Pages, Costs, and Agencies Added To The Obama/Pelosi Health Care Behemoth

CBO projected “savings” are never realized. Congressional cost estimates are always dramatically understated. The broken and corrupt process demands it be this way. Review projections for social security, medicare, senior prescription drugs, and any other government run program and show me even one that came in anywhere near the initial budget or projections. What makes any sane person think this health care fiasco will be any different? It is a fiction generated by those who seek power, money, and control and touted by the incompetent.

The purpose of this post is not to be contentious or argue in favor of any particular point of view. I’ve stated my own views on the Obamacare debate in some detail elsewhere; at present I’m not seeking to start this again (among other things, my personal time schedule wouldn’t permit me to get into the usual one against six debate which is the invariable outcome). So, once again, I’m not seeking a debate; I’m simply seeking a reaction to a very, very narrow question.

To wit:

The abortion issue.

Now, virtually all private insurance plans pay for abortion. You buy United Health Care or Aetna or Blue Cross or Humana and pay more in premiums than you get back in health care services and you are directly subsidizing abortions. That’s the reality. The fact is, you are voluntarily doing this: it isn’t some program imposed on you by government. Private insurance pays for most of the abortions which take place in this country. You choose to buy private health insurance (or you accept private health insurance from your employer) and you are directly subsidizing abortions, of your own free choice.

Now, what’s going on now, in the House, is interesting. No guarantee how this is going to turn out. No guarantee that the final bill won’t be changed in Senate/House reconciliation, etc. But, just for the sake of academic argument, let’s say that what seems to be going on now actually ends up being the way the final bill gets signed into law.

In order to get enough votes to pass, Pelosi may be forced to give in to demands from conservative Democrats (no, that’s not entirely an oxymoron) that the final bill puts in a total prohibition against the “public option” plan paying for any abortion services and for government-subsidized private plans paying for any abortion services.

Now, what this would do (stay with me on this) is to force lots of people who would otherwise be covered by private health insurance which pays for abortions into a public plan (or publicly subsidized private plan) which did NOT pay for abortions. Hence, the total number of abortions actually performed would certainly go down (not close to zero and maybe only by 10% or so or whatever, but they would still go down).

In fact, for someone who didn’t want to subsidize abortions with his (or his employer’s, which is the same thing) own money, the only option might be the “public option.”

Wouldn’t that be just a tad bit ironic?

- Larry Weisenthal/Huntington Beach, CA

The number of taxpayers in 2007 was 138 million. So it averages out of a tax increase of about $1,232 per taxpayer per year. But it doesn’t stop there. The government expects an 8% compounded increase in the total cost yearly after that.

The Democrats claim the health bill will help 96% of the American people. That leaves 12 million people. Out of the 47 million people not insured, 10 million people are illegal aliens which are said won’t be helped and 17 million are in households making $50,000 or more so they probably will not get aid. So that leaves 8 million people that will get help from this bill. That’s $37,500 per person per year using that $3 trillion cost.

But of course there is even more! Pelosi’s bill has a stick when it comes to states inacting tort reform. If a state inacts tort reform, the federal government will deny federal health aid to the state. So a person in the state getting Medicare will be getting no care and those getting Medicaid will be getting care from money provided by the state side. Tort reform would save $58 billion a year according to Sen. Reid and between $100-$200 billion a year in unnecessary medical tests according to Reuters.

Here’s the problem: The cost of privately-run health programs rose even more than the cost of government-run health programs. One way or another, we are going to have to pay the costs of health care. The implication of Mike’s post in #6 is that the reason expenses exceeded budget was because of government inefficiency, waste, fraud, etc. There may have been a bit of that; but there’s inefficiency, waste, fraud, etc. in privately-administered health care plans, as well. The reason costs have sykrocketed beyond budget is because the cost of health care has skyrocketed.

Health insurance premiums for small businesses are going up 15% in this year alone, after more than doubling during President Bush’s tenure. Even as benefits are going down and out of pocket costs are going up.

Look at the economy and business environment, right now. You think that the 15% increase wouldn’t be just as much of a job killer as any tax increase? And the increased out of pocket costs won’t be a burden on consumer spending and saving? But tax increases to pay for Medicare (even to make Medicare solvent) would have been less, over the years, than the increases in private insurance premiums plus increases in out of pocket costs would have been.

I think that there are many creative ways to attack the Pelosi health care bill and Obamacare in general. I compliment the FA contributors for their scholarship and diligence in finding flaws in the general Democratic health care initiative. But arguing this on the basis of total cost is the weakest argument which you can make against this bill. It won’t increase total costs (insurance premiums + taxes + out of pocket costs) beyond what they are going to be in the absence of health care reform.

- Larry Weisenthal/Huntington Beach, CA

If this bill passes, it will be a very sad day for me. I came to America with no money, lots of dreams and worked my a$$ off to be able to enjoy a better life and a better future for my children. What happened to that America? It is fading and I cannot explain the apathy of most Americans to engage themselves in the political process. We have became complacent with our lifes. Our conservatives values have been attacked by a bunch of nitwigs who love to hate America from the morning til the evening because Marx says so. A bunch of good for nothing elected officials are voting right now to take my freedom away. Where are those nice decent Americans that knew what was right and were willing to fight for freedom?.

They just passed the votes. One republican voting for them!
God Help Us!

openid.aol.com… look again. Reuter claims that Medicare fraud is $200 billion a year. Medicare’s budget for 2009 was $408 billion. So 49% of Medicare payments are to pay for fraud. Pelonsi’s plan calls for the cost to be $37,500 a year for each of the 8 million that it’s going to help. I really doubt any private insurance payment is that high in the U.S. Not only is your healthcare bill going to naturally go up, you will have to pay about $1,000 a year in new taxes to pay for Pelonsi’s new plan.

The Republican plan would cut costs, but the Democrats don’t want to do that.

For all we disagree on, I’m curious to know how my sentiments regarding health care align with conservative contributors and readers of this blog.

Disclaimer: I am a layperson on all fronts with respect to health-care, so I won’t be too surprised if my ideas are ultimately shredded, but that’s at least one better than keeping them from ever seeing the light of day.

First, I’ll make some enemies on the right: I feel that our government should offer a welfare-like health care plan which fully funds/reimburses all palliative care (ease of suffering).

I have no qualms about being taxed out-right for the ease-of-suffering care for other members of society. I do not think anybody, anywhere, should be in a position to not ease the suffering of a fellow human – that, in my mind, should constitute criminal behavior.

Now, for some enemies on the left: The government should play no role whatsoever in decisions or funding pertaining to curative treatments.

All curative treatments should be funded out-of-pocket or by private insurance (at the discretion of the patient / patient’s family) and, for patients and families unable to afford that financial load, then from appeals to charitable organizations (or, equivalently, to the hospitals or clinics to act in a charitable manner) for financial assistance.

Speaking for myself, I have no problem allocating enough of my income to pay for the minor medical issues encountered by myself and my family; nor with paying for private insurance to use should I or my family encounter major medical expenses.

Furthermore, I’d happily contribute a significant portion of my income to a charitable organization which gave explicit and clear guidelines to how and under what circumstances those funds would be disbursed to people in need. Transparency and accountability would be key here: I’d demand the right to review an online database of all cases submitted for funding (stripped of personal identifying information), to see the amount of charitable funding (if any) ultimately contributed or lent for each case, and to see a statement detailing the rationale behind the funding decisions for each case. Accountability might come in the ability to vote off board members who regularly made funding decisions I find un-palatable.

From my naive layperson perspective, it seems a system such as this aligns the right’s desire for personal freedom with the left’s desire to treat all members of society with the human compassion empathy according to the values encompassed by the community as a whole.

Shall the shredding now commence?

Mike Thompson (D-CA) – North Coast Congressman Mike Thompson doesn’t think the House of Representatives health care bill is perfect, but he thinks it’s a historic step forward.

”I don’t think it’s close to perfect,” Thompson said Saturday afternoon, hours before he intended to vote for the bill. “This is like any other major piece of legislation — we’re going to be working on this forever. As long as there are people and there’s a need for health care, we’re going to be refining this legislation. It’s the nature of the beast. But, this bill brings us one step closer to quality, affordable health care for all Americans.”

Mike Thompson is a worthless cull, once a man who won votes from both sides of the aisle, now and in recent years he has shown himself to be a partisan tool. He was going to vote for this bill in the very beginning, before the Recess when they were trying to ram it through. Before anyone, including himself, had read it, before anyone knew what was in it. Before the Tea Parties, before the “nasty” Town Hall meetings, before the people started asking questions and before the people told him what they thought.

He would have voted for it no matter what was in it – and he has now done just that.

There is no reason for us to pay for Congressmen and Senators like him to fly to Washington and maintain an office there. We know how he will vote. He does not need to be present or to attend any meetings or read any legislation. It is all dictated for him. We can fill in the blank for his vote while he sits on a street corner begging for change.

Gone are the days when Congressmen were Statesmen.

There is an election coming. Register to vote if you haven’t. VOTE even if you have been slacking. Make this one count.

@Old Trooper:

It’s interesting that the people who best understand the health care system, those who work in it everyday, those who bill private insurance companies, Medicare, and who also have to bill patients everyday and have to live with the consequences — overwhelmingly are in favor of not merely health care insurance reform but also are in favor of a public option. This was shown in rigorous, recent, peer-review studies, which I’ve referenced before. These would be the doctors who actually work in the system and see how it works.

Those most in favor of both reform and general and public options in particular are primary care physicians — pediatricians, family medicine doctors, internal medicine doctors, geriatricians. Those who are opposed tend to be the likes of plastic surgeons and other surgical specialists who perform lucrative elective surgeries. The health care system today rewards procedures and treatments like chemotherapy (oncologists do very well, under the current system — there’s an interesting chapter in the new book Super Freakonomics which goes through the numbers regarding the ineffectiveness of chemotherapy, relative to the huge amount which is spent on it — something like 40% of all Medicare drug costs). The present system doesn’t reward cognitive medicine — a wise doctor diagnosing a condition and coming up with an effective treatment which doesn’t require some sort of a procedure. This will probably change, somewhat, under a reformed system, but, overall, a majority of all major classes of physicians are in favor of both reform and a “public option.”

I appreciate your concern for my well-being, Old Trooper, but I can take care of myself, under both current and proposed systems. You don’t need to worry about seeing doctors in homeless shelters or collecting unemployment compensation, no matter what system emerges.

- Larry Weisenthal/Huntington Beach, CA

people need health care and someone has to pay for it. That “someone” is ultimately us.

What is health without the true basics of life?

people need food and someone has to pay for it. That “someone” is ultimately us.
people need shelter and someone has to pay for it. That “someone” is ultimately us.
people need clothing and someone has to pay for it. That “someone” is ultimately us.

People need liberty and freedom. If government provides everything and thus “dictates” based on the availability or usage of what government provides, how much of our liberty and freedom will we need to give up for the security to have government providing everything?

If the government takes away some of our liberty and freedom someone has to pay for it. That “someone” is ultimately us.

Larry re: the abortion issue (#4)

Larry regardless of “who’s paying”, the ‘ Obamacare abortion plan’ is vastly misunderstood if relegated to a “number’s issue.” Everyone who wants an abortion always finds a way to pay for it, even if they need to go on a payment plan.

To a conservative, ‘Obamacare abortion’ is like a “ Roe v Wade on steroids.” It’s bad enough we have to live with a totally unconstitutional Roe v Wade, but for the United States, to “socialize abortion” is beyond egregious (unlike a private insurance company that is simply making a “business decision.”)

Who, more than any country in the world, is the greatest protector of human life? Well, we know who it won’t be much longer if Obama gets his way.
I will take bets with anyone interested that there is absolutely NO WAY ‘Obamacare’ will ever pass without abortion coverage or with a conscience clause. Consequently, after our congress has sold it soul for the final votes, I suggest they do us a favor and burn the Declaration of Independence with the signing; why pretend to play the game any longer on the sellout of America?.

I also have to bring attention here to a bit of irony regarding Obama’s “closest advisor, Anita Dunn, who “so often turns to her greatest ‘political’ (yeah, like Mother Teresa was ever the least bit ‘political’) philosopher Mother Teresa. The irony is this: Mother T, also a Nobel Peace Prize Winner, passionately warned that “The greatest destroyer of peace is abortion.” I guess our Nobel Peace Prize winner most pro abort president in US History didn’t get that little bit of wisdom from his ‘Mao advisor’, unless of course, O’care is really about power and control. Just sayin’.

What’s the baseline these guys are calling for where you get “free” healthcare??? how poor is poor?? If everyone ends up basically paying for a plan…. isn’t this more an act of COWARDICE than “reform”??? I mean if most of us already have coverage (I do) .. wouldn’t it be EASIER to just “bill” (and ENFORCE IT) those who freeload?? Work payoff programs and the like??? You owe a big bill, and uncle sugar pays.. you work for uncle sugar till you are paid up! Those who don’t, or cry that “slavery” crap…. there’s the door!!

it seems it’s ALWAYS this way!! Easier to pork Joe Taxpayer than to tell Ted Freeloader to pony up or beat feet!!!

Quoting me: Larry W: It’s interesting that the people who best understand the health care system, those who work in it everyday, those who bill private insurance companies, Medicare, and who also have to bill patients everyday and have to live with the consequences — overwhelmingly are in favor of not merely health care insurance reform but also are in favor of a public option.

Mata responds:

I shouldn’t even be posting this eve since I’m short on patience. But this one, Larry….. steam from ears. What a load of horse manure.

@Mata, @Mike

http://content.nejm.org/cgi/content/full/361/14/e24

Overall, a majority of physicians (62.9%) supported public and private options (see Panel A of graph). Only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option (see Table 1). Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so. Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001), but a majority still supported it. Finally, there was also majority support for a public option among AMA members (62.2%).

Conclusion: Nonetheless, it seems clear that the majority of U.S. physicians support using both public and private insurance options to expand coverage. A majority of physicians also support the expansion of Medicare. Support for the public option is consistent across physician specialties, practice settings, and regions of the country, and therefore should be carefully considered by lawmakers as they finalize legislation to reform health care and provide coverage for 47 million uninsured Americans.

This most recent study is entirely consistent with the results of another peer-reviewed study, published in a different medical journal, a couple of months ago.

P.S. (to Mike): Your cavalier use of the verb “to lie” is a reflection of the sad state of political discourse in general, circa 2009.

- Larry Weisenthal/Huntington Beach, CA

Larry, for every poll you cite how doctors just love this public option bit, there are polls that state the opposite. But as you are a fan of the NEJM as the quintessential final word of fact… as if asking 2130 doctors is a definitive statement of anything save that only 43% of them felt strongly enough to return the survey questionaire at all. Of those 90% were urban practitioners for their various specialties, and 70% were operating primarily out of hospitals. So again I will say to you, you may be able to speak for yourself, and perhaps your circle of friends. We’ll even give you the benefit of adding the 58.3% of those 2130 responders (or 1241 more physicians) who agree with you.

Considering that the BLS put the number of physicians and surgeons in the US at 633,000 in 2006, the opinions of 1241 is tandamount to .000196% of the number of medical professionals three years ago… and likely even less today if you are correct the field is growing in number.

Forgive me if I’m not wow’ed by your statistical proclamations.

The responders were reacting to a proposal that genuinely combined private/public options…. altho 58% of the physicians were specifically in support of lowering the Medicare age to 55… not offering it to the world at large. That’s significantly different that what the House bill that passed is proposing. But then, they weren’t asked if they support Pelosi health care… they were asked if they support public/private options… which we *already* have in Medicare, Medicaid and the VA. You might as well be asking them if they like turkey when there’s a chicken in the oven.

Let’s talk about your business decision to opt out of the public option because of the financial drag on your business yet again…. You cut the Medicare public option patients for a “concierge” service. Your “concierge” service will be defunct as this public option becomes the sole insurance provider… as it is designed to do, and as Obama and his supporters openly claim is their goal. You will no longer have the private concierge option to pay your prices, and you too will be stuck with whatever panel of czars decide is a fitting payment for your services.

I look thru the NEJM various supporting documents for your prized poll, and I see nothing that indicates these 1241 responders either understand that single payer is the goal with this legislation, or that they want to see single payer as the end result. In fact, I see just the opposite…. that they are fine with working with the current system of private and public options that exist, perhaps extend the Medicare benefits to 55+ and nothing more.

Funny… that’ ain’t what’s happening, is it?

@Mata (#30):

Mata, it is perfectly appropriate for you to fault polling methodology, or whatever, but that’s not what you were doing, when you wrote:

Do NOT… I repeat… DO NOT represent your personal circle of friends as the majority here. You want to spread this crap around FA over and over, you’d better come up with something other than your own personal career and reputation as definitive truths.

Can you at least acknowledge that your representation (#23) of what I was doing in my post (#20) was inaccurate?

With respect to your comments about statistical sampling, this is how all polls work. The 43% response rate is pretty good, by the standards of most polls, as is the size of the sample. My statement (quoted in the first paragraph of #28) was entirely supportable, as written.

Let’s talk about your business decision to opt out of the public option because of the financial drag on your business yet again…. You cut the Medicare public option patients for a “concierge” service. Your “concierge” service will be defunct as this public option becomes the sole insurance provider… as it is designed to do, and as Obama and his supporters openly claim is their goal. You will no longer have the private concierge option to pay your prices, and you too will be stuck with whatever panel of czars decide is a fitting payment for your services.

Let’s elaborate on this: Yes, I dropped out of Medicare, because I didn’t like their reimbursement level. But this was at a time when many of the large private insurers (e.g. Blue Cross, Aetna, United Healthcare) didn’t pay anything, leaving their clients (my patients) to pay the whole bill (my patients won 16 of 16 cases against Blue Cross in small claims court, for amounts ranging from $1500 to $4500, but still Blue Cross kept denying, because most cancer patients don’t want to go through the stress of doing this). P.S. Just got another shout out, passed along only since your brought this up:

http://www.cancerdecisions.com/content/view/284/2/lang,english/

With regard to the US government ever “outlawing” the “private option,” that’s an entirely theoretical risk; “private options” exist in Germany, France, Japan — even in England, where the majority of physicians are actually government employees, unlike in any of the other Western democracies. But, even in England, there are private practitioners and a “private option.” It’s virtually inconceivable that a “private option” would ever be OUTLAWED here. In any event, it’s the same sort of scaremongering as “rationing” and “death panels.”

- Larry Weisenthal/Huntington Beach, CA

>>Let me repeat that slowly… this is a step to single payer. Digest thoroughly, please.<<

There isn't anything in the House bill which remotely hints at "single payer." I'm sure that there are lots of things which Barack Obama might wish for, which he'll never get. A "single payer," with a total government monopoly which doesn't exist even in England may be his secret wish, but if wishes were dollars, we'd all be rich.

It's the same thing as rationing and death panels. Just more scaremongering.

You accused me of basing my statements on personal opinions of me and my friends. This was wrong.

You misrepresent the NEJM study.

What you glossed over was that the “public option” the physicians favored was the expansion of existing Medicare to citizens 55 and older.

No, this was an entirely separate issue (see Panel A, in the referenced paper).

- Larry Weisenthal/Huntington Beach, CA

While waiting for my prior reply to Mata’s #33 to appear:

Yet if you were to find those that shared the most similar structure to Obama/Pelosi proposal, it would be Canada and England.

WTF ????

Where in the world did you get that gem of an analogy?

- Larry W/HB

@Hankster:

Let’s say that you are going to “reorganize 16% of the economy.”

How many pages would you feel are appropriate for describing how this objective is to be achieved?

2,000?

1,000?

500?

100?

10?

1?

What type of an organization chart? What’s the maximum number of permissible boxes and lines and arrows?

Just curious.

It’s a gargantuan undertaking. A breathtaking undertaking. I’m sure that they didn’t get it totally right; probably made some really boneheaded mistakes. It’ll no doubt get reshaped, not only by the present Congress and President, but also by future Congresses and future Presidents. But it’s a beginning. True health insurance portability (which will allow people to change jobs and to change states, without having to base this decision on whether or not they’ll lose their insurance coverage). No lifetime limits on coverage. Dramatic expansion in people covered. There’s much more to like than to loathe, in my opinion.

- Larry W/HB

@pdill:

Larry, re: the Bishops and abortion, no worries (to the dems), it means nothing; won’t last.

I don’t agree. The Senate is more conservative than the House. Whatever bill gets finally passed and signed into law WILL have the robust provisions that (1) no “public option” plans can pay for abortion and (2) no private plans subsidized with public money can pay for abortion.

I don’t know how you can criticize the Bishops for supporting the bill.

What’s more important, a “conscience clause” or reducing abortions? Abortion rights advocates are furious about this, and with good reason. Millions upon millions of women will be moving from private plans, which pay for abortions, to public and public-subsidized private plans, which will not pay for abortions. This will clearly reduce abortions in this country and how can you criticize the Bishops for supporting this?

The House bill has a very important provision which will clearly reduce abortions and the bill is supported by Catholic bishops, who have always been in favor of not only reducing abortions but improving access to health care through government-funded mechanisms. I don’t know why the bill should not, therefore, be supported by the Catholic laity.

The conscience clause can be a separate war, to be fought another day.

Personally, I strongly support the prohibition of public funds from even indirectly subsidizing abortions which are performed for reasons other than rape, incest, and threat to the life (not “merely” health — which is an exception open to abuse) of the mother. I hope (and believe) that this provision will remain in the final bill ultimately signed into law by the President.

- Larry Weisenthal/Huntington Beach, CA

It’s a gargantuan undertaking. A breathtaking undertaking. I’m sure that they didn’t get it totally right; probably made some really boneheaded mistakes.

>>>So why the mad rush to cram this “overwhelming change” through??? How about, bite by bite, step by step??? And GET IT RIGHT!!! Think it through….. but no…… HURRY HURRY or we’re DOOMED!! B.S.!!!

The darn thing isn’t supposed to go into effect until what, 2013??? (Note:AFTER the next ELECTION.. COINCIDENCE”????? NOT!!) So there is PLENTY of time to work thru this and do it, RIGHT!! So why the mad dash??? To jam it thru BEFORE anyone had the time to study it….
If not, explain WHY!!!

The left keeps claiming that “Bush” used “emergencies” to do his “evil deeds”…..

Obama is doing the EXACT same thing…. Crisis!!~ Crisis!! Crisis!! Some “Change”…….

@Hankster:

Why not take it “step by step?” Because it will never get done that way. It’s a bold initiative; getting it through is taking the mother of all legislative sausage-making efforts.

By the time it finally gets signed into law, there shall have been lots of time for everyone to get their voices heard. From Tea Parties and Town Meetings and marches on Washington in the summer to opinion polls to cable television to talk radio to mainstream media to blogs to op-eds to Sunday morning news/interview shows to debate on the House and Senate floors. This is one issue which isn’t slipping in, under the horizon.

Why not wait? Well, for one thing, the Dem majority may very well be a thing of the past, come January 2011. National health care was first proposed by Teddy Roosevelt and it’s never been done yet. Of course, conservatives will protest and oppose it. George Will pointed out that this is why we have two parties. Checks and balances.

Often stalemate. But occasionally something big does get done.

- Larry Weisenthal/Huntington Beach, CA

@Hankster:

Lastly….. I see, in typical Liberal fashion, you totally IGNORED my question on “Is it even LEGAL”????

I didn’t ignore it, and I’m not a “typical liberal” (well, maybe by FA standards, but not by real world standards). I didn’t comment on your question because I’m not a constitutional scholar. I presume it’s legal, because, of all the arguments made against it, illegality has not been on the front burner of complaints.

And, yes, I agree with you that this whole thing is entirely political. The Dems didn’t put in the anti-abortion provision because they wanted it, it’s there because they had to put it in in order to get it passed. But it is there, and it’s a better bill because of it. Very effective politicking by the Catholic Bishops. Rather than yelling at town meetings and obstructing, they effectively used their political clout to get the bill changed for the better.

The GOP wants malpractice tort reform? Simple, agree to vote for the bill and in goes tort reform. Or else bellow and whine and get nothing. The GOP isn’t out to get the best bill possible, it’s out to kill the bill. I’m not saying that the GOP is totally wrong and I’m not saying that the Dems are totally right. But politics is the art of the possible. They are doing what’s possible, not what’s ideal and not what could be done if the party out of power wanted to leverage the best deal it could, as opposed to betting the ranch on killing the bill. That’s their choice.

- Larry Weisenthal/Huntington Beach, CA

well now we’re getting somewhere!

It’s not legal from the standpoint that federal gov has no legal standing to be getting into, or interfering with, PRIVATE business!!! Now, legally “regulating” is one thing, but getting INTO the business of off the scale…….
They did it with the car companies…..
AIG etc…..
It seems following the law is the furthest thing from the minds of those in DC these days…. which is WHY i give them ALL a “NO vote!!!
As to “agree to this and you’ll get a “gimmee”….. umm isn’t that the kind of stuff “Tony Soprano” would have pulled??? You give me this, and give you THAT??? Your principles be damned…. you’re all for sale!! An offer you “can’t refuse” ???? Why not just SELL their votes??? THAT right THERE is why this country is falling FAST!! We’re selling our souls.. “for a deal”….

Sorry, but that’s not the government as it was explained to be back when I was in school…..

I see Larry’s engaged in multiple conversations in my absence. So forgive me for regressing to address some of our back and forth.

Responses to @Larry’s #34.

There isn’t anything in the House bill which remotely hints at “single payer.” I’m sure that there are lots of things which Barack Obama might wish for, which he’ll never get. A “single payer,” with a total government monopoly which doesn’t exist even in England may be his secret wish, but if wishes were dollars, we’d all be rich.

First and foremost, of course there isn’t a “hint” using the words “single payer” in these multiple proposed bills. If they used those words specifically, the bill would be shot on sight and DOA. However just because the words “single payer” are not used, does not mean the end goal is exactly what Obama and sundry others have stated as their desire. I will remind you with the video below.

Not enough? Let’s check out a few of those unimportant Obama associations and partners in Congressional crime.

Naw… single payer just *couldn’t* be the goal, right? And your quest is not really to cure cancer…. right. sigh

Secondly, perhaps you may want to brush up on the definition of “single payer” which means that the payments are controllled by a “single payer”… ala the government…. whether the services are administered in govt or private facilities. By Congressional notions, they are creating a system that functions from a medical trust fund account. And we all know how those “trust fund” accounts go… as the SS fund has been empty for years from Congressional looting. Any “public option” is designed as a “single payer” with payments collected and held by federal entities, and reimbursements decided by public entities.

Which then brings me to@your other “WTF?” comment INRE my analogy of the House O’healthcare as resembling NOTHING that other nations have, but certainly closer to Canada or England than to France.

As I pointed out, the Obama/Pelosi (ultimately) socialized medicine will be collecting the cash for the gov’t coffers, and gov’t will control the reimbursements and handling of those funds. Additionally, they are slamming employers with mandates, and penalities if they don’t fall into line. Individuals will be penalized if they don’t have proof of insurance, all which is tied into IRS time… filing tax returns. Get my drift so far?

By contrast, the French system’s money, per a June 2009 Medical News Today article, is controlled by employer and unions with gov’t oversight. Nothing similar to France when it comes to who gets, and doles out, the money. There are no mandates on employers, nor are citizens fined and penalized via their tax returns.

Let’s compare the Obama/Pelosi take-the-money-and-run plans with Canada now… again, from this year’s Medical News Today, Canada’s system is funded thru their sales and income taxes (i.e. a mandate thru their tax system) and is, as they describe it, “socialized insurance”. Meaning the nation becomes a huge risk pool. The low risk pay more, the high risk pay less. Very socialized utopia, don’t you think? Well, maybe if you’re in the high risk group. I’m quite sure the low risk feel quite skewered.

However unlike the greedy wench, Pelosi, the Canadians let their provinces and territories set the budget and administer the funds. At least Canada’s government brings it down to local levels, and doesn’t place the power of the money and decisions in the hands of the federal honchos.

While we’re comparing that “gem of analogy” you are missing since you aren’t paying much attention to details, let’s talk about England’s health care and their recent “payment by results” changes…. you know, the same stuff the libs talk about when they want to reimburse doctors based on performance? Oh, even in it’s early evaluation stages, England has found a reduction in costs. Overall that’s good. But then, that depends upon the meaning of “performance”, don’t you think? And, of course, the time. Can we assume that someone in excruciating pain may certainly feel better and somewhat immune from what ails them if the drugs mask the problem instead of curing the problem?

On this “performance pay” bit, I’m still the jury out. Not sold on it entirely until I see just what the measures of successful “performance” and “results” are. But that’s another story. Right now, we’re discussing whether the odd ball US proposals (which I still say resembles no one) are closer to Canada or England than they are to France. The French have no “pay for results” reimbursement criteria.

So far it looks like the US Congress has taken the talking point of “French health care public/private options” (which we *already have* here), and mutiliated it into Frankenstein healthcare by incorporating all of the worst features of the worst systems to give it life.

Now let’s go back to the “single payer” definition from medterms.com… again….

Single-payer health care is distinct and different from socialized medicine in which doctors and hospitals work for and draw salaries from the government.

Doctors and hospitals work for and draw salaries from government. We already have “socialized medicine” by those standards with the military VA benefits and facilities. Let’s look at Obama’s long range plans… pay for education (medical would top his list…). Similar to France there in that the State pays for their education and they work for govt hospitals.

You’ve opted out of low ball reimbursements for your financial health. You did this for your own survival. And Larry, as much as I bring this up over and over, I’m trying to make a point. I applaud your survival instincts. I do not applaud your drive to create a system where you will be forced into a system where the majority of the nation’s citizens will not enjoy the fruits of your research and accomplishments. You will not be reimbursed your costs by a single payer, govt controlled public option. And their very existance will destroy the private insurance market as unaffordable but by the most wealthy… assuming we have many left after all this spending frenzy that tripled the budget and massively ballooned the national debt to the unimaginable in under a year.

There doesn’t need to be the words “single payer”… or as you understand it to be “socialized medicine”… in these bills. They are designed as the first step to just that system. They won’t tell you that you are buying a Volkswagen when you think you’re buying a Cadillac. They’ll let you figure that out a few years downline.

MataHarley,

Very informative, it couldn’t have been said better.

The Catholic Bishops may have won a battle, but not the war. As long as tax dollars are going to Planned Parenthood, we are paying for abortion in spite of the Hyde Amendment. Passing the abortion amendment in the health care bill will not prevent our tax dollars from being thrown in Planned Parenthood’s pot from another part of our budget.

http://www.dakotavoice.com/2009/07/u-s-house-votes-to-continue-taxpayer-funding-for-planned-parenthood/

We’ve had denials all the way up to the president that abortion funding was in the health care bill, funny how it took arm twisting and finally relenting to an amendment to ban something not in the bill. Funnier is how angry that amendment made a sizeable chunk of the House democrats, they may be the ones that scuttle this whole fiasco over something that wasn’t in the bill.

After watching the spat between Rangel and Boehner, that non existant funding might be put right back in the bill during the reconciliation process, which would lose the votes of the dem pro-lifers that just got what wasn’t in the bill, out of the bill. Oh what fun democrats can be, wonder which wall they will eventually decide to slam into, sigh.

This has even got the high trafficked abortion rights supporting, lefty blogs in a fightin’ mood. They’ve already got the list of those pro-life traitors and are going to get rid of them. Twill be interesting to see how they manage to challenge primaries in blue dog districts by funding liberal candidates to replace them. The little foot stompers are soooo cute when they are mad. Their common sense must have escaped from that hole the anger burned in the top of their pointy little heads. I’m thinking the “American people” aren’t really in the mood for these characters anymore.

@Missy:

You said:

The Catholic Bishops may have won a battle, but not the war. As long as tax dollars are going to Planned Parenthood, we are paying for abortion in spite of the Hyde Amendment. Passing the abortion amendment in the health care bill will not prevent our tax dollars from being thrown in Planned Parenthood’s pot from another part of our budget.

Now this is interesting. The main concept introducing this thread was that the health care bill was too complicated and tried to do too much. So you find fault with winning a battle, because it didn’t win a broader war.

It’s a HUGE battle that they won. I should also add, it’s the only important battle which anti-abortion forces have won, since … ? Since a whole long time ago. Tell me a bigger battle they’ve won since Roe v Wade.

What you’ve got is outlawing public funds for funding abortion in both (1) the “public option” and (2) publicly-subsidized private insurance. Let’s say that Mata is correct. In her world of hysterical, scaremongering fantasy, we have a “single payer” system, where private insurance in outlawed. In today’s real world, most private insurance pays for abortions and most abortions are paid for by private insurance. So, in a “single payer” system, because of the Catholic Bishops, we’d go from a system of private insurance paying for abortions to public insurance not paying for abortions. This would — beyond the shadow of a doubt — reduce the number of abortions — actually save lives, if you view it is these terms.

Even without a “single payer” system, abortions will go down. Conservatives have been arguing that millions of people will end up with the “public option.” There is no doubt that millions of people will get subsidized private insurance — moved from private plans which pay for abortion to private plans which don’t pay for abortion.

Of course, liberals are screaming. While conservatives continue to scream. What the Catholic Bishops did was to engage in effective politicking. They actually got something done which was very important.

Health care reform is going to pass. Everyone knows this. The Democrats would give their eye teeth to get GOP support. Such support would be important enough that they’d make concessions. I think that malpractice tort reform could be written into the bill, in exchange for GOP support. Or else the GOP could take a “principled” stand against the entire thing and get nothing.

The Bishops worked with the Democrats and achieved a great deal. Vastly more to reduce abortion than anything the GOP was able to do, during their 6 years of power in the Bush years.

The House bill would, I think, be the greatest anti-abortion achievement, dating to Roe v Wade, perhaps. I’m curious: can anyone think of any legislation which came close to achieving what Pelosicare would achieve, if actually signed into law?

- Larry Weisenthal/Huntington Beach, CA

I only mentioned the bishops because that was part of the present conversation, in here. I should have added…..some think. I personally don’t think the bishops carried as much weight behind this amendment as the people from the congressional districts of Stupak and the people’s reps that voted for the amendment.

I also think this issue could possibly be the end of the road for this health care bill. It appears that the democrats have both strong opposition and strong support of abortion within their party. That opposition to abortion within the dem party, btw, would be something I would consider a battle won since Roe v Wade. For too long pro-choice party members have dominated on the abortion issue, another reason why I left that party.

If you think the Catholic Bishops are going to be able to go up against NARAL, NOW, Emily’s List, Planned Parenthood, etc. and win, I think you would be wrong. If Rangel and pro-choice dem conferees get the amendment removed at reconciliation, pro-life democrats reject the bill, if it remains, pro-choice members stand down, result… stalemate and a divided democratic party. I repeat, battle won since Roe v. Wade, the nerve of those pro-life dems, don’t they realize the money these groups have invested to get that party to where it is today! They are now refocusing, energized and mad as hell, pro-life member’s races are going to be challenged, no more of this nonsense.

Maybe you might want to spend some time reading some of the hostile comments pro-choice democratic reps have been making since the amendment passed, the reps that have been continuously funded by the above groups. It’s getting ugly.

I’ve also noticed democrats still have all their teeth, a similar amendment was put forth by Pence, R-IN last summer, overwhelmingly voted down on a party line vote. Same with tort reform, no budging, I don’t see them going to the GOP during the midnight hour reaching out so they can get this thing passed. They have made it clear from the beginning it was to be partisan. Baucus was the only member of Congress that reached out to a handful of Republicans, certainly not enough from the other side of the aisle to ever honestly be able to classify this as bipartison.

@Per Larry’s comments #55, and @ that I live in a hysterical, scaremongering fantasy world.

Didn’t watch the videos, eh Larry? Rather difficult to put words into the mouths of Obama, Barney Frank, Sebelius, Rahm’bo when you can listen to them state their quest from the Dem donkey’s mouth. But I’m a “scaremonger” living in a “fantasy”??”

Well, the hysterical part might be appropriate as that charge sent me into peals of hysterical laughter! But while we’re all playing amateur mental health doctors, let me return the psychoanalysis, Larry. You’re an intelligent man who is dangerous in your complacency… i.e. refusing to acknowledge what you hear (assuming you actually watched the videos to hear their quest for single payer) and placing blind faith in the lying powerhouses (both parties) that we continually elect to Congress. It is those like you who will join happily with Obama to “remake” America into what you believe is a more just nation. And you and others will do this with nary a care as to the fiscal repercussions of this massive government program. Obviously your education focused more on the anatomy, and considerably less on economic world history.

You say:

This is precisely why hysterical cries of “single payer” “single payer” “single payer” are just hysterical scaremongering.

Since you insist not on reading links, let me put this where you can’t miss it.. the definition of single payer:

Single-payer health care: A system of health care characterized by universal and comprehensive coverage. Single-payer health care is similar to the health services provided by Medicare in the US. The government pays for care that is delivered in the private (mostly not-for-profit) sector. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage their medical practices or hospitals.

Single-payer health care is distinct and different from socialized medicine in which doctors and hospitals work for and draw salaries from the government.

Here’s another from a group with whom you’ll feel comfortable… Physicians For a National Health Plan.

Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs.

Unless you again wish to morph real definitions, this is all about creating a massive public option SINGLE PAYER financial system. It is nothing short of tunnel vision and, if I may add, “fantasy” on your part to redefine the medical dictionary’s meaning of “single payer” to fit your political schpiel, Larry. You pronounce this whole O’healthcare plan hunky dory because you rest easy that there is no overt “outlawing” of private insurance and I guess are okay with the creation of a huge single payer system.

Then you insist it’s perfectly fine because no where does the huge *single payer* system “outlaw” (YOUR words, not mine) private insurance.

Well one doesn’t have to ban SUVs to drive them out of business either, Larry. Have a look around…. Congress steadily creates regulations and standards that are impossible for a vehicle of that size and power to meet with any profit structure, and voila… we’ll wake up one morning and no more SUVs. They slowly slip from sight… almost indiscerable to the prozac-laden public eyes. Just less and less of them every year.

Yet prior to their demise (and they are on the demise…) did you see a law that “banned” or “outlawed” SUVs?

So it goes with the public option single payer system, overtaking the private free market system.

When you pit one business… with the ability to print (apparently) unlimited money and raise taxes to operate… against a free market business who depends upon a profit and no access to currency printing presses and the taxpayers’ wallets, the free market model will simply die off. Even if there are a few around to create umbrella health policies, there will be fewer choices for competitive pricing, and only the wealthy who can afford the penalties of “cadillac” plans will be able to afford them.

What you, in your stubborn tunnel vision, fails to comprehend is the economic domino effect of government controlled health insurance on other businesses. It is similar to real estate in that when the housing market is down, it affects the financial health of industry related businesses such as home improvement manufacturers and supplies, jobs for contractors/construction… which then affects retail spending power spilling over to other businesses.

Medical is no different. When medical providers… from physicians to facilities… are forced to depend upon the bulk of their payment from lowball government reimbursement rates, cutting overhead in anyway possible will commence in order to make ends meet. This means equipment that will not be purchased (and therefore not manufactured… at least here), salaries that will be reduced (affecting consumer spending), and perhaps using cheaper overseas manufactured products (outsourcing will increase).

Nothing about this Frankenstein health care utopia will benefit this nation fiscally, and in fact will drive it into the ground. Witness Canada, France, England etal…. all in big trouble with their health care. Yes yes… you’re going to say “but it’s because of the rising costs”. Well, Larry… moving to increased single payer systems does NOT reduce costs. Speaking of fantasies, adding 111 bureacratic departments to administer this behemoth will reduce costs about the same time I’m crowned Miss America.

Yet you want to take the leap of O’faith and embark, expecting a different outcome from a model proven time and time again to fail in history. That, Larry, is what I mean when I say you are dangerous. Were you a radical (I guess like me? LOL), uneducated and unable to deliver a smooth debate, you’d merely be written off as a disruptive loon and your dissertations ignored.

But you are well-spoken, educated. Therefore you carry with you a measure of credibility for those who are unaware of all the details, and of the ultimate quest as imparted to the nation from the POTUS lips and supporters themselves. But no… you choose not to hear that. You merely change the definition of “single payer” is order to muddy the debate waters and label historical facts and trends as “scaremongering”.

Would it not be easier for the nation to make a decision if we genuinely acknowledge the words of POTUS and company, telling us exactly what they foresee with this legislation? Instead we can’t have that debate. Why? Because you and too many others ignore the gorilla standing before your nose in the room when you assert there is no “single payer” quest.

Dang… forgive me if I believe the lips of the Eunuch in Chief instead of your “fantasy” interpretations.

I will also suggest you pull out your medical terms dictionary for a reality check. Even some of us less educated dumb dumbs know the meaning of single payer. Hardly a foreign concept since a combo of single payer/private options is our current Medicare/VA system.

@Mata:

Regarding “single payer:”

To quote you:

If they used those words specifically, the bill would be shot on sight and DOA

Please read what you wrote. These are your words. You are absolutely, 100% correct. Which is precisely why all your talk of “single payer” is simply fanciful scaremongering. Not one bit different from the hysterical scaremongering of “death panels” and “rationing.” No one is going to outlaw private insurance plans for the general population until a solid majority of Americans is in favor of doing this, which won’t be until long after Obama, Frank, Emmanuel, Sibelius, et al have left the scene.

What I care about is providing health care for all Americans, or as many as possible. I agree 100% with the Catholics Bishops on this. I care about ending lifetime benefit limitations. I care about improving health care insurance portability, so that job decisions are made for economic reasons and not for retention of health care benefits reasons. I care about reducing medical bankruptcies.

I look around the industrialized world and I can’t find a worse health care system than that which exists in the USA, save for the sector of the population which is 65 or older, which has the best health care system in the world. Even if it is a bogeyman “single payer” system. Which a GOP lawmaker would try to kill at his own political peril, as it is the health care plan which has the highest consumer satisfaction ratings of all major health care plans.

Your priorities are different than my priorities. We have an honest difference of opinion which isn’t going away. This is the reason, why, as George Will said recently, we have two major political parties.

- Larry Weisenthal/Huntington Beach, CA

@openid.aol.com/runnswim said: ” No one is going to outlaw private insurance plans for the general population “

They won’t need to Larry. It’s abundantly clear that the Dems plan is to drive private insurers out of business or to make their plans so ridiculously expensive that only the super rich will be able to afford them.

Most readers here will recall what Obama said about building new coal plants. It was fine with him if they built new coal plants, but his goal was to bankrupt them.

How many Obamatons do we need coming out of the woodwork who have admitted that their goal is to destroy the private insurance market?

Larry W: For the sake of argument, let me agree with Mata that this is the secret wet dream of Obama and colleagues.

Not much of a secret when it’s on videotape for all who choose to view it…

BTW, you’re repeating yourself on the retort to my comment about them dodging the words “single payer”.

This might be why Pelosi – like you – contributes to the disinformation campaign when she stripped an amendment to the House bill last Thursday that allowed states to pursue single payer systems without insurance industry lawsuits. Why? She said “…it would break President Obama’s commitment to people keeping their current insurance plan if they like it.”

Well ain’t that a smooth move. The feds can put in a single payer public option…. which as all of us except Larry know means it’s administered by the government… but the states can’t because it would eliminate private insurance choice.

Anybody besides Larry *not* getting this forked tongue language?

The public plan has to be run as a business and pay for itself. The public plan will certainly be administered and run by private insurance company contractors.

ummmm… yeah, right. What government “public plan” has paid for itself, Larry? The only one that was even somewhat self-sustaining *used* to be the USPO. Not any more.

And I have to love that “pay for itself”. You mean, of course, must be paid for by the taxpayers. Government isn’t some corporation that functions on profits. They exist only by the taxpayers’ dime.

And what’s this horse manure that “…. the public plan will certainly be administered and run by private insurance company contractors” stuff? Did you not read the bill like you didn’t listen to the words “single payer” from Obama’s lips?

Five words for you, Larry. HEALTH INSURANCE EXCHANGE TRUST FUND – created in the Treasury Dept and who’s operation and administration duties fall under the jurisdiction and control of a new bureaucrat appointed by the POTUS called the Health Choice Commissioner. Even the CO-OPs are quasi-member run as these non-profits provide health insurance thru the government controlled HEALTH INSURANCE EXCHANGE. All roads lead back to the feds unless they (the feds) approve an application for a state-based health insurance exchange.

Oh, BTW, that “public option” that you don’t want to acknowledge is single payer in structure? Only offered thru the HEALTH INSURANCE EXCHANGE… back to the feds control again.

The “public option” has premiums determined by the HHS Secy and newly created Commissioner, adjusted for geographics and constantly morphing to insure funding. Can you say rising premiums? The very same problem we are going thru this nonsense for now?

Also, there’s yet another little fed money stash for operations of the public option within the Treasury. I had to laugh when the House bozos wrote in there that, under no circumstances, would it be eligible for TARP funds bailouts. Wow…. not even implemented yet and they’re already discussing what funds can be used for a bailout. Not that it matters. All bailouts – and public option funds – originate with the tax payer’s wallet.

All providers are part of the “public option” network unless they opt out. Got your application ready for that, Larry? May as well make your opt outs across the board, yes?

Therefore your idea of a “private contractor” administered system for this public option is really, at best, a potpourri of subcontracted non-profit operations who do the government’s bidding on reimbursements, accounting etal.

In short, if you bother to read, you’ll find the House “public option” is fully administered and controlled by the government entities already in existance, and the new ones created. It is, by all medical definitions, a *single payer* financing system. Period. You can spin it all you want, but I’m afraid you have grasped onto a sinking twig of debate.

@mata:

I’ve travelled extensively, to much of the European and much of the Asian world, and I have very good, close friends (mostly people in my own profession) in each place. The USA is never going to be nearly as “socialized” as Europe, Japan, Korea, and even Thailand. Even in Turkey, the lives of educated people are little different from my own. I found nothing to fear, lifestyle and personal freedom wise, in any of these countries, including Turkey.

I don’t fear for our future, Mata. You speak in apocalyptic terms. I suggest that you just buy another gun, lock and load, and hunker down.

Rather than looking for enemies in the White House and halls of Congress, you’re paranoia would be better directed toward our real enemies. Here’s an interesting email I just now received (one of those mass mailing, pass it alongs). Quite thought provoking:

Juval Aviv was the Israeli Agent upon whom the movie ‘ Munich ‘
was based. He was Golda Meir’s bodyguard — she appointed him to track down
and bring to justice the Palestinian terrorists who took the Israeli
athletes hostage and killed them during the Munich Olympic Games.

In a lecture in New York City a few weeks ago, he shared
information that EVERY American needs to know — but that our government has
not yet shared with us.

He predicted the London subway bombing on the Bill O’Reilly show
on Fox News stating publicly that it would happen within a week. At the
time, O’Reilly laughed and mocked him saying that in a week he wanted him
back on the show. But, unfortunately, within a week the terrorist attack
had occurred.

Juval Aviv gave intelligence (via what he had gathered in Israel
and the Middle East ) to the Bush Administration about 9/11 a month before
it occurred. His report specifically said they would use planes as bombs
and target high profile buildings and monuments. Congress has since hired
him as a security consultant.

Now for his future predictions. He predicts the next terrorist
attack on the U.S. Will occur within the next few months.

Forget hijacking airplanes, because he says terrorists will NEVER
try and hijack a plane again as they know the people onboard will never go
down quietly again. Aviv believes our airport security is a joke — that we
have been reactionary rather than proactive in developing strategies that
are truly effective.

For example:

1) Our airport technology is outdated. We look for metal, and the
new explosives are made of plastic.

2) He talked about how some idiot tried to light his shoe on fire.
Because of that, now everyone has to take off their shoes. A group
of idiots tried to bring aboard liquid explosives.. Now we can’t bring
liquids on board. He says he’s waiting for some suicidal maniac to pour
liquid explosive on his underwear; at which point, security will have us all
traveling naked! Every strategy we have is reactionary.

3) We only focus on security when people are heading to the gates.

Aviv says that if a terrorist attack targets airports in the
future, they will target busy times on the front end of the airport
when/where people are checking in. It would be easy for someone to take two
suitcases of explosives, walk up to a busy check-in line, ask a person next
to them to watch their bags for a minute while they run to the restroom or
get a Drink, and then detonate the bags BEFORE security even gets involved.

In Israel , security checks bags BEFORE people can even ENTER the
airport.

Aviv says the next terrorist attack here in America is imminent and
will involve suicide bombers and non-suicide bombers in places
where large groups of people congregate. (I. E., Disneyland, Las Vegas
casinos, big cities ( New York , San Francisco , Chicago , etc…) and
that it will also include shopping malls, subways in rush hour, train
stations, etc., as well as rural America this time ( Wyoming , Montana ,
etc.).

The attack will be characterized by simultaneous detonations around
the country (terrorists like big impact), involving at least 5-8 cities,
including rural areas.

Aviv says terrorists won’t need to use suicide bombers in many of
the larger cities, because at places like the MGM Grand in Las Vegas , they
can simply valet park a car loaded with explosives and walk away.

Aviv says all of the above is well known in intelligence circles,
but that our U. S. Government does not want to ‘alarm American citizens’
with the facts. The world is quickly going to become ‘a different place’,
and issues like ‘global warming’ and political correctness will become
totally irrelevant.

On an encouraging note, he says that Americans don’t have to be
concerned about being nuked. Aviv says the terrorists who want to
destroy America will not use sophisticated weapons. They like
to use suicide as a front-line approach. It’s cheap, it’s easy,
it’s effective; and they have an infinite abundance of young militants more
than willing to ‘meet their destiny’.

He also says the next level of terrorists, over which America
should be most concerned, will not be coming from abroad. But will be,
instead, ‘homegrown’ — having attended and been educated in our own schools
and universities right here in the U.. S. He says to look for ’students’
who frequently travel back and forth to the Middle East . These young
terrorists will be most dangerous because they will know our language and
will fully understand the habits of Americans; but that we Americans won’t
know/understand a thing about them.

Aviv says that, as a people, Americans are unaware and uneducated
about the terrorist threats we will, inevitably, face. America still
has only have a handful of Arabic and Farsi speaking people in our
intelligence networks, and Aviv says it is critical that we change that fact
SOON.

So, what can America do to protect itself? From an intelligence
perspective, Aviv says the U.S. needs to stop relying on
satellites and technology for intelligence. We need to, instead, follow
Israel ’s, Ireland ’s and England ’s hands-on examples of human
intelligence, both from an infiltration perspective as well as to trust
‘aware’ citizens to help. We need to engage and educate ourselves as
citizens; however, our U. S. government continues to treat us, its
citizens, ‘like babies’. Our government thinks we ‘can’t handle the truth’
and are concerned that we’ll panic if we understand the realities of
terrorism. Aviv says this is a deadly mistake.

Aviv recently created/executed a security test for our Congress, by
placing an empty briefcase in five well-traveled spots in five
major cities. The results? Not one person called 911 or sought a policeman
to check it out. In fact, in Chicago , someone tried to steal the
briefcase!

In comparison, Aviv says that citizens of Israel are so well
‘trained’ that an unattended bag or package would be reported in seconds by
citizen(s) who know to publicly shout, ‘Unattended Bag!’ The area would be
quickly & calmly cleared by the citizens themselves. But, unfortunately,
America hasn’t been yet ‘hurt enough’ by terrorism for their government to
fully understand the need to educate its citizens or for the government to
understand that it’s their citizens who are, inevitably, the best first-line
of defense against terrorism.

Aviv also was concerned about the high number of children here in
America who were in preschool and kindergarten after 9/11, who were
‘lost’ without parents being able to pick them up, and about our
schools that had no plan in place to best care for the students
until parents could get there. (In New York City , this was days, in some
cases!)

He stresses the importance of having a plan, that’s agreed upon
within your family, to respond to in the event of a terrorist emergency. He
urges parents to contact their children’s schools and demand that the
schools, too, develop plans of actions, as they do in Israel .

Does your family know what to do if you can’t contact one another
by phone? Where would you gather in an emergency? He says we should all
have a plan that is easy enough for even our youngest children to remember
and follow..

Aviv says that the U. S. government has in force a plan that, in
the event of another terrorist attack, will immediately cut-off EVERYONE’s
ability to use cell phones, blackberries, etc., as this is the preferred
communication source used by terrorists and is often the way that their
bombs are detonated…

How will you communicate with your loved ones in the event you
cannot speak? You need to have a plan…

If you believe what you have just read, then you must feel
compelled to send to every concerned parent or guardian, grandparents,
uncles, aunts, whatever and whomever. Nothing will happen if you choose not
to do so, but in the event it does happen, this particular email will haunt
you….”I should have sent this to….. “, but I didn’t believe it and just
deleted it as so much trash from old Bill Jones!!!

LW/HB

@mata:

I just re-read your last post.

I repeat, Larry. You are dangerous. I don’t want to live in your and Obama’s idea of the United States. I prefer the one the Founding Fathers created. The legacy of you and your hero President will be the demise of the US as founded. And that’s certainly not a legacy I’d covet.

I’m “dangerous” – because I — along with a healthy majority of my medical colleagues, are in favor of a health care financing overhaul with a public option and, in fact, would like to see single payer Medicare extended down to age 55?

And because I — like many economists — including conservative economists — see the virtues of taxing carbon, to stimulate alternative energy development, reduce pollution, reduce dependence on foreign oil, preserve some of our oil reserves for those who follow us?

I read your messages on this thread, once again. They are filled with hysterical scaremongering and topped off with a lavish dose of paranoia. You envision the mother of all conspiracy theories. One involving not only the West Wing but extending throughout the mainstream media, the medical profession, the Catholic Bishops, and America’s universities. The only people who have not been hoodwinked by this conspiracy are the only people left in this country who are “true Americans,” a descriptor which does not apply to anyone who wants to provide decent health care to all Americans and who wants to leave our children with a little bit of oil to make their own petrochemicals.

America has survived a great many trials and tribulations, since its founding. It will survive Barack Obama just fine, thank you.

- Larry Weisenthal/Huntington Beach, CA

@Aye (#69):

Beautiful, just beautiful. A perfect example of trying to have it both ways. Did you even read what you linked?

On one hand, MataHarley claims that we are all going to be forced into a public option — which explicitly bars abortion payments. On the other hand, your linked article makes the same claims that the Democrats have been making — that pretty much everyone who has totally private (non-subsidized) insurance will keep that insurance. For these people, the status quo will be maintained — that would be the same status quo which Aye is fighting so hard to maintain.

This would seem to be a win-win situation for conservatives.

Either people keep their existing plans, and the abortion status quo is maintained and there is no creeping socialism.

Or else people move to a public plan or, if they make less than (I think) $80,000 (or whatever — someone can correct me), then they qualify for publicly subsidized private insurance — and these plans also prohibit funding for abortion.

The Catholic Bishops aren’t dumb. In fact, they are political card sharks. The liberals who have just been gored by the Bishops are also not dumb. They know that they’ve taken a huge loss.

My challenge is still up there:

Name a single piece of legislation (or cumulative achievement of the Bush administration) which had a greater impact on reducing abortion than the Pelosi health car bill would have, if enacted and signed.

- Larry Weisenthal/Huntington Beach, CA

@curt (#71)

Thanks for correcting that. Should have looked to Snopes it, before posting.

But the terrorism scenario does seem plausible, does it not?

- LW/HB

Larry W: On one hand, MataHarley claims that we are all going to be forced into a public option — which explicitly bars abortion payments.

Larry, I have not once addressed the public option and abortion. Please keep your enemies list straight. LOL

Nor did I say we were “forced into a public option”. What I said was that the public option SINGLE PAYER system is designed to eliminate private insurers. We will not be “forced”. We will simply no longer have a choice. That is two very different methods of accomplishing the desired end goal.

Larry, I have not once addressed the public option and abortion. Please keep your enemies list straight. LOL

I never said that you did address the public option and abortion. But you have argued that we are to be herded into the public option (single payer). “Forced” by not having a choice. It’s semantics. You are claiming that Pelosi care means inevitable single payer public option. The Democrats claim that the public option will affect very few.

Aye agrees with the Democrats, not with you.

I was simply bemused by this.

- Larry Weisenthal/Huntington Beach, CA

I’ll accept the explanation of the 2nd amendment “dig”, LW. Thanks for clarifying that point.

I never blamed President Bush for 9/11, and it’s beyond unfair to blame Ft Hood on Obama.

Tho this is a subject for another thread, I’ll just say this…. there is no similarity between 911 and Ft. Hood for the looming danger that was specific to the event. With 911, there was a vague memo that mentioned planes as weapons. Hardly a new concept since the Japanese perfected kamakazi attacks in WWII. Yet I did blame legislative walls on sharing intel between CIA, FBI and local law enforcement. That has, in theory, been somewhat corrected if not perfected.

Ft. Hood is a wholly different matter. We had an Army Major with formal complaints, a history, and being watched by the FBI for six months with his contacts with AQ. He was not only given his automatic promotion, but the complaints about him were dismissed as a politically incorrect bombshell in Muslim relations.

Heads should roll INRE Ft. Hood, Larry. This was too obvious, and the man’s position in the military to risky to allow him to continue to serve. With his outspoken actions against the US INRE the ME conflicts, he should have been dischanged (IMHO, *dishonorable dischage to boot) and sent on his merry way. And whatever PC measures that were in place that disallowed defusing this scum of a human should be removed immediately.

As for the Eunuch in Chief…. my comments were less about his personal involvement on a single man’s intel, and more about the lengths that were gone to by the media and his appointees to avoid calling this a terrorist incident. Seriously premature, disingenuous, and apparently very wrong. There is something distinctly unhealthy about this nation’s nanny protective coat around a POTUS. Any cry of disagreement brings the full power of the WH down on the dissenters.

@Mike (#81):

You and Aye never cease to get try and get mileage out of that misleading table (which Aye shows as a chart).

The implication is that the out of control spending is because of government inefficiency, waste, fraud, etc. In point of fact, it’s because of coronary artery angiograms and bypass surgery; it’s because of CT scans, and PET-CT scans, and MRI scans; it’s because of upper and lower GI endoscopy; it’s because of DaVinci robotic surgery machines; it’s because of $10,000 a month cancer drugs, and on and on.

Absent Medicare, we’d have all gone broke, trying to take care of our parents. Medicare has not cost the nation trillions of dollars; it’s saved the nation hundreds of billions of dollars, while providing health care unsurpassed in quality and patient satisfaction.

Item: The cost of private health insurance for small businesses is going up by 15% in this year alone, after doubling during the 8 years of the Bush administration. Why is Medicare borderline insolvent? Because it is politically impossible to double Medicare taxes every 8 years, as the private health insurers increase their premiums.

Just more “spinning,” from the token liberal (who’d be considered a conservative on The Daily Kos).

- Larry Weisenthal/Huntington Beach, CA

Larry, it was 2130 responders, of which only 1241 agreed with you. And I didn’t say the public option was *only* changing the age threshhold of Medicare, lowering to 55. That was, per Panel B, their preferred method of handling the existing public option. They did not advocate it become blanket coverage for the nation.

Nor did I say that the POTUS was subverting the Constitution with health care. Again, that’s your hysteria speaking. I might also add that’s an argument you were having with someone *else*. I question Congressional authority to do this, however the Constitutionality of their actions can only be taken to the SCOTUS after the law is enacted and it’s challenged in a court of law. I can’t go there yet, and do not confuse me with anyone who chose that route at this point in time. You may retract your constant “hysterical” accusations, which appear to be addressing things I did not say, at any time.

We were not discussing Medicare’s administration. We were discussing the new public option’s administration. So perhaps your argument got lost in the keyboard translation. Medicare, as of this bill’s legislation, remains somewhat the same but the control over the specifics of reimbursement and coverage may be transferred to Obama’s precious IMAC health panel he’s got stealth legislation for.

I see “sinister plots”? ROTFLMAO…. ah yes, isolate and demean the “enemy”, then lecture me on focusing on our real enemies. Nice one, LW. No, Larry. I don’t see “sinister plots”. I see a POTUS who campaigned on REMAKING America into a nation country to our founding principles. Therefore, his actions have been no surprise to me in the past 10 months. It must, however, be a surprise to people like you who believed him to be centrist.

Our nation gives us ways to combat this, from peaceful redressing of grievances to outright revolution. I see no “sinister plots”. I see a POTUS and Congress determined to rule the nation in a way that will bankrupt us. I will use every Constitutional avenue to prevent the destruction of our nation’s economy. That’s the way we were founded, and that’s the methods I’ll use.

You, however, are welcome to stick to your Alinksy tactics of debate. Just be aware they are wearing thin on the nation, and the only “transparency” that’s coming about is most of the nation seeing thru the current fiscally crazy leadership and their devoted, deaf, dumb and blind followers.

@mata (quoting you from #86):

Nor did I say that the POTUS was subverting the Constitution with health care.

I was quoting you from memory, from your #75:

Anyone – citizen to POTUS – that undermines the Constitution of the US most certainly is my enemy, and is attacking the foundations of this nation

So (again, from memory) I used the word “subvert,” where you had used the word “undermine”

From dictionary.com…

un⋅der⋅mine  

–verb (used with object), -mined, -min⋅ing.

1. to injure or destroy by insidious activity or imperceptible stages, sometimes tending toward a sudden dramatic effect.

2. to attack by indirect, secret, or underhand means; attempt to subvert by stealth.

Again, Obama swore to uphold the Constitution. If he’s subverting or undermining the Constitution, then impeach the SOB. If he’s merely offering legislation which you oppose, then criticize the legislation.

With regard to the differences in numbers in the New England Journal of Medicine paper, I see. It’s the difference between the sample size and the number in the sample who agreed with my position (a large majority, as I claimed). You don’t seem to understand the principles of statistical sampling, in stating that only 1241 physicians agreed with me. The total sample size was 2130 physicians, randomly selected to represent the nation’s physicians. This contrasts with the typical sample size of 1,000 or so, in a Rasmussen or Gallup poll, to represent all the voters in the USA. Also, the response rate (43% of those attempted to be polled) compares very favorably with the results of any large national survey of anyone.

Regarding the issue of what the public option was referring to (in the NEJM article), it’s clear from your posts that you were scolding me for ostensibly not realizing that the “public option” referred to lowering the age of Medicare eligibility to 55, as opposed to a public option for all citizens. I was correct in stating it as I did, and you were incorrect in scolding me for this.

@Mike: You’ve got the last word, this time, buddy (reaction: horrors, guilt by association, get him off of me, he’s not my buddy, cooties).

- Larry Weisenthal/Huntington Beach, CA

STILL citing that phony survey where the respondents were PAID?

This was a survey of doctors. A detailed survey. Doctors typically are paid for their time in participating in such surveys. It was a very large survey, with a good response rate, which was stringently peer reviewed. I’m familiar with a prior survey which you cited. It was anything but a scientific study (“replies are still coming in”). It wouldn’t have passed peer review in any scientific journal. The Robert Wood Johnson foundation sponsored studies are very rigorous. I’ve participated in them before (though I was not surveyed in the NEJM study I cited).

- Larry Weisenthal/Huntington Beach, CA

@mata, regarding insurance industry profits. I continue to research this, but, to date, here’s the most relevant thing I can find, which concerns California Blue Cross, which consistently denies my claims, necessitating patients paying out of pocket, and in which 16 times my patients took them to court, winning 16 consecutive times, including one appeal to Superior Court, which was also upheld, with the result that Wellpoint Blue Cross has never since appealed an adverse verdict, because they want to avoid a large bad faith lawsuit (Superior Court being precedent setting):

http://www.pnhp.org/news/2003/april/blue_cross_of_califo.php

Blue Cross of California:
% Revenue – Medical Care: 78.9%
% Revenue – Administration: 13.8%
% Revenue – Profit/Income: 7.3%

http://www.calphys.org/assets/applets/0102_knox_keene_report.pdf

Comment: Although this is a report of health plan performance in California, WellPoint, the parent company of Blue Cross of California, has been attempting to acquire significant market presence in other states. Also, the business success of Blue Cross of California has led other insurers to attempt to emulate its performance by adopting some of its innovative approaches to health care coverage. All of us should be concerned about the activities of Blue Cross/WellPoint.

Of the major insurers in California, Blue Cross has the lowest medical loss ratio. Since this means that they spent the least on patient care, it is very good news for Wall Street, but not so good for those paying the premiums and for those receiving health care services. Compared to participants in other plans, Blue Cross purchasers and beneficiaries are paying more and/or receiving fewer benefits.

The Blue Cross profit is listed as 7.3%, but does this really represent their true profit? A more accurate assessment of profit can be determined if we look at their actual business model. They administer the pooled funds designated for health care. These are not their funds, but they belong to the payers and beneficiaries. Since their business model is administration, their funds (revenues) are the administrative costs plus the profits that they assess for managing the risk pool.

The funding of Blue Cross’ administration is quite high when compared to public programs. 13.8% of the risk pool is much more than Medicare’s ~3%. But Blue Cross is a for-profit corporation, and, from a business perspective, they should be doing all they can to increase the size of their own entity. Growth is a fundamental goal in any business, and more growth in administration equates with the growth of Blue Cross’ business model. As long as expanding their administrative business can increase profits, they should make every effort to do so.

The size of their business then equates with 13.8% of the risk pool. But the 7.3% profit is not the profit on the size of their business but it is a “profit” expressed as a percentage of the entire risk pool, 78.9% of which is not their funds. That 7.3% profit, when expressed as a percent of their administrative revenues (13.8% of the pool), is actually a return of 52.9% on their net administrative revenues (which is 34.4% of their gross revenues, administrative costs and profits combined). No wonder WellPoint is the darling of Wall Street.

- Larry Weisenthal/Huntington Beach, CA

YAWN!

Haven’t we heard all these leftie talking points about two dozen times already Larry?

You really do need to come up with some new material.

Here’s something you can wrap your head around, it’s from a REAL survey, the Gallup Poll, in which recipients were NOT Paid and the survey was not funded by a group looking to push a left wing political agenda:

Let’s get this out of the way first, Larry.

You wrote:

@mata (quoting you from #86):

Nor did I say that the POTUS was subverting the Constitution with health care.

I was quoting you from memory, from your #75:

Anyone – citizen to POTUS – that undermines the Constitution of the US most certainly is my enemy, and is attacking the foundations of this nation.

So (again, from memory) I used the word “subvert,” where you had used the word “undermine”

You really must slow down on your reading, Larry.

On the heels of your snopes faux pas, in which you were accusing me of considering the progressive agenda more of an enemy than the global Islamic jihad movements, I responded… in full context:

That’s a hoot, Larry. Getting a lecture about focusing on our real enemies from those that characterize me, or others that think like me, as paranoid Glenn Beck hate speech types. Perhaps you’d do well to consider your own advice.

Anyone – citizen to POTUS – that undermines the Constitution of the US most certainly is my enemy, and is attacking the foundations of this nation. And the 2nd Amendment is there for citizens to hold our freedom. Your flippant dissing of both makes me look at you with increased light… and I’m afraid that light is not very flattering. I’m sure you’re crushed….

Now, if you read very carefully, you will note that I say *anyone… citizen to POTUS*. I was not specifically talking just about Obama, nor was I talking about health care. Who I was very specifically talking about was you. gasp…. Yes you, attempting to quash legitimate debate and free speech by characterizing me as a hysterical scaremongering militia type. You, however, are not alone in this Alinsky tactic… so I included all your cohorts in your progressive agenda. You may be a moderate in some issues, but when it comes to health care and cap and trade, you are most definitely a progressive.

So it’s interesting you chose to assume I was speaking of Obama when technically I was speaking of you and those like you who choose to debate the way you do. i.e., I give you reasons for why I liken the Pelosi/Obama creation more to England and Canada. I give you excerpts from the legislation. I give you definitions of single payer that you insist upon abusing

What do I get back? The same old tired NEJM poll where you tout how wonderful a 43% response rate is…. and that’s even when they’re paid, fer heavens sake. Then you try to claim every last 2130 participant as agreeing with you.

When I point out that the single payer option in the Pelosi bill is indeed SINGLE PAYER, you say it’s going to be administrated like Medicare. When I point out your error, you then assume I’m all of the sudden talking about Medicare when I’m talking about the single payer public option.

Then you drag me into the abortion/catholic church issue which interests me not one iota. Then there’s some out of the blue accusation about the media and universities, and I haven’t a clue who said anything about them. I’d have to start reading this thread from top to bottom to figure that out. But I assure you, it wasn’t me.

I swear… it’s a bit difficult to carry on a cyber debate with you over the hours, with both of us multitasking work… as I have come to the conclusion neither of us has a clue as to what you are talking about.

But hey, if I’m your favorite target for this thread, have at it. I’m up to it.

Now I find it very interesting that you blindly accept a demonstrably false assertion that administration costs for Medicare is cheaper than private insurance when even the AMA says that’s not true… and that the costs of Medicare admin are cheated by leaving out the other agencies’ costs involved in that administration… such as SS, IRS, etc.

That statistic you accept. But then you really have to dig to find out whether the insurance companies are making 2% profit, or 7.3% profit. If you want to get technical, Larry, some may make 7%, some may lose their shirts, others may eke by and together they average about 2% profit. So telling me the stories of the California specific company, and their particulars doesn’t mean much in the scheme of things. However the telling statement in your cited article is that the other insurance companies were so impressed with a 7.3% profit structure (a sad statement in itself for an private business to hope to grow on so little) that they looked to “emulate” their performance.

Then the author comes up with a new 52% profit structure, but for only 1/3 of their total revenue. WTF?

Let’s pose a few realities for you to consider… even if we can’t get thru to the bozo reporter on the article. Let’s take everyone’s favorite demon, the oil industry. Our US oil companies are small peanuts in the oil world, predominately owned by States. As a matter of fact, even with overseas holdings, they can’t pump enough oil to fill our refineries for gas consumption. So the oil companies are not only pumping oil, they are also purchasers of oil on the world market to satisfy their petroleum contacts. Fact is, they lose their shirts on this venture. That constitutes and x percentage of their overall revenue.

Where they make up for the revenue is via P&E (production and exploration). However since the US doesn’t allow any P&E on our holy grounds, they make their money doing P&E for the other countries not busy being politically correct. They make grand cash doing that, which helps make up for the windfall losses they take supplying the US gas stations.

This same theory for business holds true for just about any corporation…. take a grocery store. They make lose their proverbial butts in the small automotive sections, flowers, etc. But they make up for it perhaps with their fresh vegetables and meat departments. The deli’s are probably there not for profit, but to minimize loss for fresh foods that did not sell.

Back to your cited article with a speculative (gasp) 52% profit for admin revenues which account for 1/3 of their income. Pray tell, what makes you think that the other 2/3rds of that business are so all fired profitable?

The insurance business is a business of risk. When Katrina rolled around, as with other hurricanes in the past, she did her fair share of wiping out the smaller insurance industries because the roll of that die was against them. It takes only one event such as a plague or natural disaster to place an insurance company on the brink of extinction. They may be high on the hog one year, and out of business the next.

As far as you “hint: lies” BS, I posted on the insurance profits back in late October. So danged busy my posts have been few of late, but I surely remember most of what I wrote. And you’ll find that the outfit doing the “fact checking” on the “evil insurance companies” was none other than the AP… no enemy of the Obama/Pelosi/Reid three stooges show.

My suggestion is if you think you have enough research from your lone little CA companies to debunk Calvin Woodard’s AP article on insurance profits nationwide statistics, you take it up with him. Other than that, my statement has far more to back up the cited profits than the reporter’s pitiful attempt to speculate what were a company’s profits without ever seeing their books. Chutzpah, when you think of it.

@mata:

Now, if you read very carefully, you will note that I say *anyone… citizen to POTUS*. I was not specifically talking just about Obama, nor was I talking about health care

Number 1: Read back through your posts on this thread. It’s a lot of ragging on Obama. So you say “POTUS” and you claim that you were talking only of a generic POTUS and not THE POTUS?

Hard to believe, given your reference to said POTUS in #60, among other places:

Therefore you carry with you a measure of credibility for those who are unaware of all the details, and of the ultimate quest as imparted to the nation from the POTUS lips and supporters themselves. But no… you choose not to hear that. You merely change the definition of “single payer” is order to muddy the debate waters and label historical facts and trends as “scaremongering”.

Would it not be easier for the nation to make a decision if we genuinely acknowledge the words of POTUS and company, telling us exactly what they foresee with this legislation? Instead we can’t have that debate. Why? Because you and too many others ignore the gorilla standing before your nose in the room when you assert there is no “single payer” quest.

Dang… forgive me if I believe the lips of the Eunuch in Chief instead of your “fantasy” interpretations

.

You are too subtle for my poor simple brain, Mata. Sublimely subtle, it would seem.

Number two: I never said you were talking about health care. I was simply making a point to Aye. You claim that Pelosicare will lead to a public option taking over everything. Aye cited an article agreeing with the Democratic position that the public option would be an inconsequential part of the total. I was just enjoying the irony of the two of you promoting polar opposite points of view.

With regard to the insurance company analysis, it’s as I wrote: lies, damn lies, and statistics. You judge the insurance industry by the standards of a service industry or a manufacturing industry, profits seem reasonable. But those businesses are different from insurance businesses. My own business is a service business. I’ve got a profit margin of about 20%, but the other 80% is my own money. It’s money that I, myself, have to put into my business. I’ve got to pay the mortgage on my building, pay my employees, buy my lab equipment, buy my drugs, pay my medical couriers, pay my liability insurance, pay for my laboratory supplies. This is not the way the insurance business works. Their only costs are their administrative costs for managing OTHER PEOPLE’S money. When you look at their profits, relative to their own out of pocket costs, they are obscene. As I said, do the math on 2% of 16% of the gross domestic product.

- Larry Weisenthal/Huntington Beach, CA

@Mike:

I personally believe that if Mitch O’Connell went to Harry Reid and said, “I’ll deliver the votes of Republicans to support your health care bill if you agree to include malpractice reform,” Reid would conference with Obama and they’d accept the offer.

Portability across state lines is something which will be rendered moot by the insurance exchanges and the public option.

But the GOP won’t do this. They are under the delusion that they won the last election. it’s up to them to wrangle the best deal they can out of the bill that the party in power is going to ram through, with them or without them. The Bishops leveraged their power to gain a huge concession. The GOP could do the same, or they can throw a temper tantrum and get nothing.

- Larry Weisenthal/Huntington Beach, CA

Mata, you are an editor and I’m just a guest; so you deserve the last word. I’ve made the points I wanted to make. As always, I thank you for the time you put into these discussions with me.

- Larry W/HB

More from the Catholic Bishops on healthcare, of which I agree completely.

In the national discussion on how to provide the best kind of health care, we bishops do not claim or present ourselves as experts on health care policy. We are not prepared to assess every provision of legislation as complex as this proposal. However, health care legislation, with all its political, technical and economic aspects, is about human beings and hence has serious moral dimensions. Our focus is the concrete realities of families with children and their access to doctors, the poor and the elderly, those with limited means and those with few or even no means, such as the mother carrying a child in her womb. Our Catholic commitment to health care picks up the pieces of our failing system in our emergency rooms, clinics, parishes and communities. This is why we believe our nation’s health care system needs reform which protects human life and dignity and serves the poor and vulnerable as a moral imperative and an urgent national priority.

We remain deeply concerned about the debate that now moves to the Senate, especially as it will affect the poor and vulnerable, and those at the beginning and end of life. We will continue to insist that health care reform legislation must protect conscience rights. We support measures to make health care more affordable for low-income people and the uninsured. We remain deeply concerned that immigrants be treated fairly and not lose the health care coverage that they now have. We will continue to raise our voices in public and in prayer; we ask our people to join us in making the moral case for genuine health care reform that protects the life, dignity, consciences and health of all.

Larry I wonder ( I ask this seriously, not in sarcasm), how “smart” you will continue to think the Catholic Bishops are when they up the Senate debate to include the protection of ALL human life? I suspect you will say, “We can add that other life stuff later”, which, BTW, would NEVER get added once the train has left the station.

I do have to agree with you that what the Bishops did was “interesting” and perhaps more brilliant than I had first given them credit. It appears that had they not put pressure on the dems, the bill may never have gotten out of the house, probably not. On first thought, that was a mistake, as in “Why didn’t you just KILL THE Bill (let it die)?” Initially, I was upset by this, knowing that there is no chance a final bill will be signed WITHOUT abortion, so why didn’t they just leave well enough alone and let it die in the house?

Perhaps they did out smart Pelosi. They HAD to have known she was playing them, but were THEY playing her? If so, it appears their ‘strategy’ (I use that word cautiously owing to the fact that faithful Catholic Bishops are first and always faithful to the teachings of Christ, not politics) was to get abortion first, and go for the rest of the life issues in the final bill. Thanks to Sarah Palin coining “death panels”, I suspect they will have the support of the majority of Americans behind them, since by logic alone, rationing HAS to occur in this monster of a bill.

I continue to predict that there is no chance a bill with “life provisions” (including non coverage of abortion) will EVER get passed under this Senate and President Obama. And that will be a good thing, because as the Bishops rightfully acknowledge, the rest of the bill, especially the economic issues, is far too complex. Consequently, I have now come to appreciate the Bishops’ fight, but they will need to save it for a less radical congress and less “agenda driven” bill.

I suspect all conservatives and most of Americans want improved health coverage, but not at ‘all costs’, especially at economic ruin to America and without the protection of all human life. Cardinal George, the leader of the US Catholic Bishops perfectly stated what I considered to be the epitome of what “Obamacare” despertly lacks:

However, health care legislation, with all its political, technical and economic aspects, is about human beings and hence has serious moral dimensions.

@pdill:

Your chosen quote is so important that I’d like to play it again:

In the national discussion on how to provide the best kind of health care, we bishops do not claim or present ourselves as experts on health care policy. We are not prepared to assess every provision of legislation as complex as this proposal. However, health care legislation, with all its political, technical and economic aspects, is about human beings and hence has serious moral dimensions. Our focus is the concrete realities of families with children and their access to doctors, the poor and the elderly, those with limited means and those with few or even no means, such as the mother carrying a child in her womb. Our Catholic commitment to health care picks up the pieces of our failing system in our emergency rooms, clinics, parishes and communities. This is why we believe our nation’s health care system needs reform which protects human life and dignity and serves the poor and vulnerable as a moral imperative and an urgent national priority.
We remain deeply concerned about the debate that now moves to the Senate, especially as it will affect the poor and vulnerable, and those at the beginning and end of life. We will continue to insist that health care reform legislation must protect conscience rights. We support measures to make health care more affordable for low-income people and the uninsured. We remain deeply concerned that immigrants be treated fairly and not lose the health care coverage that they now have. We will continue to raise our voices in public and in prayer; we ask our people to join us in making the moral case for genuine health care reform that protects the life, dignity, consciences and health of all.

I don’t see anything in it about “upping the ante,” on anything other than, perhaps, extension of benefits to the “illegals,” so that they are “treated fairly and not lose the health care coverage that they now have.”

You see the line which talks about protecting those at the “end of life,” and this triggers images of Sarah Palin’s outrageous “death panels.” I know that you believe another of Obama’s wet dreams is to be Grim Reaper-in-Chief, but that’s the mother of all hysterical scaremongering (and never has that phrase been more justifiably applied). I see nothing in the Bishop’s statement which indicates that they are going after anti-”death panel” language in the bill, where death panels refers to the so-called rationing of care. Maybe language barring the use of federal funds for euthanasia, which is a moot point, since no one is promoting euthanasia and no one is promoting assisted suicide or any such thing.

I am absolutely certain that the Bishops would have no objection whatsoever to end of life counseling, which is also moot, because Sarah Palin took that off the table, which is a great tragedy for cancer patients and many others. I again want to recommend Chapter Two in “Super Freakonomics,” where they talk about the limitations of cancer chemotherapy.

When you say “rationing has to occur,” I agree with you. Rationing is already occurring. I don’t know if you saw that article from Health Affairs which I quoted earlier (#55). Let me quote it again:

http://content.healthaffairs.org/cgi/reprint/13/4/22.pdf

The United States never has had a one-tier health care system, and, as
the recent debate on health reform in Congress has demonstrated, the
United States never will have a one-tier health care system. A working
majority of the politicians representing Americans in the policy arena
evidently view health care as essentially a private consumption good of
which low-income families might be accorded a basic ration, but whose
availability and quality should be allowed to vary with family income. This
view lends official sanction to the following three-tier system: (1) Tier I for
the low-income uninsured: a system of public hospitals and clinics that
rations health care severely through constraints on capacity. (2) Tier II for
the insured, broad middle class: a system of competitive, integrated private
health plans budgeted on a per capita basis, with limited choice of providers
and with varying degrees of tacit rationing. (3) Tier III for the Medicare
population and the moneyed elite: the traditional, open-ended, free-choice
fee-for-service health care system with little or no rationing of care.
The bottom tier will be globally budgeted through annual appropriations
by legislative bodies. The middle tier will be effectively budgeted as well,
albeit through negotiated, prepaid annual capitation payments. Finally, the
top tier will remain open-ended, as it is now, and thereby will be able to
avoid rationing. The nation’s moneyed elite would never accept anything
less for itself. When members of Congress warn us darkly about the prospect
of “rationing,” they are not thinking about the bottom tier nor, I suspect,
about the second tier. They have in mind mainly the upper tier.

Here’s what no one around here can seem to get through their thick skulls: We already have rationing. Let’s look at people who don’t have insurance. I had a fraternity brother named Gary, who was self-employed as a printer. The business was good enough that he could pay for his apartment, and clothes, and food, and car, and very modest entertainment needs. But he also had to moonlight as (of all things) a funeral director. One day, out of the blue, at age 59, he developed chest pain. It ended up not being a heart attack, but rather a very strange type of cancer, invading the sack (pericardium) around his heart.

Now Gary didn’t have health insurance. It would have been a major financial strain to buy health insurance; in addition to Gary not having a lot of money, he was a mild diabetic, which made him virtually uninsurable. You might fault Gary for not getting some type of insurance anyway, but he didn’t. Now, if Gary had insurance, he’d have been treated with chemotherapy right away. In point of fact, some of the tumor from his diagnostic biopsy procedure was sent to our lab. We ran our tests for free and found two drugs which looked extremely active against Gary’s tumor. Although I did, indeed, “diss” chemotherapy in my quoting “Super Freakonomics,” what I was referring to, end of life wise, was the situation where the patient has already received chemotherapy and perhaps the tumor shrank or even disappeared, at one point, but which then finally came back for good. My sister has been battling ovarian cancer for more than 6 years; she’s had multiple remissions and multiple recurrences. But, with many patients, there comes a point where it’s obvious that it’s not working anymore and that further treatment will just make the patient feel much worse and won’t help them live longer. It is at these points that end of life counseling is required. Because of Palin, it won’t be given and oncologists will just get richer, pushing more chemo — but I digress.

Getting back to Gary, he was newly-diagnosed and had never been treated with even a single dose of chemotherapy. He might have been one of those patients who had a truly dramatic response and remission, and he might still be alive today, more than 4 months later, and he might still have been alive next year. Our tests indicated that he’d have had a very good chance of responding to two of the entirely “standard” chemotherapy drugs. If he’d had insurance, he’d have been treated within a week from his diagnosis. Instead, the oncologist who was on hospital call for now emergency patients and who became his doctor and therefore couldn’t just abandon him instead simply scheduled Gary’s follow-up appointment for evaluation for chemotherapy for ONE MONTH AFTER HIS HOSPITAL DISCHARGE. Gary didn’t have insurance. He only had Medi-CAL. Medi-CAL doesn’t pay squat for chemotherapy (unlike Medicare, which pays very well). The doctor would have lost money treating Gary; so he didn’t.
And Gary had to be re-admitted to the hospital 3 weeks after his hospital discharge, from complications of progressive cancer. He died several days later, never having been treated once for his cancer. This would never have happened, if he’d had insurance.

This type of thing goes on all the time in America, for people without health insurance. Gary was not an irresponsible person. He didn’t deserve what happened to him. He was, quite literally, rationed to death. People without health insurance are rationed to death in this country all the time. These are the “Tier 1″ patients referred to in my cited article. What about the “Tier 2″ patients, which are typical people with average insurance? They get rationed, also, only not as overtly. They get rationed with respect to choice of doctors, choice of hospitals, choice of drugs on the approved health plan formulary. They get rationed with respect to treatments, although they don’t know it. Their doctors are experts on what their plans pay for and what they do not. So they only receive treatments which are covered under their health care plans.

Some health care plans are very generous with respect to hospital benefits. Patients with these policies stay in the hospital longer, while patients with health care plans mandating short stays are booted out, often literally with their surgical drains still dangling. Most people have heard about the in and out child deliveries and in and out surgeries. People with the best insurance (what I might call concierge insurance) don’t have to go the in and out route. The rest are rationed to in and out. There’s lots and lots of rationing which goes on everyday. Not decided by government “death panels” (truly the most vile political scaremongering I’ve ever heard; and Sarah Palin has directly contributed to the pain and suffering of hundreds of thousands of future cancer patients, and I consider her to be an utterly despicable, self serving human being); instead decided by health insurance operatives.

When people speak of the horror of rationing, they have no compassion whatsoever for the people without health insurance, who are literally being rationed to death every day. They are speaking about rationing for THEMSELVES. Well, most of those people are already being rationed. If they don’t want to be rationed, they have the option of purchasing concierge level insurance or paying out of pocket. They’ll still have that option under Pelosicare.

I noted earlier that some forms of chemotherapy currently cost $10,000 per month and one year’s worth of treatment has to be given to extend life by one month. $120,000 for one month. Without unlimited money, is there a point where cost effectiveness has to be considered? What about future drugs, which may cost $20,000 per month? This is not fanciful; it’s here today. I frequently do tests on tumors where I come up with the best drugs being Avastin plus Sutent. The cost of giving both of these drugs together can be $20,000 per month. No insurance will currently pay for this. Some of my patients do receive treatments like this. How? They pay for it out of pocket (not to me; I don’t treat the patients I test, because I’d consider it to be an enormous conflict of interest to do so).

I keep pointing out that health insurance premiums for small businesses like mine are going up 15% this year, after doubling during 8 years of President Bush. What I’m saying is that rationing is already here, and it’s going to be worse. Who do I want doing the rationing? Certainly not Wellpoint Blue Cross, behind closed doors. I want coverage decisions made right out in the open, as it is with Medicare. With public announcements in advance of hearings. Opportunities for all to weigh in, provide data, speak at open public hearings, public deliberations by panels of outside experts. Posting of provisional recommendations. More opportunity for public comments and political pressures by Congress. etc. etc. These are the so-called “death panels.” The insurance industry has them. They are private, closed doors affairs. Medicare has them. They are transparent. Pelosicare will certainly have them. That’s the way government works. Transparent.

Interesting article in the news yesterday. Cedars Sinai Hospital in Beverly Hills — hospital to the rich and famous — seems that they horribly overdosed 260 patients with radiation during CT scans:

http://www.latimes.com/news/local/la-me-cedars10-2009nov10,0,2052232.story?track=rss

What was unusual about this story is simply that the mistake became public knowledge. Probably, it was too big to cover up. If this had happened in a VA hospital, the outcry would have been deafening. Private hospitals and private doctors aren’t under the same conditions of transparency as are public institutions and public employees. Private sector medicine typically is allowed to bury its mistakes in private.

In short, I trust public institutions to make “rationing” decisions much more than I trust private institutions. Since I don’t want to be rationed, I’ll keep cash reserves to pay out of pocket and I’ll have the best supplemental insurance I can obtain. But I want basic care, with no lifetime payment limitations, to be available to everyone, like my friend Gary.

I love what the Catholic Bishops are doing. They are working for medical coverage for all, as they have been doing for decades. They are working to actually reduce abortions, which is what will happen if Pelosicare gets signed into law. They are working for a conscience clause, which I also support. It looks like they will also be working to extend coverage to “illegals,” from the language of pdill quotation (above). They are working to get the best deal they can. If they don’t get 100% of everything, I’m sure that they won’t walk away from the whole thing (as the GOP has done) and get nothing. They’ll do the best that they can and ultimately take what they can get.

I ask you again, pdill, do you support what the Bishops are doing? In the end, will you support Pelosicare (or whatever version of it finally gets signed into law) if the Bishops end up supporting it?

I’m on the side of the Bishops. I support them 100%. I think that the Bishops actually helped Pelosicare get through the House. This gave the Democratic moderates “cover” to vote for the bill. I think that this will have the same effect in the Senate. Senators voting for the bill can claim that they are on the side of the angels, which is exactly how I look at the Bishops.

Coverage for all Americans. Yes! Reduce abortions — actually reduce abortions and not just spend another decade paying lip service to overturning Roe v Wade — yes! Conscience clause — yes! Coverage decisions made transparently (I added this one) — yes, yes, yes!

- Larry Weisenthal/Huntington Beach, CA

@openid.aol.com: Yes, I am sure it strokes your ego immensely to have Mata devote so much time to debunking your leftward lunacy. And I don’t fault her for doing so except to the extent that it keeps her from devoting the time necessary to reach the wider audience.

Now, if you two want to get a room somewhere and hash it out, fine by me.

@openid.aol.com:

A few questions:

First, you state that Gary’s doc chose to deny treatment because there was no insurance coverage. Doesn’t this violate the Hippocratic Oath or ethical standards that the doc swore to uphold? If so, did you report the doc? If not, why not?

Second, Gary was a friend of yours. Obviously you thought enough of him to perform the lab tests free of charge. Did you also extend to Gary the option of free chemo through your facility? If not, why not? You do, after all, by your own admission enjoy an obscene 20% profit from what you do day in and day out.

Frankly, the story about the doc choosing not to treat Gary due to lack of insurance doesn’t smell exactly right.

Your friend Gary chose to not have health insurance. He exercised his God given right of freedom of choice and, ultimately, suffered the consequences of that decision.

Larry I’ve always made it clear that I’m for reformed health care providing it protects all human life and isn’t lining the pockets of the “caretakers” at the expense of patient care. I DO support the Bishops fight for life, and made it clear in my last post that they are bishops not politicians, trying as much as possible to “get GOOD healthcare” but to also keep the “doctor of death” OUT of what’s on the table.

My goodness, even my favorite atheist/liberal/democrat writer, Camille Paglia, gets it right on healthcare, along the lines of what most of us at FA have been saying all along; keep it fair, simple, and use COMMON SENSE. Why we are demolishing the house and ‘rebuilding’ because of a ‘leaky faucet’ is the first sign that this isn’t about ‘health care’. We could have already insured all of the “Gary’s” who are uninsurable with the money we wasted on the scam “stimulus” or H1N1 hype “national emergency”, an ‘emergency’ so terrible the Obama girls didn’t even get the vaccine. How about we get what “THEY” get Larry, they being the elected in Washington?

Excerpt from today’s Paglia column

As for the actual content of the House healthcare bill, horrors! Where to begin? That there are serious deficiencies and injustices in the U.S. healthcare system has been obvious for decades. To bring the poor and vulnerable into the fold has been a high ideal and an urgent goal for most Democrats. But this rigid, intrusive and grotesquely expensive bill is a nightmare. Holy Hygeia, why can’t my fellow Democrats see that the creation of another huge, inefficient federal bureaucracy would slow and disrupt the delivery of basic healthcare and subject us all to a labyrinthine mass of incompetent, unaccountable petty dictators? Massively expanding the number of healthcare consumers without making due provision for the production of more healthcare providers means that we’re hurtling toward a staggering logjam of de facto rationing. Steel yourself for the deafening screams from the careerist professional class of limousine liberals when they get stranded for hours in the jammed, jostling anterooms of doctors’ offices. They’ll probably try to hire Caribbean nannies as ringers to do the waiting for them.

(My emphasis) A second issue souring me on this bill is its failure to include the most common-sense clause to increase competition and drive down prices: portability of health insurance across state lines. What covert business interests is the Democratic leadership protecting by stopping consumers from shopping for policies nationwide? Finally, no healthcare bill is worth the paper it’s printed on when the authors ostentatiously exempt themselves from its rules. The solipsistic members of Congress want us peons to be ground up in the communal machine, while they themselves gambol on in the flowering meadow of their own lavish federal health plan. Hypocrites!

As for Palin, you sure make a bold leap to “drug resistant chemotherapy.” How about the 2o year old who ends up a quad as a result of an auto accident, or the overweight teenager or middle aged mother of two who needs expensive (and available), life saving treatments? That’s the kind of stuff that has everyone with a conscience concerned. I can assured you that under O’care, there simply won’t be enough docs to be pumping drug resistant chemo into the newly diagnosed, being that most of them won’t live through the 6 month or more waiting list! In addition to the disabled or the “worthless to society crowd because they can’t control their eating habits or didn’t get a college degree”, Palin is also referring to the mentally challenged. Shame on you Larry for making the case for Palin killing cancer patients when in fact, she will have greatly contributed to the salvation of the “non elite” crowd.

I don’t disagree with you that insurance companies ration, but it also works the other way. I once had an internist BEG me to have a bone density test (I was 30 years old). I told him flat out no and he at least was honest and told me I had good insurance that would pay for it (he had just gotten his “new bone density scanner). That’s just one example of many, but with “insurance rationing” also comes “physician abuse.”

I also don’t disagree with you that the private insurance payments are absurd and only getting worse. I currently live between two coasts of the country because I can’t take my “Blue Shield” out of CA. Ok, I admit I still love CA in the winter months, but if it weren’t for health insurance, I would NOT continue to be a CA resident. My policy just went up another $200 a year, in the middle of the year, and that’s for high deductable.

Bottom line, and to put a rest to your question “ Do I agree with the Bishops”, it’s hard to answer directly. I certainly believe in their fight for human life, and you too agree with the conscience clause which I respect. Unlike you, I KNOW they will not compromise without the conscience clause, because doing so would mean every Catholic Hospital in America will have to close. I also know, based on church teachings, that they are against socialism and big government control.

The reality is, and we will know soon enough (feel free to bookmark this page), there is no way healthcare under Obama will pass with the “life” issues demanded by the Bishops. That’s because, as I and many have tried to tell you, this isn’t about “healthcare”; it’s about single payer power.

There will be no Obamacare, and that will be a good thing. Hopefully, after 2010, we will get a fresh, non-corrupt, and “educated” new congress (both parties), and pass a simple bill, starting with one that allows insurance to cross state lines and be competitive.

If in the end the Catholic Bishops end up being the “deal breakers” for Obamacare, then hey, maybe God is looking out for us.

@openid.aol.com/runnswim:

Beautiful, just beautiful. A perfect example of trying to have it both ways.

You’re right Larry.

This is a perfect example of you trying to have it both ways.

You go on and on about how the Bishops have pulled off some sort of coup and that their accomplishment represents a watershed moment that will reduce the number of abortions.

However, in order for that contention to be true you would have to admit that there will be a massive migration onto the public option, forced or otherwise.

Yet you’ve spent the greater majority of your interchanges on this thread claiming that there will be no such mass migration and that the public option will only affect a minor number of people.

So, which is it?

Of course none of that really matters because it is becoming more and more obvious, that even from the moment of passage, the non-abortion restrictions were destined to be stripped out.

Larry W: Mata seems to feel as if virtually everyone will be covered by the public option — that the public option will out-compete private insurance plans, owing to government-related unfair competition advantages. I tend to agree with Mata — although this will take a very long time — long after Obama, Emmanuel, Frank, Sibelius, et al have left the scene.

GASP! LOL

And yes, my projections are long term, and not immediate. So yes… we are in agreement. Our disagreement lies in that this is good in your opinion, and I believe it to be a fiscal nightmare that will sink the economy.

Larry I agree with what much of what you wrote to Aye, as it is on track with the point I was also trying to make. While our current system “under treats” the uninsured, it just as much “over treats” the well-insured.

Do you understand that most of us against Obamacare are NOT in love with the status quo, we only prefer it over the train wreck that is about to happen if we don’t stop it. I also think it is fair to say that none of us, and I would suspect you included, have any problem with the standard of medicine in the US, only the execution of it.

What we need is INSURANCE REFORM, not “health reform.” So here is my burning question to you. Why aren’t you on the bandwagon to change what matters most, competition between states for medical insurance. If my memory is correct, Mata made mention (somewhere recently) that she thinks the reason relates to states’ rights. I don’t think it has as much to do with the rights of each state as it does the monopoly and kickback of each state, and to both parties.

The “solution” is so simple and logical to just let the “free market” work; consequently all of America can be insured as one big “group” at an affordable cost. The fact that this isn’t even on the table should be more than enough evidence that this is not about insurance, only a power grab. Would you please answer my question as to why you prefer a monster national bankrupting government bureaucracy, with everything from “dog insurance (I kid you not), to grant monies for minority nursing students (?), to prison sentences for those of us who don’t pay up?

On another note, I want to revisit your outrageous attack on Sarah Palin yesterday claiming that she has “undone” the ‘counseling’ treatment of cancer patients (like anyone is even going to be alive to need it after the “waiting period” if Obama gets his way). Despite that fact that she was referring more to the disabled (young and old), here’s proof that you are dead wrong on that. This may shock you Larry, but the “panel”, has already been put into place via the “stimulus package.” Here’s an excerpt but you might want to read the whole thing, as it will prepare you for a soft landing as you continue to live in your Obama fantasy world.

The AP is technically correct in stating that end-of-life counseling is not the same as a death panel. The New York Times is also correct to point out that the health care bill contains no provision setting up such a panel.

What both outlets fail to point out is that the panel already exists.

H.R. 1 (more commonly known as the Recovery and Reinvestment Act, even more commonly known as the Stimulus Bill and aptly dubbed the Porkulus Bill) contains a whopping $1.1 billion to fund the Federal Coordinating Council for Comparative Effectiveness Research. The Council is the brain child of former Health and Human Services Secretary Nominee Tom Daschle. Before the Porkulus Bill passed, Betsy McCaughey, former Lieutenant governor of New York, wrote in detail about the Council’s purpose.

As for Gary, that’s a very heart-wrenching story. None of us can bring Gary back, but I bet if he was here, and was given a choice of affordable private insurance vs. Obamcare, it would be a no brainer for this simple reason: If Gary couldn’t afford private insurance, he certainly wouldn’t be able to afford Obamacare, as will be the case with most of us, even those of us who “do pretty well.”

If we ever get the monopoly broken on the state to state issue, the rest will fall into place. Docs will make the wages they justly deserve without having to be MBA’s and salesmen, patients will get lifesaving care they need, and the US will continue to be the best place in the world for medical treatment.

@openid.aol.com/runnswim said: “@Mike: Here’s what’s special about Mata. She actually writes original stuff. “

That kind of cheap shot is beneath you Larry. I’ll keep it in mind as I research my next original piece and see if you notice when I post it.

Clearly YOU have run out of anything original to say on this issue. You just keep repeating the same worn out talking points over and over and over as if they are true if you say them often enough.

Give it a rest. Obama’s takeover of health care if failing and your flailing won’t save it.

@ openid.aol.com/runnswim (Larry)

…private practice doctors, who are very careful to perform what we in the profession are honest enough (among ourselves) to call a “wallet biopsy” before we even agree to evaluate a patient…

Well, there it is. The whole reason for Larry’s liberal leanings. He needs government to step in to stop him from being greedy, because he can’t do it himself.

(thanks to that egotistical monster Sarah Palin…)

Are you serious. Sarah has nothing on your boy Obama. President Obama sent a video to the anniversary of the fall of the Berlin Wall. In his speech, did he mention the work of Reagan? Thatcher? Nope. He did find a way to work himself into the speech though.

“Few would have seen on that day that… that their American ally would be led by a man of African descent.”

I’m seriously tired of hearing this $120,000 a year to prolong life for another month. It doesn’t make sense. Mathematically speaking, if I was paying $10,000 a month for a drug that only kept me alive for another month, I’d probably skip the next 11 payments. Just saying. I’m not a doctor, but engineering requires maybe a little more math than you super smart doctor types.

I can’t speak for anyone else, but if (God forbid), I ended up with a terminal disease, I would speak to my doctor about everything, including end of life. However, since I trust most doctors about as far as I can throw them, I would take their advice with a grain of salt.

Leave the rest of us out of your healthcare utopia. Just because you and some of your colleagues can’t help yourselves from digging into patients with deep wallets, doesn’t mean everyone is that way. It’s mostly just liberals.

Original larry? Take your own advice. As Mike pointed out, you keep saying the same things over and over. You even used the “echo chamber” complaint for about the 3rd or fourth time that I can recall. You should have been here for the Newt Gingrich/NY-23 debate.
You are very much a liberal. You have no insight into yourself, live in extreme denial, and project onto others your own short comings.

@mata: Will have to wait until tonight for in depth response, but can’t let one thing go by until then:

who the hell annointed you or any medical professional the official care taker of end of life issues?

It’s a straw man argument. I never said that, thought that, felt that. Quite the contrary: the whole point of end of life counseling is to spend a lot of time with the patient, carefully explaining the reality of the situation, and allowing the patient to make an informed choice.

@openid.aol.com/runnswim:
@MataHarley:

I hear Red Roof Inns is offering a holiday special on rooms

@Mike (#130): I thought I had an invitation to stay with you.

Indian giver.

Hey Mike, maybe you need to play “harder to get.”

Just to clarify something, Larry…. you were speaking of the physician not being paid for his extra 45 minutes worth of time to ’splain that chemo just may kill him faster than the cancer. This I understand well as I’ve lost four friends this year alone… dying by chemo and not the cancer.

The point is, the end of life counseling was for those covered by Medicare already, and just gave a larger staff of (IMHO) unqualified people to help patients plan for wrapping up their affairs. This is not the job of medical providers. It is their task… for the insured and uninsured whom they are treating… to explain their prognosis and the medical options available and under what circumstances. This costs them nothing but time… not the drug charges.

And it most certainly is out of the jurisdiction of the medical provider to be speaking of living wills and powers of attorney for their assets and heirs.

@ mata:

1. Not mandatory

2. Reimburses doctors, not clerks

3. Covers any and all end of life counseling, not just the non-medical sorts of things enumerated. The purpose of putting in language like that wasn’t to mandate any particular type of counseling; or to limit it to any particular type of counseling; it was merely to illustrate that the counseling could be comprehensive – even extending to such practical considerations as living wills — very important to doctors, who are faced with the decision on whether or not to call a “code” for a cardiac arrest.

Currently, all of this clerical stuff gets explained by low level clerks — a great percentage of the time. The clerks can’t begin to explain what really goes on with a “code” — broken ribs and much other gore. These things are better explained by doctors. The bill didn’t mandate anything at all. It simply provided reimbursement to doctors who took the initiative to talk about such things and answer questions.

In practice, as I said, the most frequent time when true end of life counseling would come up would be when oncologists decide that further chemotherapy would be more likely to harm than help. You say that it’s the job description of an oncologist to take the 45 minutes to one hour (and it can easily be that long — or longer — if it is done properly) to break the news to the patient that medical science has about run out of treatment options. I don’t disagree, but i really wish that someone would tell that to lawyers and other professional consultants. Doctors are a human as anyone else; they are more likely to take the time to do it right if they get paid for it. 45 minutes out of a busy doctor’s day is a huge amount of time. Oncologists can be taking care of hundreds of patients at a time, many or most of whom will eventually require such counseling (a huge burden, collectively), and, because of Palin, will be much less likely to get it.

http://mediamatters.org/research/200907290047

Yes, I know Media Matters is a liberal-oriented web site, but this is a very nice, concise summary. If you find fault or error with what is summarized there, feel free to point out what it is that they have wrong.

- Larry Weisenthal/Huntington Beach, CA

Larry W: You say that it’s the job description of an oncologist to take the 45 minutes to one hour (and it can easily be that long — or longer — if it is done properly) to break the news to the patient that medical science has about run out of treatment options. I don’t disagree, but i really wish that someone would tell that to lawyers and other professional consultants. Doctors are a human as anyone else; they are more likely to take the time to do it right if they get paid for it. 45 minutes out of a busy doctor’s day is a huge amount of time. Oncologists can be taking care of hundreds of patients at a time, many or most of whom will eventually require such counseling (a huge burden, collectively), and, because of Palin, will be much less likely to get it.

I wanted to address this separately. Altho, in one way, it relates to me pointing out the obvious to you that legislation is not an “advisory brochure”, but law. If lawyers and professional consultants are acting otherwise (in service and in lawsuit before the bench in court), then that – again – is the fault of legislative language empowering them to do so.

I’m glad you agree that it’s part of the job. But the answer is not to redelegate that responsibility and allow for payment for unqualified individuals to do so via a mandate.

@mata:

Your distortion (which I’ll give you the benefit of the doubt is simply a result of you not understanding the bill) is breathtakingly inaccurate.

Your repeated assertions that there be mandatory end of life counseling was determined by the independent Politifact.com…’s “Truth-o-meter” to be “PANTS ON FIRE UNTRUE”

http://www.politifact.com/truth-o-meter/statements/2009/jul/23/betsy-mccaughey/mccaughey-claims-end-life-counseling-will-be-requi/

You are not interpreting the language of the bill correctly. I’ll get to that below, but here’s what the AUTHOR (Oregon’s Rep Blumenauer) of Section 1233, HR3200 says about HIS OWN BILL:

http://blumenauer.house.gov/images/stories/documents/myth%20vs%20fact.pdf

Myth vs. Fact: Advance Planning Consultations in H.R. 3200

Few areas are more vital for honest discussion and careful consideration than end-of-life care
for America’s seniors. Unfortunately, families often do not know their loved ones’ preferences
for end of life care and are not confronted with these difficult decisions until an emergency
arises. This leaves spouses, sons, daughters and grandchildren unprepared; as a result
families struggle to make decisions in the midst of turmoil.

The House health care legislation includes a provision (Sec. 1233) that provides seniors with
better care as they grapple with these hard questions. This provision extends Medicare
coverage to cover the cost of patients voluntarily speaking with their doctors about their values
and preferences regarding end-of-life care. These are deeply personal decisions that take
thoughtful consideration, and it is only appropriate that doctors be compensated for their time.

Myth: Patients will be forced to have this consultation once every five years.


Fact: Advance planning consultations are not mandatory; this benefit is completely
voluntary.

The provision merely provides coverage under Medicare to have a conversation
once every five years if – and only if – a patient wants to make his or her wishes known to a
doctor. If desired, patients may have consultations more frequently if they are chronically ill or
if their health status changes.

Myth: Patients will be forced to sign an advance care directive (or living will).


Fact: There is no mandate in the bill to complete an advance care directive or living
will. If a patient chooses to complete an advance directive or order for life sustaining
treatment, these documents will help articulate a full range of treatment preferences, from full
and aggressive treatment to limited, comfort care only. Patients that choose to have these
documents and can customize them so that their wishes are appropriately reflected.

Myth: Patients will have to see a health care professional chosen by the government.


Fact: There are no government-chosen professionals involved. The legislation simply
allows Medicare to pay for a conversation between patient and their doctors if patients wish to
talk with their doctor about end of life care preferences.

Provision Endorsed By: AARP, American Academy of Hospice and Palliative Medicine,
American College of Physicians, American Hospice Foundation, Center to Advance Palliative Care,
Consumers Union, Gundersen Lutheran Health System, Hospice and Palliative Nursing Association,
Medicare Rights Center, National Hospice and Palliative Care Organization,
National Palliative Care Research Center, Providence Health and Services,
and Supportive Care Coalition.

Here’s the language of the Section. .

Section 1233. Advanced Care Planning Consultation

`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years.

Larry’s comment: Let’s pause here. What does the above say? It doesn’t “mandate” anything whatsoever. There’s nothing in the language which mandates anyone to do anything. It simply means that, under “normal” circumstances, Medicare will pay a doctor (NOT A CLERK) for said doctor’s time in providing counseling in this area once every 5 years (this is a limitation, to prevent Medicare fraud, e.g. to prevent a doctor from having such a consultation with a given patient every week and billing Medicare every week. It says that the Medicare beneficiary is entitled to have Medicare pay for such a consultation every 5 years, if the patient wants it and the doctor wants to do it). This is NOT a mandate that such a consultation ever occur! Where in the world did you get that?

Now, the bill goes on to explain issues which are to be included in the counseling, IF the patient wishes to receive it and the doctor wishes to provide it. This sort of thing is absolutely usual and customary in description of Medicare benefits. When a doctor bills for a service, he uses a billing code. Each billing code provides language explaining what is to go into the service being billed. It means that, IF you wish to bill under this code, it is required that the services you provide include specific elements. Your services under the billing code are not limited to the specific elements, but must include them, if you wish to receive payment. They do not MANDATE that you provide these services, they simply say that, if you wish to be paid for the services you have to at least include the elements which are enumerated. In many cases, there are limitations as to how often you can provide the service and be billed for it. In the case in question, you can provide it only every 5 years, unless there has been some sort of important change in the patient’s medical condition to justify providing the service more often.

Continuing on with the language of the bill:

Such consultation shall include the following:

`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

Let’s again pause here. You apparently feel that the above are strictly legal matters which either do not concern doctors or which doctors are not qualified to explain. I strongly disagree. In fact, I think that doctors are the professionals MOST qualified to explain these matters.

It comes up all the time: the patient is incapacitated. A decision needs to be made. The doctor can’t just make a command decision on the part of the patient (unless it’s a true life threatening emergency). Let’s say that the patient is mentally incapacitated (because of brain metastases, severe systemic infection, drugs, whatever). The doctor needs to do some sort of procedure (say, a spinal tap). Who is authorized to give permission to do this, on behalf of the patient. The point is, doctors are the best qualified professionals to explain to patients why they need durable powers of attorney and the powers and responsibilities of the person holding the durable power of attorney. The same thing with advance directives/living wills. Does the patient want feeding tubes, if required? What is a feeding tube? (nasogastric tube, gastrostomy tube, jejunostomy tube, etc. What lawyer is really qualified to explain these sorts of things?). Does the patient wish to be kept alive with total parenteral nutrition? What does that entail? What about a ventilator? Tracheostomy, in the event of airway compression by a cancer? All sorts of things — some general in nature and some specific to the patient’s own specific medical condition. It’s a way of allowing the patient to make as many choices as possible — in advance — as opposed to having to rely on the person designated by the patient to hold durable power of attorney.

Continuing:

`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

Comment: These have nothing to do with death panels, euthanasia or any other such thing. It’s simply making sure that, if the doctor and patient want to do this counseling together and the doctor wants to bill for it, the doctor is required to provide the patient will all necessary and relevant information. Section D and E, in practice, would basically be providing the patient with a printed information sheet, listing resources, along with a verbal explanation. This section, along with the advance directives, living will, durable power of attorney, are specifically relevant in discussions between cancer patients and their oncologists, at a time when the oncologist feels that further available anti-cancer treatments (especially chemotherapy) are more likely to hurt the patient than help the patient.

The rest of the bill (section pertaining to end of life counseling is simply providing detailed guideline.

`

(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include–

`(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State–

`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that–

`(I) ensures such orders are standardized and uniquely identifiable throughout the State;

`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;

`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

`(5)(A) For purposes of this section, the term `order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that–

`(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;

`(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

`(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items–

`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

`(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;

`(iii) the use of antibiotics; and

`(iv) the use of artificially administered nutrition and hydration.’.

Now, Mata, you seem to have a problem with Nurse Practioners and Physician’s Assistants being eligible also for reimbursement. You may not be aware that both Nurse Practitioners and Physician’s Assistants are NOT some sort of low level clerical personal or aids: these are licensed professionals who are trained and licensed to provide many of the services traditionally provided by physicians. These professionals work semi-autonomously, albeit under the general supervision of a physician.

http://en.wikipedia.org/wiki/Nurse_practitioner

http://en.wikipedia.org/wiki/Physician_assistant

I’ll repeat again that Sarah Palin (and her supporters in this shameful hysterical scaremongering distortion) have done a profound disservice — potentially to hundreds of thousands of cancer patients covered under Medicare. The intention of the bill was honorable and noble: To compensate physicians for their time in provided needed counseling regarding end of life issues — again, these sorts of conversations most frequently involve cancer patients, in whom additional anti-cancer chemotherapy is more likely to harm the patient, rather than helping the patient.

- Larry Weisenthal/Huntington Beach, CA

@aqua (#137):

We were talking about comparative effectiveness research: why it is important and why, in it’s absence, doctors routinely play patients like violins, to the advantage of doctors and disadvantage of patients.

I’ve given the following example before, but I’d like to summarize it again, in the specific (new) context of comparative effectiveness research.

Example: Prostate Cancer

Background information is that prostate cancer is extremely common. Most men who make it to age 90 are incubating prostate cancer; few will die of it, however. Prostate cancer is a disease that many men live with, but relatively few die of. In the cases of those men who are destined to die of it, it has never been established definitively that there is any form of primary treatment (e.g. surgery, radiation) which will prevent death. It seems to be that prostate cancers which are destined to be aggressive may already have spread beyond the prostate (via the lymph nodes and/or blood stream) by the time it is first diagnosed.

Here’s how patients are played like violins and how they are played like violins.

You are a 60 year old man. You are having some problems with your love life, so you go to a urologist to have a medical evaluation (and maybe a prescription for Viagra). The urologist does as he is asked, but then suggests to you that you have a simple blood test for PSA (prostate specific antigen). If it’s elevated, then you could be harboring prostate cancer, which, he assures you, is “best caught early.”

Here’s the issue: Do you go along with him and have the test?

In the real world, almost certainly, you do. $ to the urologist (follow up visit for results). Anxiety and lost time to you. If the PSA is elevated, you then consent to have a needle biopsy of your prostate. $$$ to the urologist. Pain and suffering and expense for you. Then, let’s say, there is cancer in the biopsy needle. Of course, you want it to be treated. $$$$$$$ to the urologist. Pain, suffering, erectile dysfunction, urinary incontinence (could be permanent) to you. Perhaps $$ to the manufacture of Depends and $$$$, over time, to the manufacturer of Viagra. Additional $$$, for years’ worth of follow up visits. Perhaps additional surgeries to deal with complications.

Now, it turns out that the Europeans did a very nice comparative effectiveness study, published earlier this year. There was a similar study, performed and published at the same time, by a consortium of American investigators.

The American study showed no difference in death from prostate cancer in men who were screened with PSA testing and those who were not, despite the fact that the men who were screened had lots more biopsies, prostatectomies, complications from prostatectomies, radiation, complications of radiation, expense etc.

The European study showed a 20% decrease in deaths from prostate cancer in the group of men who were screened.

So, being a math whiz, when the urologist suggests getting a PSA test, you don’t just comply. It’s just a blood test, and you feel silly telling him that you won’t be able to make a decision until you research it. After all, you are already there. You may as well just have the stupid little blood test. But you still want some data. “What’s the evidence that this might help me?” you ask. Urologist doesn’t mention the negative American study. Such huge studies are never perfect. Since urologists don’t want their sacred cows killed and eaten, the pour over the negative study with a fine tooth comb, and they’ll always find a flaw upon which they can pounce (sort of like conservatives not liking the New England Journal of Medicine study showing that a large majority of the nation’s physicians would like to see health care reform and would like to see a public option in this reform — so they nit pick it to death).

With the American study duly nit picked, the urologist feels justified in not mentioning it to you. Instead, he quotes the European study:

“If we do this blood test, you’ve got a 20% less chance of dying of prostate cancer!”

He makes the sale. Simple blood test. 20% less chance of dying. Wow! What’s not to like.

Here’s what’s to like:

You have to do the blood test on 1450 men to prevent one death. In performing the test, you’ll get elevations which will prompt hundreds of biopsies which do NOT diagnose prostate cancer, but which do produce pain, suffering, inconvenience and $$$ for the urologist.

In 48 of these 1450 men, you will diagnose prostate cancer on the needle biopsy. With prostate cancer duly diagnosed, you will normally be directed into a radical prostatectomy (because it’s the urologist who is running the show). But, when you get the diagnosis, you might well tell the urologist that you want to think about it and research it and maybe get a second opinion. More $$ for other doctors. Maybe you opt for radiation therapy: external beam, radioactive “seed” implants, radioactive iridium wire implants, proton beam — lots of specialists to whom you may spread the $$ in getting the information to make your decision. Most men do end up with radical prostatectomies — radiation producing its own complications.

So you end up doing 48 radical prostatectomies (or 36 prostatectomies and 12 radiation therapies, or whatever) to prevent a single death from prostate cancer.

Now, would you really want to have the blood test, knowing that there was only a 1 in 1450 chance that it would help you and, if it were to help you, there would be a 47 in 48 chance that you’d get your prostate gland whacked out for nothing and only one chance in 48 that, if you had your prostate gland whacked out, it would help you?

If you give up red meat, there’s a greater than one chance in 48 that it will prolong your life. If you had to do one of the other, what would you give up: your prostate gland or red meat?

Freakonomics sort of stuff. They should put it in the next book.

But this is precisely why “comparative effectiveness research” is so important and should be supported by everyone.

Calling yourself a cello and not a violin. Priceless. Got a nice chuckle out of your humorous self-deprecation.

- Larry Weisenthal/Huntington Beach, CA

General comment: I do a lot of ragging here, on my own profession (medicine in general and oncology in particular). I also do this in my various talks to physicians and oncologists. I recently received a video file of a talk I gave in Berlin, last March 19, 2009. I just posted this on Vimeo:

http://vimeo.com/7577309

Vimeo allows for long format videos; Youtube limits to 10 minutes.

It’s 33 minutes long, but you can fast forward to exactly 6 minutes and 45 seconds in and get to a 3 minute section where I lob some very pointed criticisms at my profession, which are quite relevant to some matters discussed on this health care thread. The first couple minutes are a general introduction, then I go through some data, and then launch into the critique at 6 minutes and 45 seconds.

- Larry Weisenthal/Huntington Beach, CA

Let me put this simply, Larry. If you want the Medicare end of life consultations to be covered, you have to have them every five years (needed or not) or more often if there are health issues inbetween because of the built in “limitations”. Otherwise, that service is not covered.
That, my friend, is a mandate in order to obtain coverage. It is a “use it, or lose it” situation.

Where in the world do you get that? It’s ridiculous. The 5 year thing just means that, if you are in a stable condition and are not having changes in your health, you are entitled to such a consultation every 5 years. It’s no different than Medicare saying you are entitled to have a colonoscopy every 5 years. There is no “mandate” to have a colonoscopy! And you can have a colonoscopy at any point in time that there is a change — let’s say new onset of blood in the stool. So then, you can have one, for examples, only 2 years after the previous one. But if it’s just a routine, screening test, you can’t get it more often than every 5 years. If you happen to miss a 5 year “anniversary,” you can still get one at 6 years or 7 years or 8 years. There’s no “use it or lose it.” What an absolutely ridiculous assertion! What would be the rationale? If the idea is to use this counseling to kill old people, then why punish them for being forgetful and missing a 5 year anniversary?

I said nothing about “forcing” people to sign living wills. What I said is that discussions about living wills and estate planning, wrapping up your final plans, is not the business of any medical professional. I stand by that. I also mentioned in a comment above that it was arrogant to assume the import of a medical provider in an individual’s life about these very personal issues.

Firstly, there’s nothing in the bill about “estate planning!” That’s ridiculous. And do you have any idea what a living will is? It’s completely about what types of medical treatment are to be given and which are not. It’s all about medicine/health care. Do you want to have a “code” called if you have a cardiac arrest? What goes on in a “code?” Patients need to know this in order to decide. Do they ask their lawyer or do they ask their doctor? If they ask their lawyer, he’ll certainly bill them. How many lawyers really understand all the various medical procedures which might be provided in near end of life situations? Well enough to explain them to patients? Doctors understand the procedures which are in question and they are, by far, the best ones to explain these to patients. If they take the time to do this, they should be paid for their time, just as lawyers are certainly paid for their time. You were complaining on another thread about Medicare “squeezing” doctors. This is an attempt to compensate doctors, like oncologists, who have to do a whole lot of this stuff, which is important, and for which they are currently not being paid.

And if the patient doesn’t want a “medical provider” to advise them about medical procedures, THEY DON’T HAVE TO use this! But if they do want their medical provider to advise them about these MEDICAL issues, then the bill says that Medicare will pay the doctor — PROVIDED that this isn’t done more often than every 5 years (if no change in situation since the preceding counseling — again, this is simply to prevent Medicare fraud).

Larry Weisenthal/Huntington Beach CA

Larry W: The 5 year thing just means that, if you are in a stable condition and are not having changes in your health, you are entitled to such a consultation every 5 years. It’s no difference than Medicare saying you are entitled to have a colonoscopy every 5 years. There is no “mandate” to have a colonoscopy!

Again, you did not read the language:

Paragraph 3: An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1)

Again, I point out paragraph 1 as it relates to paragraph 3 above.

Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years.

The way this language reads, if you want the consultations covered, there is a 5-year limitation… meaning use it, or lose it for coverage. I don’t care if colonoscopies are mandated or not. That’s nothing to do with *this* mandate. This, of course, is exactly the opposite of your personal interpretation:

But if they do want their medical provider to advise them about these MEDICAL issues, then the bill says that Medicare will pay the doctor — PROVIDED that this isn’t done more often than every 5 years

I understand your interpretation of the language as it’s shared by every proponent of government provided health care, Larry. And in fact, the author of this bill section, Rep. Blumenauer, echoes that this was his intent with the language.

But again I remind you of your statement INRE doctors spending that extra 45 minutes to explain the risks/results of alternative treatment, and how lawyers exploit that in a court of law with vague legislative language.

Now one has to wonder, when implemented, who is correct? Would it have been exploited in the courts and denied coverage as interpreted as the same way I see it? Could they have potentially tied any treatment to the fact that someone refused such coverage and consultations?

The point is, the language is vague, and could be argued either way. And I’m generally one who tends to take the worst possible scenario as fact to avoid ugly surprises later.

It is also an unnecessary service/cost and provided by the wrong people, IMHO. It is not a service that is not unavailable via other avenues…. and for little to no cost.

Now let’s take another argument about this voluntary and/or mandated counseling that parallels with the unnecessary increased costs for services available for free elsewhere. This is from MedPage Today just a yesterday… pointing out that more pro-active patient mentality drives up costs unnecessarily.

The so-called “participatory patient” is becoming more common. These patients take a more pro-active approach in their health care, using the internet to research their diseases. Most doctors support these “e-patients,” but unfortunately, our health system may not be as amenable. This piece from NPR details how, in one practice, 30% of costs are due to demands made by more involved patients. Because the system doesn’t encourage doctors to spend the time needed to engage with pro-active patients, many simply take the path of least resistance and order the requested tests. And that drives up health spending.

Why, Larry, are you advocating increased costs for services offered for free elsewhere?

Now, let’s take another repercussion of such legislation… and this goes to the heart of your hatred for Sarah Palin. Quite frankly, I don’t think you understand her point. So let me reference some of her written testimony to the New York State Senate Aging Committee hearing.

To understand this provision fully, it must be read in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.”[4] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As one commentator has noted, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones…. If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to ‘bend the curve’ on health-care costs?”[5]

As you stated in your letter to Congressman Henry Waxman of California:

Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives…. It is egregious to consider that any senior citizen … should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign.[6]

~~~

A great deal of attention was given to my use of the phrase “death panel” in discussing such rationing.[7] Despite repeated attempts by many in the media to dismiss this phrase as a “myth”, its accuracy has been vindicated. In the face of a nationwide public outcry, the Senate Finance Committee agreed to “drop end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly.”[8] Jim Towey, the former head of the White House Office of Faith-Based Initiatives, then called attention to what’s already occurring at the Department of Veteran’s Affairs, where “government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care.”[9] Even Washington Post columnist Eugene Robinson, a strong supporter of President Obama, agreed that “if the government says it has to control health care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.”[10] And of course President Obama has not backed away from his support for the creation of an unelected, largely unaccountable Independent Medicare Advisory Council to help control Medicare costs; he had previously suggested that such a group should guide decisions regarding “that huge driver of cost . . . the chronically ill and those toward the end of their lives….”[11]

The fact is that any group of government bureaucrats that makes decisions affecting life or death is essentially a “death panel.” (snip)

Potential abuse, increased waste of funds for already provided services, and open to misinterpretation.

I rest my case.

And yes, I do know what a living will is… instructions INRE DNR. If that was Dad’s wishes, the last thing I wanted was for him to be taken to a hospital, put on life support, and force my mother to pull the plug. That is not something I’d want her to live with.

Powers of attorney (the 2nd arena of discussion) have everything to do with estate planning, unless that power of attorney is strictly limited to the living will. In fact, the legislative language specifically mentions durable power of attorney, which encompasses a considerably wider scope than merely DNR or medical decisions while incapacitated. It is not, as the legislation implies, merely a “health care proxy”. This advice can lead to empowering someone with far more decision making directives than the patient wants, and is best left to an attorney structuring just what they want that empowered person to be able to do.

Only an attorney can effectively limit the scope of power when constructing the POA, and therefore only an attorney should be providing legal advice. Doctors have no business practicing law.

A living will/DNR instruction isn’t the only “end of life” counseling, and includes minimally what to do about funeral arrangements, credit cards, social security notifications etal. The debris we leave behind in this world is immense.

Why should we drive up Medicare costs, paying medical professionals for small segment of genuine end of life counseling, when the larger scope of all involved is provided via other means? In fact, the legislation itself points out they have access to such via national toll-free hotlines, the advance care planning clearinghouses, and State legal service organizations.

Again why, Larry, are we adding to Medicare costs when this service is already available via free means?

This is all rather moot, when you think of it. This does not exist in the new bill, and these services are readily available via other channels. I see it as a waste of funding, and speaking with a medical professional about such is the last thing I’d want to do about such matters. All I’d want is, tell me what the treatments are (both what they would cover via Medicare, and what I could obtain OUTSIDE of Medicare, as the latter is often held back by the “wallet” mentality). Then let me make my decision.

I’ll figure out my own end of life plans without their help, thank you.

Reply to #150 went to spam.

I am sorry that I wasn’t able to proof check the formatting. I hope that it comes out OK, whenever it is retrieved and posted.

- larry w/HB

After 200 some-on posts by Larry, focused on NOTHING but this topic, I am now convinced he’s getting a kickback from the Whitehouse. NOBODY could be this damn adamant about such a losing POS as this bill without having something going on to make it worth it.

Or he’s sneaking meds.

Either way, it’s become pathetic.

@mata (#153)

You gotta love the GOP. “Medicare is going broke!” Another “failed” government program.

Dems try to fix it: “Death panels!”

IMAC has nothing to do with death panels; it’s making reimbursement decisions on the basis of transparent, public deliberations (as opposed to private insurance and individual doctors, who make reimbursement and treatment decisions behind closed doors and inside closed skulls).

The “end of life counseling” had nothing to do with death panels; it was about reducing ineffective end of life treatments, improving quality of life at and of life, and also trying to control Medicare costs.

The legislation was good, clear legislation, as written. If there were any ambiguities, it would have been helpful to suggest changes in the language to clarify those ambiguities, instead of screaming “death panels.”

I do “totally get it”. I do encourage doctors to counsel patients on their options for treatment. Unlike you, I don’t think they should be paid extra for what they should do morally as part of their gig, and wrap up yet another revenue grabber by masking it as “end of life counseling” fee.

On one hand you maintain that doctors are leaving Medicare in droves, because they are being squeezed financially. On the other hand, you don’t think that a doctor should be paid for sitting down with a patient and telling him that his chemotherapy isn’t working anymore and further chemotherapy is much more likely to shorten his life than prolong his life and it is likely to make him feel worse and that, unfortunately, there are no more promising treatments left in the cupboard and said patient, of course, has lots of questions, and doctor patiently answers all of them and, in the course of this discussion, such things as advance directives and living wills and durable powers of attorney (“medical surrogate”) and hospice care come into it, and doctor explains the technicalities and limitations of foreseeable medical procedures, so that patient can make best informed decisions, and you feel that said doctor deserves no compensation for this, although you are only too happy to see said doctor get compensated for pushing chemotherapy and perhaps performing more futile surgery or giving more futile radiation.

The path of least resistance is just to keep treating, to the end. You get paid more; it takes less of your time; and it’s less stressful on you (no fun, at all, giving end of life counseling).

I have no problem at all with people pointing out ambiguous language, questioning cost effectiveness; taking the position that doctors shouldn’t be paid for thinking and talking but only paid for cutting and sewing and pushing drugs and directing radiation treatments (though the misincentive to provide treatment services as opposed to dispensing advice and counseling is at the heart of some of the most serious problems with the health care system).

You argue that the bill is imperfect and could be improved or isn’t necessary; that’s one thing.

Claiming that it’s about government bureaucrats deciding who’s going to live and who’s going to die and encouraging doctors to withhold effective treatment for the purpose of getting patients to die faster — that’s despicable.

And all Palin cared about was raising her profile, at the expense of tens of thousands of cancer patients. What she did was utterly despicable.

- Larry Weisenthal/Huntington Beach CA

@patvann:

After 200 some-on posts by Larry, focused on NOTHING but this topic, I am now convinced he’s getting a kickback from the Whitehouse

#1. I am a medic; so, of course, it’s the issue most important to me. Some on this blog only post on national defense or terrorism issues.

#2. You haven’t been around long enough. When I have the time and interest and when it’s topical, I like to debate economics, climate change, foreign policy, whatever.

But thanks for counting my posts. Nice to know that I’ve got such a loyal follower.

- Larry W/HB

Larry W: You argue that the bill is imperfect and could be improved or isn’t necessary; that’s one thing.

Claiming that it’s about government bureaucrats deciding who’s going to live and who’s going to die and encouraging doctors to withhold effective treatment for the purpose of getting patients to die faster — that’s despicable.

Never once have I suggested that it was about doctors withholding treatment, encouraging patients to die faster. You put words into my mouth that I have never uttered. And that, Larry, is despicable. Again, you confuse me with someone else.

You totally misunderstand the IMAC legislation. Or perhaps you’ve never read it, as it’s a side bill with little fanfare. Have at it… Here’s the last proposed text I have. It is all about their power to recommend adjustments to reimbursements for everything from services to hospice care, prostetics, etal. When they cut percentage reimbursements, what exactly do you think happens to the insured patient… as well as the medical providers?

You say:

…it’s making reimbursement decisions on the basis of transparent, public deliberations (as opposed to private insurance and individual doctors, who make reimbursement and treatment decisions behind closed doors and inside closed skulls).

100% wrong, as you like to say. There is nothing public about the 5 man appointed panel, working behind closed doors with their recommendations first being reviewed by the Chief Actuary of the Centers for Medicare & Medicaid Services, and then passed on to the POTUS for approval. It can then only be reversed if the Senate can pull together a joint resolution within 30 days noting disapproval.

Yeah… real “transparent”, Larry.

As far as leaving Medicare in droves…. as I said, doctors should do this as part of their job. Period. I’m not going to argue that point any more, nor acquiesce that a way for them to pad their under cost reimbursements via an end of life counseling fee is the answer to service shortages. Fact is, real “reform” would be for better prices on equipment and supplies so their costs weren’t skyrocketing, or full reimbursement for their equipment and supplies. But add on extras to pad the loss is absurd.

If doctors choose “the path of least resistance” because it’s more money and less time consuming, *they*, not Palin, are the culprits. You blame her for their wallet mentality. That makes you despicable, and succumbing to the irresponsible shifting of blame, or the “it ain’t my fault” mentality. That is sheer, arrogant chutzpah.