Category Archives: Medicine

The key to victory: don’t lose your nerve

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If Obamacare doesn’t pass, it will in the end be because the Democrats forgot that rule. Granted, they have some reason—right now, 2010 isn’t looking like a great year for them. Support for the President’s health care “plan” (one has to put it in quotes because there is not in fact one coherent plan) is down to 41%, with 56% opposed, and the numbers are even worse among senior citizens; perhaps more importantly, the sense of inevitability is gone, with a slight plurality of voters saying no health care bill will pass this year (and a majority of independents—58%). The President’s approval rating continues to sag as well.

Still, his Approval Index is somewhat better than it was earlier this year, and the Democrats have pulled to within two points of the GOP on the generic congressional ballot; and perhaps most importantly, the Democratic caucus on the Hill has the votes to pass any bill it pleases with no help whatsoever from the Republican minority. In short, if the Democratic Party actually believes in its declared principles, all its leaders have to do is stick to their guns and they can do what they believe to be best.

Will they? Well, if Rich Lowry is to be believed, maybe not:

That’s the prediction of a source in the Senate. He thinks Reid will certainly vote for cloture, but that the bill will be so unpopular—and his own standing in Nevada so precarious—that he’ll vote against it on final passage, especially if—as seems likely—the sweetheart deal for Nevada on Medicaid is eventually stripped out.

If—and it seems implausible, but if—one of the two primary legislative leaders of the Democratic Party is in fact prepared to bail on the most important element of his party’s political agenda in a bid to save his own skin, then combined with the Senate Finance Committee’s decision to euthanize the “public option,” one would have to conclude that we’re seeing a major failure of nerve. Barack Obama may well need to pull a mighty big rabbit out of his hat if he wants to win this one—and given that he hasn’t managed that yet, and seems to have no real idea how he might, I don’t know where he’s going to find one.

Reflections on Obamacare as potential law

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The great misnomer in the health care “reform” debate comes in references to “the health care bill” or “the health care plan.” There is no one health care bill, and no one health care plan. There are various versions of legislation, and much yet to be decided, and probably whole sections that haven’t been written. There is in no reasonable sense one coherent piece of legislation.

More importantly, though, even when there is, and even if it passes, we still won’t be that much clearer on what the law is. Randall Hoven explains:

Let’s just say that you use HR 3200 as a surrogate for Obama’s plan. It definitely has words—1,017 pages worth. Here is what Congressman John Conyers said about it.

What good is reading the bill if it’s a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?To appreciate this statement, you should know that Conyers has been in Congress since 1965; only John Dingell, the bill’s sponsor, has served longer in the House. You should also know that Conyers has a law degree. And now he is chairman of the House Judiciary Committee.

If a legislator of 44 years, himself a lawyer and in fact chair of the judiciary committee, along with two other lawyers cannot figure out what this bill means, what hope do you, or I, or any “neutral” fact checker have of figuring it out?

William Jacobson, a professor of law at Cornell Law School, chronicled his efforts to understand this “dense House bill” in the American Thinker. He used a “dartboard” method to randomly select pages to analyze, stopping after seven such pages. “I will try to explain what the section and provisions on the page mean. There is no guarantee that I will be able to do so, as some of these provisions may be incomprehensible.”

“Incomprehensible” to a law professor. Also incomprehensible to an experienced legislator and lawyer working with other lawyers. Yet we are supposed to believe, say, the Huffington Post, when it interprets Obama’s health care plan for us?

This is not just a health care issue; it is an issue with all modern legislation. That is, the legislation passed by Congress and signed by a President become ink blots for those left to interpret it in the future. The money to fund the legislation is quite real, but the meaning of the legislation is more like quantum mechanics: there is no “there”, just probability distributions.

In other words, whatever plan passes (if a plan passes at all) won’t be “law” in the sense that we usually think of; it will, rather, be only an approximation. The way things work these days, we might think we know what the law means, but we really don’t until the courts are done making up their collective mind how they want to rewrite—err, I mean interpret—it.

This isn’t the only issue that arises, either, when we stop to consider Obamacare not as a political issue but as a potential addition to the law code. There is in fact a more significant one: is it even constitutional? Retired attorney and constitutional law instructor Michael Connelly, having read all of HR 3200, doesn’t think so:

This legislation also provides for access by the appointees of the Obama administration of all of your personal healthcare information, your personal financial information, and the information of your employer, physician, and hospital. All of this is a direct violation of the specific provisions of the 4th Amendment to the Constitution protecting against unreasonable searches and seizures. You can also forget about the right to privacy. That will have been legislated into oblivion regardless of what the 3rd and 4th Amendments may provide.

If you decide not to have healthcare insurance or if you have private insurance that is not deemed “acceptable” to the “Health Choices Administrator” appointed by Obama there will be a tax imposed on you. It is called a “tax” instead of a fine because of the intent to avoid application of the due process clause of the 5th Amendment. However, that doesn’t work because since there is nothing in the law that allows you to contest or appeal the imposition of the tax, it is definitely depriving someone of property without the “due process of law.”

So, there are three of those pesky amendments that the far left hate so much out the original ten in the Bill of Rights that are effectively nullified by this law. It doesn’t stop there though. The 9th Amendment provides: “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.” The 10th Amendment states: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are preserved to the States respectively, or to the people.” Under the provisions of this piece of Congressional handiwork neither the people nor the states are going to have any rights or powers at all in many areas that once were theirs to control.

Much has been made, and quite properly, of the fact that the President wants to transfer 1/7 of the American economy to government control; but if Hoven and Connelly are right, that’s only the lesser danger. The greater danger is the corrupting effect HR3200 (or more likely, its descendant) would have on our laws and our political process. It’s a funny thing, when a Republican was in the White House, the Democrats raged against the “imperial Presidency”; but when it’s one of their own, they’re happy to go along with an absolutely unprecedented power grab by the Executive Branch. They must not figure they’re ever going to lose another election.

This is what death panels look like

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and why you shouldn’t believe anyone who tries to tell you that there will be no difference between government bureaucrats and the insurance-company bureaucrats we have now (even as problematic as that current bureaucracy is, even as badly as we need to prune it). Read Michelle Moore’s New Ledger piece on “Rationed Care & The Most Vulnerable Among Us” . . . but be prepared, it’s an emotional read. I don’t think it’s any coincidence that it was Sarah Palin, a mother of five, including a baby with Down Syndrome, who came up with the phrase “death panels”; newborns who aren’t “perfect” and perfectly convenient truly are, even more than the elderly, the most vulnerable among us. They are the ones who most deserve our care—not to be abandoned as “too expensive.”

(Cross-posted at Conservatives4Palin)

Obamacare could end the Democratic majority

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In a fascinating article on RealClearPolitics, Sean Trende performs a thorough statistical analysis of the following proposition:

In 1994, Democrats failed to pass a healthcare bill, and they lost their majorities. Ergo, if Democrats fail to pass a healthcare bill in 2009, they will be at serious risk of losing their majorities in 2010, so to save their majorities, they should make certain above all else to get something passed.

This is a popular theme in the leftist blogosphere at the moment; but after analyzing it, Trende concludes it’s the exact backwards of the truth.

The 1994 elections weren’t caused by Democrats not supporting Clinton enough. They were caused by Democrats supporting him too much. Democrats who support President Obama more than their districts allow risk suffering a similar fate in 2010, and there are enough of them to cost the Democrats their majority.

As for President Obama, he needs to remember that the failure of Clintoncare didn’t mark the destruction of Clinton’s Presidency. In fact, it marked its rejuvenation. It set that Administration back on the centrist track that saw him leave office with 60%+ approval ratings. I don’t know whether America is center-right or center-left, but I do know that whatever the answer, “center” deserves to be in “all caps” font. The President and his party would do better to remember this.

The endpoint of overreaching

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One could say many things about Barack Obama’s speech last night, and analyze it from a number of angles, but in the end, it’s a political speech—only one thing really matters: did it move the needle? From everything I can see, it didn’t; people pretty much are where they were. Those who thought he was wonderful think he’s wonderfuller, those who were already convinced are more so, those who had doubts and questions still have them, those who were opposed haven’t left their positions, and the great debate on the Right seems to be whether the outburst from Rep. Joe Wilson (R-SC) was inappropriate. (I find it somewhat disturbing that so many people don’t think it was—for his part, Rep. Wilson has quite properly conceded that it was and apologized. I guess the abuse the Democrats gave George W. Bush has skewed some folks’ idea of appropriate behavior.)

There were a number of responses from the GOP which were more constructive, beginning with the official one by Rep. Charles Boustany (R-LA), a colleague of Rep. John Fleming both in the Louisiana congressional delegation and in the medical profession. Rep. Boustany hit all the key points clearly and concisely, and did a good job of presenting a positive Republican alternative, not just criticizing the President’s plan.

Perhaps the most important GOP response, unofficial though it was, came from Sarah Palin, who by virtue of her unofficial position was able to go beyond the necessary points and respond with greater freedom (and who didn’t have to cover them, since Rep. Boustany did his job so well). In particular, she continued to press on a couple key issues:

Many Americans fundamentally disagree with this idea. We know from long experience that the creation of a massive new bureaucracy will not provide us with “more stability and security,” but just the opposite. It’s hard to believe the President when he says that this time he and his team of bureaucrats have finally figured out how to do things right if only we’ll take them at their word. . . .

In his speech the President directly responded to concerns I’ve raised about unelected bureaucrats being given power to make decisions affecting life or death health care matters. He called these concerns “bogus,” “irresponsible,” and “a lie”—so much for civility. After all the name-calling, though, what he did not do is respond to the arguments we’ve made, arguments even some of his own supporters have agreed have merit.

In fact, after promising to “make sure that no government bureaucrat . . . gets between you and the health care you need,” the President repeated his call for an Independent Medicare Advisory Council—an unelected, largely unaccountable group of bureaucrats charged with containing Medicare costs. He did not disavow his own statement that such a group, working outside of “normal political channels,” should guide decisions regarding that “huge driver of cost . . . the chronically ill and those toward the end of their lives. . . .” He did not disavow the statements of his health care advisor, Dr. Ezekiel Emanuel, and continuing to pay his salary with taxpayer dollars proves a commitment to his beliefs. The President can keep making unsupported assertions, but until he directly responds to the arguments I’ve made, I’m going to call him out too.

You may agree with Gov. Palin or not, but the fact remains that she clearly didn’t see anything new in the President’s speech, and in particular that she didn’t see any sign of a significant overture to folks on the right; from her perspective, it was just more of the same, and more of the same isn’t going to make a difference in a high-stakes debate like this one. That’s why Jay Cost opened his analysis of the speech by saying,

In my judgment President Obama’s address last night was little more than a campaign speech with the Congress as the set piece. Evaluated from that perspective, it was a success. But from the perspective of finding a policy solution—i.e. actual governance—it contributed nothing to health care reform.

In Cost’s stark evaluation, the speech was a flop and an opportunity lost because the President was unwilling to actually act:

However, it failed to address the reason for their doldrums. Democrats need rallying because of internal divisions over actual policy disagreements. President Obama did not deal with those divisions. When you strip away the setting, the soaring rhetoric, the poetic cadences, and all the rest, you’re left with the criticism that both Hillary Clinton and John McCain leveled at him through all of last year: he voted present. . . .

What did last night’s speech contribute to finding a solution [to the divide over the public option]? I’d say that the answer is nothing. The President (once again) refused to get his hands dirty on this issue. He praised the public option to the hilt, rhetoric intended for the progressives, then he hinted that it could be ditched, rhetoric intended for the moderates. At some point in the policymaking process, a choice will have to be made. It was not made last night, which means that this was a governing opportunity lost.

Absent a firm belief in the genius of Barack Obama, it’s hard to dispute Cost on this one. President Obama overreached himself here, trying to load too much freight on his speaking ability and make rhetoric carry a load it simply cannot carry unaided. This was a moment demanding real leadership, not merely exhortation, but the President tried to win it with exhortation alone. The result appears to be that he’s right where he was 24 hours ago, but with one more bullet spent. That doesn’t bode well for his presidency.

The President’s problem: hubris

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That’s not exactly how Charles Krauthammer puts it, but that’s the problem he’s identified:

Obama then compounded it by vastly misreading his mandate. He assumed it was personal. This, after winning by a mere seven points in a year of true economic catastrophe, of an extraordinarily unpopular Republican incumbent, and of a politically weak and unsteady opponent. Nonetheless, Obama imagined that, as Fouad Ajami so brilliantly observed, he had won the kind of banana-republic plebiscite that grants caudillo-like authority to remake everything in one’s own image.

Accordingly, Obama unveiled his plans for a grand makeover of the American system, animating that vision by enacting measure after measure that greatly enlarged state power, government spending and national debt. Not surprisingly, these measures engendered powerful popular skepticism that burst into tea-party town-hall resistance.

Obama’s reaction to that resistance made things worse. Obama fancies himself tribune of the people, spokesman for the grass roots, harbinger of a new kind of politics from below that would upset the established lobbyist special-interest order of Washington. Yet faced with protests from a real grass-roots movement, his party and his supporters called it a mob—misinformed, misled, irrational, angry, unhinged, bordering on racist. All this while the administration was cutting backroom deals with every manner of special interest—from drug companies to auto unions to doctors—in which favors worth billions were quietly and opaquely exchanged.

“Get out of the way” and “don’t do a lot of talking,” the great bipartisan scolded opponents whom he blamed for creating the “mess” from which he is merely trying to save us. If only they could see. So with boundless confidence in his own persuasiveness, Obama undertook a summer campaign to enlighten the masses by addressing substantive objections to his reforms.

If you don’t believe Dr. Krauthammer, consider this from the Politico article on Barack Obama’s speech to Congress tonight:

2) He will not confront or scold the left. “This is a case for bold action, not a stick in the eye to our supporters,” said an official involved in speech preparation. “That’s not how President Obama thinks. The politics of triangulation don’t live in this White House.”

3) He will make an overture to Republicans. “He will lay out his vision for health reform—taking the best ideas from both parties, make the case for why as a nation we must act now, and dispel the myths and confusion that are affecting public opinion,” the aide said.

You cannot do both of these things at once. You just can’t. You cannot “make an overture to Republicans” without promising to actually consider Republican ideas and integrate them into your program—and to do that, you would have to confront the Left, to tell them that they’re going to have to give up some of the things they really want and to allow the Right to get some of the things they really want. You have to actually follow through on “taking the best ideas from both parties,” which would require actually forcing the Left to compromise, and scolding them for their dogmatic refusal to do so to this point. It’s not triangulation (and when did that become a dirty word, anyway?), it’s recognizing that you can’t eat your cake and still have it.

That the President doesn’t realize this is clear from the fifth point in Politico’s list:

5) Obama will try to reassure the left about his commitment to a public option, or government insurance plan. Aides said they are rethinking what he will say about this. He wants to thread the needle of voicing support for a public option, without promising to kill health reform to get it. But liberal congressional leaders were unyielding in their support for it on a conference call he held from Camp David yesterday, and he’s going to meet with them at the White House early next week.

Again, if he actually wants to make a serious overture to Republicans, the public option has to come off the table; that’s completely unacceptable to folks on the Right, and meaningless “concessions” that make no substantive difference won’t be enough to win any meaningful Republican support. But of course, to take that off the table, he’ll have to confront the Left, in a big way, and so far, he’s shown no stomach whatsoever for doing that (if in fact he’s ever actually wanted to). President Obama has a choice: reach across the aisle, or continue to appease the Left. He’ll have to pick.

As a result, the inestimable Jay Cost (who has to be one of the three or four best political analysts going right now) comes to this conclusion:

I think this will be little more than a change in tone—perhaps from cool/slightly mocking Obama to angry/forceful Obama. From the looks of it, the President is still planning to make all the same points he’s been hammering for months. He’ll ask for bipartisan cooperation while remaining cagey on the public option (a deal breaker for 99% of the Republican caucus). He will again insist the time for debate is over and the time for action is now. He’ll make a not-terribly-compelling case about how this somehow relates to the current economic morass, even though the benefits do not kick in for years. He’ll fearlessly stand up to Republican straw men, who never offer anything except disingenuous attacks.

Which, if that does indeed to turn out to be the best he can do—and if it isn’t, then why haven’t we seen something better well before now?—raises a critical question: what’s the point of this speech? Why is the President doing this? Cost suggests two related reasons:

First, it has begun to believe its own spin that the President is good at giving game changing speeches. But he isn’t really. Nobody is. If the game could change because of a speech, the game would constantly be changing because lots of people can give a decent speech, especially when they have a TelePrompTer. President Obama is a compelling speaker to a relatively narrow segment of the country—namely, African Americans and white social liberals. He inspired them to support his primary campaign against Hillary Clinton—but other voters (including many in his own party) were harder to win over. His Philadelphia speech on race was no Cooper Union; it merely distracted attention from the main question of why he spent so many years in that church. His numbers still fell, and he struggled through the rest of the primaries, even losing South Dakota on the day he declared victory. He then gave big speeches in Europe and Denver, but it was only thanks to the financial panic of last September that he had a breakthrough.

Still, his speechifying seems to give some people a thrill up the leg—and the idea that he’s not just a good speaker, but a game changing speaker, has become conventional wisdom. I think the White House believes that this is actually true.

Second, it does not know what else to do. It looks like Congress is at something less than square one. There is no passable compromise that has been proposed—nothing that can win enough votes in the center without losing the left flank. But now the “Gang of Six” has basically broken up, public approval has tanked, moderates are scared, and if there isn’t bad blood on the Democratic side of the aisle there is at least a lot of finger pointing. If Humpty Dumpty breaks and you don’t know how to put him back together—why not give a speech and boldly proclaim how important it is to put him back together?

Cost believes, and has been arguing, that the administration needs to scale its plan way back and go for incremental health-insurance reform rather than trying to revamp the whole system on the fly; I think Cost is right. If President Obama were to take that tack, he could keep the moderates in his own party and pick up the moderates from the other side of the aisle; with a little creativity, he might even come up with something that could attract support from some conservatives without losing liberals, which would be a huge accomplishment. While he would probably still emerge from this whole fight weakened, producing an actual bipartisan reform package would allow him to recover a lot of face and a lot of his prestige—as well as some of his “post-partisan” image—and thus to salvage a fair bit from an initiative that so far has been a complete fiasco for him. As Cost concludes,

If the President scaled back his ambitions, the final bill would not be as far to the left as the liberals like, but since it is not comprehensive they could at least plan to fight for the public option another day. Then, Obama could pick up enough moderates to pass it, and he could declare victory.

Incidentally, this is how most legislation gets passed in the Congress.

Which suggests, yet again, that Barack Obama would be a more effective president if he’d spent enough time actually doing his job as a legislator to actually understand things like that. As it is, all he can do is give (yet) another speech. If Allahpundit is right and the purpose of this address to Congress is really to push hardliners on the Left to compromise without admitting he’s doing so (which would alienate his base a fair bit more than he already has), then the President may actually accomplish something almost despite himself. We shall see.

Thomas Sowell asks a very important question

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one that I’ve been asking as well, in his latest column:

One plain fact should outweigh all the words of Barack Obama and all the impressive trappings of the setting in which he says them: He tried to rush Congress into passing a massive government takeover of the nation’s medical care before the August recess—for a program that would not take effect until 2013!

Whatever President Obama is, he is not stupid. If the urgency to pass the medical care legislation was to deal with a problem immediately, then why postpone the date when the legislation goes into effect for years—more specifically, until the year after the next Presidential election?

If this is such an urgently needed program, why wait for years to put it into effect? And if the public is going to benefit from this, why not let them experience those benefits before the next Presidential election? . . .

If we do not believe that the President is stupid, then what do we believe? The only reasonable alternative seems to be that he wanted to get this massive government takeover of medical care passed into law before the public understood what was in it.

Moreover, he wanted to get re-elected in 2012 before the public experienced what its actual consequences would be.

Hard to argue with Dr. Sowell’s conclusion.

She said “death panels,” she meant “death panels”

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and for excellent reason, as Sarah Palin told the New York State Senate:

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.” The work of Dr. Ezekiel Emanuel, President Obama’s health policy advisor and the brother of his chief of staff, is particularly disturbing on this score. Dr. Emanuel has written extensively on the topic of rationed health care, describing a “Complete Lives System” for allotting medical care based on “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.”[12]

(Full text of her testimony below.)

Gov. Palin backed this up with her op-ed this evening in the Wall Street Journal:

In his Times op-ed, the president argues that the Democrats’ proposals “will finally bring skyrocketing health-care costs under control” by “cutting . . . waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies . . .”

First, ask yourself whether the government that brought us such “waste and inefficiency” and “unwarranted subsidies” in the first place can be believed when it says that this time it will get things right. The nonpartisan Congressional Budget Office (CBO) doesn’t think so: Its director, Douglas Elmendorf, told the Senate Budget Committee in July that “in the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount.”

Now look at one way Mr. Obama wants to eliminate inefficiency and waste: He’s asked Congress to create an Independent Medicare Advisory Council—an unelected, largely unaccountable group of experts charged with containing Medicare costs. In an interview with the New York Times in April, the president suggested that such a group, working outside of “normal political channels,” should guide decisions regarding that “huge driver of cost . . . the chronically ill and those toward the end of their lives . . .”

Given such statements, is it any wonder that many of the sick and elderly are concerned that the Democrats’ proposals will ultimately lead to rationing of their health care by—dare I say it—death panels? Establishment voices dismissed that phrase, but it rang true for many Americans. Working through “normal political channels,” they made themselves heard, and as a result Congress will likely reject a wrong-headed proposal to authorize end-of-life counseling in this cost-cutting context. But the fact remains that the Democrats’ proposals would still empower unelected bureaucrats to make decisions affecting life or death health-care matters. Such government overreaching is what we’ve come to expect from this administration.

As far as I’m concerned, she’s right on. Contrary to the misrepresentations of her position, she’s not accusing the president of wanting to fund euthanasia; the concern, rather, is that people will be denied care because some bureaucrat somewhere doesn’t think their lives have sufficient value (defined in economic terms) to be worth saving. Of course that’s what will happen—it’s inevitable. It’s also unacceptable, and here’s hoping it stays that way.

Full text of Gov. Palin’s testimony to the New York State Senate Committee on Aging:

Senator Reverend Ruben Diaz
Chair, New York Senate Aging Committee
Legislative Office Building
Room 307
Albany, NY 12247

September 8, 2009

RE: H.R. 3200: America’s Affordable Health Choices Act of 2009 and Its Impact on Senior Citizens

Dear Senator Diaz,

Thank you for asking me to participate in the New York State Senate Aging Committee’s hearing regarding H.R. 3200, “America’s Affordable Health Choices Act of 2009.” You and I share a commitment to ensuring that our health care system is not “reformed” at the expense of America’s senior citizens.

I have been vocal in my opposition to Section 1233 of H.R.3200, entitled “Advance Care Planning Consultation.”[1] Proponents of the bill have described this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. That is misleading. 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.”[2] During those consultations, practitioners are to 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.[3]

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]

It is unclear whether section 1233 or a provision like it will remain part of any final health care bill. Regardless of its fate, the larger issue of rationed health care remains.

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.” The work of Dr. Ezekiel Emanuel, President Obama’s health policy advisor and the brother of his chief of staff, is particularly disturbing on this score. Dr. Emanuel has written extensively on the topic of rationed health care, describing a “Complete Lives System” for allotting medical care based on “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.”[12]

He also 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.”[13]

Such ideas are shocking, but they could ultimately be used by government bureacrats to help determine the treatment of our loved ones. We must ensure that human dignity remains at the center of any proposed health care reform. Real health care reform would also follow free market principles, including the encouragement of health savings accounts; would remove the barriers to purchasing health insurance across state lines; and would include tort reform so as to potentially save billions each year in wasteful spending connected to the filing of frivolous lawsuits. H.R. 3200 is not the reform we are looking for.

Thank you for calling attention to this important matter. I look forward to working with you again to ensure that we keep the dignity of our senior citizens foremost in any health care discussion.

Sincerely,

Governor Sarah Palin

1 See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
2 See HR 3200 sec. 1233 (hhh)(1); sec. 1233 (hhh)(3)(B)(1), above.
3 See HR 3200 sec. 1233 (hhh)(1)(E), above.
4 See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
5 See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html
6 See http://www.nysenate.gov/press-release/letter-congressman-henry-waxman-re-section-1233-hr-3200
7 See http://www.facebook.com/note.php?note_id=113851103434
8 See http://thehill.com/homenews/senate/54617-finance-committee-to-drop-end-of-life-provision
9 Seehttp://online.wsj.com/article/SB10001424052970204683204574358590107981718.html
10 See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.html
11 See http://www.nytimes.com/2009/05/03/magazine/03Obama-t.html?_r=1&pagewanted=1
12 See http://www.scribd.com/doc/18280675/Principles-for-Allocation-of-Scarce-Medical-Interventions
13 Seehttp://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf

 

Further links on Obamacare

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For those who doubt that the purpose of the Democratic health care “reform” is a government takeover of our health-care system—and that the only unsettled issue in their minds is the best way to get there as quickly as possible—watch this:

Those opposed to the expansion of the abortion industry should consider this comment from Ed Morrissey:

On the campaign trail, Obama told Planned Parenthood that the Freedom of Choice Act, which would eliminate state restrictions on abortion and repeal the Hyde Amendment ban on federal funding for it, would be his first legislative priority. ObamaCare allows him to pass FOCA without the head-on fight. If the public option remains in the bill and it covers abortion, that will have the de facto effect of repealing the Hyde Amendment. The interstate nature of ObamaCare and the public plan may also allow the Department of Justice to fight state abortion restrictions, such as parental notification, on the grounds that the regulations interfere with interstate commerce. It’s FOCA by other means.

For those still dubious about Sarah Palin’s invocation of “death panels,” ponder this from Nat Hentoff (no fundamentalist Republican):

I was not intimidated during J. Edgar Hoover’s FBI hunt for reporters like me who criticized him. I railed against the Bush-Cheney war on the Bill of Rights without blinking. But now I am finally scared of a White House administration. President Obama’s desired health care reform intends that a federal board (similar to the British model)—as in the Center for Health Outcomes Research and Evaluation in a current Democratic bill—decides whether your quality of life, regardless of your political party, merits government-controlled funds to keep you alive. Watch for that life-decider in the final bill. It’s already in the stimulus bill signed into law. . . .

No matter what Congress does when it returns from its recess, rationing is a basic part of Obama’s eventual master health care plan. Here is what Obama said in an April 28 New York Times interview (quoted in Washington Times July 9 editorial) in which he describes a government end-of-life services guide for the citizenry as we get to a certain age, or are in a certain grave condition. Our government will undertake, he says, a “very difficult democratic conversation” about how “the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care” costs.

And if anyone is wondering why all the fuss—is this really that big a deal?—let Andy McCarthy explain:

These last seven months ought to tell us that the usual political rules don’t apply when predicting this president’s behavior. His purpose is revolutionary change in an American society he grew up understanding to be fundamentally unjust, racist, materialist, imperialist, and the agent of global misery. He is in Washington to transform the nation from the top down. Nationalized health care is key for him. If he gets it, sovereignty shifts from the citizen to the state. By law, government will be empowered to manage minute details of our lives. Over time—when, as the American Thinker’s Joseph Ashby observes, a “1,000-page health-care law explodes into many thousands of pages of regulatory codes”—that is precisely what government will do.

Obama is not a normal politician. He’s a visionary, and using health care to radically expand the scope of government happens to be central to his vision. For my money (if I have any left), achieving it is more important to him than is getting reelected. His poll numbers and those of congressional Democrats may keep plunging (for the latter, there must come a point where that is statistically impossible), but they have the votes to Rahm this thing through.

And if it comes to that, they will most certainly try, unless enough Democrats in Congress get cold feet. Sure, that wouldn’t be what the president promised to get elected, but so far, that hasn’t stopped him yet:

A dissenting view on health-care spending

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There is general agreement that our country spends too much on health care. I’m not so sure that’s actually true.

Why? The key here is recognizing the truth of David Goldhill’s distinction: “Health insurance isn’t health care.” This points us to another distinction, that of spending on care vs. spending on insurance. We tend to run them together, and I would certainly agree that we spend too much on these two things in combination; but we need to understand that in fact they’re two very different things—and I would argue that we should view spending money on them very, very differently.

Money spent on health care proper is money that goes to local businesses, perhaps a local non-profit organization (that would be, perhaps, your local hospital), and to other businesses that employ people to make things and to design new things to make. Money spent on healthinsurance is spent on bureaucrats who generate paper; indirectly, it also goes to subsidize trial lawyers and their campaign contributions to Democratic politicians. A good chunk of what you pay for health care also goes to this purpose, of course, in the percentage of your bill that is used to defray insurance costs for your doctor, your hospital, and so on.

Do we spend too much money on health care? No, what we spend too much money on—far too much money—is bureaucrats and trial lawyers. This is what needs to change most of all if we’re going to bring down the combined cost of health care and health insurance; and if we focus instead on reducing the cost of health care, we’re going to reduce the quality of our care without ever addressing the real problem and the real inefficiency of the current system.

This is, I think, what has happened to health care in Britain under the National Health Service. British cyberfriend David Riddick defends the NHS, in part, on the grounds that the UK spends less on health care than the US, and certainly the share of GDP spent on the combination of health care and health insurance is lower there; but given that they spend a higher percentage of that on bureaucrats, I don’t think that’s actually a good thing. That doesn’t drive good care, because the money isn’t being spent on care, and it doesn’t help the British economy any, either. Bureaucrats aren’t productive for the economy—they don’t create wealth, they don’t create jobs, they don’t create innovation; they just create red tape and paperwork.

The same is not true of much of the rest of the health care sector in modern economies. To take one example, the community where I live is the home of a cluster of orthopedics-products companies that make artificial joints, spinal hardware, and the like—products that relieve people (mainly, but not only, older people) of a great deal of pain and greatly improve their quality of life. These companies employ a lot of people, offering good manufacturing jobs as well as a lot of design and engineering work, and they drive research, as they’re always working on developing new and better products. So far, they’ve weathered the financial storm quite well; people will put off luxuries and elective purchases in tough economic times, but if you’re in pain and you can’t walk right, you’re not going to put off getting a new knee or a new hip if that will solve the problem.

Right now, though, they’re deeply worried about the push to nationalize our health care system, because it’s going to devastate their business. That artificial hip that the president keeps talking about, the one that he thinks might have been a waste to put in his grandmother, didn’t come from nowhere; it probably came from Warsaw, and it employed a number of people. His idea of how to cut health-care costs isn’t going to reduce the amount of money that goes to bureaucrats—it’s going to increase that spending, because we’ll need a lot more bureaucrats to run his program and decide which people are allowed to get new hips and knees. Instead, it’s going to reduce the amount of money that goes to companies like Zimmer and Biomet, which means it’s going to reduce the number of people they employ to design and build their products.

Health care “reform” as envisioned by the Democrats will take money out of their pockets to pay even more bureaucrats; it will shift money from a profitable sector of our economy, one that creates jobs that pay good wages and new products that improve people’s lives, to an unprofitable sector (the government)—and all in the name of spending less money. The contrast with the “stimulus” package is ironic. There we were told, “Spending money is good—increasing spending is good for the economy.” When it comes to health care, though, the government is telling us that spending money is bad, and so we need to hire lots and lots more bureaucrats so that we can cut down on the money we spend on actual health care. In the spirit of the “stimulus” package, wouldn’t it make more sense to increase the amount of money going to companies like Biomet and Zimmer so that they can hire more people and help the economy?

We tend to talk about the cost of health care as if cost were the only side of the coin, and it just isn’t; the money we spend doesn’t just vanish into thin air. Instead, that money goes to actual people, and much of it drives good things in our economy. Health care spending creates economic growth; it’s good for our country. We don’t need to spend less money on care; we need to spend less on bureaucrats and trial lawyers. Unfortunately, the president’s plan gets this backwards; we need to put it right way ’round.