Joust The Facts

Amen To That!

Mr. President, for America's sake, please, please, listen to your hometown newspaper.

On some level, then, the president plainly agrees with critics of Obamacare, this page included, that the law needs to be rewritten: He and his administration keep rewriting its major components — remember the mandate that sizable employers offer coverage in 2014? — as practicalities and politics demand.

But in this country we don't change bad laws by presidential fiat. We change them by having Congress rewrite them or by starting from scratch. Obama doesn't want to reopen this law for fear that Republicans and some Democrats will substantially rewrite it. But that's what has to happen.

We understand why the president and leaders of his party want to rescue whatever they can of Obamacare. On their watch, official Washington has blown the launch of a new entitlement program ... under the schedule they alone set in early 2010.

What we don't understand is their reluctance to give that failure more than lip service. Many of the Americans who heard their president say Thursday that "we fumbled the rollout of this health care law" would have been pleased to hear him add: So we're admitting it. This law is a bust. We're starting over.

Epic failure of the development and launch of the federal exchange website? Check

Modifications to the stipulations of the law by whim of the executive? (Delaying the employer mandat until after 2014 midterms) Check

Handouts to favored businesses, favored constituencies? Check

Fraudulent statements about the nature of the new law? ("If you like your plan you can keep it.  Period.") Check

Fraudulent statements about the nature of the law's financing.  (It's a mandate!  No, wait, it's a tax!)  Check

Fraudulent statements about the cost of the law globally as well as individually? (Remember the mythical $2500 individual savings, and the mythical deficit reduction?) Check

Lies in testimony to Congress from those in charge? Check

The main question at this point is whether this was all intentional.  Is this an intentional chaos designed to create a demand for single payer?  It wouldn't surprise me in the least.  One thing may work against that strategy: failure of the government on this scale should raise serious doubts on that front also.

Covered? I Think Not.

The Heritage Foundation ObamaCare ad:

Let's survey the carnage so far. Zero signups in Hawaii? Zero on the first day in Louisiana? And the software alone, the one that is virtually unusable, cost $634 million (and was supposed to cost $93 million as originally proposed?

That's your smart, efficient government at work.

The Joust The Facts "Quote Of The Day"

From Robert Samuelson, at Real Clear Politics about yet another insidious design flaw in the unpopular health care reform known in Orwellian fashion as the  "Patient Protection and Affordable Care Act," or more colloquially as ObamaCare.  Mr. Samuelson's article addresses the definitions of full-time and part-time workers.  For the latter under ObamaCare the employer does not have to provide health insurance; once you reach 50 of the former, however, you do.  The Bureau of Labor Statistics defines part time as less than 35 hours, while the PPACA defines part-time as less than 30 hours.  Problem?  Yes.

The argument about Obamacare is often framed as a moral issue. It's the caring and compassionate against the cruel and heartless. That's the rhetoric; the reality is different. Many of us who oppose Obamacare don't do so because we enjoy seeing people suffer. We believe that, in an ideal world, everyone would have insurance. But we also think that Obamacare has huge drawbacks that outweigh its plausible benefits.

It creates powerful pressures against companies hiring full-time workers -- precisely the wrong approach after the worst economic slump since the Depression. There will be more bewildering regulations, more regulatory uncertainties, more unintended side effects and more disappointments. A costly and opaque system will become more so.

Amen to that.

A Health Care Decision Reminder

Over the last week or so we've been deluged with stories attempting to pre-emptively delegitimize the Supreme Court's decision on the ObamaCare health care law, the inappropriately named Affordable Care Act.  The latest was from Roger Simon, writing at the ostensibly non-partisan Politico yesterday.  He does so by quoting extensively from Jeffrey Toobin, whose viewpoints are wholly partisan.  And from former Justice John Paul Stevens, who was on the losing side of the Bush-Gore election dustup in 2000.

At this writing, I do not know how a majority of the justices will rule on Obama’s health care plan, which was passed into law by Congress. Two branches of government have spoken, but their speech is but a whisper compared with the shout of our high court.

The die was cast in 2000. And it would take the most dewy-eyed of optimists to expect the court’s decision to be anything other than political.

Justice John Paul Stevens, now retired, wrote in his dissent in Bush v. Gore in 2000: “Although we may never know with complete certainty the identity of the winner of this year’s Presidential election, the identity of the loser is perfectly clear. It is the Nation’s confidence in the judge as an impartial guardian of the rule of law.”

That is a lot to lose. But we have lost it. And getting it back may be a long time in coming.

You see, if the court rules the individual mandate constitutional and allows the law to stand, then it's the correct decision and the members of the court were able to overcome their political slant.  If they determine the mandate unconstitutional, then it's purely politics.  It must be easy to be on the left.  You're always correct, and any disagreement can only be because of political bias.

Recall, however, just how weak the arguments in favor of the individual mandate were in court.  The same Jeffrey Toobin called them a "train wreck."

Today’s arguments focused around the central constitutional question of whether Congress has the power to force Americans to either pay for health insurance or pay a penalty.

According to CNN’s legal analyst Jeffrey Toobin, the arguments were “a train wreck for the Obama administration.”

“This law looks like it’s going to be struck down. I’m telling you, all of the predictions including mine that the justices would not have a problem with this law were wrong,” Toobin just said on CNN.

And on the question of a limiting principle, Justice Steven Breyer got silence from Donald Verrilli.  Remember also that there's no severability clause in the law, meaning that if any part is struck down the whole law should be by right.  It's not the SCOTUS that wrote the law that way.  Justice Antonin Scalia remarked that on the issue of severability it would be "cruel and unusual punishment" to require them to read the whole law and pick and choose how it should have been written.  Recall also that the government did a poor job as well in arguing for the Medicaid payment extortion written into the law, whereby states would lose federal dollars entirely if they didn't expand their state program in a way acceptable to the feds.

The court’s divisions were on vivid display Wednesday during a discussion of the law’s Medicaid expansion, which gives states more federal money if they agree to enroll more of the poor. States can refuse, but only if they pull out of the program altogether.

The states challenging the legislation say that is not an option. The Medicaid program has grown so large that it is impossible to forgo federal funding and still provide medical care to the poor, they say.

"Nice state you got there.  It'd be a shame if something were to happen to it."  Of course, that's the Obama administration modus operandi, demonstrated this week against Arizona who had the temerity to try to control the flow of illegals across their southern border by applying federal laws.

So, as you read all the articles today screaming about the health care law being overturned (my prediction), remember just how weak the arguments were in its favor just three short months ago.

6/28/12 0935: More:

• Ace has a nice roundup, including  a link to a Reason compendium of pre-emptive strikes.
• I agree with The Blogfather, and he with me.
• Gabe Malor at Ace of Spades addresses Mr. Toobin's nonsense in Roger Simon's Politico piece about the Roberts court overturning more legislation.  Unfortunately for Mr. Toobin, he doesn't read the NY Times.  From Mr. Malor:

Just three laws per term! Far, far from being "eager" to overturn legislatures, as hack Toobin dribbled, and obviously, indisputably playing no unusual role in "second-guessing laws," as Fallows alarmingly squeaked, the Roberts Court has been a model of restraint. Restraint is, naturally, one of Chief Justice Roberts' well-known characteristics and it was remarked upon during his confirmation hearings. One could even creditably call the Roberts Court the most restrained, incrementalist Court of the modern era. (I assure you, these numbers have not changed appreciably in the past two years.)

Should the mandate be overturned today, liberals will repeat their lie endlessly in order to cast doubt on the legitimacy of the Supreme Court and to tarnish the Chief Justice's good name. You know better. Do not believe this sad, angry lie. And do not let some foolish lemming repeat it in your presence. The truth is that the Roberts Court has been unusually restrained in overturning laws when compared to its predecessors.

As Good An Indictment Of ObamaCare As You'll See

From The Cato Institute's Michael Tanner, in the pages of the NY Post.  He writes it from a "why should anyone trust the government" angle, but if you just focus on Obama's government healthcare takeover and want to convince yourself that that was a colossal and expensive mistake, well, read on.

For example, a recent survey by the Kaiser Family Foundation shows family premiums increasing by a whopping 9% this year, three times more than the previous year’s increase. The average family policy now costs more than $15,000 per year. Not only has ObamaCare failed to slow premium growth, but at least 2 percentage points of that increase is directly attributable to the health-care law’s provisions.

ObamaCare is also already reducing our health-insurance choices. The new law has already driven a number of insurance companies out of the market, meaning there will be less competition and fewer choices. Moreover, the new law has already cut back on flexible-spending accounts used by some 30 million workers, slashing permissible contributions in half and limiting what account funds can be used to pay for. And just released regulations from HHS may well eliminate most health savings accounts, effecting another 10 million workers and their families. And, of course, once the individual mandate kicks in, in 2014, assuming its not struck down by the Supreme Court, all of us will have to purchase a government-designed insurance plan, even if it is more expensive or contains benefits that we don’t want.

We also know that ObamaCare is going to cost us more in debt and taxes. A new study from the Congressional Budget Office concluded that the subsidies in the bill will add $1.36 trillion to the national debt over the first seven years after the bill is fully implemented. And at a time when 47% of Americans already pay no income tax, the bill’s tax credits will remove as many as 8.1 million more Americans from the tax rolls.

And we know that the health-care law will slash payments to physicians and hospitals, meaning it will be more difficult for us to find and see a physician. The government’s own actuaries estimate that these payment cuts could force as many as 15% of hospitals to close.

Let's see.  Fewer doctors and hospitals (reduced access) - check.  A huge increase in the national debt - check.  Reduced freedom of choice in health care insurance options - check.  Increasing levels of income redistribution - check.  Increased costs, more even than the previous rate of increase, for those reduced options and access - check.

It's no wonder the bill is steadily more unpopular.

[T]he Kaiser Family Foundation released its October tracking poll and found that only 34% of respondents have a favorable view of the Affordable Care Act, down from 41% in September. Notably, the decline was due to losing Democratic supporters, who dropped to 52% support from 65% month to month. Meanwhile, 51% of the public is opposed to the vast new government health-care entitlement, up from a prior 2011 average of 45%.

One Reason Why Your Health Insurance Costs So Much

A little anecdote that may help explain some of the escalation in insurance premiums that people are about to find as year end approaches  - for reasons other than the colossally intrusive and costly ObamaCare.

I saw a patient in the office a couple of weeks ago.  A gentleman in his 40's, he had twisted his knee two months earlier and since had been bothered by knee swelling, pain along the joint line medially (the inside part of the knee), and a catching sensation which cause his knee to buckle when it occurred.  He was unable to squat or kneel.  I examined him after taking the history, finding an effusion in the knee (the swelling), sharply positive provocative testing for a meniscus tear (the McMurray and snap tests), and prominent joint line tenderness directly over the meniscus.  Plain x-rays showed no degenerative changes.  And there's one other thing.  This patient had a very similar problem with the other knee four years ago, and I had arthroscoped that knee removing a torn medial meniscus with an excellent outcome.

So, clearly, this man had a symptomatic torn meniscus, with most probably an unstable flap tear (producing that catching/buckling sensation).  This is about the most clearcut, obvious presentation you could have.  He had had symptoms for two months, and anti-inflammatories had not helped.  I, quite appropriately, suggested arthroscopic surgery to resect the torn meniscus.  I've examined thousands of knees, and I had seen this many times before.  Based on the plethora of findings given above I didn't need an MRI of this knee to confirm the diagnosis.  I thought that was what the insurance company wanted, to save money by eliminating unnecessary testing.  I was wrong.

The insurance company, a large HMO, refused to approve the surgery until the patient had an MRI to verify what I knew to be true.  I didn't need one, I told them, but they insisted. The patient had the MRI, and of course it demonstrated the torn meniscus.  We'll be going ahead with the surgery soon.

Trust the doctor?  Not on your life.  No, instead we need an expensive diagnostic study read by a radiologist who hasn't examined the patient, increasing the cost of care on this one patient.  Now picture thousands of orthopaedic surgeons and hundreds of thousands of patients annually having the insurance company second-guessing the experienced surgeon.  By the way, my practice has our own MRI, and I still tried not to use it.

I tried to save some health care dollars.  I really tried.  But the insurance company wouldn't let me.

You think this is bad?  Wait until I tell you about PT for rotator cuff tears.

You Mean Like ObamaCare And Higher Government Debt?

From the Obama re-election campaign's new attack on the Republican frontrunners:

President Obama’s re-election campaign argues in a memo set to be released this morning that Texas Gov. Rick Perry and former Massachusetts governor Mitt Romney — the two frontrunners for the Republican nomination — have “embraced policies that the American people oppose” on Social Security and immigration.

For example, most Americans, by 63-27, opposed raising the debt ceiling this summer.  Yet not only did Mr. Obama want it raised, he wanted it raised enough that it wouldn't need to be re-visited before the November 2012 elections.

And in the case of health care reform, the polls were roughly 55-35 against just at the time it was passed and signed - "against the will of the American people," as it were.  And it continues to be unpopular.

There are, of course, other examples.  But logical consistency has never been Mr. Obama's strong suit.

Ed Morrissey shows that even on Social Security and Immigration Mr. Obama is out of the mainstream himself.

Unconstitutional? So What's Next?

The Heartland Institute's Peter Ferrara tells you, over at The American Spectator.  First, a brief explanation of why the whole law collapses without mandated insurance purchase.

Without the individual mandate, the rest of Obamacare is transparently unworkable, as President Obama and the Democrats themselves said during the jihad for its enactment. That is because the bill also includes what is known as "guaranteed issue" and "community rating." Under those provisions, an insurance company must insure whoever applies, and charge them no more than anyone else, no matter how sick or costly they are when they first apply...

The skyrocketing premiums cause younger and healthier individuals to drop their coverage. That forces insurers to raise premiums even more because the remaining pool is even sicker and costlier on average. The younger and healthier than flee even more, knowing they can automatically get coverage later if they become sick! ...

...without the individual mandate, the whole system inevitably collapses as described above.

He proposes a couple of free market solutions: block grant Medicaid to states to cover their poorest with income-based vouchers for private insurance, and create state high-risk pools to assist with private coverage when insurance is prohibitive.  I would add the provision of insurance crossing state lines and (perhaps) the portability of insurance when changing jobs.

These are market solutions that maintain the private health care system while supplementing it for the most vulnerable.  It still allows people to go without, if they're young, healthy, and elect to do so.  Those individuals should be encouraged to buy low-cost catastrophic coverage so that unforseen disasters could be handled.  That's encouraged, not mandated.  But, as Mr. Ferrara notes, covering the masses was never really the goal.

The only reason President Obama and the Democrats would not even consider this approach is that it does not involve the government takeover of health care, which was the real goal all along, so the wise government could run health care in the interests of progressive "social justice" (which sometimes means denying people health care).

One area this essay doesn't touch is Medicare, which is in its own entitlement death spiral as the baby boomers reach 65.  However, putting Medicare on a more sound footing does not require dismantling and turning over to the government the best medical care in the world.  Retiree health care can certainly be addressed separately.

Everyone's worry is about Supreme Court swing vote Anthony Kennedy.  Frankly, it's a little hard for me to understand how any of the nine justices, if they are truly versed in the Constitution, could conclude any differently than Judge Vinson.  I'm certain the Justices Sotomayor, Kagan, Ginsberg and Breyer will find a way, but their minority opinion in the ultimate judging of ObamaCare will be a classic demonstration of contrived logic and avoidance of proper consideration of constitutional limits on federal power. 

2/2/11 1005: And what would be a discussion of constitutionality and limits on federal power without a preposterous response from someone purported to be a constitutional scholar.

First, the higher prices and taxes aren’t Vinson’s problem if the bill itself violates the Constitution. Judges are supposed to rule on the facts and the law, not on the policy choices they like best. The prices and taxes are Congress’ issue to solve, within the limits of their authority under the Constitution.  Prices might drop and taxes might go down if Congress nationalized all means of production, too, but that doesn’t make it legal or morally right.

Second, the role of the judiciary is to check the power of Congress and the executive.  That’s why actual Constitutional scholars refer to the “checks and balances” of the three-branch federal system.  Maybe Obama learned his Constitutional law at the same place Chuck Schumer learned civics, but applying a check to Congressional overreach isn’t “judicial activism,” it’s one of the main purposes of the federal courts.  “Judicial activism” occurs when judges create laws from the bench in the absence of legislative action.

"Judges are supposed to rule on the facts and the law, not on the policy choices they like best."  I hope the liberal bloc of SCOTUS remembers that.

The Joust The Facts "Quote Of The Day"

Let Freedom Ring!!

"It is difficult to imagine that a nation which began, at least in part, as the result of opposition to a British mandate giving the East India Company a monopoly and imposing a nominal tax on all tea sold in America would have set out to create a government with the power to force people to buy tea in the first place."

Difficult, though obviously not impossible if you're someone who thinks it's the government's responsibility to impose the society that you envision, and if trampling on the individual rights of citizens is the price, so be it. Eggs, omelettes, etc.  And so, tha battle over the constitutionality of ObamaCare continues.  Next up, the Appeals Court.

An Orthopaedic Surgeon Discusses ObamaCare

Dr. David Janda is from Michigan, and is supporting Rob Steele against Rep. John Dingell.  Here he gives some insight into the rationing of care built into the health care bill.

 

 

Interesting.  And they said that there was no rationing in the bill.  And they said that if you like your doctor and your insurance you can keep it.  And the AMA supported this, despite the fact that it's going to chase doctors out of the system by harassing them.

Tell me.  Is it better to have doctors and access to care, but no insurance, or to have insurance but fewer doctors and less access to care?  Is it better to have doctors and patients deciding together the proper treatment for that individual, or to have treatment prescribed/proscribed by impersonal bureaucrats who previously worked in the DMV?  Yes, I know that insurers are already doing some dictating of treatments.  But you can reason with insurers, sometimes.  The government never listens.

They Took A Bite From The Poison Apple

National Journal reports that voting for ObamaCare, Obama's health care reform stealth government takeover, has proved particularly poisonous to incumbent Democrats, particularly the Blue Dogs.

But the reality that Democrats hate to discuss – and even some Republicans have been hesitant to fully embrace – is that the party’s signature health care law is what’s turning a bad election year into a disaster of potential history-making proportions.

It was the debate over health care that propelled now-Sen. Scott Brown’s unlikely special election victory in Massachusetts back in January. And it’s the growing unpopularity of the new law that’s fueling Republican energy, turning off independents and jeopardizing the prospects of dozens of Democrats who looked like locks for reelection just a year ago.

Josh Kraushaar details not only those Democrats who, despite the conservative nature of their districts, voted for the bill and now find themselves afloat on rocky seas with no oar, but also lists those who opposed the bill and may indeed survive the turbulent waters.

This only makes sense.  The Democrats who voted for the bill against the judgment and wishes of their own constituents are in trouble precisely for that reason.  They were sent to Congress to represent the people of their district.  But they didn't.  Instead they were sold a bill of goods by statists anxious to annex one-sixth of the U.S. economy, told to vote for a bill that no one in Congress had ever read, the "negotiations" replete with back-room deals, threats, and promises that could not be kept.  Voters in their districts were against it, but that didn't stop them. Does the name Bart Stupak ring a bell?

The people in general don't like the bill, by roughly 56-44, depending on which poll you believe.  Contrary to the claims of Mr. Obama and his minions, it is not getting more popular, but less.  If you subtracted those in New York City, Los Angeles, San Francisco, Seattle, Boston, Philadelphia and Chicago from the mix the weight of opinion against this bill is sharply negative, maybe as high as 70-30.  And guess what?  These Democrats in trouble don't represent the people in NY, LA, SF, Seattle, Boston, Philly or Chicago.  They represent the others, the ones who hate it.

Or, rather, they represent them, for now.

Mr. Kraushaar makes the rather obvious point that this election really is about policy, not about money or messaging.  The Democrats keep trying to make it about the latter items, by insisting that they just haven't been communicating well enough, or stating that people who are scared are simply not up to listening to science or facts, or bleating about the US Chamber of Commerce and "foreign money."  But they know what it's really about, and they don't like it and can't admit it.

The JTF "Quote Of The Day"

From a Green Room post at Hot Air by Karl, a look at the media's treatment of the tea party, and it's non-treatment of the serious financial decisions facing the country.

Indeed, our unsustainable financial situation led to the creation of a Tea Party movement — one of the biggest political developments in America over the past two years. It would seem to be the perfect news peg for ongoing media coverage of our government’s fiscal irresponsibility. Of course, it didn’t work out quite that way, did it? Instead, the establishment media ignored, then attacked the Tea Party movement — first as astroturf, then as racist, as Birthers, as hypocritical (for not having formed when the problem was less dire, and for gullibly expecting the government to make good on current entitlement promises or reform them before adding new ones), etc. The establishment media’s coverage of the Tea Party often seems devoted to discussing anything other than the issues at the heart of the movement.

Thus, the establishment media reveals itself, not as the people’s watchdog against irresponsible government, but as the irresponsible government’s guard dog against the people.

Bingo!  There is no watchdog media when Democrats are in power; far too many are experiencing leg tingles to do the job of looking critically at the claims and proposals of Congress and the White House.  Thus, as Karl points out, ObamaCare's financial sleights-of-hand get airbrushed if not wholly ignored, to the detriment of the people.  The article on which that post was based was written in November, 2009.  Read both the post and the article from the New Yorker by John Cassidy, and then claim, Michael Kinsley, that you weren't warned.

Just how out of control is federal spending?  This out of control.

Two Too Wrong

Bernard Kliban ("BKliban") was a cartoonist who produced such masterpieces as "Never Eat Anything Bigger Than Your Head And Other Drawings," "Tiny Footprints,"  The Biggest Tongue In Tunisia And Other Drawings," collections of odd, eclectic and thought-provoking cartoons that took usually more than a glance to understand and appreciate.  I highly recommend them.  One of his very amusing yet insightful original cartoons was ""The Birth Of Advertising," shown below.

Now, meet Paul Hodes, D-NH, now running for the Senate in New Hampshire.

A "true fiscal conservative?"  It's one thing to polish your record so that it shines in the best light possible.  It's quite another to treat the electorate as if they are idiots to whom you can tell anything and expect them to believe you.  Let's have a look at the record, shall we?  That's right.  Voted for Cap & Tax. Voted for the $800B "stimulus."  Voted for the bank-and-back-breaking government takeover of health care, among other fiscal atrocities  Voted with the Democrat leadership roughly 95% of the time.  If he hadn't voted "present" on the resolution to honor the World Champion NY Yankees (and you'd better vote that way if you're from Carlton Fisk's home state) that number would be even higher.  Some "true fiscal conservative."

Now meet David Axelrod, political guru and marketer extraordinaire for the President.

White House senior adviser David Axelrod said Sunday on NBC’s “Meet the Press” that he thinks voters will eventually warm to health care reform.

“I think that health care, over time, is going to become more popular,” he told David Gregory. “But people are focused on this economy right now — they’ve got anxiety about this economy. That’s what’s driving the vote right now.”

Fortunately, the reporter corrects the record for Mr. Axelrod in the very next paragraph.

President Barack Obama’s signature accomplishment is currently so unpopular with voters that no Democratic candidate is running ads promoting it. 

Imagine being one of the 60 Senate Democrats and 219 House Democrats who voted for the bill, and being so proud of the "signature accomplishment" and its benefit to the American public that when the very next election comes along you can't even talk about it.

Horse s**t.

9/14/10 1040:  Geez, you start working on something early in the morning, and what with the demands of fatherhood, canine owner and orthopaedic surgeon you're unable to tie up all the loose ends until about 10:20 AM, and then you find out some professional blogger beats you to it.  There is no justice.  Of course, Ed puts in a little additional research and discovers that the only reason Mr. Hodes can claim to abhor pork is that he hasn't eaten any ... for 2011, for which Ms. Pelosi's congress hasn't passed a budget.

Nice work, Ed.

Prognostic Caution And Lockerbie

There is an old doctor joke. 

A patient is sitting in his doctor's office and the physician reviews the medical facts, and states, "Mr. Howard, I'm sorry to tell you that you've got cancer.  You have only six months to live." 

The patient pauses, then says "Doc, that's terrible news.  I don't have a job now, and I was hoping to get back to work after the surgery.  I don't know if I'll be able to pay off what I owe you by then."

Whereupon the doctor gives Mr. Howard six more months.

When it comes to the Lockerbie bombing of Pan Am Flight 103 and the only man convicted for the attack it seems truth is stranger than fiction.

LONDON – The regrets of a cancer expert who assessed the only man ever convicted of the 1988 Lockerbie jetliner bombing have intensified the anger felt by victims' relatives over Scotland's decision to release the Libyan on compassionate grounds.

Professor Karol Sikora and other experts had said Abdel Baset al-Megrahi probably had only three months to live when he was freed from a Scottish jail last August and allowed to return home to Libya. But one year later, Al-Megrahi, who is being treated for prostate cancer, is still alive.

Sikora, one of three experts who assessed al-Megrahi's health for Libyan authorities, was quoted by Britain's Observer newspaper Sunday as saying he should have been more cautious about the chances of survival.

"If I could go back in time, I would have probably been more vague and tried to emphasize the statistical chances and not hard fact," Sikora was quoted as saying.

"In medicine we say 'Never say never and never say always,' because funny things happen. All you can do is give a statistical opinion," said Sikora, dean of the School of Medicine at Buckingham University, in central England.

Prostate cancer can be fatal, but it's very common for a patient to die with prostate cancer rather than from it.  For a prisoner who participated in the mass slaughter of 270 innocent people, the entire system should have been extremely cautious in predicting al-Megrahi's demise from it.

A report made public by Scottish authorities shows the Scottish Prison Service's medical chief, Andrew Fraser, was advised by four specialists at the time of al-Megrahi's release. The report described the three-month prognosis for al-Megrahi as "reasonable," but confirmed that none of those consulted ruled out that al-Megrahi might live longer.

Precisely why he should still be in prison in Scotland.  It was, however, sold to the public on the currency of that three month prognosis.

Sikora told the Observer he remains certain al-Megrahi will die of cancer, "I suspect in the next few weeks. To tell the truth, I'll be quite glad because we can move on."

Some people never learn from their mistakes.

As Massachusetts Goes

So goes the USA?  Megan McArdle at The Atlantic has a look at the scrambling being done in the Bay State to cover, jerry-rig or otherwise manipulate the problems that plague the state's health reform/universal coverage plan into something marginally tolerable.

Even if you're in favor of the healthy reform, this is a lousy, desperate way to go about it.  This kinds of mandatory "contributions" are essentially a punishment for past, legal behavior.  Practically, they tend to be vulnerable to regulatory takings challenges.  Economically, they dramatically ratchet up the risks of doing business in Massachusetts...

The quality of legislation coming out of Massachusetts on this stuff right now is really frighteningly bad.  There's none of the technocratic fine tuning that we were assured was the greatest reward of this sort of program, just crude, blanket rules that do much reflect the realities of the market.  Rather, they're a cathartic outlet for legislators frustration that any reality exists outside of the power of their pens.

Just wait until we see these kinds of gamesmanship, punitive fines, regulations and takings on a national basis when the audaciously promised "savings" from health care reform fail to materialize, along with the loss of private insurance, the loss of your doctor, and the loss of the quality that was personified in the American medical system.

The legislature, in order to stick a finger in the dike of insurance losses, is trying to siphon $100M from successful profits.  Call it a "windfall profits" tax, a one-time taking.  Just to, you know, solve the problem.

But that won't solve the problem, merely postpone it.  And when it has to be done again, they'll call it one-and-done once more, won't they?

There is a version of Murphy's Law that says that no system can be foolproof because fools are so ingenious.  The corollary is that no foolproof system can be devised by fools.  And what is a legislature if not foolish for thinking that such a system is even possible?

Medical Supply And Demand, Texas Style

In economics the theory of supply and demand governs price, availability, and demand for a given product or service.  If the supply and ease of production of a commodity is high, and demand for the product is low, then the price must fall in order for any selling to occur.  Conversely, high demand for a scarce commodity generates a high price point.  Such would be, or rather should be, the case in medicine, relatively speaking, as not everyone can practice medicine safely and effectively (supply is limited) while the demand is steadily increasing. 

Well, what happens when the government steps in and artificially lowers the price?  What's happening in Texas is that the rate at which physicians are dropping out of Medicare is accelerating.

Two years after a survey found nearly half of Texas doctors weren't taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.

“This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn't fix Medicare soon, there'll be more and more doctors dropping out and Congress' promise to provide medical care to seniors will be broken.”

[...]

The opt-outs follow years of declining Medicare reimbursement that culminated in a looming 21 percent cut in 2010. Congress has voted three times to postpone the cut, which was originally to take effect Jan. 1. It is now set to take effect June 1.

Just wait.  The coercive power of the state will need to be employed ever tighter in order to "make the system work" what with all these greedy, uncaring physicians turning their backs on needy seniors.  And the result, as I wrote before the health care bill was passed, will be a future dearth of people wanting to pursue careers in medicine.  Sure, some will still do it for altruistic reasons, or for reasons of scientific inquiry.  But you're going to lose many who have the aptitude and the desire but don't wish to have their future economic mobility and security hamstrung by an oppressive federal government.

Well, look on the bright side.  Most of those that opt not to pursue medicine will be lawyers, or study finance and work for Goldman Sachs.

5/18/10 1400: More, from Scott Gottlieb, MD, in the Wall Street Journal.

Consolidated practices and salaried doctors will leave fewer options for patients and longer waiting times for routine appointments. Like the insurers, physicians are responding to the economic burdens of the president's plan in one of the few ways they're permitted to.

For physicians, the strains include higher operating costs. The Obama health plan puts expensive new mandates on doctors, such as a requirement to purchase IT systems and keep more records. Overhead costs already consume more than 60% of the revenue generated by an average medical practice, according to a 2007 survey by the Medical Group Management Association. At the same time, reimbursement under Medicare is falling. Some specialists, such as radiologists and cardiologists, will see their Medicare payments fall by more than 10% next year. Then there's the fact that medical malpractice premiums have risen by 10%-20% annually for specialists like surgeons, particularly in states that haven't passed liability reform.

The bottom line: Defensive business arrangements designed to blunt ObamaCare's economic impacts will mean less patient choice.

5/18/10 1730: Here's more, From Ed Morrissey at Hot Air, who noticed Dr. Gottlieb's article.

The end result of the consolidation that will follow ObamaCare will be increased bureaucracies and fewer choices.  The mandate burden will mean fewer independent clinics and providers, thanks to the increased start-up costs.  Doctors will look for the economies-of-scale approach and join a decreasing number of larger networks.  Insurers will affiliate themselves with fewer providers and networks as they pare down their offerings, which will already be constrained by the mandates for minimum coverage.  The so-called “Cadillac tax” will eliminate the high-end policies now offered as insurers attempt to avoid the ruinous taxes and fees imposed on those plans.

Take this out to its logical endpoint and what do you have?

That's right.  Single payer.  What was that about a "trojan horse?"

The JTF "Quote of the Day"

From Megan McArdle, discussing Rep. Henry Waxman (D-CA) and his call for CEO's of companies altering their earnings picture on the basis of changes to tax law in the health reform law:

Waxman is incensed because this seems to put the lie to the promise that if you like your current plan, nothing will change.  But this was never true.  Medicare Advantage beneficiaries are basically going to see their generous benefits slashed, retiree drug benefits suddenly cost more and may now be discontinued, and ultimately, more than a few employers will almost certainly find it cheaper to shut down their plans.  If Congress didn't want those things to happen, it should have passed a different law.

In fact, it was never true that "if you like your current plan you can keep it."  So why did someone prominenet keep telling us that over, and over, and over?  And why did our vigilant media refuse to refute that lie every time it was uttered?

Shouldn't The Order Have Been Reversed?

A screenshot from Yahoo!'s homepage this morning: (ckick to enlarge)

"The landmark health care vote may backfire if Obama can't sell the plan to angry voters."

Shouldn't the plan have been sold to the people - wait, scratch that - shouldn't the people have been fully informed about the plan, and it's detrimental consequences, before it was passed?  Actually, the question is, shouldn't a plan have been devised that could be supported by a majority of the American people and representatives from both the Democrat and Republican sides?

Lefty Matthew Yglesias blames the GOP, by propagating the fiction that liberals were ready to compromise on the bill.  If so, they had the opportunity immediately after the Obama healthcare summit, wherein it became clear that Republicans had principled objections, including the fact that increasing taxes in the middle of a recession with high unemployment numbers is a bad idea, according to every honest economist (obviously I'm leaving Paul Krugman out of this).

Exit question number 1: How many doctors began anticipating and timing their retirement today?

Exit question number 2: What's the over/under on Democrat losses in the House this November?

3/22/10 0915: A couple of video links:

John Boehner caught telling the truth on the floor of the House:

And here's Charlton Heston commenting on the shortsighted insanity of it all:

If Obama Were Serious About Reforming Health Care ...

... he'd listen to and embrace Republican ideas, such as those elaborated by Newt Gingrich and John Goodman in the Wall Street Journal in Wednesday's edition.  Ideas like, for example, true doctor-friendly (as opposed to lawyer friendly) tort reform, health insurance portability, and avoiding drastic Medicare cuts from a system that already underpays providers.  The truth, unfortunately, is that a simple, effective, and popular idea like tort reform never would see the light of day, given the ownership of the Democratic Party by the trial bar.

After the Supreme Court's 1976 Buckley v. Valeo decision affirmed the constitutionality of dollar limits on campaign donations to candidates, plaintiffs attorneys realized they could work within the new rules to increase their political influence. Three years later, the plaintiffs bar set up the Attorneys Congressional Campaign Trust. Its successor organizations have given $33 million in political action committee (PAC) donations to federal campaigns since 1990, according to data gathered by the Center for Responsive Politics (CRP).

These PAC contributions only scratch the surface. Contribution limits favor those best able to "bundle" donations. The plaintiffs bar, with thousands of well-heeled members willing to write $2,000 checks, is well-situated to play this game. While corporations' interests are dispersed among hosts of competing tax and regulatory concerns, the trial lawyers have a focused cause: maintaining the lawsuit industry and expanding legal liability rules that lead to more lawsuits.

Since 1990, the sums donated to federal political candidates by lawyers—excluding lobbyists—exceed $1 billion, according to CRP. Lawyers as a group have given more to federal candidates than any other industry or profession. Their ability to keep tort reform out of the health-care reform bills is unsurprising: Congressional campaign contributions by lawyers in the last election cycle were about $25 million more than the combined total of political donations from doctors, pharmaceutical companies, HMOs, hospitals and nursing homes.

By the way, it's "Democrats" and not "politicians" since 70-80% of lawyer and law firm donations are directed to Democrats.

It's actually simpler than that.  If Mr. Obama were really serious about health care, he'd have invited the Republicans to the table to help craft the legislation before the Obama-Reid-Pelosi "Dance of 1000 Fools" of the last 9 months.  Instead, he spoke only with Democrats, stated - wrongly - that only his side had any ideas on how to solve the problems, and tried to force a major restructuring of one-seventh of the US economy through on a party-line vote.  But now that Senator 41 has taken his seat, and with continued disagreements even among Democrats, that dog won't hunt.  He talks a good game,

“I’m willing to move off of some of the preferences of my party in order to meet them halfway, but there’s got to be some give from their side as well,” Obama said during a surprise visit to the White House briefing room following a meeting with congressional leaders from both parties. “I also won’t hesitate to condemn what I consider to be obstinacy,” he warned.

but he could have magnanimously reined in his Congressional leadership and opted for this sort of give and take when he had 60 in the Senate, and didn't.  Now it simply comes off as oleaginous, too clever by half.*

*too clever by half: to be too confident of your own intelligence in a way that annoys other people

From Rich, To Rubin, to Plouffe, to Obama

Follow along, okay?

From Frank Rich, in the NY Times:

It was not a referendum on Barack Obama, who in every poll remains one of the most popular politicians in America. It was not a rejection of universal health care, which Massachusetts mandated (with Scott Brown’s State Senate vote) in 2006. It was not a harbinger of a resurgent G.O.P., whose numbers remain in the toilet. Brown had the good sense not to identify himself as a Republican in either his campaign advertising or his victory speech...

Does health care matter? Not as much as you’d think after this yearlong crusade. In the Post/ABC poll, the issue was second-tier — at 24 percent. Obama has blundered, not by positioning himself too far to the left but by landing nowhere — frittering away his political capital by being too vague, too slow and too deferential to Congress. The smartest thing said as the Massachusetts returns came in Tuesday night was by Howard Fineman on MSNBC: “Obama took all his winnings and turned them over to Max Baucus.”

To Jennifer Rubin, in Commentary:

Everything is fine, perfectly fine. According to Rich, the real issue is that Obama was not angry enough or  wasn’t everywhere enough. Or Left-leaning enough. You can almost sense Republican candidates and operatives holding their collective breath, smilingly nervously and whispering to each other, “They couldn’t be that obtuse, could they?”

As if the Democrats didn’t have enough problems, Rich and many other of his ilk are counseling Obama to go hard Left and shed any facade of bipartisanship. This certainly will test just how low the Democrats’ standing with independent voters can go. If Massachusetts proved anything, it is that the course that Rich counsels — gin up the base — is a losing proposition...

It remains to be seen whether Obama is going to follow Rich’s advice, and more important, whether anyone on the ballot in 2010 will be dim enough to do so as well.

To David Plouffe, Washington Post:

We still have much to do before November, and time is running short. Every race has unique characteristics, but there are a few general things that Democrats can do to strengthen our hand.

-- Pass a meaningful health insurance reform package without delay. Americans' health and our nation's long-term fiscal health depend on it...

During the campaign, who will be whispering in Republican ears? Watching GOP leaders talking about health care the past few days, it was easy to imagine lobbyists and big health insurance executives leaning over their shoulders, urging death to health insurance reform.

As opposed to trial lawyers and unions, I guess.  Mr. Plouffe's piece is amusing in its predictability.  It's like Captain Renaud rounding up all the usual suspects.  Mr. Plouffe has been brought back by Mr. Obama to centralize the Democratic campaign strategy for the fall.  Once a central planner, always a central planner.

As Ms. Rubin writes, they couldn't be that obtuse, could they?

Health Care Reform That Defies Logic

Massachusetts just sent Scott Brown to the Senate largely based on his staunch opposition to the proposed health care reform.  Connecticut doesn't like it.  Rasmussen shows 61% opposed.  So how do Sen. Harry Reid and Speaker Nancy Pelosi propose "improving" the bill to get it passed?  Make it more palatable to the left, progressives, and staunch liberal Democrats.

No, really.

Struggling to salvage health reform, Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi have begun considering a list of changes to the Senate bill in hopes of making it acceptable to liberal House members, according to sources familiar with the situation.

The changes could be included in separate legislation that, if passed, would pave the way for House approval of the Senate bill - a move that would preserve President Barack Obama's vision of a sweeping health reform plan.

But the move comes with political risk, because it would open Democrats up to charges that they pressed ahead with roughly the same health care bill that voters appeared to reject in the Massachusetts Senate race Tuesday. Republican Scott Brown won on a pledge to try to block Obama-style health reform.

The idea is to have a second bill that moves the overall reform further left.  And these ... Democrats think that move will win the day with the American public, who have already told them firmly once, in blue Mass., to stop.

As an aside, I've seen some progressives puzzled that Massachusetts, which already has its own universal care framework, rejected similar legislation nationally.  Paraphrasing, "after all, it wouldn't really affect them, they already have it."  Maybe that's because they've seen it, know it, and know that it's a problem they didn't want to inflict on the rest of the country.

Money And Influence

Yesterday the SCOTUS ruled, in Citizens United v. FEC, that Congress should not have limited the freedom of political speech as they did with the McCain-Feingold campaign finance law.

The 5-to-4 decision was a vindication, the majority said, of the First Amendment’s most basic free speech principle — that the government has no business regulating political speech. The dissenters said that allowing corporate money to flood the political marketplace would corrupt democracy...

President Obama jumped at the decision to rail against the influence of big corporations that this would unleash

President Obama called it “a major victory for big oil, Wall Street banks, health insurance companies and the other powerful interests that marshal their power every day in Washington to drown out the voices of everyday Americans.”

We can talk about free speech vs. the detrimental influence of large independent expenditures by unions and corporations, if you like.  But Drew M.  handles the discussion nicely over at Ace of Spades today, and Justice Kennedy's majority opinion (pdf) is worthy as well.  From the former:

Sure the Constitution protects ‘the press’ but as bloggers of today and pamphleteers of the founding era know, you don’t need to be a corporation to be ‘the press’. Clearly corporate media isn’t a necessary condition of ‘the press’ so why should media corporations be afforded special protections for 1st Amendment activities others aren’t?

There's also the inconvenient fact that corporations are nothing more than an aggregation of individuals (investors, workers, managers, etc). Each of these people have first amendment speech rights. Why exactly should those rights be destroyed simply because they are exercising them collectively instead of individually? (hint: they shouldn't)

There’s simply no merit to the left’s critique and they won’t like where it leads. The beauty of being a lefty is that every case is different and the argument you use one day, isn’t applicable to similar circumstances the next day if it doesn’t help you.

From the latter (pp 3-4):

Premised on mistrust of governmental power, the First Amendment stands against attempts to disfavor certain subjects or viewpoints or to distinguish among different speakers, which may be a means to control content. The Government may also commit a constitutional wrong when by law it identifies certain preferred speakers. There is no basis for the proposition that, in the political speech context, the Government may impose restrictions on certain disfavored speakers. Both history and logic lead to this conclusion.

Read that once more, and think about it.  Do you really want the government deciding which entities can have their voices heard, and which cannot?

Besides which, there is a current example of a large and influential block of individuals exercising political speech through their donations that must be very familiar to Mr. Obama and the Democrats, and which was completely unaffected by the restrictions of McCain-Feingold in shaping policy.  This group of individuals was considered at every turn by those crafting the health care legislation.  Their influence likely cost Mr. Obama the chance to ever have "reform."  Their influence was so broad and so deep that the Senate bill that passed catered to their whim.  The provisions that catered to them was the reason why most physicians were against the bill.  It's a large reason why it was so difficult to manage the costs of reform.

I think we know that I'm referring to the trial lawyers, the tort bar.  The unwillingness to cross that bridge is the reason that Mr. Obama and the congressional Democrats can't crow about passing a reform bill, because enough physicians would likelly have supported any bill that had real tort reform.  But so scared were Democrats of losing the support of the deep pockets that finance their campaigns that Howard Dean famously admitted that they couldn't and wouldn't be touched.

So whine all you want about the "evil" of corporations' free speech rights under this ruling.  Then tell me that it's okay that some pigs are more equal than others.

Ted Kennedy's Legacy?

The "legendary" senator from Massachusetts was a proponent of government run health care of the single-payer variety.  Oh, I know, he just wanted "reform" of this heinous system that leaves millions of uninsured Americans (and illegal immigrants) without medical care.  No, actually, that's not right either.  It leaves them without insurance.  They get health care, albeit not as conveniently as those with insurance.  In any event, he wanted single payer.  Let's quote from his convention speech in 1980:

Finally, we cannot have a fair prosperity in isolation from a fair society. So I will continue to stand for a national health insurance. We must -- We must not surrender -- We must not surrender to the relentless medical inflation that can bankrupt almost anyone and that may soon break the budgets of government at every level. Let us insist on real controls over what doctors and hospitals can charge, and let us resolve that the state of a family's health shall never depend on the size of a family's wealth.

The President, the Vice President, the members of Congress have a medical plan that meets their needs in full, and whenever senators and representatives catch a little cold, the Capitol physician will see them immediately, treat them promptly, fill a prescription on the spot. We do not get a bill even if we ask for it, and when do you think was the last time a member of Congress asked for a bill from the Federal Government? And I say again, as I have before, if health insurance is good enough for the President, the Vice President, the Congress of the United States, then it's good enough for you and every family in America.

There you have it.  "National health insurance," complete with wage and price controls dictated in Washington.  The second paragraph I include simply for the amusing child-like innocence on the part of the speaker, and the assumption of a similar innocence in the listening audience.  Could he really have no clue as to what the government (i.e., taxpayers) paid for the health insurance and subsequent care that he received?  Could he really believe that because he is a Senator the government is in control of the finances of the private sector doctors and hospitals he visits?

Well, the ultimate Ted Kennedy legacy may be written next Tuesday: the election of a Republican for what was his Senate seat by the voters of Massachusetts, one who is campaigning with the looming healthcare monstrosity (and his opposition to it) front and center.

"He’s making health care a front-and-center issue in the most liberal state in the country, and it’s working for him,’’ said Whit Ayres, who cofounded Resurgent Republic, a group of conservative pollsters and strategists formed to shape the national debate. “That’s the major message - that this bill is an albatross around the necks of the Democrats, and if it works this well in Massachusetts, just imagine how well it will work in less liberal states."...

He has called for Congress to “go back to the drawing board’’ and come up with a new plan. And he has capitalized on speculation about whether Democrats might try to delay his confirmation if he wins in order to ram the health bill through, stoking concerns about transparency and fairness raised by special deals Democratic leaders made last year to entice fence-sitters to vote for the bill.

“Threatening to ignore the results of a free election and steal this Senate vote from the people of Massachusetts takes their schemes to a whole new level,’’ the Brown campaign said in a recent statement, in a burst of rhetoric that has been typical of his camp. A spokesman for Brown declined to comment for this story.

Polls have the race swinging dramatically to Republican Scott Brown.  A robo-poll from Pajamas Media shows an even bigger gap, one which would be shocking if accurate for a state like Massachusetts.  Jennifer Rubin writes:

Since September, the country has witnessed the visible battle over ObamaCare — late-night votes, Cash for Cloture deals, and a bill that offends a wide array of groups. Democrats have never looked up or paused to consider the public’s views on the matter. They tell us they will “sell it” to us later. That arrogant defiance of public opinion and the unseemly legislative process that produced a grossly unpopular bill have fueled a resurgence of anger and determination among conservatives and even usually apathetic independents. They now are anxious to send a message to Washington: stop ignoring the voters.

Exactly.  Speaking in generalities majorities are in favor of "the government" taking care of people who need help.  Once the majorities see what the nuts and bolts of such a commitment entails with health care those majorities flip, which is precisely what we're witnessing.  The people of Kennedy's own state, now that they see the devils in the details - higher taxes, ballooning federal spending, scarcity in health care, reduced quality, waits and rationing - are realizing that a system that provides quality care to even those without insurance is better than a system designed to insure everyone at, eventually, the cost of that quality.

Senator Kennedy called nationalized health care "the cause of my life."  The people of Massachusetts, now that they see what that entails, may say to forget it.  As for his legacy, it may always have been ... well ...  something else, regardless.

1/17/10 2300: Jeff Jacoby with more:

What Obama and his party delivered, however, was not uplifting and transparent bipartisanship.

It was trillion-dollar increases in government spending. It was party-line votes on 2,000-page bills. It was “cash-for-cloture’’ backroom deals. It was tone-deaf boasts about millions of jobs “created or saved,’’ even as unemployment soared into double digits and millions of American jobs disappeared.

Above all, it was the attempt to force through a radical health-care overhaul that would drive up the cost of medical insurance, slash Medicare by half a trillion dollars, and subject one-seventh of the US economy to government micromanagement...

A year ago, Americans were enchanted with their new president. Today they are suffering from severe buyer’s remorse. Massachusetts may be the bluest state, but voters here are fed up too.

Gruber: Analysis Spiced With Bias

The Politco's Ben Smith reports that MIT economist Jonathan Gruber has been on the government health care analysis payroll, to the tune of about $300,000 this year.

One of the key voices for Congressional health care legislation, MIT economist Jon Gruber, is taking fire from the precincts of the left that oppose the Senate plan over the fact that he is on contract with Department of Health and Human Services.

He's been paid $297,600, according to federal documents, to produce "a technical memorandum on the estimated changes in health insurance coverage and associated costs and impacts to the government under alternative specifications of health system reform." The contract, which was awarded June 19, wasn't widely known or regularly disclosed.

"[D]on’t you think it’s rather, um, dubious that the guy evaluating the heath care reform–for $300,000–is also the package’s single biggest champion? And no one has been transparent about this contract?" writes Firedoglake blogger Marcy Wheeler of the contract, which was first mentioned on DailyKos.

Mr. Smith asked Dr. Gruber about the contracts and appearance of "pay for play," and Dr. Gruber responded that "at no time have I publicly advocated a position I did not firmly believe."  It is obvious when you read his material published in the New England Journal of Medicine that he indeed does firmly believe in what he espouses.  But it's also apparent in reading the articles that his analysis glosses over areas that are major issues in the health care debate with breezily worded dismissals of criticisms.

For example, in a January, 2009 article, "Universal Health Care Coverage Or Economic Relief - A False Choice," Dr. Gruber first leads cheers for the push:

These are exciting times for advocates of universal health care coverage, with sizable Democratic majorities in both houses of Congress and a Democratic president who made universal coverage a central pledge of his campaign.

Sen. Nelson's Late Realization

But perhaps not too late.

Sen. Ben Nelson said Tuesday it was a mistake for the Obama Administration to take on massive health care reforms in 2009, and suggested efforts would have been better spent addressing the economy.

Nelson, who provided the crucial 60th vote to advance the bill toward Senate passage on Dec. 19, has been active ever since trying to explain his actions to Nebraskans. Ads have aired on television and Nelson is making the rounds with the state’s media.

He requested Tuesday’s interview with the Tribune.

“I think it was a mistake to take health care on as opposed to continuing to spend the time on the economy,” he said...

“I would have preferred not to be dealing with health care in the midst of everything else, and I think working on the economy would have been a wiser move,” he said.

Senator Nelson has been underfire both within his very red state and nationally for, well, quite a lot really.  For being the 60th vote for the Senate healthcare bill, for doing so by either getting the other 49 states to pay Nebraska's added Medicaid costs in perpetuity, or getting America to pay all additional Medicaid costs for all states - which would have changed the CBO scoring dramatically, and for "selling" his vote so cravenly on a bill with such enormous impact and importance.  This is an attempt to walk back that vote, and to quiet the criticisms.

There is, of course, a better way to do that.  He could just say no next time he gets the chance.  After all, if it's the worng time to take up health care, he does have it in his power to make that statement more forcefully.

Apt Analogies

As I watch the impending train wreck of payoffs and bribes, double counting, and six years of services paid with 10 years of taxes, of tax increases during an economic downturn and with unemployment still high, of freedoms stripped from Americans, of the threat to healthcare as we in America know it (and we know it pretty well), I thought of two cultural references that captured the moment for me.  The first, from Joni Mitchell and her Big Yellow Taxi:

"Don't it always seem to go, you don't know what you've got 'til it's gone."  The second, from Charlton Heston, featuring a lady friend from France:

I know, American medicine isn't "paradise."  Right.  Just like Churchill's formulation on democracy, it's actually the worst system in the world ... except for all the others.  Although, with the way Congress has approached this issue maybe the American representative democracy ain't all it's cracked up to be.

I hope to have a lot more to say about all this soon, but business has been crazy lately, and with holidays upon us I've been over my head with responsibilities.  But hey, Merry Christmas everyone.

"And Nothing Will Come Between You And Your Doctor"

Barack Obama, speech to joint session of Congress, Sept. 9, 2009:

"I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need."

Senator (and physician) Tom Coburn of Oklahoma, in today's WSJ:

Additionally, the Reid bill depends on the recommendations of the U.S. Preventive Services Task Force in no fewer than 14 places. This task force was responsible for advising women under 50 to not undergo annual mammograms. The administration claims the task force recommendations do not carry the force of law, but the Reid bill itself contradicts them in section 2713. The bill explicitly states, on page 17, that health insurance plans "shall provide coverage for" services approved by the task force. This chilling provision represents the government stepping between doctors and patients. When the government asserts the power to provide care, it also asserts the power to deny care.

When the government fails to pay for unapproved services (note: unapproved, not unnecessary) it of course restricts them.  This is the government standing between you and your physician.  Mr. Obama's statement that "no government bureaucrat or insurance company bureaucrat gets between you and the care that you need" has a different meaning to him than it does to the rest of us.  He clearly means the statement to apply to approved services only.  And in order to determine those approved services it places itself as supervisor ... final arbiter, really ... of  the patient care decisions of a million physicians and their 300 million patients.

What Is Wrong With Congress?

It's actually kind of a rhetorical question.  I think everyone really knows the main thing wrong, and this is a prime example.

What does it take to get a wavering senator to vote for health care reform?

Here’s a case study.

On page 432 of the Reid bill, there is a section increasing federal Medicaid subsidies for “certain states recovering from a major disaster.” 

The section spends two pages defining which “states” would qualify, saying, among other things, that it would be states that “during the preceding 7 fiscal years” have been declared a “major disaster area.” 

I am told the section applies to exactly one state:  Louisiana, the home of moderate Democrat Mary Landrieu, who has been playing hard to get on the health care bill.

In other words, the bill spends two pages describing would could be written with a single world:  Louisiana.  (This may also help explain why the bill is long.)

Senator Harry Reid, who drafted the bill, cannot pass it without the support of Louisiana’s Mary Landrieu.

How much does it cost?  According to the Congressional Budget Office: $100 million.

That's from Jonathan Karl at ABC's 'The Note.'  I'm, sorry to quote it so extensively, but it's necessary I believe.  This is the Senate Majority Leader trying to buy the vote of another Senator with $100M of your (and my) tax dollars.  Oh, sure, we're supposed to feel that this is a selfless act, because it goes to the people of her state and not directly into her pocket.  But the money will be distributed to politcally favored groups, who will no doubt recycle some of it in campaign contributions and support to her re-election efforts, and so it goes.  An endless cycle of legal bribery.

This health care bill will remake one fifth of the US economy.  If it's not worth voting for without this clause, it shouldn't be worth voting for with it, $100M of "walking around money" or not.  The "this is what you have to do to pass legislation argument" doesn't wash.  Either it's a great bill, and it should pass on it's own merits, or it's a lousy bill that doesn't deserve support.  And that's the case regardless of how much of our money Mr. Reid wants to throw to the wavering Senators.

A Lump Of Coal In America's Stocking

Speaker of the House Nancy Pelosi is giving America a Christmas present. (hat tip: Allahpundit at Hot Air, video at Townhall).

First off, isn't her constituency going to be miffed at the use of the term "Christmas?"  Second, looking at the numbers at Hot Air, it seems America isn't terribly receptive of her munificence.  This is no HDTV or Swiss watch.

Honesty Is The Best Policy?

The politics and financial considerations of the Democratic health care reform proposals have become almost mind-numbing, and the people may be right to feel overwrought by the onslaught of plans, amendments, CBO calculation, public options, mandates, triggers, opt-ins and opt-outs, and new taxes in trying to understand what is being handed them.  In situations like this it's often helpful to have a proponent of the effort provide a certain clarity, as the Wall Street Journal points out today.

Mr. Cassidy is more honest than the politicians whose dishonesty he supports. "The U.S. government is making a costly and open-ended commitment," he writes. "Let's not pretend that it isn't a big deal, or that it will be self-financing, or that it will work out exactly as planned. It won't. What is really unfolding, I suspect, is the scenario that many conservatives feared. The Obama Administration . . . is creating a new entitlement program, which, once established, will be virtually impossible to rescind."

Why are they doing it? Because, according to Mr. Cassidy, ObamaCare serves the twin goals of "making the United States a more equitable country" and furthering the Democrats' "political calculus." In other words, the purpose is to further redistribute income by putting health care further under government control, and in the process making the middle class more dependent on government. As the party of government, Democrats will benefit over the long run.

John Cassidy writes for New Yorker magazine, and his article can be read here.  Here we find some other gems, such as this:

The future cost savings that the Administration and its congressional allies are promising to deliver are based on wishful thinking and sleight of hand. Over time, the reform, as proposed, would almost certainly add substantially to the budget deficit, thereby worsening the long-term fiscal crisis that the country faces.

And this:

The Pelosi bill, in particular, wouldn’t do much, if anything, to address the overall escalation in health-care costs...

And about the IMAC, the Independent Medical Advisory Council that would be tasked with restraining costs, he writes:

“By removing some of the political pressure around such reforms,” Romer said in the same speech, “the IMAC would make it easier for improvements to be made year after year.” This statement can only be described as wishful thinking. I hope it will be proved right, but Washington is replete with now-defunct independent bodies and commissions that toiled dutifully, did good work, and made little difference.

Read both, then tell me that the proponents have been completely honest.  It doesn't seem that the reform will magically expand coverage to an eighth of the populace while lowering costs and reducing paperwork, all without restricting the freedom of Americans.

Thomas Sowell Echoes Joust The Facts

First Mr. Sowell today, on the "costs" of healthcare:

There is a fundamental difference between reducing costs and simply shifting costs around, like a pea in a shell game at a carnival. Costs are not reduced simply because you pay less at a doctor's office and more in taxes-- or more in insurance premiums, or more in higher prices for other goods and services that you buy, because the government has put the costs on businesses that pass those costs on to you.

Joust The Facts, October 29, "Creating Scarcity In Medicine The Easy Way":

As a provider, out there trying to keep my own practice alive, pay my employees appropriately and have their own pay keep up with inflation (at a minimum), deal with rising supply costs, rising bureaucracy costs, rising health care costs, and rising overhead, Medicare and Medicaid don't cut it.  Doctors drop Medicare because they can't pay the bills on Medicare patients, and Medicaid pays significantly less.  Scarecrow looks at the governmental macroeconomics of health care reform rather than the effects on medical practices, seeing the forest but missing the trees.  And I think that is what a lot of legislators in Washington are doing, and they're missing the individual trees.  This isn't just a game where if you shift dollars around from pocket to pocket they multiply miraculously.

Mr. Sowell, on physicians in the future:

If doctors' incomes were cut in half, that would not lower the cost of producing doctors through years of expensive training in medical schools and hospitals, nor the overhead costs of running doctors' offices.

What it would do is reduce the number of very able people who are willing to take on the high costs of a medical education when the return on that investment is greatly reduced and the aggravations of dealing with government bureaucrats are added to the burdens of the work.

Joust The Facts, op. cit.:

It's difficult enough to become a doctor, what with an extra four years of school, an extra 3 to 6 years of residency and then fellowship training, and then face the gradual buildup of a practice as your community slowly becomes comfortable with you as the go-to person when they find themselves in need.  If the payoff after all that effort is that you'll annually be at risk of bankruptcy based on which way the country's breezes are blowing, then fewer and fewer bright, motivated individuals will make the effort - and delay their gratification - to get there.

It's good to hear others join my voice in making a chorus.

The Wall Street Journal Echoes Joust The Facts

Today's WSJ editorial: "The Worst Bill Ever"

All of this is intentional, even if it isn't explicitly acknowledged. The overriding liberal ambition is to finish the work began decades ago as the Great Society of converting health care into a government responsibility. Mr. Obama's own Medicare actuaries estimate that the federal share of U.S. health dollars will quickly climb beyond 60% from 46% today. One reason Mrs. Pelosi has fought so ferociously against her own Blue Dog colleagues to include at least a scaled-back "public option" entitlement program is so that the architecture is in place for future Congresses to expand this share even further.

As Congress's balance sheet drowns in trillions of dollars in new obligations, the political system will have no choice but to start making cost-minded decisions about which treatments patients are allowed to receive. Democrats can't regulate their way out of the reality that we live in a world of finite resources and infinite wants. Once health care is nationalized, or mostly nationalized, medical rationing is inevitable—especially for the innovative high-cost technologies and drugs that are the future of medicine. 

Joust The Facts, Oct. 31, "Feigned Disappointment, Thinly Disguised"

The public option doesn't represent "consumer choice" or "competition."  It represents yet another government intrusion in the private market designed to distort and eventually eliminate the private market.  It's 1990 pages of smoke and mirrors, strobe lights, and special effects.  The progressives are feigning disappointment at something that they know isn't the least that could be passed, but the most, and something that they know can later be transformed into what they're after.  Single payer.

Joust The Facts, Oct. 29: "Creating Scarcity In Medicine The Easy Way"

So keep arguing about Medicaid rates, maybe moving them closer to Medicare (gasp!), and shifting costs onto the states by expanding Medicaid (the states love this), or "public options" dictating Medicare rates, or maybe (gasp!) Medicare +5.  In twenty years there'll be a tremendous wait for physician appointments, particularly for specialists, waits for elective surgery like hip replacement, and waits for testing like MRI.  The engineering world may develop some marvelous breakthroughs but nobody will be able to afford them.

Is this the "worst bill ever?"  I don't know.  Read the editorial and see what you think.  There's a lot of competition for the top spot.  Let's just say it'll be the worst bill ever, until the next one.

What About The "Promise" Of Tort Reform?

From President Obama's speech to Congress on health care reform:

Now, finally, many in this chamber -- particularly on the Republican side of the aisle -- have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. (Applause.) Now -- there you go. There you go. Now, I don't believe malpractice reform is a silver bullet, but I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. (Applause.) So I'm proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. (Applause.) I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today. (Applause.)

That was, at the time, all theater as well.  He doesn't really commit to anything except "moving forward on a range of ideas."  Everyone watching, everyone in the room, knew he had no intention of allowing true tort reform, the kind that's been shown to work in, for example, Texas, including caps on non-economic damages.  The wording was designed for people to feel like he understood the problem and addressed the issue, but not to commit to actually doing anything about it.  Sure enough, this is exactly what we have in the House bill.

The health care bill recently unveiled by Speaker Nancy Pelosi is over 1,900 pages for a reason. It is much easier to dispense goodies to favored interest groups if they are surrounded by a lot of legislative legalese. For example, check out this juicy morsel to the trial lawyers (page 1431-1433 of the bill):

Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.

Must.  Help.  Poor.  Attorneys.

10/31/09 1350: A good line from Ed Morrissey:

No one should be the least bit surprised that the same Democratic Party that takes in over 80% of political donations from trial lawyers has attempted to kneecap tort-reform pilot programs in ObamaCare ... Maybe they should just call themselves the Ambulance Chasers Party and be done with it.

Feigned Disappointment, Thinly Disguised

Erica Werner of the Associated Press writes that, darn it, that House health care bill is just way too centrist for the taste of House progressives.  But, gosh, kicking and screaming they're willing to support it, even though it just caters way to much to the concerns of moderates and conservatives.

WASHINGTON – They may not like it, but many House liberals look ready to accept a compromise health care bill, putting Democratic leaders well on the way to delivering on President Barack Obama's call for overhaul.

After claiming for months they couldn't vote for a bill without the strongest possible government-run insurance option, liberals are putting aside their disappointment over the weaker version in the legislation for a historic chance to remake America's medical system.

"The current language is far weaker than what I would have preferred, and I think that is also true of the Progressive Caucus," Rep. Emanuel Cleaver, D-Mo., a member of the Congressional Black Caucus, said Friday. "But because I did not come up here to participate in gridlock and acrimony, I have told leadership that I am willing to compromise."

Obama privately told House liberals they should chalk up a win.

This is theater, and it's not even good theater.  It's a bad off-Broadway farce.  They got what they wanted all along, knowing that single payer was was a non-starter, they got the public option as the camel's nose under the tent.  Once such an entitlement is established they know full well that scaremongering and demagoguery will very likely take it where they want it to ultimately go.  Single payer.

Don't fall for it, moderates.  The public option doesn't represent "consumer choice" or "competition."  It represents yet another government intrusion in the private market designed to distort and eventually eliminate the private market.  It's 1990 pages of smoke and mirrors, strobe lights, and special effects.  The progressives are feigning disappointment at something that they know isn't the least that could be passed, but the most, and something that they know can later be transformed into what they're after.  Single payer.

The politics now work in their favor, if the press continues to report it this way.  Gosh, those progressives really are ready to meet the conservatives halfway, but the "make Obama fail" caucus of Republicans (and moderate Democrats, which will go unmentioned) just has no interest in getting anything done.  Remember that in the minds of the press, bipartisanship exists not when Democrats try conservative ideas (when have they ever?), but when Republicans vote for the most liberal ideas.

10/31/09 0630: And speaking of theater.  Call this one Feigned Excitement.

White House officials announced Friday that they had counted exactly how many jobs were created or saved by recent stimulus spending: 640,329.

Exactly?  Wow.  That must be some precision data.

So how many were saved and how many created? They don’t know.

In a briefing with reporters, officials acknowledged they can’t tell the difference between jobs “saved,” and jobs “created” by the $787 billion stimulus package.

They said they also can’t tell the difference between private sector jobs and government jobs.

And they said that they had found and corrected significant errors in the data submitted in 57,000 separate reports to the federal government by Recovery Act funding recipients

And in the Understatement Of The Year category, the winner is

“The data isn’t perfect,” [Recovery Act Czar Ed] DeSeve said. “Further updates and corrections will be needed.

On further review, I'm pretty sure they'll find 640,330 jobs really is the number.  (via Hot Air)

Creating Scarcity In Medicine The Easy Way

Over at Firedoglake a writer named "Scarecrow" attempts to convince that the 1990 page behemoth House health care bill unveiled this morning doesn't go far enough in expanding Medicaid coverage.  Rarely have I seen something so clueless on the day to day economics of medicine for those who work in the field.  There's a lot of talk about government policy, and all it does is to obscure the issue of service, as in, will it be available?

So, in order to protect private insurers from competition from a lower-cost PO and avoid paying providers Medicare rates plus 5 percent, which Blue Dogs think is too low, the House bill would pay providers even less (or no more*) than Medicare and take more than 3 million people completely out of the private market.

But of course, the market carve-out for Medicaid saves money, which means that if Blue Dogs really wanted to save money, they would enlarge the Medicaid carve out — say, up to 250 or 350 percent of FPL. In other words, if the fiscal-deficit scolds were genuinely serious about reducing the cost of the reform bill, they would expand eligibility to public health care to a lot more people and forget about shielding private insurers from competition.

But then they’d be accused of creating a powerful argument for Medicare for all, and we can’t have that. Because as Joe Lieberman reminds us, those government entitlement programs just increase the deficits — uh, except when they lower them.

Deficit, schmeficit.  Maybe if we cut the rates to half of Medicaid levels we can have years with a surplus!  Scarecrow adds an update; it doesn't help any.

* Update: A provision in the earlier House bills would increase Medicaid payments to match or come close to Medicare payment levels. If this provision is still in the revised bill, it should mitigate concerns that Medicaid payments will unduly discourage providers from treating more Medicaid patients.

Oh, that's much better.  As a provider, out there trying to keep my own practice alive, pay my employees appropriately and have their own pay keep up with inflation (at a minimum), deal with rising supply costs, rising bureaucracy costs, rising health care costs, and rising overhead, Medicare and Medicaid don't cut it.  Doctors drop Medicare because they can't pay the bills on Medicare patients, and Medicaid pays significantly less.  Scarecrow looks at the governmental macroeconomics of health care reform rather than the effects on medical practices, seeing the forest but missing the trees.  And I think that is what a lot of legislators in Washington are doing, and they're missing the individual trees.  This isn't just a game where if you shift dollars around from pocket to pocket they multiply miraculously.

It's difficult enough to become a doctor, what with an extra four years of school, an extra 3 to 6 years of residency and then fellowship training, and then face the gradual buildup of a practice as your community slowly becomes comfortable with you as the go-to person when they find themselves in need.  If the payoff after all that effort is that you'll annually be at risk of bankruptcy based on which way the country's breezes are blowing, then fewer and fewer bright, motivated individuals will make the effort - and delay their gratification - to get there.  Oh, and there'll be vultures circling overhead watching every move, ready to swoop in for their pound of flesh, because we can't have tort reform, either.  Better to go get that MBA or JD and see a light at the end of the tunnel.

Are all the doctors going to leave?  No, because true altruism will motivate some, scientific interest will motivate others, and the fact that medicine is a relatively recession proof and permanent employment will motivate others.  But that won't be enough to replace those who leave and also keep up with a growing population with growing medical needs.  The places that will be hardest hit will be poor areas, and rural ones.

A lot of physicians chose to go into "the family business," as the sons or daughters of physicians themselves.  This is true for me and two of my partners.  And I can tell you that none of us are recommending that our children follow in our footsteps.  Mine are still too young, but of the other two partners none of their six kids have done it.

So keep arguing about Medicaid rates, maybe moving them closer to Medicare (gasp!), and shifting costs onto the states by expanding Medicaid (the states love this), or "public options" dictating Medicare rates, or maybe (gasp!) Medicare +5.  In twenty years there'll be a tremendous wait for physician appointments, particularly for specialists, waits for elective surgery like hip replacement, and waits for testing like MRI.  The engineering world may develop some marvelous breakthroughs but nobody will be able to afford them.  Oh, except for members of congress, because they are special, and the very, very wealthy.  And people (like me) who know doctors in the system, as Gwendolyn pointed out yesterday.  We'll know who to talk to; we'll get to the head of the line.

In The Blues Brothers the leader of The Good Ol' Boys band, whose gig Jake and Elwood stole at Bob's Country Bunker, told Jake when he asked for their union cards that "You're going to look pretty funny trying to eat corn on the cob with no f*in' teeth."  Well, keep punching out the doctors and twenty years from now you're going to look pretty funny trying to get your knee replaced.  Get on the list, and wait.

On the other hand, I guess the good news is that doctors won't be in the upper echelons of income anymore, so they won't have to pay the surtax on the wealthy that'll fund these Medicaid rates.

Would Running One-Fifth Of The Economy Be Child's Play, Then?

The Democratic majority currently in control of the federal government thinks they need to manage one-fifth of the economy, because it's simply not fair for some uninsured American citizens, and because it just costs too darn much.  They'd like you to believe that they have the plan, the experience, the genius to pull this off.

If much smaller responsibilities and programs are an indication, however, there's no evidence that, for our federal overseers, this is anything close to child's play.  Witness the federal first-time homebuyers credit.

It's hard not to laugh when viewing the results of the federal first-time home-buyer tax credit. The credit, worth up to $8,000 for the purchase of a home, has only been available since April of last year. Yet news of the latest taxpayer-funded mortgage scam has traveled fast. The Treasury's inspector general for tax administration, J. Russell George, recently told Congress that at least 19,000 filers hadn't purchased a home when they claimed the credit. For another 74,000 filers, claiming a total of $500 million in credits, evidence suggests that they weren't first-time buyers.

Among those claiming bogus credits, at least some of them were definitely first-timers. The credit has already been claimed by 500 people under the age of 18, including a four-year-old. This pre-K housing whiz likely bought because mom and dad make too much to qualify for the full credit, which starts to phase out at $150,000 of income for couples, $75,000 for singles

The WSJ editorial notes the obvious, something that became apparent with the cash for clunkers boondoggle, that purchases are simply time-shifted, not increased, by such incentives.

While the credit seems to have boosted home sales, many of those sales would have happened anyway and have merely been stolen from the future. Meanwhile, the credit continues to distort the housing market and postpone the day when home prices can find a floor that is a basis for a stable recovery.

So designing a large health insurance program to "compete" in the private insurance market without distorting it, and ensuring that only those eligible to participate are enrolled, and providing timely necessary care and timely payments should be easy, no?

10/29/09 1320: Did I write "cash for clunkers boondoggle?"  Yup.

Well, it’s in how Edmunds crunched the numbers. A valid way to evaluate the program economically, it says, is to look at how many people purchased cars that otherwise wouldn’t have been bought. The firm says that number is about 125,000 cars. By that measure, the government spent $24,000 to generate each sale of a new car.

For comparison, the average price for a new vehicle in August 2009 was $26,915, minus an average cash rebate of $1,667.

In all, the government spent $3 billion on a program that provided cash toward 690,000 car purchases – about $4,348 per car. That makes 565,000 people who got as much as $4,500 to buy a car they would have bought anyway, according to the Edmunds analysis.

Important point, here.  The government, as much as Barack Obama and Nancy Pelosi want to think so, can't create a market, they can only distort one.  And when they do, they do so with taxpayer dollars, and they do so much less efficiently than Adam Smith's invisible hand would.

Mika Channels Monty Python

Anyone recall the tax theories of Mr. Gumby?

Via Newsbusters, Mika Brzezinski looks approvingly at a NY Daily News op-ed from Princeton professor Peter Singer supporting taxes not on people who stand in water, but on things people do that she and Dr. Singer don't like - drinking soda and eating meat.  Here's a snippet - you'll have to read the rest over at NB.

BRZEZINSKI: Some people actually cares about their health, so I'm going to read that for those people. [reading] "A tax on sodas containing sugar has also been under consideration by Governor Paterson, among others."

SCARBOROUGH: Now when we say 'sugar,' do you mean coke, cocaine, or is that code for sugar with Paterson, or is it actual sugar?

BRZEZINSKI: [ignoring Joe, continuing to read] "In view of our obesity epidemic and the extra burden it places on our health care system - not to mention the problems it causes on a crowded New York subway when your neighbor can't fit into a single seat - it is a reasonable proposal." He goes on now to talk about red meat.  And you all need to think about this.

First, it would be helpful to know that Dr. Singer is the father of the animal rights movement, through his book Animal Liberation.  So he'll obviously take a dim view of consuming meat, red or otherwise.  And Ms. Brzezinski wants to talk about the size of the backside of the person on the subway.  So for her benefit I'm going to write this slowly.

You don't become obese because you sometimes drink sugary drinks or eat read meat, or wolf down buckets of popcorn smothered in salt and oil, or because you sometimes like dessert after dinner.  You become obese only if you are consistently on the wrong side of the equation of calories consumed vs. calories burned.  Yes, fat contains more calories per gram weight than either carbohydrates or proteins.  But studies show that it's not the diet but the calories that's the issue.  As for other health issues,  there are advocates for all kinds of diets, but I'll give you a simple one.  Eat fewer processed foods, and more basic foods.  And exercise, because not only does the exercise itself burn calories, it also builds muscle which is more metabolically active in burning those calories even when you're not exercising.

And don't worry as much about the red meat itself as about how much of everything you're eating.

And ObamaCare Would Help How, Exactly?

Reuters has a report of analysis done by an arm of their parent company, Thompson Reuters, discussing problematic wasteful medical spending in the U.S.

WASHINGTON (Reuters) – The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.

The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters, found.

"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.

"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.

"The good news is that by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care."

First, let's look at what the opening paragraph says, which is that if these dollars could be saved it would help pay for Mr. Obama's reform.  What it doesn't say is that if ObamaCare passes then these wasted dollars could be saved and would pay for the reform.  Let's see if any of the money can be saved, if so how, and whether the proposed health reform would have anything to do with such savings.

* Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.

Well, there is absolutely no attempt being made to fix this in ObamaCare.  There is no tort reform being considered, let alone proposed.  The "unnecessary" use of antibiotics can be read as a separate issue in the phrasing above, but is really part of the same defensive medicine.  So let's subtract $250B from our hypothetical $750B, leaving us with $500B in potential savings.  Looks a lot less than before, doesn't it?

* Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.

If we could eliminate Medicare fraud we should already have done so, with or without health care reform.  Passing a reform bill on the premise that such reform will make fraud easier to nail is more wishful thinking.  But let's say they'll pick up 25% of this through , being generous.  So we'll subtract $150B, and now we've got only $350B, of which $50B is likely to be saved.  Now it's even less impressive.

* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.

I've done Medicare and Medicaid paperwork, and it is equally or more inefficient.  The one benefit that these government programs have is that they generally don't do reviews for medical necessity for the surgery I perform, unlike the private insurers.  But I'm sure that will change - how do you think they're going to pick up that $50B of fraud?  Right, more paperwork.  No credit.

* Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.

And you think passing a reform bill will eliminate medical mistakes?  Uh, no.  These can improve, obviously, but never be eliminated, and such improvements can be obtained without a comprehensive reform.  No credit here, either.

* Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.

This is slick wording.  The operative word is "uncontrolled."  Diabetes is not preventable*, but poor control of diabetes can be improved.  Again, though this is something that can be and is being done gradually absent reform. But recall that preventative medicine doesn't necessarily save money, as the interventions of prevention often cost as much as the treatment of the preventable outcome.

Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.

Continuing, and taking the next two together.

"The average U.S. hospital spends one-quarter of its budget on billing and administration, nearly twice the average in Canada," reads the report, citing dozens of other research papers.

"American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than in Canada," it says, quoting a 2003 New England Journal of Medicine paper by Harvard University researcher Dr. Steffie Woolhandler.

Well, Canada is single-payer, government run.  You're not suggesting that the Obama Administration is lying, that they really intend to get us to a single-payer system, and that private insurance will eventually be eliminated, are you?  If the answer is no, then we're comparing apples and oranges here.  And if the answer is yes, then we've got a lot more to talk about before accepting any reform bill.  Interestingly, Dr. Woolhandler is a member of Physicians for a National Health Program, a single-payer advocacy group.

So of the original $750B in potential "savings" that might be gleaned, it would seem that about $50B is the best that ObamaCare can hope to recover.  The rest is either not under consideration (tort reform for defensive medicine), could be done without ObamaCare (Medicare/Medicaid fraud), or would only accrue in a single-payer system that also had tort reform (documentation and paperwork improvements).  In other words, the $800B number is a fantasy, wishful thinking used to push the agenda.

You might as well have sighted a unicorn.

*other than to the extent that obesity contributes to the adult-onset variety.

Which Is A Point I've Been Making About Health Care

Ed Morrissey, once again, this time on executive pay cuts:

And who leaves first?  The people who can most easily find better-paying jobs elsewhere.  Anyone who has worked at a company that attempts to downsize through attrition (or through across-the-board compensation cuts) has experienced this firsthand.  The best and brightest find better-paying jobs elsewhere because they are the best and brightest.  What does that leave behind?  Usually, either people who can’t afford to check out because of their age, or people who simply can’t compete in the open job market because of a lack of marketable skills, accomplishment, or experience.

Now put yourself in a futuristic hospital bed, looking around at the remaining government employees surrounding you.  Yes, even the ones in the white coats...

Taking A Crack At Constitutional Law

No, I'm not a lawyer, but I do play one on my blog.  A reporter for CNS News asked a startled House Speaker Nancy Pelosi today ... well, I'll let them tell you.

The exchange with Speaker Pelosi on Thursday occurred as follows:
 
CNSNews.com: “Madam Speaker, where specifically does the Constitution grant Congress the authority to enact an individual health insurance mandate?”
 
Pelosi: “Are you serious? Are you serious?”
 
CNSNews.com: “Yes, yes I am.”
 
Pelosi then shook her head before taking a question from another reporter. Her press spokesman, Nadeam Elshami, then told CNSNews.com that asking the speaker of the House where the Constitution authorized Congress to mandated that individual Americans buy health insurance as not a "serious question."
 
“You can put this on the record,” said Elshami. “That is not a serious question. That is not a serious question.”

The question, and it is indeed a serious one, is can Congress write a law requiring that an American citizen purchase a good or service?  Under what clause of the constitution does such authority fall?  Because an individual mandate is, make no mistake, a requirement to purchase a service.  Ms. Pelosi and her spokesman don't think this is a serious question.  Here's a defense of their position at Dissenting Justice, discovered at Memeorandum.

The Constitution is written in general terms; only a few provisions define individual rights and governmental powers with precision. To make this point more concrete, I quote from a previous essay on the subject:

It is absolutely absurd to ask whether the constitution specifically or explicitly allows Congress to regulate or reform healthcare. The Constitution speaks broadly and ambiguously. Only a few provisions are specific and beyond dispute (like the age requirement for presidents and members of Congress).

The Constitution does not specifically or explicitly authorize the creation of the Air Force or Medicare, nor does it discuss the federal prosecution of crack cocaine possession. And the "Framers" certainly did not specifically contemplate airplanes, prescription drug and hospital plans for seniors, or crack cocaine because these things were not realities when they wrote the Constitution.

If conservatives only believe Congress can regulate things that are explicitly mentioned in the actual text of the Constitution, then they should essentially advocate the abolition of the federal government. At a minimum, they should seek the immediate repeal of laws banning partial-birth abortion and kidnapping; the Constitution does not mention children or abortion.

And here is the logical fallacy.  The conservatives' concern here is not that something unmentioned in the Constitution is being put in place; rather, the concern is that the freedom of Americans to choose not to participate is being infringed.  I happen to agree that Congress has the authority to create a health care reform design for the nation (though an argument can be fashioned that it is not interstate commerce, in that health insurance does not cross state lines).  I also happen to think it's a bad idea to do so.  But that's not the question.  It is, instead, can Congress mandate participation in that system?

The Constitution doesn't discuss Medicare, but, having set up the system, Doctors and patients are each free to participate, or not.  Yes, that's President Obama's favorite medical center not participating in Medicare.  Such freedom of economic association would be eliminated by the mandate.  This is what the CNS News questioner was getting at, and Ms. Pelosi should have a coherent answer handy next time the topic comes up.  And it will.

So, Glenn, for a physician, how'd I do?  Probably not enough citations of case law and SCOTUS precedents.

10/23/09 1140: Speaker Pelosi could do worse than peruse Randy Barnett at Volokh on the matter.

10/24/09 0950: It seems Ed Morrissey encountered the same straw man argument.

So I’ll ask again: What authority does Congress have to mandate that people buy a product?  What precedent do they have to threaten people with imprisonment if they don’t buy a product merely for existing, as opposed to a prerequisite for accessing public roads as with car insurance?  The reason why Pelosi, Leahy, and Hoyer refuse to answer those questions is because they don’t have an answer to them.

A few brave souls will argue that the “general welfare” clause means that Congress can mandate anything that they see as beneficial, but that misreads the word general – which meant the welfare of the nation as a whole, not a responsibility to make each individual citizen’s life choices for them.  The opposite reading would have made Congress a totalitarian monster, with the executive as its hatchetman, and the founders would have scoffed at such an interpretation.

10/24/09 1215: Thanks for the linkback, Ed.

It's Not What You Ask, But How You Ask It

I tell my daughters, the little jesters, that asking for something nicely is much more likely to land them what they want than belligerently demanding it.  It's not "I'm hungry, get me a snack," it's "Dad, could I have a snack, please?"

Jay Cost explains this principle in relation to polling on the "choice" of a "public option" creating "competition" in health care.

The pollsters are using plenty of "feel-good phraseology." ABC News/WaPo presents the idea that the government insurance plan would "compete" with private insurance plans. This is a contested notion, as Republicans think that the public option will drive private insurance away.

Marist uses the phrase "public option," which has become the conventional term for this insurance reform - but is nevertheless an intentionally constructed phrase designed to garner maximum public support. "Government-run health care" is foreboding, but "public option" is inviting.

CNN uses the phrases "public health insurance option" and "compete."

CBS News/NY Times specifically relates the public option to Medicare, a program that is so popular that Democrats are now thinking about reframing their pitch for the public option as merely an extension of Medicare to all. I wonder if they got that idea from CBS News/NY Times!

Which makes sense.  After all, the Democratic phrasing chosen to sell the public option was poll/marketing tested in the first place.  So repeating that phrasing in the question of course gives responses in favor.  It did before, as well.  Scott Rasmussen is not beholden to looking at things through traditional liberal media goggles, and so starts to dissect out the actual opinions by asking the "what ifs" necessary.

Let's take a look at Rasmussen. He has offered a series of really interesting questions on health care. First, he gives a basic version of the question that ABC News/WaPo, CBS News/NY Times, Marist, and CNN asked:

Would you favor or oppose the creation of a government-sponsored non-profit health insurance option that people could choose instead of a private health insurance plan?

That gets strong approval, as per usual when people hear words like "choose," "compete," and "option."

Then Rasmussen asks this follow up:

Suppose that the creation of a government-sponsored non-profit health insurance option encouraged companies to drop private health insurance coverage for their workers. Workers would then be covered by the government option. Would you favor or oppose the creation of a government-sponsored non-profit health insurance option if it encouraged companies to drop private health insurance coverage for their workers?

What happens when this Republican argument is substituted for the Democratic argument? Support for the public option plummets dramatically. Nearly 3/5ths of all respondents voiced opposition to the public option when it was phrased in this way.

So in political polling it depends greatly on how you ask ... as well as who you ask.  By the way, if you want to know why the "public option" isn't really a "choice" that will "compete" fairly with private insurers, have a look at Doctor Zero's basic course in economics over at Hot Air.

"What Kind Of Fool Am I?"

Stop the world - I want to get off!  From today's Wall Street Journal, discussing the "doctor fix" that failed cloture yesterday.

The doctors lobby said in a statement that it was "deeply disappointed" by the vote, and that "Congress created the Medicare physician payment system, and Congress needs to fix this problem once and for all." If the AMA has any sense at all they'll see that they're being played for fools. (We recognize that this is a rhetorical "if.")

Not this physician-blogger.

Go To Hell, Harry

Sen. Reid wants to blame the AMA for the collapse of  the "deal" on the "payoff" to physicians.

A group of Democrats joined all Republicans in blocking a 10-year freeze of scheduled cuts to doctors' Medicare payments, legislation that was considered important to getting a broader healthcare bill through later this year.

Prior to the 47-53 procedural vote, Senate Majority Leader Harry Reid (D-Nev.) blamed the American Medical Association (AMA) for giving him bad information on the number of Republicans expected to support the measure.

Where to start?  First, the "deal."  These two items should never have been tied together in terms of physician support.  If the members of the Senate want to do the right thing by both Medicare recipients and by those physicians who treat them - and they should - this bill should have been passed a long time ago, with no strings attached.  The old formula, because there were more seniors requiring more services, led to mandatory fee cuts to physicians - cuts which thankfully had been blocked prior to this year, but had accumulated to the point that a 21% Sword of Damocles was hanging over the heads of the docs.  Apparently physicians were supposed to keep the costs down, darn it, by denying medically necessary care to seniors.  Anyone want to volunteer their aging mom or dad for that?

Second, this wasn't a "payoff," this was a threat.  "Support Democratic health reform or we'll let your fees get cut by a fifth."  As if they didn't resemble the mob enough.

Finally, I'm sure he'll sit back smugly in his armchair tonight, secure in the knowledge that he can make those rebellious MD's pay by cutting their fees for next year.  And then he can sit back and explain to seniors why it's so difficult to find a physician to provide them care.

And if the AMA did his bidding?  They'd have gained nothing, abandoning tort reform while still at risk for future cuts if costs rise higher than the reform bills project ... which they most certainly will.

10/21/09 2330: More

The AMA president may indeed have some backbone.

Here's Michelle with the vote tally.

ABC's The Note:

The real question now is how will Doctors, with Republicans and a few Democrats voting against repealing their pay cut, react to the final health reform bill being crafted behind doors by Reid and the White House.

Yes, indeed, that is the question.

10/22/09 1205: Credit Ed Morrissey with the best headline for this episode:

Reid: Those tonsil vultures stole my vote

Buying MD Support

Both the Wall Street Journal, in the lead editorial, and Dana Milbank in the Washington Post address the Democratic Congress/Obama Administration attempt to buy physician support for their vision of health care reform this morning.  First, from Dana Milbank:

Senate Democrats wanted to protect doctors from scheduled cuts in Medicare payments over the next 10 years, but there was a problem: Doing so would add a quarter of a trillion dollars to the federal deficit, making mincemeat of Obama's promise. So Democrats hatched a novel scheme: They would pass the legislation separately, so the $250 billion cost wouldn't be part of the main reform "plan," thereby allowing the president to claim that that bill wouldn't increase the deficit.

Republicans, who had been losing traction in their effort to fight a health-care overhaul, could hardly believe the gift the majority had given them.

"I have never witnessed something more sinister!" an agitated Sen. Bob Corker (Tenn.) declared on the Senate floor Tuesday morning. Citing a report that the "doc fix," as the $250 billion measure is called, was created to buy the American Medical Association's support for the main health-care bill, Corker accused the AMA of prostitution. "We all know that the selling of one's body is one of the oldest professions in the world," Corker said. "The AMA is engaged in basically selling the support of its body."

I like Sen. Corker's metaphor.  It's vivid.  Mr. Milbank demonstrates later that he doesn't quite have a full grasp of the problem of the SGR.

A decade ago, Congress passed legislation designed to limit health-care costs by slowing the growth of Medicare payments to doctors. Each year, Congress passes a "patch" to prevent the cuts from taking effect. Stabenow proposed to make this system "honest" by eliminating the cuts permanently.

Medicare is hurtling toward insolvency, but Stabenow would essentially repeal past cost-cutting efforts. And even granting that it's a good idea not to cut Medicare payments to doctors, it's a strange interpretation of honesty to separate this $250 billion cost from the health-care bill and then claim that the other bill doesn't raise the deficit

Well, which is it?  Are we "slowing the growth" of payments to doctors, or are there actual cuts?  Which refers to the actual fees paid, and which to the global budget?  The short explanation, for Mr. Milbanks edification, is that the SGR was supposed to slow the growth of the overall Medicare budget; to do so the SGR would require cuts in the already bargain basement rates for individual procedures by individual physicians, thus making medicine the only deflationary service industry in the world.

The WSJ comes up with several clever turns of phrase to establish the points.

So now Democrats are simply going to "untether" this spending on doctors from ObamaCare, hiding even more of its true costs. At a meeting on the Hill last week, Mr. Reid and White House Chief of Staff Rahm Emanuel made the quid pro quo explicit, telling the AMA and about a dozen specialty societies that in return for this dispensation they expect them to back ObamaCare, no questions asked.

It turns out the AMA is a cheap date. President J. James Rohack now looks ready to embrace whatever else Democrats offer up, even though the new bill only delays the SGR cuts for 10 years instead of doing away with the formula permanently. Never mind that the AMA's other legislative priority—tort reform—is dead on arrival. ObamaCare is stocked with other provisions that punish doctors ...

Like other industry lobbies, Mr. Rohack seems prepared to trade away his members for a sack of magic beans. ... [T]he least the AMA can do is use its political leverage for something more lasting than a 10-year promise that is bound to be revoked when ObamaCare's costs run off the rails

Again, I can't be bought.  Earlier I tried to emphasize that cost is a bit of a red herring, in that getting the costs right at the expense of the greatness of American medicine is no bargain.  Doing so dishonestly in a way that doesn't control costs would be even worse.  Further, in this instance the AMA certainly doesn't represent me.  They may be willing to trade their support for ObamaCare for short money; I'm not willing to trade it for long money, because of the inherent contradictions that will lead to deterioration of the system.

10/21/09 0905: Hmmmm.  Perhaps the AMA has a backbone, he muses optimistically?

Yet the AMA won't yet pledge support for the major health care bill that is the chief objective of the White House and congressional Democrats, despite a request that several officials say was made at a meeting last week with Senate Majority Leader Harry Reid, D-Nev.

Nor does it seem eager to soft-pedal another of its own top priorities, legislation to restrict medical malpractice payments.

"We continue to press for significant medical liability reform because we know that is a very important contributor to unnecessary health care costs," Dr. J. James Rohack, president of the AMA, said in an interview in which he declined repeatedly to say whether the organization had been asked to back off.

Higher payments to doctors and curbs on medical malpractice awards "in my mind are separate issues. I can't speak for how other people are putting this whole thing together," he added.

A Medicare/Reform Quid Pro Quo? I Think Not

In an earlier discussion of the prospect of finally fixing the SGR payment formula for physicians I wrote that I can't be bought.  That is, I will not be suddenly supportive of a health care reform that threatens to eliminate private insurance over time, ration care, and put patients at risk.

This is nonsense, and I urge my fellow physicians to stand firm.  If this payment fix is passed as it should be, assess the pros and cons of health reform on its own merits, and don't let such a temporary financial fix, one that merely avoids the threatened cuts, influence your decision making.

From The Hill, via Hot Air:

The White House and Democratic leaders are offering doctors a deal: They’ll freeze cuts in Medicare payments to doctors in exchange for doctors’ support of healthcare reform.

At a meeting on Capitol Hill last week with nearly a dozen doctors groups, Senate Majority Leader Harry Reid (D-Nev.) said the Senate would take up separate legislation to halt scheduled Medicare cuts in doctor payments over the next 10 years. In return, Reid made it clear that he expected their support for the broader healthcare bill, according to four sources in the meeting. …

Reid also asked that doctors ease up on demands for medical malpractice reform during the upcoming healthcare debate. Democrats have traditionally resisted calls for tort reform, which trial attorneys — a reliable base group — staunchly oppose.

But the primary focus of the meeting was on Democratic plans to bring to the Senate floor a standalone bill costing nearly $250 billion that would freeze cuts in doctors’ payments mandated by a 1997 law. Without the freeze, doctors would see their Medicare payments drop by 21 percent next year and by 40 percent by 2016. The bill’s costs are not offset by tax increases or spending cuts at a time when the Obama administration estimates the federal deficit at $1.4 trillion.

Look at that last paragraph again.  "Without the freeze, doctors would see their Medicare payments drop by 21 percent next year and by 40 percent by 2016."  Let me give you a few Medicare physician rates, for perspective.  Total Hip Replacement (27130) which removes chronic pain and restores the ability to walk = $1300.  Care for a broken shoulder without surgery (23600) = $250.  Yes, you read that right.  Repairing a bimalleolar broken ankle with plates and screws (27814)= $700.  Remember that all of these include 90 days of aftercare, and all of them can involve considerable risk of lawsuit and/or complication.  Now do the math for a 40% reduction.  Exactly.  And they want us to back down on tort reform, too?

Ed Morrissey has it right.

Despite that little PR stunt in the Rose Garden, doctors mostly oppose ObamaCare, and for very good reasons.  More and more of them avoid Medicare patients, as the reimbursement rates are ridiculously low.  In order to actually get physicians to support the reform, the Democrats had to sweeten the pot.  Reid and the Senate did that in an underhanded, dishonest fashion.

And now we're supposed to get down on our knees to thank Sen. Reid and the Democrats for the munificence of not cutting these already pathetically low reimbursements?  Give me a break.

10/20/09 1720: From the comments at Hot Air:

The pharmaceutical industry has already found out how long these promises last.

Indeed.

Jonathan Alter's Misunderstanding

In truth, it's a very common misunderstanding, so let's spell it out here.  Mr. Alter writes:

The key to a political victory on health care isn't just passing a bill, it's controlling insurance premiums. After much-ballyhooed reform, Massachusetts failed to restrain premiums, which are set to increase another 10 percent next year. If the same thing happens nationally after Obama signs a bill, Americans will take it out on Democrats. So assuring that premiums don't skyrocket should be the No. 1 priority as committee chairs get down to the short strokes.

The best antidote to premium gouging, of course, is a public option.

No.  The key to health care reform, political victory or not, is to prevent health care in America from deteriorating to the detriment of its people.  If care is rationed, technology limited producing waiting lists and elderly shunted into "comfort care" then regardless of the structure, regardless of the costs, America will hold Democrats responsible.  And given that that's what happens in other nations with government systems, there's a fairly high bar for proving that it won't.

Democrats will be much better off approving reforms that preserve what's great about American healthcare even if costs continue to rise than controlling costs while failing to preserve that greatness.  And if the costs are not controlled and healthcare deteriorates ...

I Can't Be Bought

The Senate - now that the Finance Committee has passed the collection of thoughts on healthcare known as the Baucus "Bill" - is looking to a "permanent" fix in the Medicare physician payment schedule.  This is transparently being done to buy physician support for the larger healthcare reform effort, and it's laughable.

As you may or may not know, the last Medicare payment "fix" involved something known as the SGR, for sustainable growth rate formula for determining annual adjustments in provider payments.  The American Academy of Orthopaedic Surgeons has a good summary here.  It was flawed from the moment it was instituted, and has never been fixed.  As a result, every year it calls for cuts in physician payment rates - in an environment where overhead and salaries for employees continues to increase.  Congress has acted annually to block the cuts, but has let them accumulate to the point where, without a fix, next year will call for a 21% reduction.  Oh my.

Now, with health reform on the table, the Democratic Congress and Obama Administration are looking for physician support for their efforts, so they're making an effort to do something that should have been done 10 years ago, and fix the formula.

The Senate is poised to take action on a costly bill to hike Medicare payments to physicians just weeks before bringing a sweeping healthcare overhaul to the floor.

No.  They're looking to prevent the 21% cut.  That's not a "hike" in payments.

Next year, without congressional intervention, Medicare’s fees to physicians would drop by 21 percent. In addition to their desire to prevent those cuts, Democrats are eager to win the support of physicians for healthcare reform. The American Medical Association (AMA) has already endorsed the House healthcare reform bill, which contains a $245 billion payment fix.

See, I told you.  And I'm sorry, but I can't be bought that easily.  And the AMA found out after they came out in support based on that "fix" that most physicians feel the same.  The right thing to do is to fix the SGR formula.  If such a poison pill called for cuts in union salaries at, say, GM and Chrysler they would have fixed it long ago.  But doctors?  We don't give a rat's behind about them.  Until ...

Until they need support for a reform that calls for - I'm not kidding - cutting physician Medicare payments by 25% with no future inflation adjustments.  No doctor should support this based on that alone.  And if you're going to remove that provision, then the CBO better re-score the Baucus "Bill".  I can't be bought.  The Democrats here are actually trying to get something for nothing.  They'll never be able to let the Medicare 21% cut go through as too many MD's would drop Medicare patients, and the seniors - who regularly vote in great numbers - would take it out on them at the ballot box.

This is nonsense, and I urge my fellow physicians to stand firm.  If this payment fix is passed as it should be, assess the pros and cons of health reform on its own merits, and don't let such a temporary financial fix, one that merely avoids the threatened cuts, influence your decision making.

10/15/09 1740: It's not just doctors.  The administration thinks it can buy the support of seniors as well.  Mind you, all of this buying is being done with your tax dollars.

And Sen. Snowe Voted For The Fig Leaf

Via the NY Post:

As others have noted, Baucus used all manner of budgetary gimmicks to oblige the CBO to give him the headlines he needed -- a supposed pricetag of "just" $829 billion over 10 years, with enough other spending cuts and tax hikes to avoid adding to the federal deficit. But the CBO exposed the truth by taking the rare step of calculating what the bill would cost in its second 10 years...

Baucus' most elementary trick was to have the bill's "first 10 years" include several years when it hadn't really kicked in. It was scored for 2010 to 2019, yet it wouldn't be in full swing until 2015 -- when its costs would exceed those of its first five years combined.

In fact, the bill wouldn't cost anything in 2010. In its real first decade (2011-20), it would cost more than $1 trillion..

Also, Baucus' savings are highly suspect. As the CBO notes, his bill would cut Medicare payments to doctors by 25 percent in 2011, then hold them at that level perpetually. In other words, given inflation, Baucus proposes endless cuts in what the program pays physicians and others.

Assuming 3 percent annual inflation, by 2014 doctors' real incomes from Medicare payments would be cut by a third from 2010. By 2025, they'd be cut in half.

And when you fail to reimburse adequately for something, you get less of it.  Tell me, who will spend the 8 to 15  extra years of training to be a doctor?  Will there be enough of them?

I had an interesting conversation yesterday as I was getting my car inspected.  The proprietor of the auto shop is a former patient of mine, very happy after his shoulder surgery.  He is adamantly opposed to ObamaCare, and expressed it as follows.

"Hey, my roots are in Canada, and I've got a lot of relatives still there.  Some of them died waiting for proper care."

Oh, sure, right.  ObamaCare isn't single payor.  Absolutely.  Get ready, America.  It's coming.

10/14/09 1145: Via James Taranto:

Yet another dispatch from the Liverpool Care Pathway, from London's Daily Mail:

A grandfather who beat cancer was wrongly told the disease had returned and left to die at a hospice which pioneered a controversial "death pathway."

Doctors said there was nothing more they could do for 76-year-old Jack Jones, and his family claim he was denied food, water and medication except painkillers.

He died within two weeks. But tests after his death found that his cancer had not come back and he was in fact suffering from pneumonia brought on by a chest infection.

To his family's horror, they were told he could have recovered if he'd been given the correct treatment.

Well, that really is a "Death Pathway."  Bear that in mind as you read this:

"Thank you. And by the way, we're going to have to, if you're very old, we're not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It's too expensive...so we're going to let you die. (emphasis at NewsBusters)

It's all part of the plan, isn't it?

White Astroturf And Public Deception

Yesterday President Obama gave a presentation on health care, backed up by 150 physicians in white coats.  It turns out that, for the cameras, these 150 doctors were given their coats by the Obama stagehands staff.

WASHINGTON -- President Obama yesterday rolled out the red carpet -- and handed out doctors' white coats as well, just so nobody missed his hard-sell health-care message.

In a heavy-handed attempt at reviving support for health-care reform, the White House orchestrated a massive photo op to buttress its claim that front-line physicians support Obama.

A sea of 150 white-coated doctors, all enthusiastically supportive of the president and representing all 50 states, looked as if they were at a costume party as they posed in the Rose Garden before hearing Obama's pitch for the Democratic overhaul bills moving through Congress.

The physicians, all invited guests, were told to bring their white lab coats to make sure that TV cameras captured the image.

But some docs apparently forgot, failing to meet the White House dress code by showing up in business suits or dresses

I don't wear a white coat anymore, preferring shirt and tie with or without sportcoat as my professional appearance.  Apparently a number of these MD's were in the same boat, these "invited guests."  Wow, 150 docs.  That's, like, .015% of the total physician population.  These were members of Doctors For America, the post-election offshoot of Doctors for Obama.

And all this to counter the actual opinions of physicians on this matter.  Recall that Investor's Business Daily poll of physicians that suggested that 45% of physicians would consider quitting or retiring early if the Obama health reform outline passes.  Don't like that one?  Prefer the NEJM poll that some are pointing to?  Some have interpreted that poll to mean that 63% like Mr. Obama's plan.  Let's have a look at the data.

 

The doctors answered the following question.

Survey respondents were asked to indicate which of three options for expanding health insurance coverage they would most strongly support: public and private options, providing people younger than 65 years of age the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans; private options only, providing people with tax credits or subsidies, if they have low income, to buy private insurance coverage, without creating a new public plan; or a public option only, eliminating private insurance and covering everyone through a single public plan like Medicare.

There are several points worth making.  First, only 9% favor single payer.  Nine percent.  Three times as many favor private-only options.  Second, the group that chose the middle response (which biases the poll as many people when given three choices will choose the middle ground so as not to appear extreme) didn't answer the more pertinent question, which is "Would you favor a government option for health care reform if such a device eventually led to single payer government health care?"  That's what the plan's architect, Jacob Hacker of Yale, insists is the purpose of the public option.    And there are an awful lot of people who intend for the public option to lead to single payer.  I submit that such a question would have a significant dropoff in support.

For evidence, I give you the Million Med March.  No, it wasn't anywhere near a million, as it was held on a Thursday, and hey, we work for a living.  But there were a heck of a lot more than 150.

Oh, and, by the way, Jacob Hacker isn't just in the political science department at Yale.  He's on the board of Doctors for America.

Red Flag Rules And The Senate

"What are the so-called Red Flag Rules," you ask?

As many as nine million Americans have their identities stolen each year. The crime takes many forms. But when identity theft involves health care, the consequences can be particularly severe.

Medical identity theft happens when a person seeks health care using someone else’s name or insurance information. A survey conducted by the Federal Trade Commission (FTC) found that close to 5% of identity theft victims have experienced some form of medical identity theft. Victims may find their benefits exhausted or face potentially life-threatening consequences due to inaccuracies in their medical records. The cost to health care providers — left with unpaid bills racked up by scam artists — can be staggering, too.

The Red Flags Rule, a law the FTC will begin to enforce on August 1, 2009, requires certain businesses and organizations — including many doctors’ offices, hospitals, and other health care providers — to develop a written program to spot the warning signs — or “red flags” — of identity theft. Is your practice covered by the Red Flags Rule? If so, have you developed your Identity Theft Prevention Program to detect, prevent, and minimize the damage that could result from identity theft?

So the FTC has deputized my office to help identify identity thieves, with a formal system to flag possible violators.  This, I'm sure, saves the government quite a bit of money in the enforcement divisions.  My office will be in the position of needing to verify with each and every patient that they are who they say they are, and that they have the insurance coverage they say they have, and that their method of payment is their own, and not through a stolen credit card or falsified insurance information.

(pause for effect)

The Senate Finance Committee, on the other hand, doesn't think much of these red flag rules, or rather, doesn't think they should apply when obtaining coverage under a government-run plan/cooperative/marketplace.  A simple requirement for a photo ID - which doctor's offices must now request from each patient who registers with us - does not apply when registering for the insurance plan in the first place.  Deputizing physicians' offices to root out identity thieves and insurance fraud - good. The government rooting out identity thieves, insurance fraud and those not eligible for benefits - bad.