Primary Care Reimbursement Under Health Care Reform


Posted on 28th December 2009 by Gordon Johnson in Uncategorized

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We have heard much about the size of the new Health Care Reform Act, something nearly 2,000 pages. We have heard very little about what is inside of it except that it will cover more people, provide coverage for those with preexisting conditions and expand the coverage by as much as 30 million people. But how is it going to cut costs? And how will it assure that low income people truly have access to medical care?

One of the provisions included in the Senate plan is to increase the reimbursement rate of primary care doctors who are seeing Medicaid patients. See Health Care Business News at In that article they explain:
A key objective of the bill is to bolster the ranks of the primary care workforce. The legislation includes a raft or new funding and measures aimed to encourage doctors to move into primary care . And in a measure to help increase transparency, the legislation requires HHS to develop a “Physician Compare” web site where Medicare beneficiaries can compare measures of physician quality and a patient’s perception of care.
This is an important part of the plan. Primary care doctors are in my opinion, the most important doctors in our system and sadly the lowest paid. See

Our current medical system is built around the concept of a gatekeeper, the primary care or family practice doctor. If you have a problem, it is only through treatment by the family care doctor or referral to a specialist from the primary care doctor that you get treated. Thus it is the gatekeeper who plays the most important role in diagnosis of disease. It is also the gatekeeper who must retain the most overall knowledge of medicine as he must be able to spot a problem across the entire spectrum of medical diagnosis. People think that because they are less specialized they have lower skills. For our system to work properly, that can’t be the case. As capitalist, if we want to attract our best doctors to this role, we have to pay them like our best doctors.

When I look at brain injury diagnosis, I see the enormous role that family doctors have to play. In my model, each concussed person would go back to the Emergency Room the day after his or her injury to be seen by the same doctors who saw them on the day of concussion, to determine if there was continuing or worsening symptoms. That is not what is happening in our current system. What happens in our current system is that the concussed patient is told to follow-up with their family doctor, if they get worse. If the family doctor does not know more about diagnosing a concussion than the average neurologist, then the diagnosis and the documentation of symptomotology that is so important will be missed. The reason that second day documentation is so significant is that without it, it becomes extremely difficult to sort out the issue of whether the symptoms that come later are related to brain injury.

My pet project – had I a lobbyist in my pocket for concussion care reform – would be to require the follow-up visit to the ER. Since I don’t have those kind of connections, this provision to increase access (and compensation to family doctors) is a step in the right direction. Now we must do what we can to educate the primary care doctor that testing for amnesia in the days after the accident will tell us more about the severity of injury and potential for disability than all of the scans that have been or will ever be invented.

Health Care Reform Now Awaits Reconciliation


Posted on 27th December 2009 by Gordon Johnson in Uncategorized

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The New York Times is the world’s best newspaper. I learned that in Journalism school almost 40 years ago. It is still true today. Like all newspapers, it is at risk of failure because of the revolutionary shift in advertising revenues caused by the rise in the internet. I never subscribed to the New York Times, because I was a Midwesterner and it just didn’t seem practical. Well the NY Times is now part of my daily reading, because they have perhaps the best online newspaper: I sure hopes the webpage helps the newspaper survive.

I was newly impressed with the NY Times this morning when I read their analysis of the two health care proposals in our Congress, the House version and the Senate version. I think it is a must read for anyone concerned about the health care debate, or about the health of brain injured people. That article is here: If you are required to register to get to this page, by all means, register. In fact, make the your home page, I did.

This article has the most comprehensive explanation of the two bills in Congress and a simple and reasoned explanation of which aspects of each bill should be retained. We hope that our Senators are capable of seeing the big picture and allowing small compromises to get this historic legislation passed. We hope our progressive colleagues in the House don’t blow up the coalition on Health Care Reform over a liberal agenda that can wait for another day.

Read the details. This comes under the category of things you need to know as a citizen.

Health Care Reform Gets Over its Biggest Hurdle


Posted on 24th December 2009 by Gordon Johnson in Uncategorized

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Congratulations to Harry Reid for getting a health care reform bill thru the Senate. After 50 years of effort, the Democrats have almost done it. The next step is reconciliation with the House version and even though the outcome isn’t perfect, it is a huge step. While President Barack Obama has gotten criticism from every direction in the process, he must get high grades for this achievement. When he signs a Health Care Reform bill into law, it will be a moment in history as historic as his election.

I admit that there have been times in the last few weeks when I wondered if the special interest control of our legislatures might ultimately mean that the American system of making laws was broken. But Obama, Reid and Pelosi have found a way to get this done. The found a way to get it done despite the most intensive lobbying effort in history and a complete blockade of legislative cooperation by the Republicans.

Is this the bill that would have best for me? Of course not. I would have preferred the Medicare buy in at 55 because of course, I am 56. Is it the bill that would have been best for all Americans? Probably not. But is it a tremendous step towards coverage for all? Yes it is. After 50 years of nothing, after the collapse of the last major attempt led by two of the great politicians of the last 50 years, Bill and Hillary Clinton, to get this bill out of the Senate is remarkable.

There is some sausage making left over, but when it is done, millions will have health coverage that didn’t, and even though it isn’t everyone, it is still millions whose will have access to medical care.

Bush versus the Trial Lawyers


Posted on 11th September 2009 by Gordon Johnson in Uncategorized

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It is 9/11 today and a good time to reflect on the direction our country has taken this decade and the role trial lawyers can play in our safety and future. In his address on health care reform to the Joint Session of Congress on September 9, 2009, President Barack Obama gave a game changing speech about the overwhelming need for health care reform in the U.S. Yet two incidents from that speech standout in the media and public perception of what he said. Those two incidents were the “you lie” comment from Congressman Joe Who and the Republican enthusiasm for Barack’s discussion of medical malpractice reform. In coming blogs, we will address the high points of what he said about health care reform, but on 9/11, I think it is important to defend the role of American Civil Justice lawyers, in contrast to the havoc that the Republican’s have left us over the last decade.

The Republicans want to blame it all on the trial lawyers. We liberal Democrats want to blame the Republicans for destroying American legitimacy in the world in their endless pursuit of Corporations first and their politics of being tough on national security. Keith Olberman on his show Countdown before the President’s speech said the major issue in the domestic politics of the last 100 years was whether our government was on the side of the Corporations or the people. The competing interests are clear, but it is not just domestic politics which illustrate the danger of choosing Corporate interests over people. In our so called “War on Terror” we chose Corporate warfare (or was that Welfare) versus lawyers.

Two detours on my career otherwise devoted to brain injury advocacy over the last two decades arose out of the events of September 11, 2001. The first, I became an outspoken critic of our first War on Terror and the invasion of Afghanistan. The second, I became part of the first lawsuit filed against the Airlines for 9/11. Those two footnotes to my career do illustrate why we need a lot more Civil Justice and a lot less Corporate first government.

My first public statement about the War in Afghanistan was spoken before my church congregation the Sunday after 9/11. I stood up, without an invitation, and reminded my fellow parishioners of our church’s commitment to peace during a Vietnam, a commitment that had shaped my thinking as a teen, had a major influence on who I became as an adult. I told them that you do not start a war to catch a criminal. Punishing a criminal is a job for laws and lawyers, not armies of crusaders.

I wrote these words about Afghanistan on October 30, 2001:

As the political consensus which propelled American into war starts to fade, the Republican’s and their talk show hosts, remind us of the promise of Bush and Rumsfeld that this would be a long war, that American’s will have to be patient.

I remember an amused arrogance when the Russians invaded Afghanistan circa 1979, somehow clearly remembering James Michener’s portrayal of the country. I am rereading Caravan’s (a James Michener novel copyright of 1963). It is quite prophetic. A passage worth reading with care:

“In Afghanistan, almost every building bears jagged testimony to some outrage. Scars still remained of Alexander the Great or Genghis Kahn or Tamerlane or Nadir Shah of Persia. Was there ever a a land so overrun by terror and devastation as Afghanistan.”

Then later, his character, the Afghanie engineer with the runaway American wife, tells the narrator, an American diplomat, this story of the ancient oasis where they are spending a night.

“Genghis Kahn destroyed Afghanistan. In one assault on the City he killed nearly a million people. That’s not a poetic figure. It’s fact. In Kandahar the slaughter was enormous. Some refugees fled to this caravanserai… this room. They were sure the Mongols wouldn’t find them here, but they did.

“First Genghis erected a pole right through the roof. Then the Mongols took their prisoners and tied their hands. Laid the first batch on he floor over there and lashed their feet to the pole. All around. That’s why the pillar is twelve feet across.

“They just kept on laying the prisoners down, one layer on top of the other until they reached the roof. They didn’t kill a single person that day, the Mongols, but they kept soldiers stationed with sticks to push back the tongues when they protruded. And while the pillar of people was still living – those that hadn’t been pressed to death – they called in masons to plaster over the whole affair. If you’d scrape away the plaster you’d find skulls. But the government takes a dim view of scraping. Its a kind of national monument. The Caravanserai of the Tongues.”

“I tell you these things only to explain the terrible burdens under which Afghanistan has labored. Our major cities have been destroyed so many times. Do you know what I expect … seriously. When a thousand men like me have rebuilt Kabul and made it as great as The City once was, either the Russians or the Americans will come with their airplanes and bomb it to rubble. “

I wonder, does George W. Bush believe that we American’s can win a war of patience against such a people? Perhaps we can declare victory when we have evened the score by killing 5,001 Afghanies. If not, Osama bin Laden’s goal of an Islamic uprising, deposing all western leaning Arab monarchies, will be built upon a foundation of silenced but never forgotten Afghanie tongue.

What does this story have to do with Medical Malpractice reform and the Republican commitment to Corporate World? I will discuss further my actions as a lawyer in 2001 in my coming blogs, and the reader can decide whether the trial lawyers or the Republicans chart the course our country should follow. Know this though, our mess in Afghanistan is getting deeper and the liberal Democratic president of whom I am so proud is at a crossroads decision point to send another 30,000 troops their to pacify the country. If he listens to the politicians and generals and not the historians, our attempted occupation of the unoccupiable country, may be remembered in infamy as long as Genghis Kahn.

Next. You don’t start a war to catch a criminal. That is what the laws, lawyers and the Courts are for.

White House putting off budget update


Posted on 20th July 2009 by Gordon Johnson in Uncategorized

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Healthcare reform, Wallstreet’s collapse and rebirth, unemployment and huge deficits. A hell of a time to finally get the kind of leader this country has needed for a decade. Money and American politics, money in American politics should be on center stage this summer. But it has been a big news cycle of deaths and so far from any upcoming election that only the wonks really seem to notice.

Here are the facts: our economy is in decline and unless we can find ways in which to generate greater economic activity at home, we are going to continue to fall further and further behind. 10% unemployment isn’t a surprise, unless you really believed what the politicians were saying (even Obama) when things looked the darkest. Wall Street can recover, but that doesn’t mean the American economy will recovery. Most of Wall Street’s numbers are based on trading, not production and what production these American companies are doing is overseas.

Regardless of how deep of a hole it seems to put us in we must have economic stimulus from the Federal Government. The complex issue is how we turn that stimulus not only into short term American jobs, but into making the American economy stronger, more competitive, greener. It seems such a logical thing to combine Obama’s idealism on these green issues with the economic needs of our country. But economic planning is complex and thwarted at every turn by special interests.

Time for true leadership in Washington and lets start by telling the truth.

Attorney Gordon Johnson

Date: 7/20/2009 10:08 AM

TOM RAUM,Associated Press Writer

WASHINGTON (AP) — The White House is being forced to acknowledge the wide gap between its once-upbeat predictions about the economy and today’s bleak landscape.

The administration’s annual midsummer budget update is sure to show higher deficits and unemployment and slower growth than projected in President Barack Obama’s budget in February and update in May, and that could complicate his efforts to get his signature health care and global-warming proposals through Congress.

The release of the update — usually scheduled for mid-July — has been put off until the middle of next month, giving rise to speculation the White House is delaying the bad news at least until Congress leaves town on its August 7 summer recess.

The administration is pressing for votes before then on its $1 trillion health care initiative, which lawmakers are arguing over how to finance.

The White House budget director, Peter Orszag, said on Sunday that the administration believes the “chances are high” of getting a health care bill by then. But new analyses showing runaway costs are jeopardizing Senate passage.

“Instead of a dream, this routine report could be a nightmare,” Tony Fratto, a former Treasury Department official and White House spokesman under President George W. Bush, said of the delayed budget update. “There are some things that can’t be escaped.”

The administration earlier this year predicted that unemployment would peak at about 9 percent without a big stimulus package and 8 percent with one. Congress did pass a $787 billion two-year stimulus measure, yet unemployment soared to 9.5 percent in June and appears headed for double digits.

Obama’s current forecast anticipates 3.2 percent growth next year, then 4 percent or higher growth from 2011 to 2013. Private forecasts are less optimistic, especially for next year.

Any downward revision in growth or revenue projections would mean that budget deficits would be far higher than the administration is now suggesting.

Setting the stage for bleaker projections, Vice President Joe Biden recently conceded, “We misread how bad the economy was” in January. Obama modified that by suggesting the White House had “incomplete” information.

The new budget update comes as the public and members of Congress are becoming increasingly anxious over Obama’s economic policies.

A Washington Post-ABC News survey released Monday shows approval of Obama’s handling of health-care reform slipping below 50 percent for the first time. The poll also found support eroding on how Obama is dealing with other issues that are important to Americans right now — the economy, unemployment and the swelling budget deficit.

The Democratic-controlled Congress is reeling from last week’s testimony by the head of the nonpartisan Congressional Budget Office, Douglas Elmendorf, that the main health care proposals Congress is considering would not reduce costs — as Obama has insisted — but “significantly expand” the federal financial responsibility for health care.

That gave ammunition to Republican critics of the bill.

Citing the CBO testimony, House Minority Leader John Boehner, R-Ohio, on Monday accused Democrats of “burying this budget update until after Congress leaves town next month.” He called the budget-update postponment “an attempt to hide a record-breaking deficit as Democratic leaders break arms to rush through a government takeover of health care.”

Late last week, Obama vowed anew that “health insurance reform cannot add to our deficit over the next decade and I mean it.”

The nation’s debt — the total of accumulated annual budget deficits — now stands at $11.6 trillion. In the scheme of things, that’s more important than talking about the “deficit,” which only looks at a one-year slice of bookkeeping and totally ignores previous indebtedness that is still outstanding.

Even so, the administration has projected that the annual deficit for the current budget year will hit $1.84 trillion, four times the size of last year’s deficit of $455 billion. Private forecasters suggest that shortfall may actually top $2 trillion.

The administration has projected that the annual deficit for the current budget year will hit $1.84 trillion, four times the size of last year’s deficit of $455 billion. Private forecasters suggest that shortfall may top $2 trillion.

If a higher deficit and lower growth numbers are not part of the administration’s budget update, that will lead to charges that the White House is manipulating its figures to offer too rosy an outlook — the same criticism leveled at previous administrations.

The midsession review by the White House’s Office of Management and Budget will likely reflect weaker numbers. But where is it?

White House officials say it is now expected in mid-August. They blame the delay on the fact that this is a transition year between presidencies and note that Obama didn’t release his full budget until early May — instead of the first week in February, when he put out just an outline.

Still, the update mainly involves plugging in changes in economic indicators, not revising program-by-program details. And indicators such as unemployment and gross domestic product changes have been public knowledge for some time.

Standard & Poor’s chief economist David Wyss said part of the problem with the administration’s earlier numbers is that “they were just stale,” essentially put together by budget number-crunchers at the end of last year, before the sharp drop in the economy.

Wyss, like many other economists, says he expects the recession to last at least until September or October. “We’re looking for basically a zero second half (of 2009). And then sluggish recovery,” he said.

Orszag, making the rounds of Sunday talk shows, insisted the economy at the end of last year, which the White House used for its optimistic budget forecasts, “was weaker at that time than anyone anticipated.” He cited a “sense of free fall” not fully recognized at the time.

“It’s going to take time to work our way out of it,” the White House budget director told “Fox News Sunday.”

Even as it prepares to put larger deficit and smaller growth figures into its official forecast, the administration is looking for signs of improvement.

“If we were at the brink of catastrophe at the beginning of the year, we have walked some substantial distance back from the abyss,” said Lawrence Summers, Obama’s chief economic adviser.

Copyright 2009 The Associated Press.

A look at health care plans in Congress


Posted on 6th July 2009 by Gordon Johnson in Uncategorized

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Will Barack Obama’s legacy be more lasting on health care than Hillary Clinton’s? The next few months will likely tell us. The big controversy is going to focus on whether there is a “public option.” The attackers of reform claim that if there is a public plan, then the private insurers will adversely affected. With an 80 plus percent growth in premiums and a 400% growth in profits during the Bush years, we can certainly hope they will be.

I don’t want to give up my health insurance coverage, but I sure wouldn’t want to be without any coverage, which is where an increasing number of American’s find themselves. Pressure must be put on all Democratic Senators to side with their constituents, not the insurance lobby in Washington to get what the people need, finally, this time.

Attorney Gordon Johnson

Date: 7/6/2009 3:31 AM

The Associated Press

A look at health care legislation taking shape in the Democratic-controlled House and Senate as President Barack Obama pushes to overhaul the system, cover nearly 50 million uninsured Americans and reduce costs. Many of the details are still being negotiated and any final health care bill would have to meld proposals from the House and Senate.



WHO’S COVERED: Around 95 percent of Americans would be covered. Illegal immigrants would not receive coverage.

COST: Unknown.

HOW’S IT PAID FOR: Cuts to Medicare and Medicaid; $600 billion in unspecified new taxes, likely including new levies on upper-income Americans.

REQUIREMENTS FOR INDIVIDUALS: Individuals required to have insurance, enforced through tax penalty with hardship waivers.

REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Certain small businesses are exempt.

SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level ($88,000 for a family of four) would get subsidies to help them buy coverage.

BENEFIT PACKAGE: A committee would recommend an “essential benefits package” that includes hospitalization, doctor visits, prescription drugs and other services. Out-of-pocket costs limited to $5,000 a year for individuals, $10,000 for families. Health insurance companies can offer several tiers of coverage, but all plans must include the core benefits. Insurers wouldn’t be able to deny coverage based on pre-existing conditions.

GOVERNMENT-RUN PLAN: Plan with payment rates initially modeled on Medicare to compete with private insurers.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Through a new National Health Insurance Exchange open to individuals and, initially, small employers; it would be expanded to large employers over time.

CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals with incomes up to 133 percent of the federal poverty level ($14,404). Currently Medicaid eligibility varies by state, but childless adults are ineligible no matter how poor, and in some states parents with incomes well under the poverty line still aren’t covered.



WHO’S COVERED: Aims to cover 97 percent of Americans.

COST: About $600 million over 10 years, but it’s only one piece of a larger Senate bill.

HOW’S IT PAID FOR: Another committee is responsible for the financing.

REQUIREMENTS FOR INDIVIDUALS: Individuals required to have insurance, enforced through tax penalty with hardship waivers.

REQUIREMENTS FOR EMPLOYERS: Employers who don’t offer coverage will pay a penalty of $750 a year per full-time worker. Businesses with 25 or fewer workers are exempted.

SUBSIDIES: Up to 400 percent poverty level.

BENEFIT PACKAGE: Health plans must offer a package of essential benefits recommended by a new Medical Advisory Council. No denial of coverage based on pre-existing conditions.

GOVERNMENT-RUN PLAN: A robust new public plan to compete with private insurers. The plan would be run by the government, but would pay doctors and hospitals based on what private insurers now pay.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Individuals and small businesses can purchase insurance through state-based American Health Benefit Gateways.

CHANGES TO MEDICAID: Medicaid would be available to individuals with incomes up to 150 percent of the federal poverty level.



WHO’S COVERED: Around 97 percent of Americans. Illegal immigrants would not receive coverage.

COST: Around $1 trillion over 10 years.

HOW’S IT PAID FOR: Possible sources include cuts to Medicare and Medicaid; about $300 billion in revenue from taxing employer-provided health benefits above a certain level; and about $300 billion in revenue from a requirement for employers to pay into the Treasury for employees who get their insurance through public programs.

REQUIREMENTS FOR INDIVIDUALS: Expected to include a requirement for individuals to get coverage.

REQUIREMENTS FOR EMPLOYERS: In lieu of requiring employers to provide coverage, lawmakers are considering penalties based on how much the government ends up paying for workers’ coverage.

SUBSIDIES: No higher than 300 percent of the federal poverty level ($66,150 for a family of four).

BENEFIT PACKAGE: The government doesn’t mandate benefits but sets four benefit categories — ranging from coverage of around 65 percent of medical costs to about 90 percent — and insurers would be required to offer coverage in at least two categories. No denial of coverage based on pre-existing conditions.

GOVERNMENT-RUN PLAN: Unlike the other proposals the Finance Committee’s will likely be bipartisan. With Republicans opposed to a government-run plan, the committee is looking at a compromise that would instead create nonprofit member-owned co-ops to compete with private insurers.


CHANGES TO MEDICAID: Everyone at 100 percent of poverty would be eligible. Between 100 and 133 percent, states or individuals have the choice between coverage under Medicaid or a 100 percent subsidy in the exchange. The expansion would be delayed until 2013, a late change to save money — the start date had been 2011.



WHO’S COVERED: The House GOP’s plan, in outline form for now, says it aims to make insurance affordable and accessible to all. There aren’t estimates about how many additional people would be covered.

COST: Unknown.

HOW’S IT PAID FOR: No new taxes are proposed, but Republicans say they want to reduce Medicare and Medicaid fraud.


REQUIREMENTS FOR EMPLOYERS: No mandates; small business tax credits are offered. Employers are encouraged to move to “opt-out” rather than “opt-in” rules for offering health coverage.

SUBSIDIES: Tax credits are offered to “low- and modest-income” Americans. People who aren’t covered through their employers but buy their own insurance are allowed to take a tax deduction. Low-income retirees younger than 65 (the eligibility age for Medicare) would be offered assistance.

BENEFIT PACKAGE: Insurers would have to allow children to stay on their parents’ plan through age 25.

GOVERNMENT-RUN PLAN: No public plan.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: No new purchasing exchange or marketplace is proposed. Health savings accounts and flexible spending plans would be strengthened.

CHANGES TO MEDICAID: People eligible for Medicaid would be allowed to use the value of their benefit to purchase a private p lan if they prefer.



WHO’S COVERED: All children and many now-uninsured adults.

COST: Estimates as high as $1.6 trillion over 10 years.

HOW’S IT PAID FOR: Obama proposed cuts within the health care system and raising taxes on households making more than $250,000 annually.

REQUIREMENTS FOR INDIVIDUALS: Unlike his Democratic primary opponent Hillary Rodham Clinton, Obama did not propose an “individual mandate.” Instead he would have required all children to be insured, making it the parents’ responsibility.

REQUIREMENTS FOR EMPLOYERS: Large employers would have been required to cover their employees or contribute to the costs of a new government-run plan.

SUBSIDIES: Obama proposed giving subsidies to low-income people but didn’t detail at what level.

BENEFIT PACKAGE: Insurers participating in a new health exchange would have had to offer packages at least as generous as a new public plan. All insurers would have been prohibited from denying coverage based on pre-existing conditions, and would have had to cover children through age 25 on family plans.

GOVERNMENT-RUN PLAN: A new public plan would have offered comprehensive insurance similar to that available to federal employees.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Through a new National Health Insurance Exchange where individuals could buy the new public plan or qualified private plans.

CHANGES TO MEDICAID: Would have expanded Medicaid eligibility, but didn’t specify income levels.


Sources: Associated Press research, Kaiser Family Foundation, Lewin Group.

Copyright 2009 The Associated Press.