The Doctor is "out"

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Quietly, right before the Thanksgiving weekend, Dr. Donald Berwick, President Obama's recess appointee to be the HMFIC of the CMS (Center for Medicare and Medicaid Services) tendered his resignation. Berwick is infamous in these parts for being a strong proponent of ObamaCare and a huge fan of Great Britain's National Health Service. (BwD word search for Berwick, here. Damn, we love this guy).

The spin from the legacy media is that Republican obstructionism kept Berwick from being confirmed when, in fact, Berwick was never submitted for confirmation. That's odd because we can't imagine the President would believe that Berwick would have any problems defending any of these quotes in a public forum to the American people:

"It's not a question of whether we will ration health care. It is whether we will ration with our eyes open."

As you will see later, Berwick's "we" is not the fraternal, royal "we", rather a much more exclusive "we".

"Traditional medical ethics, based on the doctor-patient dyad must be reformulated...The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized individualized decision making."

Step aside Mr. Individual. There are cost curves to be bent downward.

Good god, the statist-Left have become budget hawks.

"For-profit, entrepreneurial providers of medical imaging, renal dialysis, and outpatient surgery, for example, may find their business opportunities constrained."

You can pretty much kiss medical innovation good-bye because innovation costs money (with the hope of a return (see also, evil profits)) and we now worship at the altar of cost containment.

"A progressive policy regime will control and rationalize financing—control supply."

The man is absolutely obsessed with rationing. And how is controlling supply which limits choice for the consumer/patient a good thing? We thought the idea was to bend the cost curve downward which comes as a result of more competition on the supply end. Unless, what they are really concerned with is controlling, ahem, demand, in a back-door manner.


And then there is this:

"Please don't put your faith in market forces," said Berwick. "It is a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can do. I do not agree. I find little evidence anywhere that market forces, bluntly used, that is, just consumer choice among an array of products with competitors' fighting it out, leads to the health care system that you want and need. In the US, competition has become toxic. . . . Do not trust market forces to give you the system you need. . . . I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do." Berwick, as head of CMS, sought to be one of these "leaders with plans."

Translation: "You're too stupid to make health care decisions for yourself and your family. That's why people like myself and others in the benevolent ruling class are here to figure it all out for you."



Berwick has a point, though: our current healthcare system is so byzantine and so divorced from cost-price transparency, it's almost as if we need diviners' of Berwick's obviously massive intellect to guide us. Unfortunately, if you have been following this blog for any length of time, you know the 2,200 page ObamaCare has not only done nothing to improve the situation but will only perpetuate an increasingly hopeless situation.

At the end of the day, the quotes above reveal Berwick to be a dangerously un-democratic individual. Those are not the words of a man who believes in self-determination, individual choice or free will: American values, all. He is collectivist autocrat drunk on the assumption of his own moral and intellectual superiority who worships at the altar of the state.

There was no way in hell this guy would survive a confirmation hearing and worse, a public confirmation hearing would lay bare many of the counter-intuitive and completely bogus underpinnings that justify and rationalize ObamaCare. Rather than being rode out of town on a rail as he should, it figures that the President let this loser slip out of town under cover of darkness just ahead of a holiday weekend.



Good riddance.

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When health care really isn't about health

Want to know what ObamaCare is going to look like? Look no further than its predecessor, RomneyCare in Massachusetts which only 4 years after being signed into law is unraveling at the seams.

Back in April, the Massachusetts insurance commissioner rejected 235 of 274 premium increases that state insurers had submitted for approval as the carriers said these increases were needed to cover unexpected claims, as underlying Mass. health care costs continued to rise annually at an 8% clip (but, didn't they tell us government-managed health care would bend the cost curve downward?)

Now we learn that the state's 5 major insurers have, so far, collectively lost $116 million due to a rate cap imposed upon them by fiat. And no amount of demagoguing the evil insurance industry is going to prevent rates from continuing to climb as long as the imposition of an ever-increasing regulatory regime is calling the shots in the health care industry.

But, they told us that government-managed health care would contain costs?

They may have said that and they may have even believed it but that's not what they are really pursuing. Though ardent ObamaCare supporters will swear up and down that rationing is simply not a component of ObamaCare, the very people who will be administering ObamaCare keep slipping up by exposing their true intentions.

"If you're going to do health-care cost containment, it has to be stealth," said Jon Kingsdale, speaking at a conference sponsored by the New Republic magazine last October. "It has to be unsuspected by any of the key players to actually have an effect." Mr. Kingsdale is the former director of the Massachusetts "connector," the beta version of ObamaCare's insurance "exchanges," and is now widely expected to serve as an ObamaCare regulator.

He went on to explain that universal coverage was "fundamentally a political strategy question"—a way of finding a "significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less.' And that's the challenge, how to do it. It's like we're waiting for a chain reaction but there's no catalyst, there's nothing to start it."

(italics, ours)

We don't know what Kingsdale would call that but we sure do.

And check out this short video clip (H/T: Left Coast Rebel) on Obama's freshly-minted recess appointment to head up Medicare and Medicaid, Dr. Donald Berwick:



Again, once you declare a particular goods and service a "right" you will be paying through the nose for it.

And how about "holding politicians accountable"? We currently have Congressmen refusing to meet with their constituents at town halls and other public meetings because of the hell they know they are going to catch because of ObamaCare. Is Berwick referring to that kind of accountability?

And then the money quote: "Health care is by definition redistributional". We're thankful for two things right now: These egg-head seminars and Youtube without either of which would we be able to hear people like Berwick lettin'er rip and exposing their true intentions.

By their own words, Berwick and Kingsdale, the very people who will be running ObamaCare, admit that the quality of individual care is not a priority but rather the degree of equality of care. If the degree of individual quality of care suffers and suffers greatly under ObamaCare as a result of rationing or price controls (rationing by proxy), as long as everyone has equal access to the same crappy health care then health care can be declared a success.

Don't believe us. Just take it from Berwick and Kingsdale.

Specially reserved language

Who's up for some more Dr. Donald Berwick quotes (the man who will be running Medicare and Medicaid)?

Here's Berwick on British socialized medicine:

"I am romantic about National Health Service. I love it (because it is) 'generous, hopeful, confident, joyous and just.'"

The only adjective you should be using in favorable terms to describe a bureaucracy is "coldly efficient". However, you know you are in for interesting times when a high level appointee eschews this guideline to the point that you feel he's springing a wee bit o' wood.

And here's Berwick on the Brits' NICE (National Institute for Clinical Excellence):

"It acts as a comparative-effectiveness tool for the National Health Care Service, comparing various treatments and determining whether the benefits the patients receives - SUCH AS PROLONGED LIFE - are cost-efficient for the government" (lifenews.com, May 27).

(emphasis, ours)

Now, what is it you suppose that this NICE does, in effect? In case you are having some difficulties in figuring it out, let's let the good doctor, himself, explain:

"It's not a question of whether we will ration health care. It is whether we will ration with our eyes open."

We're not quite sure what that eyes open thing is all about but what we think Berwick is stating about ObamaCare is that there will be rationing. Just a thought.

Again, all the protestations from the Obamabots railing against the usage of terms like "rationing" and "death panels" aside, one only need to look at the language of those who will be administering it to see they are saying the same thing in both explicit and implicit terms.

Paging Dr. Berwick

It would appear that Dr. Donald Berwick's (President Obama's pick to head Medicare and Medicaid) beloved British health care system is in some trouble.

Some of the most common operations — including hip replacements and cataract surgery — will be rationed as part of attempts to save billions of pounds, despite government promises that front-line services would be protected.

How would you describe what is happening in the paragraph above? We think it's reasonable to assume given the language that is used and given the specific action that is taken to achieve the desired result, what is happening in that paragraph is "rationing".

Patients’ groups have described the measures as “astonishingly brutal”.

Eye surgery could delay hip operations An investigation by The Sunday Telegraph has uncovered widespread cuts planned across the NHS, many of which have already been agreed by senior health service officials. They include:

* Restrictions on some of the most basic and common operations, including hip and knee replacements, cataract surgery and orthodontic procedures.

* Plans to cut hundreds of thousands of pounds from budgets for the terminally ill, with dying cancer patients to be told to manage their own symptoms if their condition worsens at evenings or weekends.

* The closure of nursing homes for the elderly.

* A reduction in acute hospital beds, including those for the mentally ill, with targets to discourage GPs from sending patients to hospitals and reduce the number of people using accident and emergency departments.

* Tighter rationing of NHS funding for IVF treatment, and for surgery for obesity.

* Thousands of job losses at NHS hospitals, including 500 staff to go at a trust where cancer patients recently suffered delays in diagnosis and treatment because of staff shortages.

* Cost-cutting programmes in paediatric and maternity services, care of the elderly and services that provide respite breaks to long-term carers.

Again, rationing, delays, cuts, job losses, cost-cutting programs, reduction (of services), closure(s), not our words but theirs used to describe the inevitable results of government-managed health care.

When you declare particular goods and services as a right, why should it surprise anybody when those rights to which everyone is entitled start costing far more than they would if they were subject to market forces?

The nerve of the British pols to start denying British citizens their "rights".

Perhaps the Senate confirmation hearings for Dr. Berwick will provide the appropriate platform to get his reaction to what is happening over in England and to explain how it is the same thing will not be happening over here.

All your health care are belong to us Pt. II

If you were to come up with reasons as to why to be very troubled regarding the coming of ObamaCare, you can go to fine places like the Heritage Foundation or the Cato Institute, both of whom (among others) which have been doing yeoman's work in compiling studies and figures debunking the claims of ObamaCare supporters.

But why go through all the trouble when one of the chief players in administering ObamaCare, the recess-appointed Dr. Donald Berwick, gives you all the ammunition that you need.

Dr. Berwick, the floor is all yours (Pt. I is here):

"A progressive policy regime will control and rationalize financing—control supply."

The man is absolutely obsessed with rationing.

"The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property."

Again, you're too stupid to figure out complicated stuff like health care. Let "the machine" do it for you.

"And it's important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, social justice, employment, and the like."

"Hence, those working in health care delivery may be faced with situations in which it seems that the best course is to manipulate the flawed system for the benefit of a specific patient or segment of the population, rather than to work to improve the delivery of care for all. Such manipulation produces more flaws, and the downward spiral continues."

It's not really about "health" at all but rather about nearly every damn thing else. It's time to embrace the notion that ObamaCare really isn't about providing excellent health care but instead providing crappy health care as long as its provided equally.

We don't want to hear any static when we use the terms "rationing", "regime" and yes, "fascist" when describing ObamaCare when the big dogs of the ObamaCare regime use the exact same language or describe their vision of ObamaCare in manner that is synonymous with our chosen terms.

Again, a shout-out to our liberal friends and supposed fans of ObamaCare. Is Dr. Berwick's vision of health care in this country similar to yours?

Don't look now, it's already here.

File this one under, "We told you so", or perhaps more aptly, "He told you so" because if you didn't want to believe us or perhaps thought we were engaging in hyperbolic fear-mongering, we would've directed you to the musings of one Dr. Donald Berwick who has quite a bit to say on the subject of rationing.

And even then, if perhaps you thought the man's apparent affection towards rationing was taken out of context or otherwise distorted to make a point, well then...

A decision to rescind endorsement of the drug would reignite the highly charged debate over US health care reform and how much the state should spend on new and expensive treatments.

Avastin, the world’s best selling cancer drug, is primarily used to treat colon cancer and was approved by the US Food and Drug Administration in 2008 for use on women with breast cancer that has spread.

It costs $8,000 (£5,000) a month and is given to about 17,500 women in the US a year. The drug was initially approved after a study found that, by preventing blood flow to tumours, it extended the amount of time until the disease worsened by more than five months. However, two new studies have shown that the drug may not even extend life by an extra month.

The FDA advisory panel has now voted 12-1 to drop the endorsement for breast cancer treatment. The panel unusually cited "effectiveness" grounds for the decision. But it has been claimed that "cost effectiveness" was the real reason ahead of reforms in which the government will extend health insurance to the poorest.

The FDA is charged with determining the "effectiveness" of a drug not its "cost effectiveness". A wild assumption, we realize, that "cost effectiveness" is best determined by an open and transparent market place.

For those of you out there that would say the article gave scant evidence that "cost effectiveness" was the actual reason the FDA shot down Avastin, that would not be an unfair critique. However, given the cravenly cynical and hyper-political manner in which ObamaCare was Bush-Pushed across the finish line and what proponents like Berwick, who will be in charge of running Obamacare, have flatly stated about rationing and comparative effectiveness boards, why on earth would we give these unaccountable and politically-manipulated bureaucrats the benefit of the doubt?

We see no reason to so, yes, we will be embracing our inner cynic towards any and all matters related to healthcare in a constant effort to remain ungovernable.

They're ba-aack...

After being dropped from text of ObamaCare, the controversial and supposed "death panels" section looks to be making a comeback via the regulations-writing process.

When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.


Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.

"...achieve the same goal by regulation."

Yet another kick in the nuts for those Blue Dogs who voted for this monstrosity.

So, it's not actually part of ObamaCare but will be part of ObamaCare anyway. And don't let anyone know about it.

Back in August of last year, we sunk our teeth into the infamous Section 1233 to see if, in fact, there were any "death panels" lurking about. Here are a couple of salient bits from our analysis:

Executive summary: Although our review of Section 1233 does not turn up any “death panels”, the language in that section contains enough wiggle room for these “counseling” sessions to produce unsavory situations and outcomes because of the inevitable rationing that will come with government-managed healthcare.

and this:

Conclusion: First and foremost, this legislation, because of the Byzantine fashion in which it is written should be opposed on principle alone. Well, all legislation is written in that manner. Perhaps, but we all reserve the right to be smarter than we used to be and nothing this important should give someone a headache while trying to read it, let alone interpret it.

So while there does not appear to be a death panel, per se, the vague manner in which the language is crafted leaves plenty of wiggle room for physicians to steer patients towards decisions that would lead to a lessening of treatment(s), malnourishment, dehydration and a cutback on anti-biotics.

And if you believe, as we do, that government-managed healthcare will lead to shortages and thus the eventuality of rationing, one can connect the dots to see where this is all going.

And it's not just us down here in the fever swamps of the blogosphere who believe that O-Care will eventually lead to health care rationing. Dr. Donald Berwick, the HMFIC of Medicare and Medicaid not only believes it but appears to be a big fan:

"It's not a question of whether we will ration health care. It is whether we will ration with our eyes open."

And it's because of this, we found the following quite amusing:

Mr. Blumenauer, the author of the original end-of-life proposal, praised the rule as “a step in the right direction.”

Here's a portion of an email from Blumenauer to his peeps:

The e-mail continued: “Thus far, it seems that no press or blogs have discovered it (ed.: uh-oh), but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”

In the interview, Mr. Blumenauer said, “Lies can go viral if people use them for political purposes.”

While we (the royal "we") have been accused of spreading misinformation and lies regarding ObamaCare, we've taken a look back at our criticisms of ObamaCare and have concluded that our biggest guns, our strongest arguments against ObamaCare have come directly from the mouths of its biggest supporters and the very people charged with executing, er, administering ObamaCare - people like Berwick, the Secretary of Health and Human Services, Kathleen Sebelius, and the President himself.

And to think that they firmly believe the current unpopularity of ObamaCare is due to a "messaging" problem. Keep yakking, people, keep yakking.

All your health care are belong to us Pt. III

The hit machine that is Dr. Donald Berwick (President Obama's hopeful for heading up Medicare and Medicaid and who will now be subject to Senate confirmation) keeps on rolling (Pts. I and II can be found here).

If the terms "rationing", "regime" and fascist pig somehow offend you with respect to ObamaCare, we suggest you listen to the man himself.

Doc?

"For-profit, entrepreneurial providers of medical imaging, renal dialysis, and outpatient surgery, for example, may find their business opportunities constrained."

You can pretty much kiss medical innovation good bye because innovation costs money (with the hope of a return (see also, evil profits)) and we now worship at the altar of cost containment.

"One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early."

We love showing this quote and those similar made by other ObamaCare acolytes to women in our age group who have benefited from early detection. Let's just say that their reaction is usually less than favorable.

"I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care."

"Health care has taken a century to learn how badly we need the best of Frederick Taylor [the father of scientific management]. If we can't standardize appropriate parts of our processes to absolute reliability, we cannot approach perfection."

"Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy."

"Political leaders in the Labour Government have become more enamored of the use of market forces and choice as an engine for change, rather than planned, centrally coordinated technical support."

"The U.K has people in charge of its health care—people with the clear duty and much of the authority to take on the challenge of changing the system as a whole. The U.S. does not."

Translation: All your health care no longer belongs to you. That physician-patient relationship? Forget it. Standardization is simply code for rationing. Rationing of medical goods and services that have passed through the bureaucratic wickets of Berwick's "people" who will, with missionary zeal, enforce equality over quality.


Follower update: Nickie Goomba and What Makes Us Right are in the house.

The Doctor will see you now

Here's B-Daddy on end-of-life counseling:

The left is on the defensive over federal funding to incentive doctors to counsel patients to forgo aggressive end of life treatment, aka "death panels." I am not arguing that doctors shouldn't have a discussion about end of life treatment and patients make their wishes known ahead of time rather than in extremis. Good planning is good planning. But here is why I object to the regulations:

Yes. We're teases. Go here for the rest.


We don't think anyone denies that having the "sit down" with the doctor to map-out what you would like done in end-of-life scenarios is a good thing.


However, as Dr. Donald Berwick, HMFIC of Medicare and Medicaid services comes barging into the room...

"Traditional medical ethics, based on the doctor-patient dyad must be reformulated...The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized individualized decision making."

How does that inspire any confidence? How does that convince anyone that this law that was fashioned in such a haphazard and slap-dash fashion is truly concerned with the quality-of-life of the individual rather than bowing before the new statist god of controlling costs?

Good lord, they've become budget hawks!


Beers with Demo new follower update: Karsten Ray is in the house. Welcome, Karsten!

All your health care are belong to us

For those of you who continue to insist that ObamaCare will not intercede in the relationship between the physician and the patient nor will it entail the rationing of services, we bring you some more quotes from the man who will be running Medicare and Medicaid, the effective ObamaCare Czar, Dr. Donald Berwick:

"I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do."

"You cap your health care budget, and you make the political and economic choices you need to make to keep affordability within reach."

"Please don't put your faith in market forces. It's a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can."

"Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs."

(italics, ours)

Translation: You are too damn stupid to figure out this stuff for yourself. In fact, only people like me should be calling the shots with respect to you and your family's health care. Your silly notions of free markets and individual choice are completely irrelevant under this regime. Get used to it - I think you'll learn to like it.

We try to stay away from formerly-incendiary language that is now warmed-over and meaningless but how can you read those quotes and not come to the conclusion that the guy is a stinking fascist pig? The icing on the cake is the fact that this guy is a recess appointment... not even subject to an up or down vote by the Senate. Fitting, no?

So, again, where are the good-government liberals? Where are our pro-choice friends who used to march around in "Keep your laws off my body" t-shirts and declare any intervention into the physician-patient relationship by the government as an evil to be avoided at all costs? Did you all really mean it or was it just a highly selective ideology and battle cry reserved expressly for the unfettered right to abort the unborn?

The silence is deafening.

More to follow.

Owning it

Health and Human Services Secretary, Kathleen Sebelius, on portions of the health care bill that suck: Don't blame me...

Dozens of politicians got elected on Nov. 2 by calling the health care overhaul laws passed in March a "government takeover," but its implementer-in-chief characterized the laws as a public-private partnership with the business community in a speech Monday.

Speaking to the National Business Coalition on Health's annual meeting, Health and Human Services Secretary Kathleen Sebelius said most of the key concepts in the unpopular law originated in private business' attempts to cut health care costs and improve worker health. And she asked for continued help.

"We know that the business community is among the best innovators when it comes to prevention and wellness, and we want to give you the support you need to build on those efforts and share those best practices," she said.

(italics, ours)

In a horribly lame attempt to shift blame, did she more or less just admit right there that it was lobbyists that wrote large portions of the bill?

And then immediately after throwing them under the bus for doing such a lousy job, she actually solicits more help from these same people. Unreal.

Yep, we're in the very best of hands.


P.S. Related: Obama's pick to head up Medicare and Medicaid, Dr. Donald Berwick and his love affair with the collapsing-under-its-own-weight British healthcare system will be up on the Hill tomorrow for hearings

Dumbing down evil (UPDATED)

Whatever happened to grand evil? What happened to those who wanted to purify the human race through mass slaughter or those who wanted total world domination at the end of a bayonet? How sad our evil has become, how trivial. Where Margaret Sanger, the foundress of Planned Parenthood wished to eliminate the feedleminded through eugenics, the highest ambition of that organization is now to help us rut like hogs in a sty.

That from KT, our favorite moral scold, who has more on the sorry state of current affairs and how utilitarianism just isn't as sexy as it used to be.


(UPDATE #1):
File this one under: "Why blog when others are more capable than you". We liberated the below from the comment section. From KT:

ligneus left a comment on that post that brought up the issue of partial birth abortions and babies that survive abortions and Obama's position on both.

I'm considering a follow-up on that post, but I need to wait at least a day before I do it. Instead, I'll ask the question that's rolling around in my head right now:

What are we getting in exchange for jabbing babies' heads with scissors, sucking out their brains and crushing their skulls? Seriously, what are we buying with this? There are some great photos of an SS division preparing to smash the Warsaw ghetto out there on the 'net. At least the SS were trying to make the world safe for the Aryan master race. What are we buying when we let semi-aborted babies die alone in a laundry room because we don't want anyone to help them?

If you're going to sell your soul, shouldn't it be worth more?

Thanks for the link.

We'll take a crack at it: Um, we have no earthly clue.

The public face, at least, for justifying partial birth abortion is that restrictions on partial birth abortion are the proverbial camel's nose under the tent of abortion rights as a whole. If they won't let us puncture the skulls of the unborn and suck the brains out with a medical shop-vac then what other evils will be visited upon us by the conspiratorial religious-right?

But the statist-Left claim to personal autonomy and choice was always highly selective to begin with and that preserving unfettered partial birth abortion was the battle they fought the most ferociously was always mildly bizarre at best.

And now the statist-Left has forfeited any sort of ahem, moral high ground regarding personal autonomy/choice with their support of the passage of ObamaCare. Your healthcare is no longer yours but that of the stewardship by the likes of Dr. Donald Berwick.

So, no. We don't have a rational explanation either except for perhaps complete ideological inconsistency and/or hypocrisy. Perhaps in his third autobiography, the President and owner of a AAA rating from NARAL while a Senator can explain it to us.

Imagine the fits of rage some folks will be in when abortion services become rationed, as well, in order to bend the cost curve downward.