From Palin no less... she has a point.
Terry is tired about talking about health care because his "President" the great "O" is getting his brains beat out.
This episode mostly teaches that we remain a right center nation and his election was in part a euphoria of "hope and change" but now that he actually enacting his agenda there is serious buyers remorse forming.
All Conservatives need to do is slow things down and let these schemes see the light of day and viola, they come to a screeching halt.
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Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly, and the disabled would suffer the most under such rationing; and that under such a system these “unproductive” members of society could face the prospect of government bureaucrats determining whether they deserve health care.
The President made light of these concerns. He said:
“Let me just be specific about some things that I’ve been hearing lately that we just need to dispose of here. The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma because we’ve decided that we don’t, it’s too expensive to let her live anymore....It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, etc. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready on their own terms. It wasn’t forcing anybody to do anything.” [1]
The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” [2] With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.
Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program." [3] During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services. [4]
Now put this 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.” [5] 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 Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones.... If it’s all about alleviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” [6]
As Lane also points out:
Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that’s an incentive to insist.
Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic. [7]
Even columnist Eugene Robinson, a self-described “true believer” who “will almost certainly support” “whatever reform package finally emerges”, agrees 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.” [8]
So are these usually friendly pundits wrong? Is this all just a “rumor” to be “disposed of”, as President Obama says? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:
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. [9]
Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens....An obvious example is not guaranteeing health services to patients with dementia.” [10] Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” [11]
President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.
August 13, 2009
When Liberal Leaders Confront a Centrist Nation
By Michael Barone
There are more conservatives than Republicans and more Democrats than liberals. That's one of the asymmetries between the parties that helps to explain the particular political spot we're in. The numbers are fairly clear. In the 2008 exit poll, 34 percent of voters described themselves as conservatives and 32 percent as Republicans; 39 percent described themselves as Democrats but only 22 percent as liberals.
It's been this way for a long time. The premise of John Kenneth Galbraith's "The Liberal Hour," published in 1960, was that conservative politicians wanted to identify themselves as liberals, as supporting Franklin Roosevelt's New Deal, when it came time for elections.
But as in his description of the economy in "The New Industrial State," Galbraith was telling us how things had been, not how they would soon be. By the late 1960s, with riots blazing in big cities and rebellions roaring on university campuses, the balance shifted away from liberals and toward conservatives.
The result is that the two parties have offsetting political advantages. Democrats tend to win on party identification. Republicans tend to win on ideology. Democrats don't have to appeal to as many independents as Republicans do. Republicans don't have to appeal to as many moderates as Democrats do.
But the Democrats have a problem here. The party's leadership currently tilts heavily to the liberal side. Barack Obama is from the university community of Hyde Park in Chicago. Speaker Nancy Pelosi is from San Francisco, and important House committee chairmen are from similar "gentry urban" locales -- Henry Waxman from the West Side of Los Angeles, Charles Rangel from a district that includes not only Harlem but much of the Upper West Side of Manhattan, Barney Frank from Newton, Mass., next door to Boston.
Of the 21 top leadership members and chairmen, five come from districts carried by John McCain, but the average vote in the other 16 districts was 71 percent to 27 percent for Obama.
All these Democratic leaders understand that their home turf tilts far left of the rest of the nation. But a politician's political base is ultimately his or her reality principle. Moreover, most of these leaders -- though Obama obfuscated this in his campaign -- have strong, long-held convictions that are well on the left of the American political spectrum.
These are the people -- the House leaders more than Obama, surprisingly -- who have shaped the Democrats' stimulus package, cap-and-trade legislation and health-care bills. The rules of the House allow a skillful leader like Pelosi to jam legislation through on the floor, although she's had more trouble than expected on health care. But their policies have been meeting resistance from the three-quarters of Americans who don't describe themselves as liberals.
Republican leaders tend to come from mostly suburban districts closer to the national political average. Of the 19 lawmakers who are in the GOP's House leadership or who are ranking committee members, four come from districts carried by Obama. The average vote in the other 15 districts was a less-than-landslide 57 percent to 41 percent for McCain. Only three of those districts voted more than 60 percent for McCain.
In these circumstances, the Republicans have been winning the battle for public opinion and, more importantly, for public enthusiasm -- in sharp contrast to 2008. Democrats complain that Republicans have no alternatives on health care or other issues. Actually some of them do, but no one is paying any more attention to them than people did to Democratic proposals four years ago, when Republicans held the White House and congressional majorities.
The exit poll showed that though the Republican label had lost support since 2004, conservatives did not lose their edge over liberals. The health-care debate has shown that the economic distress caused by the financial crisis and recession has not, at least so far, moved significant numbers of Americans to change their views on the proper balance between markets and government.
"I don't want the folks who created the mess to do a lot of talking," Barack Obama said on a campaign stop in Virginia on Aug. 6. "I want them just to get out of the way so we can clean up the mess."
When a politician tries to stop debate, it's a sign he's losing the argument. Obama seems to have let the House Democrats overplay their hand. He ignored the fact that in our system neither party ever has all the advantages.
There He Goes Again (Just Don't Call Them "Death Panels")
Somebody call White House flack Linda Douglass at Fishy-1-1 - Mickey Kaus is circulating discouraging arguments suggesting Obama's risky health reform scheme might actually lead to "death panels", and yet again he is relying on Obama's own words:
If, as Harold Pollack argues, "rationing of life-saving or life-extending care" would not really be a priority for the "effectiveness" panels--such as the Obama-endorsed IMAC--then it was all the more stupid to bring the topic up, no? Here's the first graf from a Bloomberg account of an early Obama health care foray back in April:
April 29 (Bloomberg) -- President Barack Obama said his grandmother’s hip-replacement surgery during the final weeks of her life made him wonder whether expensive procedures for the terminally ill reflect a “sustainable model” for health care.
Gee, where could the misinformed town hall crazies have gotten the idea that Obama was thinking about saving money by denying expensive procedures toward the end of life? ... [via Dish] ... 1:49 P.M.
Ha! Folks who really want to stick it to Obama and sow hysteria about "death panels" will extract this from Obama's same fateful interview with David Leonhardt of the Times (my emphasis):
THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
DAVID LEONHARDT: So how do you — how do we deal with it?
THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.
So Obama "suspects" that the legislative process will produce some sort of independent group that can give non-determinative "guidance" on end-of-life care for the chronically ill, with an eye towards saving money. Just don't call them death panels!
Well, as are friends on the left will surely chant in unison, it's not in the bill right now so it is calumny and perfidy to suggest we might end up there. Even though Obama "suspects" we will.
HOW "NOT DETERMINATIVE" IS NOT DETERMINATIVE: Just how voluntary will Obama's voluntary guidelines be? If the government posts suggestions on a website and leaves it at that, that is one thing. But suppose governmnt watchdogs decide that a doctor who routinely fails to comply with the voluntary guidelines ought to be subjected to a full examination of his billing practices, treatment decisions and hiring practices. How many doctors will "volunteer" to comply with the guidelines rather than deal with that?
Think it can't happen? There is a cottage industry in helping people with chronic pain get prescription medicine; doctors hate the paperwork and the risk of a DEA investigation. Obviously this is not a perfect example - some people do get high on opioid pain pills in a way that probably would not apply to end-of-life care. But I stand by the point that doctors will allow a government hassle factor to guide their treatment decisions (and if they followed the voluntary guidelines, how are you going to sue them?).
The people are finally waking up to the fact that "change" really means facism. Do you think Independants would have voted for Barry if they actually knew what he meant with the word "change"? It also appears that "hope" means that we will be hoping that our childrens children will finally be able to pay off Barry's deficit.
Mark - I guess "hope" must mean first paying off the $10T Reagan/GWBush debt, no?
Also - when criticizing Obama's deficits, how much blame do you give GOP Congress and GWB? He did hand Obama a $1.3T annual deficit that was rapidly growing. This, after inheriting a surplius from Clinton. How much blame do you allocate to GWB & GOP?
I will be shocked if this question is answered in any meaningful way.
Jimmy -
Please stop posting the articles - just include a link. I am much more interested in hearing what you have to say.
IBD editorialized that it was a good thing that Stephen Hawking did not suffer Britian's NHS system - he would not have survived the state run triage.
What IBD is too stupid to know is that Hawking is British and he credits their system with saving his life. He wrote a poignant response to their insipid blather.
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