The change and transformation of America is death of freedom by regulations, laws, and coercion in healthcare regulations and current education reform.  We know parental and teacher concern about CCSSI and ESSA, but what are doctors upset about? They are concerned about even more physician decisions (those years in medical school aren’t enough to trust their professional decisions for patients) being directed by federal guidelines and physicians are rewarded if they align to government goals.  Doesn’t that align to what teachers are facing in the classroom?  The WSJ published an editorial on June 1, 2016, Macra: The Quiet Health-Care Takeover,  a 962-page rule (which) puts the federal government between doctors and patients.  The article is behind a paywall (go pick up your newspaper you haven’t discarded yet or head to the library), but the first paragraph is available:


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The Medicare Access and CHIP Reauthorization Act is known as Macra and according to authors James Capretta (Senior Fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute) and Lanhee Chen (a research fellow at the Hoover Institution and director of domestic policy studies in the Public Policy Program at Stanford University), it was enacted to replace the outdated and dysfunctional system for paying doctors under Medicare.  It is their contention that the law empowers the federal bureaucracy at the expense of the doctor-patient relationship, putting the quality of American health care at risk.   Macra governmental reforms mirror the control of the Federal Government in education.  The educational similarities are in parenthesis:


  • Macra contains Congressional general guidance (Title IX bathroom language) and details of implementation is left to the Executive Branch (Dept of Education determines guidance and implementation)
  • Macra is a 962 page full of regulations (ESSA is a 2,000 plus page document)
  • Macra assumes federal government has the knowledge and wherewithal to engineer better health care through ‘delivery system reforms’ forgetting the utter failure of the bureaucracy’s previous effort (the USDOEd’s efforts to fix education since 1965 has been a dismal failure)
  • Macra rules are onerous and physician reimbursements are higher if physicians agree to opt into the alternative payment system and targets set by the government (Federal funding has been threatened if schools don’t follow the USDOEd and Department of Justice guidance)
  • The government creates the spending targets doctors must reach for full reimbursement plus bonus (USDOEd doles out, or not, its blessing on a state’s college to career standards)

Capretta and Chen write: Macra and the administration’s regulations are simply attempts to resuscitate accountable-care organizations through coercion.  That’s the same blueprint for education reform: death of state, local, and professional sovereignty by Federal accountability measures.

More from Becker’s Hospital Review:

The rule would allow the federal coverage to control almost every aspect of physician care in the U.S., according to Mr. Capretta and Dr. Chen. In particular, they said it “forces” physicians to join ACOs through more favorable incentives under its alternative payment model arm, which rewards ACO-like programs. Yet these programs are not proven, they wrote, and they shift control from physicians to larger organizations.


Education activists are still waiting to see the validation of CCSS tests and the research/data on which the CCSS promises were made.  Revisit the sentence and revise it in educational lingo: Yet these standards, assessments, and aligned curriculum are not proven, and they shift control from local districts/states to NGOs who face no public accountability measures.


Some doctors are pushing back:


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Read the comments from doctors on the Association of American Physicians and Surgeons Facebook page.

Districts will receive lower accreditation if they don’t acquire enough points in the Missouri School Improvement Plan, a guideline from the state education agency (which is based on Federal mandates).  MSIP is generally followed by districts because of the implied threat of the withholding of Federal money if they don’t meet the centralized established goals.  Similarly, hospitals can be penalized if they don’t have the outcomes desired by the Federal Government in patient treatment.  Like Value Added Modeling (VAM) for teachers (which impacts districts and the percentage of ‘effective teachers’), hospitals face accountability measures to determine if they are providing ‘effective’ treatment.  You can read about it in Association between the Value-Based Purchasing pay for performance program and patient mortality in US hospitals: observational study:


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Federally centralized measurements of accountability don’t work in hospitals or schools.   If more teachers, administrators and state commissioners/superintendents would follow Dr. Kris Held’s statement and actions of ‘daily dissent’ during the 60 day comment period, maybe we wouldn’t be swallowed up by NGOs (medical and educational groups) who make money from the strangulation of freedom and professionalism:

MACRA rule: My Daily Dissent

Sunday, May 22, 2016

Dear CMS Acting Administrator Andy Slavitt,

Thank you for the opportunity to voice my dissent regarding the proposed rule spawned from MACRA by the Center for Medicare and Medicaid Services and published in The Federal Register on 05/09/2016. I have read the ACA, MACRA, and MACRA proposed rule. Because the rule is extensive, my dissent is accordingly substantial. To be complete, my comments will be submitted in a series of submissions, my daily dissent, over the course of the next month prior to the deadline of 5 p.m. on June 27, 2016. To clarify, the initial document I downloaded from HHS/CMS and read was 962 pages, but my comments will refer to the document as published in The Federal Register on 05/09/2016 corresponding to numbers indicated in the right lower corner of each of 625 pages. The Table of Contents alone spans 12 pages. The rule does not reflect the stated intent of MACRA and represents brazen overreach by an Executive Branch agency including expansion of powers, changing the intent of the law, and violation of Constitutional rights of the people.

Your Executive Summary’s Purpose states on page 18 that you “rebranded key terminology.” Such Orwellian attempts at crafting current day Newspeak do not distract the people of the United States from recognizing inherent hazards of your goals of collecting the most intimate, private, personal details of our medical histories without our knowledge, consent, or authorization and forcing physicians under threat of penalty to disclose our patients’ protected health information to you in violation of our code of professional ethics using untested, unproven, unsecured, interoperable, bidirectional electronic health IT for surveillance, data collection, and use by the Secretary of Health and Human Services and her agents for whatever purposes she deems appropriate including selling the data to intermediary bodies of her own approval. The change of the name of this deplorable practice from “Meaningful-Use Electronic Health Records” to “Advancing Care Information” does not change the reality that this constitutes a violation of “the right of the people to be secure in their persons…papers, and effects against unreasonable searches and seizures…,” otherwise known as Amendment IV of The Constitution of the United States, and puts us at risk of targeting by agents of the Federal government in the fashion of the Internal Revenue Service under the direction of Lois Lerner, former director of the Tax Exempt Division at the IRS a few short years ago. Such illegal search and seizure of our private medical e-papers and effects and targeting of patients and physicians based on their medical data and disclosure thereof has the potential to result in loss of life and liberty in time as the government arrogation of medicine becomes the politicization and ultimately the weaponization of medicine.

The rule’s intentionally confusing terminology, methodology, and criteria for the “All-Payer Combination Option, based on the Medicare Option, as well as eligible clinician’s participation in Other Payer Advanced APMs” (Alternative Payment Models)- which includes commercial insurance- is not convoluted enough to hide the truth from the astute and vigilant American people that this rule sets forth the codification of single-payer, government run socialized medicine in the United States of America. No, we will not be fooled again by such games in the fashion of MIT economist Jonathan Gruber and his intentional misleading and mocking what he calls “the stupidity of the American voter” as he strategically crafted the ACA to “exploit the lack of economic knowledge” of the American people.

That the rule (page 23) aims to redistribute $833 million between 687,000 and 746,000 eligible clinicians in the MIPS system and between $146 million to $429 million to between 30,658 and 90,000 eligible clinicians in APMs in 2019 alone in order to “drive” government –directed changes (termed quality improvement) in provision of “care to Medicare beneficiaries and to all patients in the health care system” amounts to extortion of physicians and conscription of patients via expansion of MACRA rules from Medicare beneficiaries only to include “all patients” by the government in an unauthorized massive grab of power, money, and the lives of the American people.

MACRA was passed as a bipartisan bill and was sold as a repeal of the dreaded unworkable SGR, which it sunsets in Section 101, but this rule does vastly much more to expand the power of CMS and other Executive Branch Agencies and their control over all physicians (not just Medicare enrolled) and all patients (not just Medicare beneficiaries). The use of IT to achieve this end as proposed in this rule is chilling. My comments pertaining to this will follow in my next Daily Dissent.


What is occurring in medicine is occurring in education:


It is not difficult to imagine [the Department of Education] establishing national“advisory” standards at some point in the future. Later, the department could require adherence to the compulsory standards, if Federal aid is to be continued. Next, standard tests, developed by the Federal Government, could be mandated to check whether the compulsory standards are being met.  Last, State and local authorities will be coerced into acceptance of a standardized curriculum as the “only possible” guarantee of meeting compulsory standards.

–Senator Harrison H. Schmitt (R-NM) during consideration of a proposal to
establish the U.S. Department of Education,Congressional Record, 1978, p. 299


We are experiencing the Grubering of Americans in medicine and education.  What NGOs support Macra and what is their PR spin to sell this Federally controlled and coercive plan?  They use terms  the educational reform NGOs use in their PR releases: disruption,   equityparadigm shift and innovation,  and the one word Americans should resist at all costs: nudgeIt’s time for a revolution and increased resistance against this quiet transformation of American medical and educational regulations and oppressive laws.  When hope and change becomes despair and loss of freedom, a new course of action is required.  This is not representative government.   This is oligarchy.


More reading about Macra:






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