Coming Soon to Maryland Hospitals - Health Care Rationing

from the Washington Post

In a world of constantly rising health-care costs, Maryland has long stood alone. Through a novel system that gave regulators unusual leverage to set prices, the state delivered care at a price that grew slower than elsewhere in the country — even at some of the nation’s most renowned hospitals.

But after saving an estimated $45 billion for consumers over four decades, the system is in danger of running aground. Hospital expenses have risen so relentlessly in recent years that the original price controls now appear unsustainable.

In its place, Maryland officials are pressing for an expansion of the state’s authority over its hospitals. The new system would not only set prices for the procedures they perform but also cap the growth in their overall spending.

The proposal has ignited a debate in Annapolis and beyond over how far the government should go in reining in sky-
rocketing health-care bills. Advocates for the plan say it is the most effective way to curb costs and that it could serve as a model for the rest of the country.

“Maryland wants to really hold health-care costs accountable,” said John McDonough, a health policy professor at Harvard University. “So far, no state has ever done that.”

But critics say the near-collapse of the state’s old system proves the perils of heavy-handed regulations.

“Hospital rate-setting clearly didn’t succeed at meaningfully slowing costs down,” said Joe Antos, who served eight years on the Maryland board that set rates.

The debate is being closely watched as health officials around the country are struggling to implement the Obama administration’s new health-care law. Many states are seeking ways to keep costs down as millions of uninsured Americans are added to the rolls of the insured.

“Should Maryland demonstrate meaningful initial cost savings, we believe other state and national efforts . . . will gain momentum,” George Huang, a senior analyst at Wells Fargo Securities, wrote in an April analysis of the Maryland proposal.

Maryland’s existing system was once hailed for eliminating an unwieldy element of the health-care system: the haggling between medical providers and insurance companies.

In other states, each time a hospital provides a service, it has to negotiate how much money it receives from an insurer. The time-consuming and often contentious process results in widely varying prices for the same procedures.

Hospitals pushed for the highest possible payouts partly because they say they do not receive enough from Medicare, the federal program that reimburses medical providers for their care of the elderly.

Maryland put an end to the wrangling. It established a state commission that directly set rates for procedures at all of its 46 hospitals. Over time, hospitals and insurers embraced the system because they knew exactly what to expect.

Medicare had to reimburse Maryland’s hospitals at a higher rate than it did in other states. But federal officials went along with it because, at the time, they wanted to experiment with other models of health care.

In the late 1970s, the U.S. government agreed to a provision that gave Maryland the unique authority to set its own prices — even for Medicare. Analysts estimate that recently the state’s hospitals have been receiving an extra $1 billion in Medicare reimbursements each year.

A handful of other states, including New York and New Jersey, tried to implement a similar system in the late 1970s and early 1980s. But unlike Maryland, they did not get the higher reimbursements written into federal law and gave up on the program.

“Maryland made a very strategic, savvy move,” said McDonough, the Harvard professor. “Had they not locked in those higher payments [from Medicare], there wouldn’t be value in the program.”

The system led Maryland hospitals to charge patients and their insurance companies much-lower prices than those in other states. New Medicare data released this month on hospitals’ sticker prices for the 100 most-common procedures showed that, in each case, Maryland’s hospitals submitted the lowest charges in 2011.

In 1976, a year before rate-setting was put in place, the average cost of a Maryland hospital admission was 26 percent above the national average, according to a widely cited study by the former head of the rate-setting commission. By 2007, it was 2 percent below the national average.

But when it came to payments from Medicare, Maryland’s reimbursements were well above the national average. For 11 of the 100 common procedures, Maryland hospitals were paid more than hospitals in other states. And for 79 procedures, the state ranked among the top five.

While hospitals nationwide received, on average, $6,011 to treat a case of bronchitis from Medicare, Maryland hospitals were reimbursed $8,375.

Over the past several years, Maryland’s system began to unravel. Hospitals saw their expenses soar, and the cost controls proved too inflexible to handle the rise.

Part of the problem with the old system is that it gave hospitals an incentive to admit as many people as possible. The more patients who walked through the door, the more the hospitals would get paid.

So Maryland officials came up with a new approach. On top of setting rates for individual procedures, they are proposing a cap on the growth of the total amount the hospital system spends per person in the state. The plan also allows hospitals to charge higher prices if they adopt preventive-care methods that improve patient health and reduce repeat visits, said Maryland’s health secretary, Joshua Sharfstein.

“We think this new approach allows us to better tackle overall costs and create a strong incentive for better health,” he said.

Under the proposal, total hospital spending would be tied to long-term economic growth in the state. That way, when the economy is in recession, costs would grow more slowly, while in boom times, they would be allowed to rise quicker, officials said.

Maryland Republicans have for years objected to the state’s central role in rate-setting for procedures. In 2011, Senate Minority Leader E.J. Pipkin, an Eastern Shore Republican, urged the federal government to rescind the state’s authority.

He said he was stunned by the scope of the state’s new proposal and added that the legislature should have been consulted.

“My question is, what does this do for patient care?” Pipkin said. “The state is trying to impose a solution on a problem, but it is a dramatic change to the system of health-care reimbursement in Maryland, and it’s not being property vetted.”

Hospitals say the plan, if approved, could be onerous, hurting the financial health of the $15 billion hospital industry that employs nearly 100,000 people in Maryland.

John M. Colmers, who chairs Maryland’s Health Services Cost Review Commission and was a key architect of the proposal, acknowledged that the proposal might be “a challenge” for hospitals. Colmers is also a top vice president at Johns Hopkins Medicine in Baltimore.

Insurers, meanwhile, have approached the new plan with cautious optimism.

“It’s probably very sensible to consider doing something like this,” said Chet Burrell, chief executive of BlueCross BlueShield CareFirst, the state’s largest health plan.

Maryland officials say that they are in intense discussions with federal officials and that the plan could still be refined. They have also reached out to hospital and insurance executives to solicit additional input. State officials hope to get approval from federal officials over the next several months so they can put the new system in place by January.

“At its core, this proposal would put a lid on total hospital spending for all the people in the state, and that’s what makes it such a big deal,” said Carmela Coyle, head of the Maryland Hospital Association. “It’s never been done before. It’s never been tried before.”

Patriot Alert!

From The Dagger and Harford Campaign for Liberty:

May 28, 2013
7 pm – 9 pm
Knights of Columbus Hall
23 Newport Drive
Forest Hill, Maryland

FED UP with Plan Maryland, the Septic Bill, the Rain Water Tax, the Tier Map, and all the other unfunded mandates being thrown at us by the EPA and Annapolis?

TIRED of having your wallet picked to fund an ever growing list of scientifically questionable environmental initiatives?

WONDERING what successes other states have had in the fight against these abuses?

Do you ever ask, “Is there is another way”?

There is another way! Mr. Chip MacLeod, an attorney representing the Clean Chesapeake Coalition www.cleanchesapeakecoalition.org will speak on efforts that this seven county organization is putting forward to fight these mandates without neglecting real environmental issues.

Also on the agenda:

You. Bring your ideas to the open mike!

An update on the nullification efforts in Cecil, Harford, and Carroll Counties. What do they mean?

An opportunity to connect with other patriots.

Free Admission
Cash bar available.
For more info, visit www.harfordliberty.org.

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Maryland Governor Grants Murders Greater Rights than Homicide Victims

from the Baltimore Sun

Surrounded by religious leaders, civil rights activists and others who have fought for years to stop executions in Maryland, Gov. Martin O'Malley signed legislation Thursday repealing the state's death penalty.

Unless the law is overturned in a referendum, Maryland will become the 18th state to end capital punishment, leaving life without parole as the maximum penalty for any crime.

"We have a responsibility to stop doing those things that are wasteful and ineffective," O'Malley, a Democrat, said before putting pen to paper.

The bill, which passed both houses of the General Assembly with votes to spare in March, fulfills a goal O'Malley set early in his administration.

Death penalty repeal was one of more than 200 bills the governor signed Thursday. Among them were measures legalizing the use of marijuana for medical purposes and allowing people in the country illegally to obtain a state driver's license.

But it was the abolition of the death penalty after more than 300 years on the books in Maryland that took center stage. Hundreds of repeal supporters lined up to have their pictures taken with O'Malley, House Speaker Michael E. Busch and Senate President Thomas V. Mike Miller. It took six photos — each with dozens of advocates — to accommodate all who wanted their moment in state history.

The first two ceremonial pens went to Sen. Lisa A. Gladden and Del. Sandy Rosenberg, Baltimore Democrats who have long pushed to end capital punishment. The third pen went to NAACP President Ben Jealous, who had urged O'Malley to try again for repeal this year after falling short in 2009.

Gladden, the Senate's leading repeal proponent since 2003, said she was "trying not to cry."

"I want to savor the moment," she said.

Rosenberg, the lead House sponsor since 2007, called the signing a significant accomplishment for Maryland. "It was time we all put an end to this unethical, racially discriminatory, wasteful process," he said. "The time and effort that goes into this issue can now go into other criminal justice issues."

Jealous, who helped round up enough votes in the Senate to persuade O'Malley to move forward this year, noted that most of the world's advanced nations have stopped executions.

"This is the day we join the rest of Western civilization by abolishing the death penalty," he said. Since the General Assembly's passage of the bill in March, Jealous said, the campaign to repeal capital punishment has gained momentum in Delaware, Colorado, New Hampshire and other states.

Kirk Bloodsworth, the former Eastern Shore waterman who was convicted of the murder of a 9-year-old girl in Baltimore County but later exonerated by DNA evidence, said he'd been waiting 28 years to witness such a signing.

"Twenty-eight years ago I was sitting in a death row cell, and it became clear to me we could execute an innocent man," he said. "No innocent person will ever be executed in this state ever again."

Del. Michael Smigiel, an Eastern Shore Republican who attended the bill signing, said he shook Bloodsworth's hand as one ex-Marine to another. But Smigiel, who voted against repeal, said he remains concerned about cases such as the killing of correctional officers and incidents such as the Boston Marathon bombing.

"I have grave concerns about the state having the power of life and death over other people, but there are circumstances where that's the only penalty that's appropriate for a crime," he said.

The signing may not be the final word on the subject. If opponents of repeal can gather 55,736 valid signatures by June 30 — the first third are due May 31 — the law would go to voters to decide in the November 2014 election.

Del. Neil Parrott, the Western Maryland Republican who led recent referendum drives, has scheduled a news conference Friday at Camden Yards to announce whether he'll try to petition the repeal law as well. Baltimore County State's Attorney Scott Shellenberger, a Democrat who supports capital punishment, also is scheduled to appear.

Parrott declined Thursday to announce the decision, but said: "One way or another, it's not over." According to the State Board of Elections, language for death penalty petition forms has been approved.

Though polls show Marylanders are closely split, repeal advocates say they are confident they would prevail in a referendum.

"No innocent person will ever be executed in this state ever again."

Really Mr. Bloodsworth? What about the VICTIMS of these homicidal criminals, won't THEY have been executed in this State? Apparently in Maryland, only the "Guilty" have "rights". The rest of us are merely advocates for "wasteful" and "discriminatory" fiscal policies. Justice has NOTHING to do with it. < /sarcasm OFF>

Gun Rights Rally Planned in Havre de Grace on May 4

From the Dagger and Maryland Liberty PAC:

Maryland Liberty Pac and Maryland Campaign for Liberty plan to peacefully rally at the 700 block of Concord Street in Havre de Grace at 4:00 PM on Saturday, May 4th, to celebrate the history of Havre de Grace in 1813 and show support for gun rights and liberty in Maryland. This is in the wake of newly passed stricter Maryland gun laws—laws that the groups say are not at all about gun control, but people control.

George Tucker, who in 1813 was a Virginia Supreme Court judge appointed by James Madison, wrote this about gun control: “This may be considered as the true palladium of liberty…The right of self-defense is the first law of nature; in most governments it has been the study of rulers to confine this right within the narrowest limits possible. Whenever standing armies are kept up, and the right of the people to keep and bear arms is, under any color or pretext whatsoever, prohibited, liberty, if not already annihilated, is on the brink of destruction.”

Havre de Grace is planning major celebrations and reenactments of the storied defense of the town against the British attack and burning of the city in 1813. Patriots plan to gather to educate citizens that their freedom and liberty are similarly under attack today, from our own elected representatives in Annapolis and Washington.

In May of 1813, most of the citizen militia (by US Code definition, all able-bodied males between the ages of eighteen and forty-five) were in Baltimore to defend that city. Left in town were the older militia members. One local man became the hero who did all he could to protect his town. John O’Neil, a gunsmith and nail maker, manned the cannon to keep the British barges at bay until he was injured and forced to use only long rifle fire and retreat to the commons.

The older militia members who were still in Havre de Grace feared the British superior display of firepower and had retreated. They left the city to be looted and burned, and John O’Neil to be captured. Similarly, these patriot groups fear that Marylanders are letting the legislature—without serious opposition—‘burn’ their rights and destroy the liberties that made Maryland the once “Free State”.

Participants are expected to point out the hypocrisy of anti-gun rights Governor Martin O’Malley (who was scheduled to speak at 7 PM at the lighthouse) being at a celebration of citizens defending themselves with the best weapons available. His administration is actively working to take away the rights of Marylanders to defend their homes, families and country with the best weapons available today. O’Malley’s office says now that this event “is not on his calendar.”

“The Kentucky long rifle was the ‘assault weapon’ of that day,” said Maryland Liberty PAC’s Joe Fleckenstein. “If O’Malley had been governor in 1813, we could be British today—and like Britain, citizens would be disarmed and crime would be rampant.”

The organizers are urging liberty-minded Marylanders to arrive by 4 PM to meet and greet the crowds with literature celebrating the history of the patriots of Havre de Grace who fought to defend all of the freedoms enumerated in the Bill of Rights. Copies of the Constitution will also be given out at no charge.

For Freedom,

Joseph Fleckenstein
Treasurer
Maryland Liberty PAC

O’Malley Comes to HDG , Gun Rally Planned to Expose his Hypocrisy

From the Cecil County Campaign for Liberty:

Friends,

Martin O’Malley is coming into our backyard next Saturday , May 4th. The War of 1812 – Attack on Havre de Grace commemoration weekend is being held this coming weekend in Havre de Grace. This event is being held to commemorate the citizen’s militia that attempted to protect Havre de Grace from the British in the war of 1812.

During the raid on Havre de Grace , Second Lieutenant John O’Neill single-handedly manned a battery until he was struck by the recoil of his cannon. There is a cannon on display at the Concord Point Light House that is a memorial to this event. Martin O’Malley will be using this memorial as a back drop as he gives a speech on Saturday. Do you see the hypocrisy in this?

Martin O’Malley giving a speech to commemorate the citizen’s militia , weeks after pushing the 2nd Amendment shredding “Firearms Safety act of 2013″. If Martin O’Malley had been Governor in 1812 , the militia would have been disarmed!

Please join Campaign for Liberty and Maryland Liberty PAC in a gun rally to point out Martin O’Malley’s hypocrisy on the 2nd Amendment. We will be gathering at the Concord Point Lighthouse from 4pm-7pm in a show of support for our 2nd Amendment rights. Martin O’Malley is scheduled to speak at 7pm.

This is your chance to let him hear how you feel about his gun grabbing Firearms Safety Act of 2013.

For more information go to hdggunrally.com . This site will be updated as more info become available. You can also go to the event page on Facebook and sign up by clicking here.

Please share this email with your friends and family. Let’s show O’Malley that “We the People” will never quit in the fight to protect our God-given rights.

For Liberty,

Bob Willick
Steering Committee Member
Cecil County Campaign for Liberty

Joe Tropp
Steering Committee Member
Cecil County Campaign for Liberty

Arlen Besel
Steering Committee Member
Cecil County Campaign for Liberty

Greg Meyer
Steering Committee Member
Cecil County Campaign for Liberty