Archives for Health

The levee’s beginning to break.  Public dissent has grown loud enough to actually have an effect on policy:  today, an “end-of-life provision” was cut from the bill, what critics like Sarah Palin have bemoaned as “death panels.”

What?  Death Panels?  Couldn’t be!   The New York Times and CNN, the very definition of Mainstream Media, have both denounced the idea as “false.”  (They couldn’t perhaps be motivated by other factors, like a media bailout, could they?)  Democrats and the media began to bash Palin, calling her comments “disgusting” and “outrageous.”  One is lead to ask, then:  what, pray tell, just got cut from the bill?

That would be Section 1233 of H.R. 3200, entitled “Advance Care Planning Consultation,” a proposal to pay doctors to counsel their Medicare patients every five years on end-of-life planning.  With the incentive of monetary gain, doctors would be motivated to hedge emotional and ethical decisions with their own fiscal concerns.  Representative Earl Blumenauer (D-OR), the author of this legislation, is denying that’s the intent of the language.  The citizenry he wishes to abuse does not believe him.

(Then-Multnomah County Commission Chairman Blumenauer, circa 1979)

While Section 1233 would have stymied proper care for seniors, it wouldn’t necessarily establish death panels, right?  Since it’s gone now, the threat of rationing end-of-life care should have disappeared as well; there would have to be some other mechanisms in the bill to actually set up ”death panels,” right??  Read on…

Reading Tea Leaves

Well, there are four bills floating around, but the House bill, H.R. 32oo, would establish a “Health Benefits Advisory Committee” (Section 123) to essentially make health care decisions for those on the public option, as its given authority over “benefit standards,” ”including categories of covered treatments, items and services within benefit classes, and cost-sharing.”  This committee, chaired by the Surgeon General, would convene as necessary to set the minimum standards required in a benefits package.

The current bill also has provisions to establish specific methods for “Reducing Potentially Preventable Hospital Readmissions” (Section 1151 of H.R. 3200), giving government the power to determine what constitutes an “applicable condition” for care by using a formula, complete with nifty ratios and “floor adjustment factors,” to determine whether or not an individual is being readmitted to the hospital excessively.  The proposal ultimately aims to draw down aggregate costs by denying readmissions.

Furthermore, the bill establishes a “Health Insurance Exchange” (to manage health insurance across the nation), the heavily-discussed ”Public Option” to private health insurance (the dangers of which I discussed on a previous post), and establishes a Health Choices Administration, with its own Commissioner (Section 141) to run the whole thing, without judicial review. It’s no wonder support for the bill is waning.  The bill modifies Medicare, cutting its budget by $361.9 billion over 10 years.  The results of this are directly evident in new polling data, with Rasmussen reporting that Americans over 65 are against Obamacare by 56 percent to 39 percent.  Rasmussen polls also reflect the toll health care is taking on the President’s job approval rating, now at 48%, down five points in the past month.

A few weeks ago, House Republican Leader John Boehner said that the Democrats who support “government-run” health care would be in for “a very, very hot summer.”  His prediction has indeed come true.  Some representatives, however, seem tone-deaf to their constituency.  To persuade their out-of-touch public officials not to sign the bill, town hall meetings have deteriorated into chaotic screaming matches.

As a free country, however, this is how America works.  Alexis de Tocqueville observed as much in 1835, that town halls and municipalities embody the essence of freedom saying, “Nevertheless, local assemblies of citizens constitute the strength of free nations,” and although “composed of coarser materials,” they are “so perfectly natural” they stand as the strongest opposition to despotism:

“Local assemblies of citizens constitute the strength of free nations.  Town-meetings are to liberty what primary schools are to science; they bring it within the people’s reach, they teach men how to use and how to enjoy it.  A nation may establish a system of free government, but without the spirit of municipal institutions it cannot have the spirit of liberty.  The transient passions and the interests of an hour, or the chance of circumstances, may have created the external forms of independence; but the despotic tendency which has been repelled will, sooner or later, inevitably reappear on the surface.”

Trust me, I’m a doctor.

When any business (or government program) is over-budget, planners must find ways to innovate, reduce overhead costs, or, in the case of government programs, print more money.  If government has to reduce costs, there is one surefire way to do it, and it’s called “rationing.”

This is what most countries with state-run health care resort to.  This position is described most accurately in a startling admission from Peter Singer, bioethics professor at Princeton, in an article entitled, “Why We Must Ration Health Care” in the New York Times in July 2009.  Singer sums up the idea of “Quality-Adjusted Life Years,” a system used to assign a sliding scale to judge the worth of humans; check it out:

“As a first take, we might say that the good achieved by health care is the number of lives saved.  But that is too crude.  The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities.  We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved.  If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years.  That suggests that saving one teenager is equivalent to saving 14 85-year-olds.  These are, of course, generic teenagers and generic 85-year-olds.  It’s easy to say, “What if the teenager is a violent criminal and the 85-year-old is still working productively?”  But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.” (emphasis added)

Do you understand this?  This is a chilling blueprint for health care cost-saving.  I thought when the New York Times said that the “false ‘death panel’ rumors had some familiar roots,” they were talking about their own Opinion Editorials.  Not so.  By assigning value to human life based solely on age, Dr. Singer gives an eerie ”how-to” on rationing health care to seniors.  The President, though, has tried to discredit any concerns about such rationing, stating:

“There are some things I’ve been hearing lately that we need to dispose of.  The rumor that’s been circulating around lately is, the House of Representatives somehow voted for death panels that will basically pull the plug on Grandma ’cause we’ve decided it’s too expensive to let her live anymore.  This arose out of a provision in one of the House bills that allows Medicare to reimburse people for consultations for end-of-life care.  The irony is, that actually one of the chief sponsors of the bill [Republican Sen. Johnny Isakson] … very sensibly thought this is something that would expand people’s options, that got spun into this idea of death panels. I am not in favor of that.  I want to clear the air here.”

And alas, at one of those raucous “Astroturf” town halls, Senator Arlen Specter also tried to debunk these “rumors” as myth, responding, “You are just not right.  Nobody 74 with cancer will be written off.  That is a vicious, malicious, untrue rumor.”

Is it now?  So, why did Republican Senator Chuck Grassley (and key negotiator for the health care bill) insist that Section 1233 get cut?   Senator Grassley lamented with his constituents, saying, “You have every right to fear:  We should not have a government program that determines if you’re going to pull the plug on grandma.”

And if these are only rumors, where did they come from?  Maybe from the bill itself?  Or from Opinion Editorials in the New York Times?  These are simply ideas, from Congressmen like Blumenauer, or from academia, from doctors, bioethicists, you know, smart people.  So what ideas do you think might be floating around the Oval Office?

Enter Ezekiel Emmanuel, M.D. and Political Philosophy Ph.D. from Harvard, a National Institute of Health bioethicist, a White House “Special Advisor for Health Policy” at the Office of Management and Budget, and the brother of White House Chief of Staff, Rahm.  Our friend Zeke wrote in 1996 on the ethics of medical rationing in a Hastings Report, and suggested a classification of health care needs, to be determined by a “communitarian” “deliberative body.”

Zeke also said the following:

“Services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed.  An obvious example is not guaranteeing health services to patients with dementia.  A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.”

Woe to those with dementia!  That’s a proverbial death sentence, but not entirely out of sync with Singer’s opinion.  In January 2009, Ezekiel Emanuel along with two other Doctors, set forth in an article entitled “Principles for Allocation of Scarce Medical Interventions,” to “evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness.”  In this article, Ezekiel and friends analyzed three separate systems:  “the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years.”  The doctors then propose their own system for rationing:  “We recommend an alternative system — the complete lives system — which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.”

The systems (that Organ Sharing points system, quality-adjusted life years, and disability adjusted life-years) they evaluate herein are scary in their own right, but instead of rejecting these systems, they instead serve as a template for their complete lives system:  “When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.”  This takes Singer’s opinion in the New York Times one step further, sliding that scale backwards for those younger than 15.  Note:  Peter Singer has propagated this sickness before, stating, “Killing a newborn baby is never equivalent to killing a person, that is, a being who wants to go on living.”

Gloves Off

Remember our President, as an Illinois state senator, supported infanticide twice – that is, whether leaving a botched aborted baby, in his words, “that fetus, or child — however way you want to describe it” – to die during the “Born Alive” debate in Illinois during 2001 and 2002.

So, this ideology is not new to the White House, or even the President himself.  I would encourage you to watch the full video of President Obama’s response to citizen Jane Sturm, regarding her 105 year old mother.  (Note that this was at CBS’ BS news conference, in which the questions were pre-determined.)  When Jane asked if her mother would have been denied the pacemaker she received at 99 years under Obama’s health care plan, he rambles on and on, and ends on quite a sour note, telling her, “Maybe you’re better off not having the surgery, but taking the painkiller.”  Watch it for yourself; just as I included the full quote from Ezekiel Emanuel’s article, I linked to the whole video so you can decide for yourself.  It’s startling to me.

Obama once said that the people he surrounded himself with would shape his strategy.  This explains why he would respond thusly in a New York Times interview, this past April, about those who can’t afford rising health care costs:

THE PRESIDENT:  “So that’s where I think you just get into some very difficult moral issues.  But that’s also a huge driver of cost, right?

“I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.”

DAVID LEONHARDT:  “So how do you — how do we deal with it?”

THE PRESIDENT:  “Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place.  It is very difficult to imagine the country making those decisions just through the normal political channels.  And that’s part of why you have to have some independent group that can give you guidance.  It’s not determinative, but I think has to be able to give you some guidance.  And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.”

So we’ll have a conversation about these moral issues, driven by the great ethicists, you know, those smart people we covered above; there’s no need for patients or their loved ones to be involved in the decision-making process.  But you said we won’t “pull the plug on grandma,” will we, sir?  Sir??

As heartless as all this seems, though, at least the President is consistent; he questioned his own 86-year old grandmother’s hip replacement near the end of her life, saying they bring up tough moral decisions.  You would think that he would at least get her some pain pills, but he said, “I would have paid out of pocket for that hip replacement just because she’s my grandmother.”  Of course he would.  But we’re not talking about the President’s family, or even particular people.  We’re talking about 300+ million Americans.  It’s easier to make decisions about “the people” than it is about individuals, isn’t it?

Although Congress and the White House are determined to dismiss the outcry over rationing as some fringe, right-wing extremist misinformation, is it wrong to ask whether rationing, as is the case in other countries with similar health care systems, could be possible if the bill didn’t cost out the way we think it might?

I don’t know.  Looking at what other countries with state-run health care have done…. it could be.  The ultimate end for a rationed health care system is something referred to as eugenics, and it’s been done before, just not here.  Some will say, “Well, rationing already happens with private insurance.”  You may even hear it from some pretty top-ranking characters, like HHS Secretary Kathleen Sebelius.  Maybe you missed Jane Sturm’s point.  Her mother went to another doctor, sought another opinion, and got the care she needed.  Under the current proposal, this would not be an option; at least, that’s what I understand would happen when the “Limitations on Changes in Terms or Conditions” were statutorily implemented, outlawing a change in private insurance after the first year. (see page 16).  What would happen if you moved to another state?  Are you forced into the public option?  As you can see, unanswered questions abound.  (If you would like a breakdown of the bill from someone reputable, I suggest the summary by Duke University professor of classics, John David Lewis.)

Someone once said, “Our nation can achieve permanent health only from within on the basis of the principle:  The common interest before self-interest.”  Someone else said, “It is true that liberty is precious – so precious that it must be rationed.”  (You can Google the authors).  I, however, reject those notions.  A free market, carefully regulated with the utmost constraint on the regulators themselves, sets the best price and provides the best services, based on public opinion, wants, and needs.  Here, both common interests and self-interests are served.

The President has the choice, now.  It’s his ballgame.  He may simply choose inaction, but I don’t see that as likely.  If he wants to act, he has three basic options:  take the reins now and demand that the bill be toned down, take a stand and veto a partisan bill when it passes Congress, or sign it into law.  If the majority is willing to accept the consequences, they have enough votes in Congress to push it through.

What can we do about this?  Well, Ronald Reagan asked the same question in 1961 when campaigning against Medicare in 1961.  During the “Operation Coffee Cup” Campaign, he said, “We can write to our congressmen and to our senators.  We can say right now that we want no further encroachment on these individual liberties and freedoms.  And at the moment the key issue is: We do not want socialized medicine.”

We have some options, too, and the public is utilizing them.  The noisy town halls driving the Democrats batty embody, in De Tocqueville’s language, “The spirit of liberty.”  Right now, emails to the House of Representatives are overloading its servers.  Americans can act, and they will.    I’ve offered suggestions for action.  As I’ve pointed out in this series, so has the Congressional Budget Office.  So have successful business-owners.  Congress is swaying as well.  Yes, Mr. President, America wants change.  Just not what you’re selling.

“You and I can do this.  The only way we can do it is by writing to our congressman even if we believe he’s on our side to begin with. Write to strengthen his hand.  Give him the ability to stand before his colleagues in Congress and say, I heard from my constituents and this is what they want.  If you don’t, this program, I promise you, will pass just as surely as the sun comes up tomorrow.  And behind it will come other Federal programs that will invade every area of freedom as we have known it in this country.  Until one day, as Norman Thomas said, we will awake to find that we have socialism.

“And if you don’t do this and if I don’t do it, one of these days you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”
- Ronald Reagan, 1961 Operation Coffee Cup Campaign

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Since its conception, the little tag at the top of my website has read (and will continue to read):  “Documenting history as it happens.”  It has never been more true than with the broad context of health care reform and the specter of government intrusion.  So let me be clear about health care reform:  This is the moment of reckoning for our 44th President.  With Congress on August recess, he has the chance to bend the descending curve of his Presidency upward again by developing a coherent health care plan that offers solutions the American people can agree on; this is possible, contingent on whether he would be willing to abandon leftist ideology and embrace centrist reform that could save his Presidency.

That’s a big “if,” though.  He has two options here:  take the reins of this runaway stagecoach now; or wait for Congress to move, and if they pass an overly partisan bill, he could use his veto power when it hits his desk, insisting on something more moderate.  When wheeling and dealing with 16% of the American economy, and the lives of Americans, he may want to take a chance with the center, and fast.

Instead of listening to the center, though, the President (along with most of Congress and the Media) has tried to neutralize them.  When the Mayo Clinic was initially critical of Obama’s public option, the President paid a high-profile visit to the Hospital.  When the Congressional Budget Office estimated the Plan would cost more than a trillion dollars over ten years, and the CBO Director told Congress that you can’t save money on health care by simply providing insurance for everyone, the President paid him a little visit as well.  As I discussed at length in my last post, however, if neutralization doesn’t work for them, maybe marginalization will.

But they can’t marginalize historical data.  In 1966, the House Ways and Means Committee estimated Medicare would cost $12 billion a year by 1990; in 1990, however, Medicare cost $107 billion, nine times more than its estimate.  Since inflation from 1966 to 1990 was 303.4%, the cost should have been a little more than $48 billion with inflation.  Whether this is a testament to the federal government’s misreading of inflation or misreading the cost of Medicare, I don’t know, but now, we are supposed to simply believe this same government can 1) fix health care, and 2) give us an accurate costing of the proposed program.  As I’ve now cited thrice, the Lewin Group estimates 70 percent (over 100 million) of those with private insurance will accept the public option.  What’s that going to do to the cost estimates?

Americans are not as stupid as the White House thinks, nor do they accept their Soviet-based taxonomy.  Realizing the costs for the 1 trillion dollar public option will burden businesses, the Small Business and Entrepreneurship Coalition began a “Not On Our Backs” Health Care Petition.  In similar fashion, the U.S. Chamber of Commerce recently wrote the House Ways and Means Committee stating, “The Chamber strongly opposes ‘America’s Affordable Health Choices Act of 2009′ in its current form.”  Why would businesses be so wholly opposed to health care reform?

The American people see these trends and are in turn skeptical of government largesse.  When the President himself discusses his desire for a stealth, Trojan horse approach to a single-payer system (waaay back in 2003), people lash out, as America will not go for state-run health care.  Americans realize that while our current system is flawed, they are not ready to trade it in for a system with less access to care and poorer quality of service, bought with the sacrifices of a few.  State-run health care systems are historically overcrowded and underfunded; Americans want health reform that brings lower costs and greater access to care.  How can we get there from here?  Read on…

Lessons Learned?

States often provide the model for effective national governance; Ronald Reagan was successful as President because he learned what worked and what didn’t as governor of California.  The federal government would be wise to take note of California’s current tax-and-spend political culture.  Building government on the backs of businesses “crowds out” private industry, in the parlance of the Congressional Budget Office; that’s why the U.S. Chamber of Commerce opposes the bill!

With health care, there are a couple of states that have tried to provide universal coverage that can be used as examples.  Let’s look at two different programs, in Massachusetts and Tennessee, respectively.

MASS:  Susanne L. King, a Medical Doctor in Massachusetts, wrote in the Boston Globe, that “Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.”  Furthermore, she says, “The Massachusetts Commonwealth Care program does not address the problem of insurance being connected to jobs.  For individuals, this means their insurance is not continuous if they change or lose jobs.  For employers, especially small businesses, health insurance is an expense they can ill afford.”

This provides two crucial points for discussion:  one about health care being tethered to employment, and a second about ways the government would budget for an unsustainable program.  I’ll cover the former later in this post, and the latter in my next post.  Dr. King points out in her article that while the program promised lower costs and increased access, it has achieved neither.  It’s no wonder, then, that a recent Rasmussen poll in Massachusetts found that only 26 percent of likely voters believe health care reform has been a success, only 21 percent believe it has made health care more affordable, and only 10 percent said health care has been getting better since their reform laws.

TENN:  According to Tennessee Representatives Blackburn and Roe, TennCare was a public option plan designed to achieve those two critical goals of lowering costs while expanding coverage.  With the emergence of a public insurance option, “private businesses dropped coverage for their employees and forced them onto state rolls,” thereby overshooting projected costs.  This real-life example supports the aforementioned forecast for a similar federal system by the Lewin Group.

What do you do when the bill comes in, and you are overcharged?  According to the Representatives, “Benefits were slashed and reimbursement rates for doctors and hospitals were reduced.  Ultimately, 170,000 people were cut from the program.  Since they weren’t being paid, fewer physicians could afford to accept TennCare patients.  So while a TennCare card guaranteed you access to care, it did not guarantee the availability of care.”  Budgetary restraints in the health care sector result in rationing, the consequences of which will be discussed in full on my next post.

I will admit that a state’s program will be significantly different than any federal system; states have to balance their budgets (somewhat), as they cannot (legally) print their own money.  Nor can they simply tax their way to budget neutrality, as California found out, and the federal government is finding out now.

Let me do something different and give credit where credit is due:  I like the White House’s idea, albeit a liberal one, of establishing an Independent Medicare Advisory Council, or IMAC, to act as a “Supreme Court” for health care in America, without the threat of an impending government takeover.  This, of course, establishes another bureaucracy, but it is an example of governance, and not business, in the health care sector.  Both the Congressional Budget Office and health care experts agree on the efficacy of the proposed program.  Although “modest” in the amount of savings it would generate, this is a first step on the path the President should pursue.

Let me suggest some other ways to reduce costs and increase access to care.

Three Proposals

So, void of any special interests, I provide three proposals to correct the course of our health care system; these do not “fix” health care, nor provide that ever-elusive free coverage (that someone else pays for), but instead, provides a little more breathing room for individuals.

1 – Eliminate the difference between employer-provided health care and individually-purchased health care. Losing a job is even more devastating when you lose your employer-provided benefits.  Simply extending COBRA coverage is not a good answer, as this quick fix is unsustainable.  If we are to learn anything from our current Great Recession, it should be this lesson.

Currently, employer provided benefits are tax-deductible to the employer and non-taxable to the employee, while individually-purchased health care is not.  This is the issue that Obama criticized Senator McCain for during the campaign, saying McCain proposed ”taxing health benefits for the first time ever … taxing health care instead of fixing it.  We can’t afford John McCain.”  Now, the Administatration is considering to do just that.

While everyone’s looking to tax those benefits to net some funds for the public option, I propose the opposite; make individually-purchased health insurance tax deductible.  This would immediately lower the cost of health insurance to the individual.  Normally, this is not available until health insurance exceeds 7.5% of your salary.

Government currently provides the incentive for employers to provide health insurance under the veiled assumption that it’s free.  Not so.  Give money to people, and let them choose their own health insurance.  This provision would also force the federal government to do what states have to do; live within their means.

2 – Provide state pools for insurance. This is, essentially, what the much-discussed Wyden-Bennett bill does.  It should be noted that this bill calls for ideological sacrifices from both sides.  According to the Congressional Budget Office, the proposal “requires individuals to purchase private health insurance and to establish state-run purchasing pools and a system of Federal premium collections and subsidies to facilitate those purchases.”  Conservatives balk at such a requirement, naturally.  The bill, however, is projected to cover 99% of Americans, and the CBO states “that the proposal would be roughly budget-neutral in 2014,” and after 2014, “the proposal would tend to become more self-financing and thereby would reduce future budget deficits or increase future surpluses.”  This, however, is something that perks conservative ears.

This bill consists of a restructuring of  the health insurance system, with the CBO noting “most health insurance premiums that are now paid privately would flow through the federal budget.”  Like I said, it calls for sacrifices, replacing a tax exclusion with a fixed income tax deduction.  The bill, however, does two significant things:  lowers costs and increases access.  It also achieves the highly popular goal of offering Americans the same health care choices members of Congress have.

Since Peter Orszag, the President’s Director of the Office of Management and Budget, was then CBO Director and author of the cited opinion, I don’t understand why the Obama Administration hasn’t adopted it as their own, especially since the revised bill is stronger, and now has 12 sponsors, 6 Republican, and 6 Democrat, making it a truly bipartisan effort.  Instead, Obama has called the plan “radical,” saying in theory, those plans work, but,  ”The problem is, we have evolved partly by accident into an employer-based system.” A “radical restructuring” would meet “significant political resistance,” Obama said, and “families who are currently relatively satisfied with their insurance but are worried about rising costs … would get real nervous about a wholesale change.”

Uhhh… Obama called something radical, and is worried about change?  Is he hitting the pipe again??  Nevertheless, twelve senators have signed on to the plan, and with some making it a make-or-break issue, I think we’ll see the Wyden-Bennett bill again, after the August recess.

3 – Drop the distinction between states for purchasing insurance. This is another plan John McCain proposed during the campaign that was subsequently ignored.  As I said in my last post, there are rougly 1300 different insurance plans to choose from nationwide; the problem is, they’re divvied up by state, and current law does not allow taking plans across state lines.  Insurance is expensive in some states ($4000 a year in New Jersey), and cheap in others ($1500 a year across the Delaware River, in Pennsylvania).

Why?  Does that make any sense?  Drop the regulation and allow people the choice of buying insurance in another state.  Representative John Shadegg from Arizona has been pushing this idea for years.  This proposal has garnered conservative support as it would lower costs while increasing options, and would be relatively easy to implement.  While we’re at it, government mandates on what insurance companies must cover should be dropped.  This nonmarket intervention has caused insurance costs to skyrocket.

Healthy Solutions

The leading method available to bend the costs associated with health care – with a singular, nonmarket intervention - is tort reform.  With all the money circulating, and health care costs rising faster than inflation, somebody must be getting rich from all of this.  Columnist Charles Krauthammer, M.D., sums up this situation best, drawing on his personal experience, so I’ll let him do it here:

This is not about politics?  Then why is it, to take but the most egregious example, that in this grand health-care debate we hear not a word about one of the worst sources of waste in American medicine:  the insane cost and arbitrary rewards of our malpractice system?

When a neurosurgeon pays $200,000 a year for malpractice insurance before he even turns on the light in his office or hires his first nurse, who do you think pays?  Patients, in higher doctor fees to cover the insurance.

And with jackpot justice that awards one claimant zillions while others get nothing — and one-third of everything goes to the lawyers — where do you think that money comes from?  The insurance companies, which then pass it on to you in higher premiums.

But the greatest waste is the hidden cost of defensive medicine:  tests and procedures that doctors order for no good reason other than to protect themselves from lawsuits.  Every doctor knows, as I did when I practiced years ago, how much unnecessary medical cost is incurred with an eye not on medicine but on the law.

Comprehensive tort reform would make all lawsuits more legitimate, and would have the secondary effect of lowering health care costs.  However, with a quick glance at the majority party, and their strong connections to the legal community, I would guess such tort reform is unlikely in the 111th Congress.

Other methods of cost controls are available to employers themselves; there are other viable methods to provide a flexible and proper health care plan for their employees, like encouraging Health Savings Accounts (the way Whole Foods does), or simply by rewarding healthy behavior (the way Safeway does, which they claim can lower America’s health care costs by 40% if broadly implemented).  The answer does not necessarily have to be for the government or the insurance companies to provide the capital.

I’m not going to harp on overall health concerns, or preventive care.  If you want to work out, go for it.  If you want to eat, drink, smoke, and die early, I don’t have much of an issue with that, as long as you don’t hurt me or mine.  The problem with this, of course, is that the costs for a few drive up health care costs for everyone.  That’s what insurance is all about, though.  The primary flaw with health insurance, however, is that it provides insurance for all health-related issues.  Costs for health insurance would be cheaper if it emulated car insurance.  Think about it; normal car insurance doesn’t cover tire rotations, new wiper blades, oil changes, or basic maintenance.

I believe, likewise, health insurance should not cover the sniffles or a backache.  When these problems get above a certain threshold, I believe insurance should kick in.  This is commonly called “catastrophic insurance.”  Such plans would lower the costs of health care for everyone associated with that insurance company, but regulations, as discussed before, dictate what insurance must cover.  Simply drop the regulation, and let the free market decide.

Faced with all these options to do something worthwhile, America now waits for realistic action from the White House.  It’s reminiscent of the crucial moment during the Iraq War (waaay back in 2006) when President Bush ordered the Surge.  He ended up being right, and although I questioned the efficacy of its execution, I thought it was the right thing to do (those of you who talked to me about it then will remember that).  I questioned Bush’s judgment, but never his motive.  Things have certainly changed with this Administration; now, I question intent.

In my next post, I’ll take a look at the darker, more sinister side of Obamacare, which is almost as scary as the freaking bats living behind the shutters on the windows of my house.

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Hypothetical scenario:

You’ve been mowing the grass all day, and you want something to drink, and bad!  You go to your local convenience store to get a refreshing… what do you want?  A soda?  Water?  A sports drink?  Tea?  Iced coffee, perhaps… I had to throw that one in.  Seriously though, there must be something like 1300 different drinks to choose from!

You look at those humongous fridges, and notice something new there… something unique.  An unflavored, unsweetened, mineralesque, vitamin-infused alkaloid for the masses.  A public option!  What makes this one unique?  Well, the company that’s punching out this product doesn’t have to make a profit.  What’s more, they get to write the rules for the other drinks on the shelf.  In five years, ten years time, which drinks will be left to choose from?

But, wait!  What if I want a specialty drink?  What if I’m not like everybody else?  Instead of a collective, we are a conglomerate of individuals with our own wants and needs… and while soft drinks are tangentially related to the discussion at hand (see below), I hope it’s obvious I’m talking about health care.  With 1300 different choices, health care reform, or health insurance reform (in the Administration’s new parlance), should be directed towards keeping a decision between you and your doctor just that, without the involvement of these clowns.

FROM CNN:  Beverage companies are running a TV ad opposing one congressional proposal that would pay for reform, in part, with a soft-drink tax.

“This is no time for Congress to be adding a tax to the simple pleasures we all enjoy … like juice drinks and soda,” the announcer in the TV ad says. “Taxes never made anyone healthy.”

But Obama is ready to play hardball.

“We can’t kick the can down the road any longer,” Obama said at a Wednesday afternoon news conference at the White House. “Deferring reform is nothing more than defending the status quo.”

He added: “Those who would oppose our efforts should take a hard look at just what it is they’re defending.”

Obama also reassured Americans who are happy with private insurance and oppose a government option.

“If you like your doctor or health care provider, you can keep them. If you like your health care plan, you can keep that, too. … You will save money [under the plan] … “

Fierce Urgency of Now

Using the same logic of a legislatively-successful, although policy-wise, a disputably-failed Stimulus package, Congress and the White House were determined to rush through some of our nation’s largest and most widely sweeping legislation before their window of opportunity closed.  After the President botched a health care press conference last week, in which he forced upon the nation a discussion – nay, an argument – about race, Senate Majority Leader Harry Reid announced that a health care reform bill would not happen until after the August recess.  Even Harry Reid knew the President had no plan to offer.  So off they went, home for the summer.

In doing so, with little to say to their constituents about the issue at hand, the Dems became easy targets for the raucous town hall meetings we’re witnessing now.  A handful of citizens, utilizing their First Amendment rights, have turned these meetings into “town hells.”  In turn, these citizens have become easy targets of both the Democratic National Committee, who called these Americans “angry mobs,” and the White House.  White House Press Secretary Robert Gibbs alleged these grassroots movements were artificial and manufactured, calling them “Astroturf” (clever).  In the briefing room, Gibbs said, ”I hope people will take a jaundiced eye to what is clearly the Astroturf nature of grassroots lobbying.  This is manufactured anger.”  Wait a minute, Gibbs; I thought “community organizing” was the great, high calling of our generation.  What’s so wrong with it now?

The most frightening effort, though, to align the nation behind a common goal by ”Organizing for Health Care” (crafted with a combination of ideas from Saul Alinsky’s community organizing manual Rules for Radicals and George Orwell’s conception of a “Ministry of Truth” from his book 1984), came from White House Director of Communications for the Office of Health Reform, former journalist Linda Douglass asked on the White House Blog for citizens to report fellow citizens to the White House for using language regarding health care that seemed “fishy.”  Read it yourself; I’m not making this up.  This effort garnered more attention when Texas Senator John Cornyn (rightly) publicly embarrassed the President in an open letter, demanding he cease the program and call off the Thought Police.

Remember, actions such as these were deemed illegal during the Bush Administration, with domestic wiretapping labelled as “spying” on Americans.  Bush’s program attempted to protect Americans from being cremated in city streets by planes falling from the sky.  Now, we are protecting people from information that could derail the Administration’s health care agenda.  Change has indeed come to America.

This is where we are:  A Brave New World where our media has embedded itself in government, and the government, with Linda Douglass as the White House’s Media Czar (you could call her our federal Net Nanny), controls the flow of information throughout the country, telling you what to believe about health care, without once citing a single fact from an independent organization, or H.R. 3200, the proposed bill at hand.   The media, in turn, sides with the Administration (of course; they need a bailout of their own), and paints dissent over health care as derangement, even going as far as Paul Krugman did by suggesting racial motivations.  Speaker of the House Nancy Pelosi recently provided cover for the media’s slant by equating Town Hall Protesters to Nazis, showing she has los juevos grandes Keith Olbermann surely must envy.

It wasn’t too long ago, as I remember, that Code Pink was sitting in on Senate hearings, shouting down the testimony of a certain Marine General.  Yes, I remember when MoveOn.org had that full page ad calling General David Petraeus “General Betray Us,” effectively derailing constructive debate over the Iraq War.  Democratic friend Cindy Sheehan even planted herself outside Bush’s ranch in Crawford, Texas, demanding to “speak” with him.  I was curious, so I went looking; what was the Bush White House’s response to this kind of dissent?

Well, former White House Press Secretary Ari Fleischer had this to say about anti-war protesters:

“I think the president welcomes the fact that we are a democracy and people in the United States, unlike Iraq, are free to protest and to make their case known.”

Furthermore, former White House Press Secretary Trent Duffy said this about the anti-war protests:

“The American people have a right to protest, and the right of free speech is something that we’re fighting for in this war on terror, to preserve that right of free speech.  So the President welcomes opinions from all Americans.”

This morning, Princess Pelosi and her left-hand man, Steny, published an Opinion Editorial in USA Today calling the health care protests “Un-American,” saying:  “These disruptions are occurring because opponents are afraid not just of differing views — but of the facts themselves.  Drowning out opposing views is simply un-American.”

When her constituents and echo chamber affiliates (such as the ANSWER Coalition, MoveOn.org, Code Pink) protested, though, I guess it wasn’t Un-American.  Wait, maybe I’m confused…

Of course, pay no attention to the upside-down American flag; way back in 2006, dissent was patriotic.  Such high-level hypocrisy is astounding.  Given the fact that these individuals were alerted by emails, and bused in by MoveOn.org and friends, was this artificial, manufactured, Astroturf?

Why Ask Why

Simply put, the President does not have a plan that he is willing to speak freely about.  Oh, he has a plan.  It’s nothing you want to hear, but he has a plan.  You can see it at work in Great Britain, France, and Canada.  So why is it so scary for Americans to conceptualize, if it is “at work” in other countries?

Yes, aforementioned White House Blog, John Adams was right in saying, “The facts are stubborn things.”  The facts are, 90% percent of voters are insured, and 75% of those voters are satisfied with their insurance.  To insure the uninsured will require a sacrifice from Americans they are skeptical of, and when a plan is intentionally shrouded by bureaucrats trying to push legislation on the citizenry, historically, Americans revolt.

Look at examples of state-run health care throughout the world; why doesn’t it work?  Canada’s cancer death rate is higher than ours; why?  Why, according to a British paper, is our cancer survival rate better than all of Europe?

Furthermore, why would Jack Layton, the socialist leader of Canada’s New Democratic Party, come to Washington, D.C., to speak to Democratic members of Congress about how great Canada’s health care is?  No, really, why would he do that, if their system is better?

Let me ask you this:  Why would Belinda Stronach, Member of the Canadian Parliament, come to California for breast cancer treatment?  Why would Silvio Berlusconi, Italian Prime Minister, come to the Mayo Clinic in Cleveland, Ohio, for his pacemaker?  According to the World Health Organization, Italy’s national health care system is 2nd in the world (France ranked first); our semi-private system ranks 37th.

So, given that, why didn’t Silvio get treatment there?  Why didn’t Ted Kennedy, the liberal lion of the Senate, set the example and show how great a public insurance plan actually is by going to France, Italy, or neighboring Canada for treatment of his brain tumor?  He could have gone to one of our own public health care centers for veterans, like the Walter Reed Army Medical Center, but instead settled for Duke University Medical Center.  Why?  With all the pull he has, why did he simply settle for a system such as ours, one that he wants to scrap, ranked 37th in the world?

Why?  Why is there a private health care business, Timely Medical Alternatives, in Canada that does nothing else but brings people to the United States for treatment?  I thought Canada’s system was better than ours; as you know, our system is driven by what Princess Pelosi calls “immoral profits.”  How would Canadians survive, if they didn’t have the backstop of an American health care system to rely on?  Is that why Jack Layton came to Washington?  You see, the World Health Organization (and others) can create metrics to say what it wants to say ideologically, but they cannot ignore these “stubborn facts.”

All of this data stands as evidence supporting a verdict opposite what this government is selling us, and Americans can see what’s at stake here.  According to the Lewin Group, the insurance ‘exchange’ that’s part of Obama’s public option will move ”up to 119.1 million of the 171.6 million people who now have private employer or non-group coverage would move to the public plan (70 percent).”  Seventy percent of private insurance would be unfunded; the private option would begin to disappear.  I spoke about this Trojan Horse back in June on my post Sheep/Dogs.

Americans want two things:  increased access to health care, and decreased costs for health insurance.  Costs are increasing greater than inflation, and that’s a problem for any program, public or private (Social Security, Medicare, and Medicaid come to mind).  Health care reform should do those two things, but instead, the Administration and Congress’ plans give government vast control of your health care options, and costs too much.  It’s a bad bill, and if Americans can’t get a good bill on health care, then they’ll simply invoke the Hippocratic Oath:  “First, do no harm.”  Something should be done, though, in the way of reform, with government relying on governance, and not business.  There are a couple of different ways to achieve lower costs and increased access to care.

My next post will show how to achieve those goals.

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There’s a lot to cover here, so let me preface it with this:  Just because certain acts or actions are within the power of the federal government does not mean it should be placed into the scope of it.  For example, I remember seeing some political cartoons showing Iraq as the 51st state and calling it “Texaco” back in 2003 at the advent of the Iraqi invasion when all of this was a lot more popular with the public.  Although the comic might have been funny, manifest destiny is no longer a goal of the United States, and is not appropriate in serious discussion on foreign policy.  Whether or not we could conquer other countries and add it to our number at this point in history is not even a question to consider.

Health Care

Likewise, many of our existing social policies, as well as those frighteningly proposed, are equally improper.  This is important to point out, as a recent poll (and I hate polls) states sixty-two percent of Americans between the ages of eighteen and twenty-nine supports nationalized health care.  Wait a minute; I fall into that category!  So does my wife, and my brother, and most of my friends from ranging backgrounds from across the country.  I haven’t heard this idea specifically expressed by any of them; then again, I haven’t heard much opposition to it either.  I think many young Americans are apathetic to the most important issues of our time.  I guess we won’t care until it’s too late.

Sadly, I see this apathy pour through discussion on a number of issues, and it breaks my heart every time; however, here I’d like to discuss universal health care and its dangers to this nation.  For the American public to relinquish private sector control of health care to the federal government is to effectively abort our nation’s Constitution.  At most, states have the right to implement health care coverage, but not the federal government.  This is not to say the current health care system is not flawed and in need of reform.  I am only arguing that giving the government complete control of your health care is foolish.

Consider the words of Ben Carson, Johns Hopkins University neurosurgeon, speaking to the class of 2006 at Columbia University’s medical school:  “You are the generation of doctors who are going to have to stand up and fight for restoring the doctor/patient relationship, for halting and reversing the government takeover of medical care, for slowing down the consolidation of everyone into HMOs, and to work on the medical malpractice issue.  If you are not prepared to engage in this battle, you may as well consider a career in a field other than medicine.  You are the future and you are the individuals who can save health care in America.”

Everyone likes to cite Sweden as the example of the greatness of socialized health care; taxes, however, comprise roughly fifty percent of Sweden’s GDP.  Also, in many cases in Sweden, it can take up to two years to be seen for routine medical procedures.  I disagree with using the old Soviet method of “Dognat Y Peregnat;” that is, to “catch and overcome” by focusing on another nation and trying to outdo them somehow in some area.  This is bad for America.  We have our Constitution for a reason, and that is to protect Americans, even if that means from its own government.  As I stated earlier, our health care system is flawed, but I don’t believe abandoning individual rights in America is part of the solution.  I don’t trust the government’s social system’s ability to ensure I get the right tax return every year, so I sure don’t trust them with responsibility for my health care.  I’ve seen the way government work takes place.  Removing competition and capitalism from the health care system is simply a flawed proposal.

I’d like to take off on two tangents here:  First, I don’t think it is proper for any other American citizen to pay for Michael Moore’s colonics; what I mean to say is health care starts with the individual.  Some medical problems are unavoidable (believe me, I know), but I don’t think someone else’s poor health decisions, such as smoking, should affect anyone else’s pocketbook; I’m sorry if that’s offensive to anyone.  This brings up my second tangent:  Too many people are walking into theaters with no opinion whatsoever and are leaving fired up over some newfound information, whether it is fact or opinion.  In the case at hand, some people actually leave a movie believing Cuba has a better social system than we do.  Effective orators and entertainers have Americans’ undivided attention and are doing a great job at shaping our mindsets.  This has to stop.  It is time to stop general American apathy and start thinking for ourselves.

Consider the words of Theodore Roosevelt in 1910, when speaking in France to the graduating class at the University of Paris:  “It is highly desirable that a leader of opinion in a democracy should be able to state his views clearly and convincingly.  But all that the oratory can do of value to the community is to enable the man thus to explain himself; if it enables the orator to persuade the hearers to put false values on things, it merely makes him a power for mischief.  Some excellent public servants have not the gift at all, and must rely upon their deeds to speak for them; and unless the oratory does represent genuine conviction based on good common sense and able to be translated into efficient performance, then the better the oratory the greater the damage to the public it deceives.  Indeed, it is a sign of marked political weakness if any commonwealth of the people tend to be carried away by mere oratory, if they tend to value words in and for themselves, as divorced from the deeds for which they stand.The phrase-maker, the phrase-monger, the ready talker, however great his power, whose speech does not make for courage, sobriety, and right understanding, is simply a noxious element in the body politic, and it speaks ill for the public if he has influence over them.  To admire the gift of oratory without regard to the moral quality behind the gift is to do wrong to the republic.”

Hillary

And now, consider the upcoming Presidential election.  It seems like a free-for-all.  I just hope whoever ends up being elected President in 2008 becomes a symbol of unification.  I haven’t seen a real candidate from either caucus that fills the billet yet.  Most say a Democrat will be elected President in 2008, and in separate conversations, most say Hillary Clinton will win the Democratic nomination.  On July 16, a Zogby Poll ranked Hillary above every Republican candidate.  Therefore, according to polls, which I hate, Hillary has a pretty good chance at the Presidency.  I don’t think people are thinking long term about this issue, as if they haven’t learned what a divisive figure can do to the United States over the last eight years of President Bush’s term.  Imagine the actual “State of the Union” the day after she is elected president; according to another poll, forty-six percent say they would never vote for Hillary Clinton.  Therefore, another President Clinton would be extremely divisive and frankly bad for the nation.

Personally, Hillary reminds me too much of Nurse Ratched from One Flew over the Cuckoo’s Nest.  Although some Americans may be apathetic to a Clinton presidency, I’m afraid the forty-six percent that oppose her would react the way Jack Nicholson did, if given the chance.  I’m not advocating violence, but this forty-six percent won’t be given a simple frontal lobotomy to ease their pain.  If elected President, Mrs. Clinton’s opposition will not disappear over night.  There are many reasons not to vote for her, cited in many new books, but I won’t get into those here.  Her supporters, male and female, seem to be focused on the fact that she is a woman, and electing a woman president would signify some sort of evolution here in the States.  Blinded by some idyllic vision, her supporters are apathetic to the inconvenient truth behind her campaign, which is the uniform distribution of wealth.  There are a lot of poor people in this country, and to Mrs. Clinton, that translates into a lot of votes.  Even though her proposals display brazen disregard for the future of this country, she still stands a good chance at the Presidency.

Health Care and Hillary

I seem to recall another Presidential candidate named Clinton who used “universal health care” as a campaign platform; the projected cost of his plan effectively killed it when he took the office.  My vitriol for Mrs. Clinton has loomed below the surface for a while, but has been perpetuated by a recent visit to Richmond.  She spoke for thirty minutes to a bipartisan crowd on July 17.  According to reports, her speech consisted of insulting the President and pushing for universal health care; the method in which she did the latter was quite clever.

Her speech began with an appeal on the behalf of the 9 million uninsured American children.  As President, Mrs. Clinton promises to insure all of them; in Richmond, she endorsed an upcoming Senate bill to insure nearly half of them with a simple 61 cent tax increase on a pack of cigarettes.  Even though the basis of this action (taxing private sector businesses) might be illegitimate, it’s hard for me to argue against it.  Cigarettes are a bane on the health of the United States; likewise, it seems immoral to refuse health insurance to children.  Later in her speech, however, she admitted this would be her first step towards universal health insurance.

In other words, just give her a little bit now, as Senator, and she will take more later, as President.  Give her your individual freedoms, one at a time, and soon, you too can receive Cuckoo’s Nest hospitality and treatment.

I believe the decision to provide universal health insurance at a federal level would be due cause to rewrite the U.S. Constitution; at that point it would obviously be inadequate.  Also, consider the fact that 40 million Americans are uninsured; imagine all of them showing up to the doctor’s office for the first time, because the service is now available.  Recent studies don’t take a lot of factors into account when plotting out how to service the American public with health insurance.  I’m afraid a government takeover of the health care system would fail; if it failed, it could literally kill us.

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