Word of the day

Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing. Rationing.




OMB Director Peter Orszag continues the "quality vs. quantity" meme.

But get used to the reality of this IPAB, "Independent Payment Advisory Board" which will not be very independent nor will it be advisory as it will take 67 votes in the Senate to override their "recommendations".

Instead of letting medical procedures or drugs stand or fall on their own merits of cost effectiveness, this politically appointed board of bureaucrats will be playing judge, jury and executioner serving the statist god of "controlling costs" in the healthcare industry.

Exit question: With this IPAB in place and calling the shots with respect to what medical procedures, instruments and drugs are allowed to be brought to market, do you now think lobbying by medical and pharmaceutical firms on the Hill will be any less?

L.A. Times: How we stopped worrying and learned to love rationing.

Under the Democrats' bills, rationing reimbursements would still be indirect. The vast majority of people would keep the same insurance they have now, whether they like it or not. The main change, aside from making insurance almost universal, would be an incremental shift in decision-making power, taking a bit away from insurance companies and giving it to the federal government. With luck, that will mean more transparency when decisions are made, maybe even a little more accountability. Under "Obama-care," if we don't like the way our health insurance is run, we can vote the rascals out. We can't do that to Blue Cross, Aetna or United Healthcare.

(emphasis, ours)

No, Doyle McManus of the L.A. Times actually said that. This entire health care reform legislative charade has been nothing more than a cautionary tale in the opaqueness of committee wheeling and dealing. But we're supposed to accept one of the 5 versions of health care reform currently floating around Capitol Hill in some vapor bill form or another because with luck it will mean more transparency when decisions are made.

The larger point of the article is that since we have rationing in health care we should just deal with it and, you know, accept even more because it’s the government doing it or something. We do indeed have de-facto rationing in healthcare because we have de-facto rationing on every goods and services we purchase. We’d love a new car every year but it ain’t happening because our finances dictate that we cannot afford a new car every year.

We’re currently rationing ourselves to a new car once every 10-15 years or so. We’ve been able to stretch out this acquisition cycle a bit because we made a sound investment up front and followed an out-of-pocket maintenance schedule that will, with luck, squeeze every last mile out of our beloved hoopdie. This is how things work in the real world.

And this is the dirty secret that the healthcare reform proponents don’t want to cop to: Healthcare costs money, plain and simple. You can wave your magic universal healthcare wand and give everybody coverage but that is going to result in some unsavory consequences. One of those consequences being it will disincentivize the medical technology field from developing new products and procedures because the government has deemed them to be non-cost effective.

Unfortunately, what the free market does now anyway in weeding out non-cost effective technologies which we wrote about here and here will be performed by an entity ill-suited to do the same.

Obamacare myths and contradictions

The big argument in favor of Obamacare: while the legislation is flawed it has to be passed as it will improve on the existing healthcare system and just like Social Security, Medicare and Medicaid it will get better and better over time. For legislation that will nationalize 1/6th of the economy and will most certainly dictate the terms and quality of your health care, how’s that for a closer?

Unfortunately, the aged-like-fine-wine conjecture is not extended to medical innovations. In the mind of the statist, a horrendously expensive and inefficient bureaucracy’s start-up costs must be ignored because the bureaucracy will most certainly wind up even more horrendously expensive and inefficient.

However, medical innovations that may be prohibitively expensive when first brought to market must be banned or rationed because of that expense, ignoring the fact that, if effective, capital will flow to fund further development of that technology in order to bring the costs down thus making it more affordable across the board.

Recall there was a time when polio vaccine was prohibitively expensive. How would you like a world where that vaccine was rationed, or worse, never allowed to come to market. The statist mindset, however, is not pliable enough to understand the rationalities of market forces and that is why Obamacare will be a complete disaster.


We purchased a 42” plasma hi-def television 5 yrs. ago for $4200. Just this past July, we purchased a state-of-technology LCD which represented a simultaneous leap in technology and quality as well as energy efficiency for $1800 (and if we we’re more “shoppers” than “buyers”, we probably could’ve got an even better deal).. So, in a span of 5 short years we purchased a technically superior and more environmentally friendly product for nearly 60% less. And one sees the same dynamic in computers and cell phones, as well.

Technological innovation happens.


Unfortunately, as we pointed out above, the statist mindset doesn’t believe the same market dynamic exists with medical innovation when it most certainly does.

When Obamacare proponents start talking about the morality of equality with respect to healthcare what they are talking about is expensive treatments that may be available to only a certain segment of the population and they will trot out this curious breed of individuals called “bioethists” to make the claim that rationing is the just and right thing to do.

Here’s some light cast upon the subject by bioethicist, Daniel Callahan:

"Cutting the use of technology will seem wrong—even immoral—to many."

Notice the reverse psychology that is implied. His going-in position is that rationing is desirable and that fact may confound you knaves out there in fly-over country, bless your hearts.

And this remains one of the most curious elements of the healthcare debate: Obamacare proponents will raise holy hell if anyone even suggests “death panels” or “rationing” and then in the very next breath will, straight-faced, tell us that rationed care is actually a desirable standard operating practice for your personal health.

Crappy healthcare for all!

Going back to the Terry Schiavo atrocity, we are finding the term “bioethist” to be the most ironic of terms in the most un-funny of ways.

B-Daddy has an excellent piece on medical technology innovation and advancement and rationing in Obamacare plus some more wisdom from Callahan that we encourage everyone to read, here.

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.

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.

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.

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.

Bad for you health?

Some previous thoughts on these alleged death panels, here. Now… the full Monty.

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.




There’s been a lot of buzz about these alleged death panels that will be part and parcel to Obamacare (side note: we need to find another term for Obamacare. The President keeps calling the healthcare reform bill that was cobbled together by 3 House committees, “my proposal” or “my plan” – he hasn’t proposed squat). In his wonderfully orchestrated townhall meeting a couple of days ago, the President said that any end-of-life counseling would be strictly voluntary.

Yahoo! Did their own fact-checking by… talking to a priest. Here’s the exchange.

Q: Does the health care legislation bill promote "mercy killing," or euthanasia?
A: No.

Q: Then what's all the fuss about?
A: A provision in the House bill written by Rep. Earl Blumenauer, D-Ore., would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health care proxy, learning about hospice as an option for the terminally ill, and information about pain medications for people suffering chronic discomfort.
The sessions would be covered every five years, more frequently if someone is gravely ill.

Q: Is anything required?


Monsignor Charles Fahey, 76, a Catholic priest who is chairman of the board of the National Council on Aging, a nonprofit service and advocacy group, says no.

"We have to make decisions that are deliberative about our health care at every moment," Fahey said. "What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini — then let me go."

Ladies and Gentlemen, the wit, wisdom and humor of Monsignor Charles Fahey. Let’s give it up for his Excellency… he’ll be here all week.

So, is the Monsignor correct? Yes and no. Let’s roll the tape. Here is the money paragraph from Sec. 1233 Advance Care Planning Consultation:

(For purposes of ease of reading and our own sanity in attempting to transcribe this .pdf file we took some liberties with respect to the construction of Sec. 1233. It is our heartfelt intent that the spirit of the bill is contained herein)

An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease…. (other bad stuff)…

A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that –

Effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual.

The level of treatment indicated under (above paragraph) may range from an indication for a full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items –

The intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems.
The individuals desire regarding transfer to a hospital or remaining at the current care setting.
The use of antibiotics; and
The use of artificially administered nutrition and hydration.

(italics and emphasis, ours)


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.

Benefit of the doubt: Denied. We’ve heard too much already with respect to what the President himself has related as to the potential of rationing end-of-life care and the immutable laws of economics when it comes to who’s paying for what to let this slide.

The current healthcare reform bill as written, will indeed impose pressure on physicians and thus their patients into decisions that will not have their personal-health best interests at heart with specific respect to end-of-life decisions.

At the end of the day: Keep your politics off my body.

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.

On wigs, rationing and pesky relatives

Our suspicions that nationalized healthcare would make health care politicized and thus leveraged by politicians was confirmed by the situation regarding an expensive breast cancer drug and New Zealand which has nationalized healthcare.

Check out reason.tv video below with a former Reason magazine Editor-in-Chief Virginia Postrel, a breast cancer survivor, herself.



And the President's own second cousin, once removed, Dr. Milton Wolf, chimes in with some thoughts on Obamacare:

The justification for Obamacare has been to control costs, but the problem is there is little in Obamacare that will do that. Instead, there are provisions that will ration care and artificially set price. This is a confusion of costs and price.

As one example, consider the implications of Obamacare’s financial penalty aimed at your doctor if he seeks the expert care he has determined you need. If your doctor is in the top 10 percent of primary care physicians who refer patients to specialists most frequently – no matter how valid the reasons – he will face a 5 percent penalty on all their Medicare reimbursements for the entire year. This scheme is specifically designed to deny you the chance to see a specialist.

Each year, the insidious nature of that arbitrary 10 percent rule will make things even worse as 100 percent of doctors try to stay off that list. Many doctors will try to avoid the sickest patients, and others will simply refuse to accept Medicare. Already, 42 percent of doctors have chosen that route, and it will get worse. Your mother’s shiny government-issued Medicare health card is meaningless without doctors who will accept it.

Again, Obamacare has gone all in with the obsession of controlling costs. If you think a bureaucracy as clumsy and cumbersome as the federal government will be able to affect bending the cost curve downward via innovation and an ability to efficiently respond to health care sector demands, you are sadly delusional.

The most effective means at its disposal to control costs is to employ broad-brushed rationing techniques such as that illustrated above.

Read the rest of Dr. Wolf's excellent take-down, here.

Continuing to peel back the layers of the onion

Guess who wants a gander at your tax returns? The Health Choices Administration, that’s who.

From Section 431 of H.R. 3200:

`(A) IN GENERAL- The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America's Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America's Affordable Health Choices Act of 2009. Such return information shall be limited to--

(italics, ours)

Now, why oh why would the feds want to know what your tax returns look like with respect to healthcare? Especially when it involves some entity called the Health Choices Administration and which is linked to some Obamacare commodity, affordability credits.

Against the backdrop of "We are God's partners in matters of life and death," and the notion that destroying functioning resources is good for the economy, it is not unfair at all to play connect-the-dots to see where this may lead.

This speaks directly to the existence or lack thereof with respect to “death panels”. It simply re-enforces our argument that provisions like this and the vague and weasel-wording of other provisions like that contained in section 1233 make the arguments of whether “death panels” actually exist and if rationing will be the end-state of Obama-care, moot points. It’s all moot because the apparatus exists within the bill to effect the same unsavory results as would an actual “death panel” or the explicit goal of rationing healthcare.

It's been said that the administration has bungled the pitch for healthcare. To an extent, there have been tactical errors made but how can one effectively pitch a plan that is this horrible?

We will note that as recently as a few weeks ago, H.R. 3200 was available only in .pdf form. Any transcribing to a blog like this had to be done by hand. Now, it's been "translated" and sections of the entire bill can be cut'n'pasted to the preferred vehicle of information dissemination.

Bottom line: the word is out and the indefensible only becomes more so with the passage of time.

The U.S.P.S.T.F. will see you now

Last week we covered the new guidelines put out by the U.S. Preventative Service Task Force that recommended that women cut back on their mammograms and additionally not to start them until age 50 vs. 40 which had been the accepted start age for decades.

We also noted how the Health and Human Services Secretary Kathleen Sebelius told everyone to pay no never mind to the Task Forces recommendations as they were merely guidelines and that the charges of rationing were just overheated rhetoric.

So, which is it? If Sebelius is telling everyone to carry on with the at-40/twice a year regimen, then what the hell good is this task force and why shouldn’t we be concerned that this just represents the blueprint for healthcare services rationing?

Well, guess who shows up in the Senate version of healthcare and is charged with determining what sort of medical procedures are covered under Obamacare. Yep, it’s our friends at the U.S.P.S.T.F.

Let’s roll the tape (for the sake of expedience and our own sanity, we’re transcribing from the .pdf file here, sans paragraph numbering and indentations.

From Section 2713 COVERAGE OF PREVENTIVE HEALTH SERVICES:

In General – A group health plan and a health insurer offering a group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for –

Evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventative Services Task Force;

Stop right there. That’s all we need to read, thank you.

By the way, the task force members that recommended the new screening guidelines for mammograms? Not a single one of them was an oncologist.

So a politically-appointed task force that heretofore was only making "recommendations" that we were told to disregard and which may or may not have any relevant professional experience in a particular medical field will be rendering what preventative services will and will not be covered by your healthcare plan. Aren't you feeling healthier already?

Over the next couple of weeks, time permitting, we hope to get into more of the fine print of the Senate health bill that will be debated next week.

H/T: Hedgecock

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?

Great moments in the history of statism Pt. IX

Venezuela will switch off lights for hours at a time in Caracas and other cities such as oil town Maracaibo in planned blackouts to tackle power shortages that threaten President Hugo Chavez's support.

Officials announced the nationwide electricity rationing lasting at least until May on Tuesday and said even schools and small health clinics would be hit in South America's top oil exporter.

Venezuela mostly depends on hydroelectricity for its power and has been hard hit by a drought Chavez blames on the El Nino weather phenomenon.

"The rationing is at a national level and is for four hours every 48 hours," said Javier Alvarado, president of the Caracas Electricity corporation, which was nationalized in 2007 and previously belonged to U.S. company AES.

How this happens while setting on top of some the largest oil and natural gas reserves on the planet as well as consistently being in the top ten crude oil producers in the world can be testament only to the folly of a command and control economy where the soup kitchen socialism of Hugo Chavez offered up to the masses via price controls on food and energy in return for their support results only in the inevitable shortages of those very goods and services by which Chavez was leveraging.

Maybe she'll have better luck than us in explaining this thing

If you thought that a law written in secretive fashion by a combination of members of Congress, their respective staffs and health care and big Pharma lobbyists and which was cobbled together to provide enough aptly-named sweeteners (Cornhusker Kickback, the Louisiana Purchase, Gator Aid) to garner sufficient votes and which also was ramrodded sideways through no fewer than 3 congressional committees might experience some minor problems with its roll-out, you would not be alone.


From The Hill:

Sen. Max Baucus (D-Mont.) said Wednesday he fears a "train wreck" as the Obama administration implements its signature healthcare law.


Baucus, the chairman of the chamber's powerful Finance Committee and a key architect of the healthcare reform law, said he fears people do not understand how the law will work.

"I just see a huge train wreck coming down," he told Health and Human Services Secretary Kathleen Sebelius at a Wednesday hearing. "You and I have discussed this many times, and I don't see any results yet."

Baucus pressed Sebelius for details about how the Health Department will explain the law and raise awareness of its provisions, which are supposed to take effect in just a matter of months.

"I'm very concerned that not enough is being done so far — very concerned," Baucus said.

Remember, we were told by the glittering jewel of colossal ignorance, then-Speaker of the House, Nancy Pelosi, that we had to pass ObamaCare so we can find out what's in it. And now, over 3 years since its passage, the biggest problem the law faces according to those voted for it is that it has not been sufficiently explained to us. Never mind that Baucus, one of the chief architects of the law and who is facing re-election next year is in full CYA mode, the man has some valid concerns, and how!


More:

He pressed Sebelius to explain how her department will overcome entrenched misunderstandings about what the healthcare law does.

"Small businesses have no idea what to do, what to expect," Baucus said.

Citing anecdotal evidence from small businesses in his home state, Baucus asked Sebelius for specifics about how it is measuring public understanding of the law.

"You need data. Do you have any data? You've never given me data. You only give me concepts, frankly," he said.

Sebelius said in response that the administration is not independently monitoring public awareness of specific provisions but will be embarking on an education campaign beginning this summer.

Of course they're not monitoring public awareness. a) it's the law of the land so all you little people can go pound sand and b) they wouldn't like the feedback so please see a). And about that education campaign... mere months... weeks? before people can start signing up for ObamaCare at the state exchanges (which are nowhere close to being set up, by the by) on October 1st? That ought to be helpful.



Later, the article takes a curious turn down the avenue of why it is that 3+ years later we still don't know jack squat about this law and it has to do with our obvious misconceptions regarding the law. Here is the odd stand-alone paragraph:

A recent Kaiser Family Foundation poll found deep and persistent misconceptions about the healthcare law. Public awareness was highest for the most politically unpopular provisions, and many people wrongly believed the law contains provisions like a "death panel" to make decisions about end-of-life care.

We suppose this represents part of the education campaign: getting The Hill to provide cover for this horrible law.


But if Sebelius and her water carriers in the press want us to give up our misconceptions regarding "death panels", we'd be glad to except for the fact that it's not really a misconception.

Nearly 4 years ago, we read the section of ObamaCare that dealt with the alleged death panels and came to the conclusion that though there were no death panels, per se, the language of the legislation allowed for a steering of patients towards decisions that would be, shall we say, less than optimal for their immediate health.

Here's us from back in 2009 and please follow the link for a fuller explanation of our thoughts on the matter:

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.

Benefit of the doubt: Denied. We’ve heard too much already with respect to what the President himself has related as to the potential of rationing end-of-life care and the immutable laws of economics when it comes to who’s paying for what to let this slide.

The current healthcare reform bill as written, will indeed impose pressure on physicians and thus their patients into decisions that will not have their personal-health best interests at heart with specific respect to end-of-life decisions.

At the end of the day: Keep your politics off our body.

If you had trouble comprehending what was written above, our apologies as we were taking our best crack at deciphering and then explaining perhaps the un-decipherable. This is what Baucus fashioned and this is what Ms. Sebelius will have to explain, herself, to the rest of us this summer. Best of luck with that, Ms. Sebelius.

Go figure: Living a long and productive life just might cost you some

Healthcare costs a lot, in part, because it costs a lot to develop new effective technologies and products to keep us healthy. Funny how we are willing to drop some coin when it comes to our own health, isn’t it?

Article here, appeared in the paper the other day had the following to say about medical technology.

Hospitals and large physician groups engage in a technological arms race. They are prodded by manufacturers aggressively pushing their products, patients pleading for the latest treatments and prestigious doctors aligning themselves with institutions marketed as innovative.

“Hospital administrators are under enormous pressure to invest in new technology,” said Chris Van Gorder, president and CEO of Scripps Health, which operates five hospitals in Encinitas, La Jolla, Hillcrest and Chula Vista.

Also contributing to rising medical expenses is the urge by health providers to maximize use of whatever services are available to them — even when it is unnecessary.

Public investment in unproven and even counterproductive alternative energy sources like wind and solar power and ethanol: good. Private investment in unproven medical technologies that may only yield marginal benefits: bad.

In countries where governments closely control health systems, costs are held down partly by evaluating new devices and procedures for effectiveness before allowing them into the market. Panels of medical experts also set treatment guidelines.

The United States puts up “a lot of barriers that make it very hard to control costs,” said Callahan with The Hastings Center. “There is particular resistance within the medical industry.”

For an example, Callahan pointed to Avastin, a colorectal cancer treatment that costs $90,000 for a one-year course of treatment but only extends a patient's life by an average of 1½ months.

Without expressly stating it, this is precisely what rationing is and the slant of the article is perfectly fine with that.

If a technology, procedure or drug passes regulatory muster for safety, let it be brought to market so that the consumers can make the call on whether or not they want to shell out the bucks for it thus removing any decision-making from “panels of medical experts”.

The idea of self-preservation and an inherent human desire to maximize our quality of life coupled with a desire to have access to the latest medical technology no matter how expensive is lost on the author and by extension, proponents of government-managed healthcare.

Keep your politics off our bodies!

Your government-managed health care update

Do you all remember the outrageous claims of death panels being effectively built-in to ObamaCare? Take a read and tell us if any of this sounds familiar. From The Telegraph:

NHS managers are deliberately delaying operations as they wait for patients either to die or go private in order to save money, according to an official report.

Health service trusts are “imposing pain and inconvenience” by making patients wait longer than necessary, in some cases as long as four months, the study found.

Executives believe the delays mean some people will remove themselves from lists “either by dying or by paying for their own treatment” claims the report, by an independent watchdog that advises the NHS.

The Co-operation and Competition Panel says the tactic is one of a number used by managers that “excessively constrain” patients’ rights to choose where to be operated upon, and damage hospitals’ ability to compete for planned surgery.

It claims unfair practices are “endemic” in some areas of England and pose a “serious risk” to the Government’s drive to open up the health service to competition.

But managers, who are already rationing surgery for cataracts, hips, knees and tonsils, say they must restrict treatment as the NHS is under orders to make £20 billion of efficiency savings by 2015.

Lord Carter of Coles, chairman of the panel, said: “Commissioners have a difficult job in the current financial climate, but patients’ rights are often being restricted without a valid and visible reason.”

Katherine Murphy, chief executive of the Patients Association, said: “It is outrageous that some primary care trusts are imposing minimum waiting times. The suggestion that it could save money because patients will remove themselves from the list by going private or dying is a callous and cynical manipulation of people’s lives and should not be tolerated.”

The article goes on to report that managers have restricted patients' rights to choose among four hospitals, including private hospitals, in order to balance their own books

.
(italics, ours)

Call us crazy but it's hard to think that the whole dying thing is what you would call a voluntary feature of the British NHS.

And given the above, you would not be mistaken for holding a sneaking suspicion that Britain's single-payer health care system doesn't seem to have quite as much emphasis on health or care as you might think.

But good to know they have a private system, right? Well, a private system only if you can afford it. So, not only is one paying into the British NHS that covers all Britons, one is also paying out-of-pocket for treatment that NHS managers are denying.

And wasn't this two-tier system of haves and have-nots precisely what government-managed health care like NHS and ObamaCare supposed to eliminate? Wasn't ObamaCare supposed to be all about equal and affordable access for everyone? Yeah, we thought so, also.

Death panels? Nothing to see here - please move along.

Just a preview of things to come, folks.

Quote of the day

"That's going to cause us to make some real decisions as to who gets how much health care and when they get it… To the extent we need to raise taxes down the road we're going to have to sort of work our way down that income level starting with people making over $250,000 and maybe even going further down. I hope we don't have to do too much of that."

We actually posted this quote back in April of this year. It’s from Lawrence J. Haas, the former communications director for Al Gore and who, you can imagine, is a big fan of government-managed healthcare.

Consider this a reminder that even before “rationing” and “death panels” entered the rhetorical fray of the healthcare debate, proponents of Obamacare knew in their hearts, even if they denied it in public, that government-managed healthcare would indeed entail the same government picking winners and losers with respect to healthcare services.

Consider this also a reminder of the blatant hypocrisy of a set of people that occupy a band on the political spectrum that have conveniently tucked away displays of bumper sticker politics to the basement of their convictions.

Different author, same story

Nearly a year after letting the House and the Senate do his heavy lifting with respect to crafting health care legislation, the President is putting forth his own plan. From the AP:

President Barack Obama is putting forward a nearly $1 trillion, 10-year health care plan that would allow the government to deny or roll back egregious insurance premium increases that infuriated consumers.

Posted Monday morning on the White House Web site, the plan would provide coverage to more than 31 million Americans now uninsured without adding to the federal deficit.

It conspicuously omits a government insurance plan sought by liberals.

(italics ours)

You know you are going to get a balanced analysis when the piece kicks off with that paragraph.

And the absence the public option? We’ll get to that later.

The premium increase referenced was Anthem Blue Cross in California that jacked up its rates by 39%. This gives the President the fodder he needs to claim the system is broken and that Obamacare is the cure in front of the much ballyhooed bi-partisan healthcare summit with Republicans on Thursday.

There’s one problem, though, with the President’s claim of budget neutrality. The CBO says it won’t be anywhere near being able to provide a score to Obamacare (we can now use that term in full veracity) by the end of the week.

Moreover, preparing a cost estimate requires very detailed specifications of numerous provisions, and the materials that were released this morning do not provide sufficient detail on all of the provisions. Therefore, CBO cannot provide a cost estimate for the proposal without additional detail, and, even if such detail were provided, analyzing the proposal would be a time-consuming process that could not be completed this week.

But back to the government being able to deny or roll back "egregious" premium increases. This is a defacto price control and economics 101 teaches us what happens when price controls are put into place: the goods and/or services that are being regulated in this manner go away. They go away because those providing the capped goods and services will not be compensated at market value and since it won’t make any financial sense to do business with those price controls, health insurance providers will a) either be forced to cut services (rationing) or b) simply go out of business altogether.

It makes sense then not to add the public option into the initial language of the legislation as that is something that people will be clamoring for once the price controls effectively drive the health insurance providers out of business.

Also, define “egregious”. Perhaps there will be a number or some sort of sliding scale that will be used as the threshold for kicking in the roll back but no matter – at the end of the day it will be decided upon by legislation (that may or may not be influenced by the headquarters address of the health insurance provider. Pickin’ winners and losers!) or by bureaucratic fiat. Either way, we lose.

Congrats to the President for finally getting off his backside and taking the lead on his legislative crown jewel, though, it doesn’t appear it’s going to be much different than the pieces of crap generated by the House and Senate.

Addendum #1: Anthem Blue Cross has agreed to a request by the California Department of Insurance to postpone their premium adjustment by two months to allow the Department additional time to review it. The new rates were filed with the appropriate regulators in November of 2009 and the news release suggests there were no problems raised by the regulators during the 3 months in the interim.

Anthem claims the steady increase in medical costs, which are not sustainable, as the reason for the rate increase. Exacerbating the situation is the increasing number of healthy young people who choose not to be covered leaving an insured pool that require more services. All current versions of health care reform legislation mandate that everyone buy health insurance from private insurers so that everyone is, you know, “paying their fair share”.