Category Archives: Medicine

The death book for veterans

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I’d meant to repost this from Conservatives4Palin yesterday, but I got distracted; I still wanted to mention it here as well, though, because it’s important. The Wall Street Journal‘s Jim Towey has done our country a service (in a piece linked yesterday by Sarah Palin on her Facebook page) by calling attention to a document recently re-promulgated by the Obama administration’s Department of Veterans’ Affairs called “Your Life, Your Choices.” This is a 52-page document for end-of-life planning which was first drafted by the Clinton administration—by an advocate of physician-assisted suicide and health-care rationing, Dr. Robert Pearlman. When the Bush 43 administration got a look at it, they ordered the VA to stop using it; as Towey describes it,

“Your Life, Your Choices” presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political “push poll.” For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be “not worth living.”

The circumstances listed include ones common among the elderly and disabled: living in a nursing home, being in a wheelchair and not being able to “shake the blues.” There is a section which provocatively asks, “Have you ever heard anyone say, ‘If I’m a vegetable, pull the plug’?” There also are guilt-inducing scenarios such as “I can no longer contribute to my family’s well being,” “I am a severe financial burden on my family” and that the vet’s situation “causes severe emotional burden for my family.”

When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?

One can only imagine a soldier surviving the war in Iraq and returning without all of his limbs only to encounter a veteran’s health-care system that seems intent on his surrender. . . .

This hurry-up-and-die message is clear and unconscionable.

In my book, George W. Bush did the only decent and honorable thing in pulling this invidious document; for the Obama administration to start using this again with VA patients—all patients, mind you, not even just those who are clearly dying—is nothing short of despicable. Thank you, Mr. Towey, for writing about this; and thank you, Gov. Palin, for using your platform to call it to our attention.

Ambulance bills subsidize ambulance chasers

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I linked last Saturday to John Mackey’s piece on eight free-market health-care reforms that would actually work and not balloon the deficit. One of the necessary steps he laid out was “Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.” This morning, Sarah Palin elaborated on that pointin a note she posted on her Facebook page:

President Obama’s health care “reform” plan has met with significant criticism across the country. Many Americans want change and reform in our current health care system. We recognize that while we have the greatest medical care in the world, there are major problems that we must face, especially in terms of reining in costs and allowing care to be affordable for all. However, as we have seen, current plans being pushed by the Democratic leadership represent change that may not be what we had in mind—change which poses serious ethical concerns over the government having control over our families’ health care decisions. In addition, the current plans greatly increase costs of health care, while doing lip service toward controlling costs.

We need to address a REAL bipartisan reform proposition that will have REAL impacts on costs and quality of patient care.

As Governor of Alaska, I learned a little bit about being a target for frivolous suits and complaints (Please, do I really need to footnote that?). I went my whole life without needing a lawyer on speed-dial, but all that changes when you become a target for opportunists and people with no scruples. Our nation’s health care providers have been the targets of similar opportunists for years, and they too have found themselves subjected to false, frivolous, and baseless claims. To quote a former president, “I feel your pain.”

So what can we do? First, we cannot have health care reform without tort reform. The two are intertwined. For example, one supposed justification for socialized medicine is the high cost of health care. As Dr. Scott Gottlieb recently noted, “If Mr. Obama is serious about lowering costs, he’ll need to reform the economic structures in medicine—especially programs like Medicare.” [1] Two examples of these “economic structures” are high malpractice insurance premiums foisted on physicians (and ultimately passed on to consumers as “high health care costs”) and the billions wasted on defensive medicine.

Dr. Stuart Weinstein, with the American Academy of Orthopaedic Surgeons, recently explained the problem:

The medical liability crisis has had many unintended consequences, most notably a decrease in access to care in a growing number of states and an increase in healthcare costs.

Access is affected as physicians move their practices to states with lower liability rates and change their practice patterns to reduce or eliminate high-risk services. When one considers that half of all neurosurgeons—as well as one third of all orthopedic surgeons, one third of all emergency physicians, and one third of all trauma surgeons—are sued each year, is it any wonder that 70 percent of emergency departments are at risk because they lack available on-call specialist coverage? [2]

Dr. Weinstein makes good points, points completely ignored by President Obama. Dr. Weinstein details the costs that our out-of-control tort system are causing the health care industry and notes research that “found that liability reforms could reduce defensive medicine practices, leading to a 5 percent to 9 percent reduction in medical expenditures without any effect on mortality or medical complications.” Dr. Weinstein writes:

If the Kessler and McClellan estimates were applied to total U.S. healthcare spending in 2005, the defensive medicine costs would total between $100 billion and $178 billion per year. Add to this the cost of defending malpractice cases, paying compensation, and covering additional administrative costs (a total of $29.4 billion). Thus, the average American family pays an additional $1,700 to $2,000 per year in healthcare costs simply to cover the costs of defensive medicine.

Excessive litigation and waste in the nation’s current tort system imposes an estimated yearly tort tax of $9,827 for a family of four and increases healthcare spending in the United States by $124 billion. How does this translate to individuals? The average obstetrician-gynecologist (OB-GYN) delivers 100 babies per year. If that OB-GYN must pay a medical liability premium of $200,000 each year (which is the rate in Florida), $2,000 of the delivery cost for each baby goes to pay the cost of the medical liability premium.” [3]

You would think that any effort to reform our health care system would include tort reform, especially if the stated purpose for Obama’s plan to nationalize our health care industry is the current high costs.

So I have new questions for the president: Why no legal reform? Why continue to encourage defensive medicine that wastes billions of dollars and does nothing for the patients? Do you want health care reform to benefit trial attorneys or patients?

Many states, including my own state of Alaska, have enacted caps on lawsuit awards against health care providers. Texas enacted caps and found that one county’s medical malpractice claims dropped 41 percent, and another study found a “55 percent decline” after reform measures were passed. [4] That’s one step in health care reform. Limiting lawyer contingency fees, as is done under the Federal Tort Claims Act, is another step. The State of Alaska pioneered the “loser pays” rule in the United States, which deters frivolous civil law suits by making the loser partially pay the winner’s legal bills. Preventing quack doctors from giving “expert” testimony in court against real doctors is another reform.

Texas Gov. Rick Perry noted that, after his state enacted tort reform measures, the number of doctors applying to practice medicine in Texas “skyrocketed by 57 percent” and that the tort reforms “brought critical specialties to underserved areas.” These are real reforms that actually improve access to health care. [5]

Dr. Weinstein’s research shows that around $200 billion per year could be saved with legal reform. That’s real savings. That’s money that could be used to build roads, schools, or hospitals.

If you want to save health care, let’s listen to our doctors too. There should be no health care reform without legal reform. There can be no true health care reform without legal reform.

—Sarah Palin

[1] Seehttp://online.wsj.com/article/SB10001424052970204409904574350370729883030.html?mod=googlenews_wsj
[2] See http://www.aaos.org/news/aaosnow/nov08/managing7.asp
[3] Id.
[4] Seehttp://www.abajournal.com/magazine/new_laws_and_med_mal_damage_caps_devastate_plaintiff_and_defense_firms_alik/print/
[5] See http://www.washingtonexaminer.com/opinion/columns/OpEd-Contributor/Tort-reform-must-be-part-of-health-care-reform-8096175.html

Links on Obamacare

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“Essential Reading” Department:

David Goldhill, “How American Health Care Killed My Father”
Yes, it’s 10,000 words. It’s also the most important thing you’re likely to read about the state of our health care system. I’ll be posting on this article in some detail when I have the time.

John Schwenkler, “Maybe the Best Thing I’ve Read on Health Care Reform”
Consider this the SparkNotes/CliffNotes version of Goldhill’s article.

Sally Pipes, “Top Ten Myths of American Health Care”
Good debunking of the current CW. Warning: it’s a PDF.

Megan McArdle, “Why I Oppose National Health Care”
“Once we’ve got a comprehensive national health care plan, what are the government’s incentives? I think they’re bad, for the same reason the TSA is bad. I’m afraid that instead of Security Theater, we’ll get Health Care Theater, where the government goes to elaborate lengths to convince us that we’re getting the best possible health care, without actually providing it.”

 

“Where Did You Get Your Medical Degree” Department:

Scott Gottlieb, “Obama and the Practice of Medicine”
Are bureaucrats really more qualified than doctors to make these decisions?

 

“Can’t Anybody Here Play this Game?” Department:

Caroline Baum: “Obama Goes Postal, Lands in Dead-Letter Office”
So comparing the “public option” to the Postal Service is supposed to make us like the idea?

Jay Cost: “Obama Misread His Mandate”
One of our few great political analysts says the administration doesn’t have the mandate it seems to think it has . . .

Dorothy Rabinowitz: “Obama’s Tone-Deaf Health Campaign”
. . . but the ineptitude of its salesmanship so far isn’t helping its case any, either.

 

“Sarah Palin Was Right” Department:

Mark Steyn: “Give Me Liberty or Give Me Death Panels”
“Government ‘panels’ making ‘rulings’ over your body: Acceptance of that concept is what counts.”

Andy McCarthy: The right interpretive framework
“Raising these issues hit the right notes: they gave people a prism for understanding the big picture of Obamacare.”

Thomas Sowell: Whose Medical Decisions?
Daniel Terrapin summarized this one nicely: “Call it what you like, ‘death panels’ will be the end result.”

Mark Steyn: You’ve Had a Good Innings
“Ultimately, government health care represents the nationalization of your body.”

Pundette: “Sen. Diaz doesn’t like euthanasia vibes he gets from House bill”
Just a reminder that Gov. Palin didn’t make this up.

Health care, Whole Foods style

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John Mackey, the co-founder and CEO of Whole Foods, lays out eight reforms that would significantly reduce the cost of health care without ballooning the federal debt.

  • Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).
  • Equalize the tax laws so that that employer-provided health insurance and individually owned health insurance have the same tax benefits.
  • Repeal all state laws which prevent insurance companies from competing across state lines.
  • Repeal government mandates regarding what insurance companies must cover.
  • Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.
  • Make costs transparent so that consumers understand what health-care treatments cost.
  • Enact Medicare reform.
  • Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.

I think he’s spot-on with this (and of course, in the piece, he goes into each in more detail); these reforms would remove most of the things that are currently driving up the cost of health care. Mackey goes beyond these as well to offer some additional thoughts and comments; most interesting to me are these, rooted in Whole Foods’ experience.

Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor’s Business Daily. In England, the waiting list is 1.8 million.

At Whole Foods we allow our team members to vote on what benefits they most want the company to fund. Our Canadian and British employees express their benefit preferences very clearly—they want supplemental health-care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health-care benefit dollars if they already have an “intrinsic right to health care”? The answer is clear—no such right truly exists in either Canada or the U.K.—or in any other country.

Absolutely correct. Read the whole thing.

Dispatches from the health-care front

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As the ABC News website tells the story (HT: C4P commenter William Collins),

The news from Barbara Wagner’s doctor was bad, but the rejection letter from her insurance company was crushing.

The 64-year-old Oregon woman, whose lung cancer had been in remission, learned the disease had returned and would likely kill her. Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.

What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.

“It was horrible,” Wagner told ABCNews.com. “I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die. But we won’t give you the medication to live.”

Barbara Wagner is not alone in this experience.

“It’s been tough,” said her daughter, Susie May, who burst into tears while talking to ABCNews.com. “I was the first person my mom called when she got the letter,” said May, 42. “While I was telling her, ‘Mom, it will be ok,’ I was crying, but trying to stay brave for her.”

“I’ve talked to so many people who have gone through the same problems with the Oregon Health Plan,” she said.

Indeed, Randy Stroup, a 53-year-old Dexter resident with terminal prostate cancer, learned recently that his doctor’s request for the drug mitoxantrone had been rejected. The treatment, while not a cure, could ease Stroup’s pain and extend his life by six months.

“What is six months of life worth?” he asked in a report in the Eugene Register-Guard. “To me it’s worth a lot. This is my life they’re playing with.”

The thing is, though, to the state of Oregon, six months of these people’s lives isn’t worth much of anything—and it’s the state of Oregon that’s paying the bills. The inevitable result of this, asSarah Palin has been pointing out, is that a dollar value is placed on human life; if the cost of keeping someone alive is higher than that dollar value, then their life is judged “not worth living.” The logical thing to do in that case is to maximize savings and simplify the situation by encouraging the patient to accept euthanasia. This time, euthanasia advocates apologized for this in the case of Barbara Wagner—not because they believed they were wrong, but because the encouragement was offered with “insensitivity,” without “the human touch.” Next time? Who knows?

There’s a reason that in her first Facebook note on this subject, Gov. Palin’s thoughts went immediately to her son Trig: this sort of attitude is already dominant in the medical response to Down Syndrome babies. There’s a reason why over 90% of such babies are aborted, and it isn’t all about what the parents think or want, let me tell you. Or, better, let Gretchen tell you, from her post “Remembering” on the group blog Beautiful Work (HT: Jared Wilson):

It was 2 years ago this month that I was sitting in a chair looking at my unborn baby in 4D. She was precious! We had previously found out that our baby had several “markers” for down syndrome and had enlarged kidneys which may have required surgery upon birth. Thus we were monitored more carefully and had a ton more ultrasound shots at a hospital. This was the first level 3 ultrasound with this pregnancy (I had had one with my 3rd with no problems). I got to gaze upon my baby for almost a full hour—it was wonderful! I was there alone as my husband was out of town. The specialist doctor called me in after the ultrasound to go over the findings. The first words out of his mouth to me were “Well you will have to come in tomorrow for your abortion because of how far along you are.” I was utterly shocked and devastated. All I could do was mutter “What??????” He then proceeded to tell me that my baby had more “markers” for down syndrome and it didn’t look good. I was more shocked that his automatic assumption was that I would abort my baby. I almost couldn’t comprehend what he was telling me in that office. All I wanted to do was run as far away from that man as possible.

Read the whole post—it’s well worth it. Like the Palins, Gretchen and her husband opted to have the baby. The irony of their story is that their baby was born two years ago . . . without Down Syndrome, and in fact with no medical issues whatsoever. The automatic reflex of the medical system would have aborted a perfectly healthy little girl.

In all this, I think the reactions of Wagner’s ex-husband Dennis, on the one hand, and euthanasia advocate Derek Humphry, on the other (both quoted in the ABC News article), are telling. Here’s Humphry:

People cling to life and look for every sort of crazy cure to keep alive and usually they are better off not to have done it.

In other words, Humphry believes, people are better off dying than fighting to live. By contrast, here’s Dennis Wagner:

My reaction is pretty typical. I am sick and tired of the dollar being the bottom line of everything. We need to put human life above the dollar.

As it happens, I do believe his reaction is pretty typical among most folks; and in my experience, Humphry’s attitude is usually lurking in there among advocates of euthanasia, even if most of them can’t afford to be as blunt about it as the founder of the Hemlock Society, a man who has already “assisted” one wife into the grave. This really is the line between the sides here.

Now, at this point, you might be thinking that this doesn’t affect you all that much, because the concept of euthanasia doesn’t really bother you that much. What you need to understand, though, is that assigning dollar values to human lives corrupts the whole system—the extent to which that already happens with our private insurance bureaucracy is part of the problem with our health care system—and that when it’s the government doing the assigning, there’s no way to counterbalance that corruption, so it spreads unchecked. As is always the way with consequences propagating through a complex system, that produces changes beyond those which we have already thought to expect.

For instance, in that same first Facebook note, Gov. Palin pointed out a very important point made by Thomas Sowell: “Government health care will not reduce the cost; it will simply refuse to pay the cost.” She went on from there, as most critics have, to point out that this will inevitably result in the rationing of health care—and so it will, as it always does. But that will not be the only effect of this new reality if Obamacare goes into effect. C4P‘s Doug Brady has also pointed out that the US health care system drives most of the world’s medical innovation, including the creation of new drugs, and that government price controls will bring an end to most of that innovation. This too is true, and important; but it too is only part of the cost of price controls. It’s not merely that price controls will limit who receives medical care, or that they will depress the future potential of that care; they will also, over time, reduce the present value of that care.

To illustrate this, I want to take you inside a world which I hope is unfamiliar to most of you: that of the neo-natal intensive care unit, or NICU (pronounced “nick-you”). Specifically, I want to tell you a couple stories from the Canadian NICU experience. One, highlighted by Mark Steyn a couple months ago, comes from Hamilton, Ontario:

Hamilton’s neonatal intensive care unit (NICU) was full when Ava Isabella Stinson was born 14 weeks premature at St. Joseph’s Hospital Thursday at 12:24 p.m.

A provincewide search for an open NICU bed came up empty, leaving no choice but to send the two-pound, four-ounce preemie to Buffalo that evening.

Steyn comments,

Well, it would be unreasonable to expect Hamilton, a city of half-a-million people just down the road from Canada’s largest city (Greater Toronto Area, 5.5 million) in the most densely populated part of Canada’s most populous province (Ontario, 13 million people) to be able to offer the same level of neonatal care as Buffalo, a post-industrial ruin in steep population decline for half a century.

Unfortunately, as Steyn goes on to point out, whenever the Canadian government starts outsourcing its health care to the US, that creates additional complications:

When a decrepit and incompetent Canadian health bureaucracy meets a boneheaded and inhuman American border “security” bureaucracy, you’ll be getting a birth experience you’ll treasure forever:

Her parents, Natalie Paquette and Richard Stinson, couldn’t follow their baby because as of June 1, a passport is required to cross the border into the United States. They’re having to approve medical procedures over the phone and are terrified something will happen to their baby before they get there.

Once Buffalo enjoys the benefits of Hamilton-level health care, I wonder where Ontario will be shipping the preemies to. Costa Rica?

The other story I want to tell you is my own. Our oldest daughter has dual US/Canadian citizenship by virtue of having been born in Vancouver, BC; I was a student in the country at the time, so we spent five years as net beneficiaries of the Canadian health care system. I’m not going to demonize it or try to deny its virtues; combined with the medical benefits my wife received for her job, she was without question our cheapest baby despite spending the first two weeks of her life in the NICU. Yet, as I wrote last summer, there were some enormous downsides to the system as well.

We had some truly brilliant doctors, and some wonderful nurses, and the staff at BC Children’s Hospital were beyond superb; they cared deeply about their tiny patients and were past masters at making bricks without straw. The thing is, they had to be.

The equipment was junk—they finally gave up on the blood-oxygen monitor on my little baby and took it off when it reported a heart rate of 24 and a blood-oxygen level of 0 (or the other way around—it’s been a few years now); while we were there, the provincial government tried to donate some of its used medical equipment, and no one would take it. The Sun quoted one veterinarian as saying the ultrasound they wanted to give him wasn’t good enough to use on his horses. Meanwhile, the doctors kept taking “reduced activity days,” or RADs (which is to say, they took scheduled one-day strikes without calling them strikes), to protest their contract. I was actually up at St. Paul’s in Vancouver for a scan one of those days; the techs were there, obviously, but no doctors. A hospital with no doctors is a very strange place.

I could also tell you about the time we took our daughter to the ER (different hospital) at midnight; there were only a few patients there at the time, but it still took them three hours just to get us into a room, and another hour to see us. It was 5am before we walked out the front door. At that, we were the lucky ones—there were a couple folks still waiting to be seen who’d been waiting when we got there.

Nor was our experience unusual, or even extreme; we prayed for people’s friends or family members dealing with serious illness, not just that they would get better, but simply that they would get treatment before they died. Sometimes they didn’t. That’s why (as I noted in that post) there’s an increasing movement against national health care in Canada and elsewhere (though not, as far as I understand, in Britain). That’s the kind of thing that happens when the dollar, not human life, is the bottom line of the health care system. We already have too much of that in our country as it is; what Sarah Palin understands, and why she’s leading the charge against Obamacare, is that letting the government run the system will only make it worse, not better. Yes, we need change; but for that change to bring actual hope, it needs to be changefor the better. Obamacare is the wrong prescription.

(Cross-posted at Conservatives4Palin)

A good piece on Obamacare

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from a former president of the American Medical Association, Dr. Daniel Johnson Jr.: Memo to My Fellow Physicians: We Have Reached the Moment of Truth. It’s well worth your time, because he knows what he’s talking about and doesn’t hesitate to call a spade a spade; I found his thumbnail history of the debate over nationalized health care particularly interesting. Here’s an excerpt:

Now, with elderly, poor, women, and children covered, all that is left is a segment of the population outside of those groups that is reasonably self-sufficient and most of which has private insurance. Those folks will be forced into government coverage because of a “public option” plan that all intellectually honest observers, including both proponents and opponents of single payer, realize is a Trojan horse for a Canadian-style single-payer system. Once private insurance is crowded out by the unfair competitive tactics of the federal government intruding into an already flawed marketplace, it will be a simple matter to consolidate all of these different groups into one single entity.

What does this mean to physicians and their patients? “Clinical effectiveness research,” when operated by government instead of the medical profession, will become “cost effectiveness” restrictions on what care is available and to whom—determined by the federal government. It will only be a matter of a short time before Americans will enjoy the pleasures of “quality adjusted life years” wherein people my age will be denied services from which they might benefit because of their age and/or some other infirmity.

We don’t have to make this stuff up: It is already the law of the land in some other developed countries, such as the United Kingdom, and has been long advocated here in the U.S. by voices from the left, including major media outlets. The federal government will exert total control over payment for all medical services.

It doesn’t take a rocket scientist to imagine what will happen when the payment-control mechanisms used by Medicare are extended to the entire private sector. The occasional inability of Medicare patients to find physicians who are willing to provide for their needed care at a loss will become the standard experience when the cost shortfall can no longer be shifted to the private sector.

Practicing physicians in the U.S. have become accustomed to the continued availability of ever better diagnostic and treatment innovations created by our academic and research colleagues. In my own specialty field of diagnostic imaging, the pace and breadth of scientific innovation to help us help clinicians be more effective in the management of sick and injured individuals or in the early detection of life-threatening illness, such as breast cancer, has been amazing. Yet I remember only too well the mid 1970s when the federal government and all but two states (Nebraska and Louisiana) did everything in their power to deny the American people access to the technology of computed tomography because of cost. As sure as the night follows the day, we will see that same kind of limitation imposed, but on a much larger scale. But in contrast to the ’70s, total federal control will prevent physicians and patients from overcoming the stricture as we were able to do back then.

Read the whole thing, and remember, this man is a good doctor: take his diagnosis and prescriptions seriously.

HT: Shane Vander Hart

Health care hypocrisy

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One of the key facts about the push to nationalize our healthcare system is that it’s coming from people who have absolutely no intention to live under the system they’re trying to produce. Barack Obama even admitted as much last month, though the media has done its best to ignore the fact. Give Jake Tapper and Karen Travers credit, though, for refusing to sweep the president’s admission under the rug:

President Obama struggled to explain today whether his health care reform proposals would force normal Americans to make sacrifices that wealthier, more powerful people—like the president himself—wouldn’t face. . . .

Dr. Orrin Devinsky, a neurologist and researcher at the New York University Langone Medical Center, said that elites often propose health care solutions that limit options for the general public, secure in the knowledge that if they or their loves ones get sick, they will be able to afford the best care available, even if it’s not provided by insurance.

Devinsky asked the president pointedly if he would be willing to promise that he wouldn’t seek such extraordinary help for his wife or daughters if they became sick and the public plan he’s proposing limited the tests or treatment they can get.

The president refused to make such a pledge, though he allowed that if “it’s my family member, if it’s my wife, if it’s my children, if it’s my grandmother, I always want them to get the very best care.”

That’s telling. Would the president be willing to accept limitations on the care his wife and children could receive for the sake of the greater good? Dr. Devinsky asked. No, the president would not. He evaded the question for as long as he could with a non sequitur about his dying grandmother, but when he finally came back around to answering it briefly, that was his answer: no.

And after all, he won’t have to accept the limitations of his plan—he’s the President of the United States. He’s famous, he’s powerful, he defines well-connected . . . and he’s a member of a government which routinely exempts its own members from the limitations of the laws it passes. Obamacare for thee, but not for me and mine, is indeed his attitude—he’s too important and valuable a person for that. That’s only for us ordinary barbarians.

For my part, I agree with Ed Morrissey:

If ObamaCare isn’t good enough for Sasha, Malia, or Michelle, then it’s not good enough for America. Instead of fighting that impulse, Obama should be working to boost the private sector to encourage more care providers, less red tape and expense, and better care for everyone.

But that’s not what he’s doing, and it’s not what he’s going to do; that’s how he wants it to work for him and his family, but not for everyone else. Unless, of course, they’re political allies whose support he needs and to whom he owes favors—then they can get special treatment too:

Who will decide when medical care is just too expensive to bother with? Who will be left to perish because they just aren’t worth the lifesaving effort? Well, for sure it won’t be any members of Congress or anyone that works for the federal government because they won’t be expected to suffer under the nationally socialized plan. It also won’t be Obama’s buddies in the unions who are about to be similarly exempted from the national plan, at least if Senator Max Baucus has his way.

Insisting on standards for others to which one is unwilling to hold oneself? The word for that, I believe, is “hypocrisy”—and the forces of Obamacare are rife and rank with it. As James Lewis pointed out recently on the American Thinker website, one of our leading advocates of socialized medicine makes a pretty good poster boy for it.

Senator Ted Kennedy, who is now 76 years old and was diagnosed with brain cancer in May of last year, is telling the world that nationalized medical care is “the cause of his life.” He wants to see it pass as soon as possible, before he departs this vale of tears.

The prospect of Kennedy’s passing is viewed by the liberal press with anticipatory tears and mourning. But they are not asking the proper question by their own lights: That question—which will be asked for you and me when we reach his age and state in life—is this:

Is Senator Kennedy’s life valuable enough to dedicate millions of dollars to extending it another month, another day, another year?

Because Barack Obama and Ted Kennedy agree with each other that they of all people are entitled to make that decision. Your decision to live or die will now be in their hands.

Ted Kennedy is now 76. Average life expectancy in the United States is 78.06. For a man who has already reached 76, life expectancy is somewhat longer than average (since people who die younger lower the national average); for a wealthy white man it may be somewhat longer statistically; but for a man with diagnosed brain cancer it is correspondingly less. As far as the actuarial tables of the Nanny State are concerned, Kennedy is due to leave this life some time soon. The socialist State is not sentimental, at least when it comes to the lives of ordinary people like you and me.

The socialist question—and yes, it is being asked very openly in socialist countries all around the world, like Britain and Sweden—must be whether extending Senator Kennedy’s life by another day, another month or year issocially valuable enough to pay for what is no doubt a gigantic and growing medical bill. Kennedy is a US Senator, and all that money has been coughed up without complaint by the US taxpayer. Kennedy is already entitled to Federal health care, and it is no doubt the best available to anyone in the world. . . .

There might be a rational debate over the social utility of Senator Kennedy’s life. We could all have a great national debate about it. Maybe we should do exactly that, to face the consequences of what the Left sees as so humane, so obviously benevolent, and so enlightened.

Consider what happens in the Netherlands to elderly people. The Netherlands legalized “assisted suicide” in 2002, no doubt in part for compassionate reasons. But also to save money. . . .

There’s only so much money available. The Netherlands radio service had a quiz show at one time, designed to “raise public awareness” about precisely that question. Who deserves to live, and who to die?

But nobody debates any more about who has the power to make that decision. In socialist Europe the State does. It’s a done deal. . . .

In the socialist Netherlands Kennedy would be a perfect candidate for passive euthanasia.

Has anyone raised this question with Senator Kennedy? I know it seems to be in bad taste to even mention it. But if ObamaCare passes in the coming weeks, you can be sure that that question will be raised for you and me, and our loved ones. And no, we will not have a choice.

One set of standards for the rich and the powerful, and another for the rest of us. One set of medical options for those who write the laws (and those who influence them), and another for those of us who live under them. That’s liberalism? It seems to me there’s something seriously wrong with that.

Which is why, to my way of thinking, Rep. John Fleming (R-LA) is a hero of the fight over Obamacare. Rep. Fleming, a physician, is the author and sponsor of House Resolution 615, which he describes this way:

I’ve offered a bill, HR 615, to give them a chance to put their “health” where their mouth is: My resolution urges members of Congress who vote for this legislation to lead by example and enroll themselves in the public plan that their bill would create.

The current draft of the Democratic bill curiously exempts members of Congress from the government-run health care option: The people’s representatives would get to keep their existing health plans and services on Capitol Hill—even though the people wouldn’t.

If members of Congress believe so strongly that government-run health care is the best solution for hardworking American families, I think it only fitting that Americans see them lead the way. . . .

Congress has the bad habit of exempting itself from the problems it inflicts on the American people. From common workplace protections to transparency and accountability measures, lawmakers always seem to place themselves and their staffs just out of reach of the laws they create.

Americans don’t know that there is an attending physician on call exclusively for members of Congress, or that Congress enjoys VIP access and admission to Walter Reed Army Medical Center and Bethesda Naval Medical Center.

It is past time that we make the men and women making the laws be exposed to the same consequences as the American public.

Public servants should always be accountable and responsible for what they are advocating, and I challenge the American people to demand this from their representatives.

We deserve health-care reform that puts a patient’s well being in the hands of a doctor, not a bureaucrat.

I think he’s right on. If it’s good enough for us, it’s good enough for the members of Congress, the employees of the Executive Branch (all the way up to the POTUS and his family), and the judges and staff of our courts. If you agree, you might want to go to Rep. Fleming’s official website and sign the online petition in support of HR 615. Well done, Rep. Fleming; trust a doctor to know a boil when he sees it, and know how to lance it—even a spiritual one.

Further thoughts on the health care deform bill

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As I noted in the previous post, there’s been a real lack of active leadership from the president on the whole issue of health care “reform,” which has been quite frustrating to his party. Unfortunately, instead of that, we’re getting more of his patented harangues. This is a bad thing because for all the praise he receives as an orator, Barack Obama is a remarkably lazy and juvenile rhetor; he has a terrible weakness for cheap rhetorical tricks, tending to lean on them heavily whenever he needs to make his case. One he particularly likes is to set up false, simple-minded dichotomies, which he can then use to either a) paint himself as offering a more enlightened third way forward, or b) portray his own position as obviously correct and that of those of us who disagree with him as obviously wrong.

As David Freddoso pointed out, that’s exactly what he did yet again in his prime-time press conference last week:

With his example of the red and blue pills, and another about whether a child’s hypothetical tonsils should be removed, President Obama unwittingly presents the real problem with his plan for reform. Here is a well-meaning government official who so fails to grasp the problem in health care that he can present such absurd oversimplifications and suggest that this sort of thing is the real problem—doctors simply lack the common sense to make obvious medical decisions. President Obama wants us to solve this problem by putting himself and other government officials in charge of rescuing medicine from the medical profession. If medical doctors with a decade of schooling cannot distinguish between good cures and ineffective ones that must be discontinued, then by gosh, we’re lucky that the good folks from the government can.

President Obama thus frames the issue as a false choice between doing nothing at all and handing over to Washington complicated, case-by-case medical decisions that cannot possibly be legislated or dictated by government.

Freddoso’s wrong about one thing: “complicated, case-by-case medical decisions” can in fact be “legislated or dictated by government”—in one way, which he mentions:

There is exactly one thing that government can do to control costs in health care: it can insist on paying below cost.

Granted, he’s thinking here of government short-changing insurance companies and medical providers, which is a significant problem in our current system:

This shifts the cost burden to private insurance companies, which in turn pass along higher premiums to their patients. This is what government-run Medicare does today for many treatments, including cancer. Government will do more of this kind of “saving” when it assumes greater responsibility for funding citizens’ health care, particularly if a government-option health care plan is established.

What he’s missing, though, is that this form of “saving” only has this particular effect when there’s still a sizeable public sector in existence to bear that burden and compensate for it with higher premiums. Kill off that private sector, as the president’s preferred approach will pretty much do, and you get a different result—which is what the Mayo Clinic is worried about:

Under the current Medicare system, a majority of doctors and hospitals that care for Medicare patients are paid substantially less than it costs to treat them. Many providers are therefore already approaching a point where they can not afford to see Medicare patients. Expansion of a Medicare-type plan without a method to define, measure, and pay for healthy outcomes for patients will move many doctors and hospitals across this threshold, and ultimately hurt the patients who seek our care.

You see, when the government bureaucrats need to make “complicated, case-by-case medical decisions,” they’re not going to make them on the basis of the things that truly make them “complicated” and “case-by-case”; they’re going to make them on the basis of the actuarial tables, on a cost/benefit analysis run purely from the perspective of the federal government, and the way they’ll make them is by telling doctors, “We won’t pay that much for that procedure” (if indeed they’re willing to pay anything for it at all). If the figure they set is low enough, the procedure won’t get done. The only variable for medical decisions will be government cost control. In his usual role as the ghoul at the party, Peter Singer has been the only one to come right out in public and tell everyone what that means: rationing of health care.

As cost issues come to dominate the government’s interest in the health care system—which is to say, as the rosy and unrealistic projections of cost savings which the Democrats are currently using to try to build public support for their plan quickly give way to reality, creating a budget crunch—this will also necessarily mean increased taxes. After all, Democrats never have the stomach for huge budget cuts (except from defense budgets), and certainly won’t be willing to embrace the kind of truly draconian rationing of medical care that would be necessary to solve that budget crunch without tax increases. That’s why, despite the promises the president made back when he was trying to get elected, the House’s health care bill already includes a significant tax on the uninsured.

As expected, the House bill would mandate that individuals and families have or buy health insurance.

But what if they don’t buy it?

Then Section 401 kicks in. Any individual (or family) that does not have health insurance would have to pay a new tax, roughly equal to the smaller of 2.5% of your income or the cost of a health insurance plan. . . .

I assume the bill authors would respond, “But why wouldn’t you want insurance? After all, we’re subsidizing it for everyone up to 400% of the poverty line.”

That is true. But if you’re a single person with income of $44,000 or higher, then you’re above 400% of the poverty line. You would not be subsidized, but would face the punitive tax if you didn’t get health insurance. This bill leaves an important gap between the subsidies and the cost of health insurance. CBO says that for about eight million people, that gap is too big to close, and they would get stuck paying higher taxes and still without health insurance.

Ed Morissey adds that “the mandate in the bill would force people to choose between paying the taxes or paying as much as three times as much for health insurance, assuming a family plan.” Still, isn’t that better than having 45.7 million uninsured people? Not necessarily; the crowning irony to this is that, as Deroy Murdock points out, the number of people for whom lack of medical insurance is truly a serious problem is actually about . . . eight million.

Obamacare is propelled by the oft-repeated Census Bureau statistic that 45.7 million Americans lack health insurance. Even if that number were accurate, why would Washington turn the health-care industry upside down for all 300 million Americans in order to help 45.7 million? In fact, as Pacific Research Institute president Sally Pipes demonstrates, public policy should concentrate on a far smaller group of hard cases.

From those 45.7 million uninsured, subtract 17.5 million who earn more than $50,000 annually. Though they can afford coverage, they evidently have other priorities. Of the remaining 28.2 million uninsured, some 14 million are eligible for, yet have not enrolled in, the Medicaid and S-CHIP programs. Meanwhile, as many as 10 million uninsured may be illegal aliens. All told, Pipes estimates that only about 8 million Americans are uninsured due to chronic illness or working-poor status. The latter have incomes too high for assistance and too low for insurance.

In other words: if the House bill passes, it will throw a huge amount of money at the problem of people who can’t afford medical insurance, and the result will be that the same number of people will be unable to afford medical insurance, except that they’ll be paying higher taxes for the privilege. Even for D.C., that will be an amazing accomplishment.

Barack Obama is no Napoleon Bonaparte

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For all the real problems with our country’s health care system, the current fight in Congress is more about Barack Obama’s agenda than it is about what this country needs; you can see that in the way he’s tried to argue that bringing in massive new regulation of our health care system is necessary to fix the economy (a line which, to judge by current polling, most voters aren’t buying). That’s why Sen. Jim DeMint declared that if the president can’t get this bill passed, “it will be his Waterloo. It will break him.” President Obama knows it, too, as an anecdote in a recent National Journal story, told by Sen. Charles Grassley (R-IA), the ranking Republican on the Senate Finance Committee, shows:

“Let’s just lay everything on the table,” Grassley said. “A Democrat congressman last week told me after a conversation with the president that the president had trouble in the House of Representatives, and it wasn’t going to pass if there weren’t some changes made . . . and the president says, ‘You’re going to destroy my presidency.’”

Which makes the president’s lack of real leadership on this issue telling. CNN’s Political Ticker noted last week that Democrats on the Hill are unhappy with his failure to do his part to get a health care bill passed:

One Democratic senator tells CNN congressional Democrats are “baffled,” and another senior Democratic source tells CNN members of the president’s own party are still “frustrated” that they’re not getting more specific direction from him on health care. “We appreciate the rhetoric and his willingness to ratchet up the pressure but what most Democrats on the Hill are looking for is for the president to weigh in and make decisions on outstanding issues. Instead of sending out his people and saying the president isn’t ruling anything out, members would like a little bit of clarity on what he would support—especially on how to pay for his health reform bill,” a senior Democratic congressional source tells CNN.

How did he respond? By going out and picking a fight with the Cambridge, MA police, which “sucked the oxygen out of the health care debate at the very moment Democrats were pleading for him to become more involved.”

President Obama clearly recognizes that in making a huge statist health care bill central to his agenda and staking a great deal of political capital on it, he has made it a bill which he must get passed if he’s to be able to lead effectively; if it fails, it will demonstrate significant political weakness to conservatives, to voters more generally, to the political class, to our nation’s allies, and to our enemies abroad. That’s why he told his party’s congressional wing that they will “destroy his presidency” if they don’t pass it without major changes; that’s why Sen. DeMint called it potentially his Waterloo.

In one sense, of course, that comparison is overstated, because the Obama administration isn’t going to fall if the Democratic health care bill fails; the president will be weakened politically, but he’ll still be the president. In another sense, though, Sen. DeMint’s comparison might not even be strong enough, because the most telling thing about this whole situation is that when faced—by his own admission—with the possible destruction of his presidency, Barack Obama has left it in the hands of Congress to prevent that. He’s happy to go on TV and host a press conference, but when it comes to the nitty-gritty work of leadership, he’s completely hands-off. For whatever reason, he just can’t or won’t do that.

This is the great difference between President Obama and Emperor Napoleon: Napoleon wason the field at Waterloo. He wasn’t on the front line itself, leading a charge, but he was right there with the army, giving orders and calling the shots. President Obama, by contrast, has left that job to Marshal Pelosi and General Reid—he’s back in Paris canoodling with Josephine. I’m not sure what that says about his ability and willingness to be a real leader, but whatever it is, it ain’t good.

Obamacare prescription: the hair of the dog

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Wikipedia: “Hair of the dog is a colloquial English expression predominantly used to refer to ingestion of alcohol as treatment for a hangover. It is occasionally used with respect to dealing with the after effects of use of other recreational drugs.”

As I’ve already said, I agree that our health care system in this country is dysfunctional—it’s inefficient, uncompetitive, too expensive, too unaccountable, and not at all transparent. Unfortunately, we have a bunch of politicians (to whom the whole thing is personally irrelevant since they have a superb taxpayer-funded health care plan which won’t be affected at all by anything they pass) whose desire is to solve these problems by feeding it the hair of the dog: making our healthcare system even more inefficient, uncompetitive, expensive, unaccountable, and opaque by adding a vast new tangle of government bureaucracy to the existing vast tangle of government bureaucracy that’s already gumming up the works. If you haven’t seen the organizational chart for this, it’s beyond belief:

If you’re wondering how that will function in practice, here’s a working model:

HT: Aaron Gardner

One of the great problems with a government-centric approach to “reforming” health care is almost theological, the same problem the early church had with the Pharisees (and the church has had throughout the centuries with those who would rather live by law than by grace): if you try to define and control anything through law, then you need a law for every bit of minutiae. This is is why government control is never the most efficient way to run anything, because it’s impossible to fine-tune the law well enough to make it truly efficient; it’s why government control stifles innovation, because all those laws lock innovation down. It’s also why, whatever the overarching principle of any law might be, the devil is always in the details.

As the above organizational chart shows, the details of the current Democratic health care bill are myriad, complicated, and confusing; and as a closer examination of some of those details shows, for this bill, they add up to a mighty big devil. Check out the Economic Policy Journalblog for a list that may very well curl your hair, including a massive expansion of government incursion into individual rights and economic freedom. Then consider that while one of the other big factors driving up the cost of healthcare is runaway litigation, this bill won’t do anything to rein that in—in fact, it will expand it. (HT: Mark Hemingway)

This is the kind of reasoning James Hirsen dubbed “Bidenomics” after our ever-quotable vice president told the AARP,

AARP knows and the people with me here today know, the president knows, and I know, that the status quo is simply not acceptable. It’s totally unacceptable. And it’s completely unsustainable. Even if we wanted to keep it the way we have it now. It can’t do it financially. We’re going to go bankrupt as a nation. Now, people when I say that look at me and say, ‘What are you talking about, Joe? You’re telling me we have to go spend money to keep from going bankrupt?’ The answer is yes, that’s what I’m telling you.

It doesn’t really deserve its own name, though, because it’s not new to VP Biden at all; it’s the same old folk logic of the hair of the dog: to fix a problem, just pile on lots more of what created the problem to begin with. Apply it to drinkers, you get drunks, who then use it to justify becoming worse drunks. Now, a government drunk on tax money and a political party supported in large part by trial-lawyers drunk on lawsuit money are using it to try to justify getting even drunker. We need to tell them to sober up.