we can have an honest conversation.”

The former speaker of the house returned to Iowa after the controversy for a three day trip throughout the state.  His first stop in Waterloo was to speak in front of a crowd of about 150 enthusiastic followers.

The Des Moines Register reports that Gingrich asked supporters to appear in a video aimed at keeping his presidential political operations alive after a tough first week.   “Any of you who are willing to do just a brief video with him [an Iowa campaign staffer] of why you’re for me it would be very helpful ’cause we have to sort of convince the Washington news media that actually the voters will decide when this election is over, not five or six pundits,” he said.

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The Australian Federal government is implementing changes to Medicare, Australia’s publicly funded universal healthcare system.

The government change includes the founding of Medicare Locals, which will be run independent of the government with links to community medical organisations.

The Australian Medical Assocatiotion (AMA) has voted to oppose the establishment of Medicare Locals and called on the government to provide greater consultation with the medical profession.

AMA President, Dr Andrew Pesce, said the government needs to involve and recognize general practitioners (GPs) in the delivery of health care.

“The AMA cannot support primary care reforms that do not explain how they would benefit patients or communities, and which do not guarantee they would maintain and support the leadership role of GPs in primary care.”

The Queensland Aboriginal and Islander Health Council (QAIHC) have come forward is support of Medicare Locals, but have stressed that Aboriginal and Torres Strait Islander interests are included in the planning process.

Chairperson of the QAIHC, Ms Sheryl Lawton, has called for a partnership between the QLD General Practitioners and the Aboriginal and Islander health sector.

“QAIHC believes that the new Medicare Locals can make a significant dent in the current inefficiencies in the health system but their effectiveness in supporting efforts to close the health gap between Indigenous and other Australians will be determined by how much Aboriginal and Islander health experts have in setting them up and in developing their role,” Ms Lawton said.

The Medicare Locals will begin operating in mid-2011, and the remaining being introduced by mid-2012.

Medicare Locals will be given funding to specifically target gaps in the health care service for those in aged care.

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