Posts Tagged ‘eligibility’

Doctor Cassell: ‘If You Voted For Obama, Seek Urologic Care Elsewhere’

April 2, 2010

A doctor in Mount Dora, Florida just became my very favorite urologist.  And I will bet his practice expands as a result of the courageously outspoken stand he recently took.

Let me begin with the rather-obviously politically-biased Orlando Sentinel account of Dr. Cassell:

Doctor tells Obama supporters: Go elsewhere for health care
A Mount Dora doctor posted a sign telling Obama health care supporters to go elsewhere.
By Stephen Hudak, Orlando Sentinel

8:22 a.m. EDT, April 2, 2010

MOUNT DORA — A doctor who considers the national health-care overhaul to be bad medicine for the country posted a sign on his office door telling patients who voted for President Barack Obama to seek care “elsewhere.”

I’m not turning anybody away — that would be unethical,” Dr. Jack Cassell, 56, a Mount Dora urologist and a registered Republican opposed to the health plan, told the Orlando Sentinel on Thursday. “But if they read the sign and turn the other way, so be it.”

The sign reads: “If you voted for Obama … seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”

Estella Chatman, 67, of Eustis, whose daughter snapped a photo of the typewritten sign, sent the picture to U.S. Rep. Alan Grayson, the Orlando Democrat who riled Republicans last year when he characterized the GOP’s idea of health care as, “If you get sick, America … Die quickly.”

Chatman said she heard about the sign from a friend referred to Cassell after his physician recently died. She said her friend did not want to speak to a reporter but was dismayed by Cassell’s sign.

“He’s going to find another doctor,” she said.

Cassell may be walking a thin line between his right to free speech and his professional obligation, said William Allen, professor of bioethics, law and medical professionalism at the University of Florida‘s College of Medicine.

Allen said doctors cannot refuse patients on the basis of race, gender, religion, sexual orientation or disability, but political preference is not one of the legally protected categories specified in civil-rights law. By insisting he does not quiz his patients about their politics and has not turned away patients based on their vote, the doctor is “trying to hold onto the nub of his ethical obligation,” Allen said.

“But this is pushing the limit,” he said.

Cassell, who has practiced medicine in GOP-dominated Lake County since 1988, said he doesn’t quiz his patients about their politics, but he also won’t hide his disdain for the bill Obama signed and the lawmakers who passed it.

In his waiting room, Cassell also has provided his patients with photocopies of a health-care timeline produced by Republican leaders that outlines “major provisions” in the health-care package. The doctor put a sign above the stack of copies that reads: “This is what the morons in Washington have done to your health care. Take one, read it and vote out anyone who voted for it.”

Cassell, whose lawyer wife, Leslie Campione, has declared herself a Republican candidate for Lake County commissioner, said three patients have complained, but most have been “overwhelmingly supportive” of his position.

“They know it’s not good for them,” he said.

Cassell, who previously served as chief of surgery at Florida Hospital Waterman in Tavares, said a patient’s politics would not affect his care for them, although he said he would prefer not to treat people who support the president.

“I can at least make a point,” he said.

The notice on Cassell’s office door could cause some patients to question his judgment or fret about the care they might receive if they don’t share his political views, Allen said. He said doctors are wise to avoid public expressions that can affect the physician-patient relationship.

Erin VanSickle, spokeswoman for the Florida Medical Association, would not comment specifically.

But she noted in an e-mail to the Sentinel that “physicians are extended the same rights to free speech as every other citizen in the United States.”

The outspoken Grayson described Cassell’s sign as “ridiculous.”

“I’m disgusted,” he said. “Maybe he thinks the Hippocratic Oath says, ‘Do no good.’ If this is the face of the right wing in America, it’s the face of cruelty. … Why don’t they change the name of the Republican Party to the Sore Loser Party?”

How about changing the name of the Democrat Party to the Demagogue Party?  Or maybe the Depravity Party?

As to Alan Grayson, just remember that this is same the hater who thought demonizing Republicans as hoping people would die was not one iota over the top.

For the record, I didn’t add any of those html links to the story; they are part of the article.  Do you see which link is missing if this was to be an even halfway fair article?

Where’s the link to the timeline???

No link to that.  Half a dozen links to other stuff, but no link to the timeline the doctor referred to.  The only thing the Orlando Sentinel does is dismiss it as “Republican.”  Nothing to see there, folks.

I don’t care if the timeline came from Republican leaders.  I only care whether it accurately reflects the facts of the bill, and whether those facts are bad.

I heard about this story via Neil Cavuto’s program on Fox News.  Dr. Jack Cassell very clearly indicates on the program that the reason for the sign that he’s being demonized about was that timeline.  It was the what and the why of the five questions journalists are supposed to ask: Why did you do what you did?

Oh, we can point out the bias in the fact that Dr. Cassell says that 98% of his patients have responded favorably to the sign, whereas the Orlando Sentinel wants to make sure the only patient who gets to speak is one of the 2%.  We can point out that the liberal blogoshphere is trying to depict Dr. Cassell as turning away patients because they voted for Obama (and isn’t that hateful?!?!), when Dr. Cassell repeatedly says he isn’t turning patients away.

Dr. Cassell is making a statement, which he has every right to do.  And on Neil Cavuto’s program, the doctor says he came to the decision to do so as a result of coming across the timeline to ObamaCare.  He says that timeline angered him so much when he looked into it that he chose to take a risk and make a stand.

SOMEBODY SHOULD TELL US WHAT’S IN THAT TIMELINE THAT GOT DR. CASSELL SO RILED UP IF THEY’RE GOING TO DENOUNCE HIM, SHOULDN’T THEY???

Here’s the timeline:

Timeline of Major Provisions in the Democrats’ Health Care Package

2009
• 2-year tax credit (total cap of $1B) for new chronic disease therapy investments
• Medicare cuts to hospitals begin (long-term care (7/1/09) and inpatient and rehabilitation facilities (FY10))

2010
• States and Federal officials review premium increases
• FDA authorized to approve “follow-on” biologics
• Increase brand name pharmaceutical Medicaid rebate (from 15.1% to 23.1%)
• Medicare payments to physicians in primarily rural areas increase (2 years)
• Deny “black liquor” eligibility for cellulosic biofuel producers credit
• Tax credits provided to certain small employers for health care-related expenses
• Increase adoption tax incentives for 2 years
• Codify economic substance doctrine and impose penalties for underpayments
(transactions on/after 3/23/10)
• Provide income exclusion for specified Indian tribe health benefits provided after 3/23/10
• Temporary high-risk pool and high-cost union retiree reinsurance ($5 B each for 3.5
years) (6/23/10)
• Impose 10% tax on indoor UV tanning (7/1/10)
• Medicare cuts to inpatient psych hospitals (7/1/10)
• Prohibits lifetime and annual benefit spending limits (plan years beginning 9/23/10)
• Prohibits non-group plans from canceling coverage (rescissions) (plan years
beginning 9/23/10)
• Requires plans to cover, at no charge, most preventive care (plan years beginning 9/23/10)
• Allows dependents to stay on parents’ policies through age 26 (plan years beginning 9/23/10)
• Provides limited protections to children with pre-existing conditions (plan years beginning 9/23/10)
• Hospitals in “Frontier States” (ND, MT, WY, SD, UT ) receive higher Medicare payments (FY11)
• Hospitals in “low-cost” areas receive higher Medicare payments for 2 yrs ($400 million, FY11)

2011
• Medicare Advantage cuts begin
• No longer allowed to use FSA, HSA, HRA, Archer MSA distributions for over-the-counter medicines
• Medicare cuts to home health begin
• Wealthier seniors ($85k/$170k) begin paying higher Part D premiums (not indexed for inflation in Parts B/D)
• Medicare reimbursement cuts when seniors use diagnostic imaging like MRIs, CT scans, etc.
• Medicare cuts begin to ambulance services, ASCs, diagnostic labs, and durable medical equipment
• Impose new annual tax on brand name pharmaceutical companies
• Americans begin paying premiums for federal long-term care insurance (CLASS Act)
• Health plans required to spend a minimum of 80% of premiums on medical claims
• Physicians in “Frontier States” (ND, MT, WY, SD, UT ) receive higher Medicare payments
• Prohibition on Medicare payments to new physician-owned hospitals
• Penalties for non-qualified HSA and Archer MSA distributions double (to 20%)
• Seniors prohibited from purchasing power wheelchairs unless they first rent for 13 months
• Brand name drug companies begin providing 50% discount in the Part D “donut hole”
• 10% Medicare bonus payment for primary care and general surgery (5 years)
• Employers required to report value of health benefits on W-2
• Steps towards health insurance administrative simplification (reduced paperwork, etc) begins (5 yr process)
• Additional funding for community health centers (5 years)
• Seniors who hit Part D “donut hole “in 2010 receive $250 check (3/15/11)
• New Medicare cuts to long-term care hospitals begin (7/1/11)
• Additional Medicare cuts to hospitals and cuts to nursing homes and inpatient rehab facilities begin (FY12)
• New tax on all private health insurance policies to pay for comp. eff. research (plan years beginning FY12)

2012
• Medicare cuts to dialysis treatment begins
• Require information reporting on payments to corporations
• Medicare to reduce spending by using an HMO-like coordinated care model (Accountable Care Organizations)
• Medicare Advantage plans with a 4 or 5 star rating receive a quality bonus payment
• New Medicare cuts to inpatient psych hospitals (7/1/12)
• Hospital pay-for-quality program begins (FY13)
• Medicare cuts to hospitals with high readmission rates begin (FY13)
• Medicare cuts to hospice begin (FY13)

2013
• Impose $2,500 annual cap on FSA contributions (indexed to CPI)
• Increase Medicare wage tax by 0.9% and impose a new 3.8% tax on unearned , non-active business income for those earning over $200k/$250k (not indexed to inflation)
• Generally increases (7.5% to 10%) threshold at which medical expenses, as a % of income, can be deductible
• Eliminate deduction for Part D retiree drug subsidy employers receive
• Impose 2.3% excise tax on medical devices
• Medicare cuts to hospitals who treat low-income seniors begin
• Post-acute pay for quality reporting begins
• CO-OP Program: Secretary awards loans and grants for establishing nonprofit health insurers
• $500,000 deduction cap on compensation paid to insurance company employees and officers
• Part D “donut hole” reduction begins, reaching a 25% reduction by 2020

2014
• Individuals without gov’t-approved coverage are subject to a tax of the greater of $695 or 2.5% of income
• Employers who fail to offer “affordable” coverage would pay a $3,000 penalty for every employee that receives a subsidy through the Exchange
• Employers who do not offer insurance must pay a tax penalty of $2,000 for every full-time employee
• More Medicare cuts to home health begin
• States must have established Exchanges
• Employers with more than 200 employees can auto-enroll employees in health coverage, with opt-out
• All non-grandfathered and Exchange health plans required to meet federally-mandated levels of coverage
• States must cover parents /childless adults up to 138% of poverty on Medicaid, receive increased FMAP
• Tax credits available for Exchange-based coverage, amount varies by income up to 400% of poverty
• Insurers cannot impose any coverage restrictions on pre-existing conditions (guaranteed issue/renewability)
• Modified community rating: individual or family coverage; geography; 3:1 ratio for age; 1.5 :1 for smoking
• Insurers must offer coverage to anyone wanting a policy and every policy has to be renewed
• Limits out-of-pocket cost-sharing (tied to limits in HSAs, currently $5,950/$11,900 indexed to COLA)
• Insurance plans must include government-defined “essential benefits ” and coverage levels
• OPM must offer at least two multi-state plans in every state
• Employers can offer some employees free choice vouchers for health insurance in the Exchange
• Government board (IPAB) begins submitting proposals to cut Medicare
• Impose tax on nearly all private health insurance plans
• Medicare payment cuts for hospital-acquired infections begin (FY15)

2015
• More Medicare cuts to home health begin

2016
• States can form interstate insurance compacts if the coverage with HHS approval (2016)

2017
• Physician pay-for-quality program begins for all physicians
• States may allow large employers and multi-employer health plans to purchase coverage in the Exchange.
• States may apply to the Secretary for a limited waiver from certain federal requirements

2018
• Impose “Cadillac tax on “high cost” plans, 40% tax on the benefit value above a certain
threshold: ($10,200 individual coverage, $27,500 family or self-only union multi-employer coverage)

Now, maybe you love what ObamaCare does.  But Dr. Jack Cassell most certainly does not.  He sees the destruction of medicine, and the destruction of his medical practice contained in this timeline that just keeps imposing more and more and more.

Dr. Jack Cassell sees what’s coming.  And you should see it too.

And he wants to poke people in the eyeballs and wake them the heck up before it’s too late.

Dr. Jack Cassell.  My very favorite urologist.