Obama's Recess Appointments

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Obama's Recess Appointments

Post by Psychicwolf » 07-08-2010 08:46 AM

BHO made some recess appointments (circumvents Senate approval) including:

Philip E. Coyle III as associate director for national security and international affairs at the White House Office of Science and Technology Policy and Joshua Gotbaum as director of the Pension Benefit Guaranty Corporation.

But the one that I am cheering loudly is Donald Berwick as the administrator of the Centers for Medicare and Medicaid Services (CMMS). I have long admired Dr. Berwick, got the chance to meet him last year (in a non-healthcare venue), and agree with him, in principle, on nearly every issue. Smart choice, Mr. President. Berwick was working closely with his dear friend Ted Kennedy on Teddy's ORIGINAL HC bill, not the insurance giveaway that finally passed.

Of course the rightie-tighties are having a cow.
:D
http://news.yahoo.com/s/ap/20100707/ap_ ... ppointment
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Post by HB3 » 07-08-2010 09:47 AM

Did he appoint Samir Shabazz to the Civil Rights Division yet?

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Re: Obama's Recess Appointments

Post by racehorse » 07-08-2010 11:01 AM

Psychicwolf wrote:

Of course the rightie-tighties are having a cow.
:D


"Rightie-Tighties" like. . . Max Baucus! :eek:

(At least Senator Baucus is consistent in his beliefs unlike most other Democrats.)

Democrats after they retook control of Congress in 2006 refused to ever officially recess to prevent President George W. Bush from making recess appointments. Such appointments were bad for the country and showed an unacceptable contempt for Congress and it's Constitutional role, they said.

How things change! :rolleyes:

Snip:



Dem Baucus joins GOP in blasting Obama CMS recess appointment

By Mike Lillis - 07/07/10 11:40 AM ET

Echoing Republicans, Senate Finance Committee Chairman Max Baucus (D-Mont.) on Wednesday blasted the Obama administration for sidestepping Congress to install Donald Berwick atop the Centers for Medicare and Medicaid Services (CMS).

"Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee — and answered," Baucus said in a statement. . . .
Rest of Article at:

http://thehill.com/blogs/healthwatch/he ... outrageous
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Post by Psychicwolf » 07-08-2010 11:27 AM

Max Baucus, the Republican in Dem clothing. :D

Dr. Berwick cannot "ration" care for Medicare and Medicaid patients because benefits in both programs are spelled out succinctly. What he can do, as a proponent of primary and preventive care, is advocate for less extraordinary end of life care and quality versus quantity in the use of high-tech cost drivers.

Sorry GOPers, Presidents of both parties regularly use this power.
Recent presidents have made more recess appointments because of partisan gridlock in the Senate, where nominations are held up, analysts say. Obama has made 18 so far. Bush made 171 in his eight years in office.

http://www.csmonitor.com/USA/Politics/2 ... them-often
Last edited by Psychicwolf on 07-08-2010 11:48 AM, edited 1 time in total.
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Post by racehorse » 07-08-2010 12:07 PM

Really 171 Bush recess appointments in six years not eight. ;) President Obama may need to get all his recess appointments in now, as we may see real "obstruction" (as opposed to simply Democratic allegations of it like we have seen so far) of almost all of his agenda in the next Congress. :eek:

--

Snip from 2007:


the Senate will technically stay in session -- a move that keeps President Bush from making appointments while lawmakers are in recess. . . .

Senate Majority Leader Harry Reid, D-Nevada, said he would schedule "pro forma" sessions during the two-week break, even though lawmakers will be absent and no business will be conducted.

The sessions are expected to last less than 30 seconds -- the clerk will announce who the presiding officer is, and then that senator will gavel the session closed.

The Constitution gives a president the power to fill vacancies without the Senate's confirmation when the legislative body is in recess. Such appointees can serve without confirmation through the rest of the current session of Congress, which ends in January 2009.

Bush has used the power before to install nominees whose confirmation Senate Democrats had blocked. The most notable instance came in August 2005 when he angered Democrats by naming John Bolton as U.N. ambassador.

"My hope is that this will prompt the president to see that it is in our mutual interests for the nominations process to get back on track," Reid said in a statement. . . .
Complete Article at:

http://www.cnn.com/2007/POLITICS/11/19/ ... index.html
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Post by Psychicwolf » 07-08-2010 12:37 PM

Irregardless of how he was appointed (and believe me CONgress probably would have held up his appointment), I am glad Dr. Berwick is going to be CMMS administrator. And now we don't have to be subjected for weeeeeeks of facetime by McConnell, et al spewing untruths or twisting what Dr, Berwick has written over the years, to try and frighten Americans.
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Post by kbot » 07-08-2010 12:45 PM

Psychicwolf wrote: Max Baucus, the Republican in Dem clothing. :D

Dr. Berwick cannot "ration" care for Medicare and Medicaid patients because benefits in both programs are spelled out succinctly. What he can do, as a proponent of primary and preventive care, is advocate for less extraordinary end of life care and quality versus quantity in the use of high-tech cost drivers.

Sorry GOPers, Presidents of both parties regularly use this power.


http://www.csmonitor.com/USA/Politics/2 ... them-often


While benefits are spelled-out, to a degree, what I think many people fail to appreciate are the behind-the-scenes checks and balances which are now very common in healthcare. If a physician feels that you as a patient require a test, let's say a CT, or an MRI (two of the most expensive procedures performed in my and most other hospitals) insurers require two things. The first is called prior authorization, and the second is medical necessity.

Prior authorization is exactly what is sounds like - the insurer has to be notified by the physician that s/he wants to order a test. The insurer can deny the coverage based on a number of factors, in which case the patient may be made to sign an ABN (Advanced Beneficiary Notification) form, which absolves the insurer of any liablity for paying the claim, and puts the burden onto the patient who "agreed" to have tghis test, nowing that the insurer refuses to cover the claim. These claims can be over $1,000.

Medical Necessity is another roadblock insurers have recently put up to weed out cases. A test needs to have a "proper" reason for performing the test, otherwise the insurer will not allow the test to be performed.

Between the two methods of - call them what they really are - "rationing", physicians spend a lot more time fighting with insurers, including Medicare, than they do in providing patient care. These examples don't apply to ER visits, which ia another driver of spiralling out of control healthcare costs because many peopel don't have theirown doctor.

Another form of rationing which Medicare and other insurers engage in, is grouping the higher cost, most commonly ordered procedures into what are called families. So, looking at CT, MRI and Ultrasound exams, Medicare will limit the number of tests of each type a person can have in a given day. Sounds reasonable, until you examine the issues involved here. Let's look at cancer patients. Where I work, we have a large oncology practice, stretching from RI, towards Boston and out onto the Cape. If we were to look a a patient who has cancer, and we want to determine what stage the cancer is in, the physician may order a CT Scan of the chest, abdomen and pelvis. These are three separate exams, yet, Medicare states that according to their rules (rationing) the patient can only have two exams. We either have to eat the cost or balance bill the patient (which we don't do). So, each time we perform these types of scans, we operate at a loss. We certainly are not going to make the patient or family suffer because of the insurers insane rules. Another example: a patient has circulation issues in the legs. The physician may order a MRI (non-invasive study) of the abdomen/ pelvis and both legs to determine where the blockage (if any) may be. It could be anywhere from thre abdomen down to the toes and may require surgery to correct. According to Medicare, these are three exams, and the patient cannot have this. They need to return on another date of service, or we have to balance bill the patient. The thing about MRIs is that if the patient moves, the whole exam is spoiled, since each acquired image builds off the previous image. So, if the patient moves, the exam may be suboptimal, Also, in scanning the patient on one day, and having them return on another, the Tech has to ensure that they overlap images so as to not miss the end of the previous study.

Medicare definitely rations - they just call it by another name. The end results are that hospitals eat the costs, patients are made to wait and treatments are delayed. Also, consider this, in the mid 1990s, the head of United Health had his salary information published. For one year (I believe it was 1994) he made, in BASE salary $53 million. Now, he did such a good job at what he did, he also made a one-time bonus of (get this) $151 MILLION, for a combined salary of over $200 MILLION for one year. Now, when you stop to consider that the job of a CEO of a company such as United Health is to increase profits (by denying claims, for example), and the you see stuff like this, you have to wonder why insurers act they way they do. now, granted, Medicare execs don't get paid the way private insurer execs do, but CMS (Medicare) sets the bar. They decide payment rate scales, and other insurers follow, basing their decisions on the market pressures brought to bear by volume contracts. Medicare applies pressure, and the others follow suit.

But, please, don't be deceived into thinking that Medicare doesn't ration. I see it occuring everyday I come in to work.
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Post by Psychicwolf » 07-08-2010 12:58 PM

kbot, I am a retired RN and my sister is the VP of Revenue for a pretty good size healthcare system out here in the Puget Sound area.:D

Her healthcare system is NOT operating at a loss, even with Medicare restrictions. And "regular" Medicare requires no pre-auth, only if the patient is "locked into" a private carrier.

I have watched with my own eyes the over deliverance of care at the end of life and the over-use, but very expensive and lucrative dependance on technology in older patients.
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Re: Obama's Recess Appointments

Post by Rombaldi » 07-08-2010 01:41 PM

Psychicwolf wrote: BHO made some recess appointments (circumvents Senate approval) including:[/url]


say it correctly.. circumventing Republican obstructionism..
Republican - re·pub·li·can (r-pbl-kn) - political party, which will control part of Congress 2011-2012, undermining the strength of the country - on purpose, in public, without apology or shame - simply for a campaign advantage in 2012.

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Post by Psychicwolf » 07-08-2010 02:22 PM

The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Lack of health insurance is a factor in life span and contributes to an estimated 45,000 deaths a year. Why the high cost? The U.S. has a fee-for-service system—paying medical providers piecemeal for appointments, surgery, and the like. That can lead to unneeded treatment that doesn’t reliably improve a patient’s health. Says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who studies health insurance worldwide, “More care does not necessarily mean better care.”

http://blogs.ngm.com/blog_central/2009/ ... -care.html

Click to enlarge the chart at the linkie. Shockingly bad outcomes for team USA medicine.:(
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Post by Cherry Kelly » 07-08-2010 05:42 PM

Different areas, different states and obviously different observations.

There is a lawsuit filed to stop the current HC law due to it being unconstitutional. As noted while there are or might be some good points, far too many that aren't.

As noted by one of the participants. The law will require more coverage than needed and at higher cost to the individual. Two mentioned by separate individuals on this aspect. Why should a post menopause woman HAVE to carry pregnancy insurance? Or a non-smoker have to carry smoking related insurance? There were others mentioned as well. BTW - you males will also have to carry breast cancer insurance. You see the gov't will dictate what is and is not accepted and there seems to be a lot of extras you will have to carry with their demands...

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Post by kbot » 07-08-2010 06:57 PM

Psychicwolf wrote: kbot, I am a retired RN and my sister is the VP of Revenue for a pretty good size healthcare system out here in the Puget Sound area.:D

Her healthcare system is NOT operating at a loss, even with Medicare restrictions. And "regular" Medicare requires no pre-auth, only if the patient is "locked into" a private carrier.

I have watched with my own eyes the over deliverance of care at the end of life and the over-use, but very expensive and lucrative dependance on technology in older patients.


Then, being a former nurse, then you probably know firsthand that end-of-life care issues are typically driven by family members, not the patient, who prior to sinking into a diminished state have signed over their durable power of attorney and established healthcare proxies to family members. Many times, family are reluctant to see loved ones pass on, and they demand that extraordinary measures be taken to save the life of their loved one. Physicians often give-in because they don't want to be sued. Also, because of DRG regulations, as I am sure that you are aware, all of the costs of these tests are rolled-into the admission into a med-surg unit, or ICU, so, for all intents and purposes, these tests are performed essentially for free. I can't explain why your sister's organization is not operating at a financial loss. Her facility is an exception to the rule. I received this information today. http://imagingbizcom.cmail2.com/T/ViewE ... E1CEBE89F9http://imagingbizcom.cmail2.com/T/ViewE ... E1CEBE89F9 which details the most current plans by CMS to ration healthcare access, especially as it pertains to imaging services. As you will see by reading the attached articles, CMS is extending the cuts further into the next few years.

Now, the question can legitimately be raised, why do these tests at all? Aren't they wasteful? A case can be made for that, surely. However, let's look at why imaging studies are performed: primarily to make a diagnosis. Can a similar finding be made by performing a good clinical exam? Probably. But, in many cases because of the hoops physicians must jump through doing government-mandated paperwork, instead of providing patient care, it it just easier to order the test. It also protects them from liability. It also provides them with definitive findings that they can act on. Recent advances in imaging modalities such as 3-D reconstructed CT and MR images were not available a few years ago, and they can quickly provide a diagnosis where in decades past, exploratory surgery was the only option. PET/ CT scans can provide early detection of cancer - and these tests are all being targeted by Medicare as being un-necessary. So, what's the alternative? Exploratory laporotomies at a cost many times higher than a CT or MR? Waiting out a course of treatment to determine if it is effective, or performing the PET/ CT instead, confirming the efficacy of the treatment, or providing proof that current treatment doesn't work, and allowing for time to switch to another, better-suited treatment?

I like to make an anology, and many people will probably find this a cold and heartless analogy, but here it is anyway. In healthcare, someone decided back in the 1970s that the field was no longer a "vocation", but a "business" and as such, for good or bad, new mindsets came into being. Look, for example at Demmings theories regarding the integration of quality control. This was a field, largely ignored for decades by American industry. But, once Demming's principles bore fruit in the reconstructed economy of post WWII Japan, people here took notice. In healthcare, Quality Assuance is now mandated - another layer of bureaucracy. Staff are required to be hired just to perform QC and QA and PI studies, and submit data to national databses where facilities are ranked and their payments adjusted based on past performances. Not a bad idea, but these systems add hidden costs to healthcare. As a nurse, you know all about chart reviews. All this costs money. "Non-productive" (as they are referred to by the beancounters) staff rely upon the monies generated by "productive" staff who have direct patient care skills, whether in Nursing or Lab, or Imaging departments to provide the hands-on care, for which they can bill the insurer and then in turn, pay the salaries of all involved - as well as pay for the building, utiliities, equipment, etc. Some costs are fixed, some rise with inflation and other economic pressures. And, in most sectors of the economy, market forces decide the pay for services provided. So, I like to use the analogy of an auto mechanic. I bring my car in, he looks at it and says, "Such-and-such is wrong with your car, and it's gonna cost you $1,000 to fix it." No negotiation on the price. I would LOVE to do to the mechanic (or anyone else, such as the super market or at the gas pump) what Medicare does to hospitals and say "Yeah, I know you are saying that it will cost me $1,000, but kiss my butt, I'm only gonna pay you $100, AND you're gonna have to suck it up, pay your staff, your bills, provide for your family and so on - and oh, stop your whining about it"

I would like someone to give me another example in society where the government mandates what fees can be charged the way fee structures are in healthcare. It may be that in Washington State, healthcare is in fine shape, but I am willing to bet that it's the exception. Many facilities across the country are gushing millions of dollars annually. It's a pace that can't continue forever. Many are also closing up shop because they can't pay their bills. And, with this new healthcare plan, it's only going to worsen. Here in Massachusetts we have universal healthcare, which was initiated by then-Governor Mitt Romney. It's a disaster. And, it's being proposed for expansion nationwide.
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Post by HB3 » 07-09-2010 11:21 PM

Hadn't really been following this one, but here's some interesting information....
Past presidents have resorted to recess appointments when they believe a nominee's appointment has been subjected to unjust political and ideological gamesmanship. And the White House said it was resorting to the recess appointment because of Republican recalcitrance.

"Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points," Communications Director Dan Pfeiffer said on the White House blog Tuesday.

That was astoundingly untrue. The only way Republicans, who have 41 votes in the Senate compared to 58 for the Democrats, could have "stalled" the nomination would have been to organize a filibuster, and that would happen only when the nomination came to the Senate floor.

They couldn't have blocked a favorable vote on Berwick's nomination from the Senate Finance Committee, which has 13 Democrats and 10 Republicans.

As ABC's Jake Tapper reported yesterday, "Republicans were not delaying or stalling Berwick's nomination. Indeed, they were eager for his hearing, hoping to assail Berwick's past statements about health-care rationing and his praise for the British health-care system."

Democrats in charge of the Senate could have scheduled hearings at any time since the administration sent his nomination to the Capitol in April. But, Tapper reported, "neither Senate Majority Leader Harry Reid (D-Nev.) nor Sen. Max Baucus (D-Mont.), the chair of the Senate Finance Committee, were eager" to hold them.

That's what makes the administration's decision unprecedented in my nearly 30 years of closely following politics: I can't recall a preemptive decision to make a recess appointment absent a controversy, ugly political battle or contentious confirmation hearing.

And that's especially true when there's no indication there will be an effort to filibuster, which Democrats would likely have been able to override. (Berwick's credentials as a Harvard muckety-muck would have given the two Maine Republican moderate senators more than enough leeway to let him pass.)

So what's going on here?
The rest:

http://www.nypost.com/p/news/opinion/op ... x5OhA1VpwM

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Post by SETIsLady » 07-09-2010 11:51 PM

What is going on here ? Umm just trying to fill the positions and btw, I see now why they use them.
President Bill Clinton made a recess appointment of Bill Lann Lee as Assistant Attorney General for civil rights, when it became clear that Lee's strong support of affirmative action would lead to Senate opposition. Similarly, when the Senate did not vote on his nomination of James Hormel to be ambassador to Luxembourg, Clinton made a recess appointment. Many people felt that the Senate's inaction was because Hormel was openly gay, and when he was appointed, became the first openly gay U.S. ambassador.

With three and a half weeks to go in his presidency, Clinton used the recess appointment power to place Roger L. Gregory on the United States Court of Appeals for the Fourth Circuit. Gregory was the first African-American to serve on that court. This was the first time since President Carter that the recess appointment procedure had been used to select someone to an Article III judgeship, which provides for life tenure and no diminution of salary. The appointment of Gregory raised questions about the meaning of the Recess Clause, Senate prerogatives, and the opportunity of a litigant in federal court to have a case handled by a judge with full independence. On July 20, 2001, the Senate confirmed Judge Gregory to a life term. The constitutional questions involved are still unresolved and were discussed in a report by the Congressional Research Service.[4]

President George W. Bush appointed two judges during Senate recesses, William Pryor and Charles Pickering to U.S. courts of appeals after their nominations were filibustered by Senate Democrats. Judge Pickering, who Bush appointed to the Fifth Circuit, withdrew his name from consideration for renomination and retired when his recess appointment expired. Judge Pryor was subsequently confirmed by the Senate for a lifetime appointment to the Eleventh Circuit. In two terms, Bush made 171 recess appointments.

On August 1, 2005, Bush made a recess appointment of John Bolton, to serve as U.S. representative to the United Nations.[5] Bolton had also been the subject of a Senate filibuster. The filibuster concerned documents that the White House refused to release, which Democrats suggested may contain proof of Bolton's abusive treatment and coercion of staff members or of his improper use of National Security Agency communications intercepts regarding U.S. citizens. Having failed to win Senate confirmation, he resigned his office in December 2006 concurrently with the adjournment of the 109th Congress.[6]

On April 4, 2007, during the Easter recess of Congress, Bush announced three recess appointments. The first was Sam Fox to serve as U.S. Ambassador to Belgium.[7] Fox's appointment had been thwarted in Congress because he had donated ,000 to the Swift Boat Veterans for Truth during the 2004 presidential campaign, a group whose advertisements many Democrats blamed for John Kerry's loss.[8]

The second appointment announced that day was Susan Dudley to head the Office of Information and Regulatory Affairs (OIRA) at the Office of Management and Budget.

The third recess appointment on April 4 was Andrew G. Biggs to serve as Deputy Commissioner of the Social Security Administration.[9] Biggs was investigated by Senate Democrats in 2005, while serving as Assistant Commissioner for the Social Security Administration, concerning whether he violated a federal ban on congressional lobbying by federal employees when he edited the prepared testimony for a lobbyist appearing before a Democratic Policy Committee Social Security hearing as alleged by John Stanton in Congress Daily.[10]

On March 27, 2010, President Barack Obama continued the practice of recess appointments with 15 appointees to boards and agencies including the contentious choice of union lawyer Craig Becker to the National Labor Relations Board.[11]

On July 7, 2010, Obama made three more recess appointments: Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services; Joshua Gutbaum to be a director of the Pension Benefit Guaranty Corporation; and Philip E. Coyle III to be Associate Director for National Security and International Affairs in the Office of Science and Technology Policy in the Executive Office of the President.[12]
http://en.wikipedia.org/wiki/Recess_appointment

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Post by SETIsLady » 07-09-2010 11:57 PM

Republicans Block Votes On 97 Federal Nominees In A Single Day

http://thinkprogress.org/2010/04/21/kyl ... uction-97/

And yeah its about politics and nothing else.

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