Patterico's Pontifications

4/26/2010

Health Care Rationing

Filed under: Health Care,Obama — DRJ @ 10:53 pm



[Guest post by DRJ]

Via Breitbart and Naked Emperor News, Peter Orzag reveals the truth about rationing and the Independent Payment Advisory Board:

Obama’s Budget Director: Powerful Rationing Panel (Not Doctors) Will Control Health Care Levels

ORZAG: “And the only real solution to our long-term fiscal imbalance, because it’s driven disproportionately by the rate at which health care costs grow, is to move towards a health care system that is based on quality and efficiency rather than quantity. Everyone agrees that we can no longer afford to just pay for quantity, that is, a fee for service system where doctors and hospitals are reimbursed based on volume.

I think folks have not really focused on the Medicare commission, the Independent Payment Advisory Board that’s created. This institution could prove to be far more important to the future of our fiscal health than, for example, the Congressional Budget Office. It has an enormous amount of potential power.

So this Independent Payment Advisory Board has the power not … it has the responsibility to put forward proposals to hit a pretty aggressive set of targets over the long term. And furthermore the proposals take effect automatically unless Congress not only specifically votes them down, but Congress specifically votes them down and the President signs that bill.

So the default is now switched in a very important way on the biggest driver of our long term costs, which is the Medicare program.

REPORTER: “Was that explained to members of Congress very carefully?”

ORZAG: “Yes, it was, and that’s why this was something that was very difficult to actually …

This is why I think this was underappreciated that this is a very substantial change. Statutory power to put forward proposals to reduce health care costs growth over time … and improve quality, and those proposals take effect automatically if Congress ignores them, if Congress votes them down and the President vetoes that bill. So, in other words, inertia now plays to the side of this Independent Board.

Wasn’t it the Democrats’ job, as sponsors of health care reform, to help Americans focus on the important parts of the legislation — like the Independent Medical Advisory Board? Instead, they clearly felt their job was to hide the ball.

This reminds me of two things and it’s hard to choose which is more appropriate: Sarah Palin’s ‘Death Panel’ or Nancy Pelosi’s ‘But we have to pass the bill so that you can find out what is in it.’

— DRJ

92 Responses to “Health Care Rationing”

  1. I noticed the dismissive tone and way he stated it, when he added quickly “and improve quality” as an afterthought quickly discarded even in the CYA way he uttered it.
    The big one was “reduce health care costs”. Based upon “efficiency” instead of quantity.
    Efficient is “take a painkiller and go home”, without the pacemaker operation, like Obama said. That’s real efficient.
    Efficient is also foregoing any new procedures, expensive long fixes, lengthy operations, return visits for follow up… etc etc.
    Efficient is in and out, and stay out.
    The truth is modern and more modern medical science is going to continuously raise costs, or something is severely wrong, and advancement stalled.
    This is the reality.

    SiliconDoc (7ba52b)

  2. Orzag is flat out wrong. Many of the people who objected to ObamaCare did appreciate and focus on the impact of these Independent Advisory Boards on the choice and quality of care. It represents a bunch of bureaucrats getting between you and your doctor, something Obama promised would never happen.

    daleyrocks (1d0d98)

  3. According to the American Spectator, the report from the Medicare actuaries that concluded ObamaCare would raise premiums was given to the administration a week before the vote, but not released until a few days ago.

    Robert (19249b)

  4. This is turning into some Greek tragedy Shakespeare used as the basis for the perfect outlandish farce.

    So, in other words, inertia now plays to the side of this Independent Board.“

    Birnam Wood shall certainly never march to Dunsinane, you can rest assured of that.

    skwiself (63b7ff)

  5. I have it on the highest authority that: “Some of people’s concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple.”

    Obviously Orzag has no idea what he is talking about and needs to read the law or at least talk to his boss, who can explain to him that he has fallen for lies spread by viscous conservatives.

    max (2f2a28)

  6. Comment by daleyrocks — 4/26/2010 @ 11:23 pm

    That comment comes from the fantasy world in which there is nobody between you and your doctor. Welcome to the real world…. where there are already mega-conglomerates who already decide your course of treatment.

    Rinnnnnnnnnggggg! That’s the alarm clock. Time to face reality.

    Intelliology (00d844)

  7. They are the liars we thought they were.

    Mr. Pink (7fdef7)

  8. Out here in the reality based world Intelliology, we call these “Death Panels”. We also note that these panels of bureacrats– now running Medicare–hold doctor reimbursement levels to about half or even less of the reimbursement levels of private insurance carriers. So the Medicare bureacrats have been getting something of a free ride on reimbursements paid by those “evil” megaconglomerates that you worry about. The real question is whether you want those reimbursement decisions made by a junior vice president in “Evil” Conglomerate or a GS-13 in the Obamacare Bureacracy. On the whole, I’ll take my chances with the junior vice president.

    Mike Myers (3c9845)

  9. I’ve returned to the Jury Strikes Back with a post on San Francisco’s proposal to boycott the state of Arizona.

    aunursa (2680ce)

  10. “Welcome to the real world…. where there are already mega-conglomerates who already decide your course of treatment.”

    That is not true. At least my most recent visits would prove otherwise. After seeing my primary Phys; he gave me options, I chose who to see and to get a second opinion. I decided my course with my primary’s assistance.

    Peter Orzag gleefully admits that will change. In fact insists it is necessary. The Feds created the crisis thru legislation so that they could take control of it (and by Feds I include Republicans and Democrats). We will get rationing whether they meant it to be there or not.

    Corwin (ea9428)

  11. Welcome to the real world…. where there are already mega-conglomerates who already decide your course of treatment.

    Even if this were true, those making the decision about my treatment are people I can fire if I don’t like the job they are doing.

    I guess that could happen under Obamacare. All I have to do is figure out the bureaucrat that made the decision. That should be easy. And then if nothing is done, I can work to elect new congressmen and a new president to change the bureaucracy. That should be no problem.

    Of course by the time all this is done I may be dead but darn it, Peter Orzag will be patting himself on the back for bending that cost curve.

    MU789 (91d8ed)

  12. “where there are already mega-conglomerates who already decide your course of treatment.”

    Right! Those decision are appealable at multiple levels they are not the law as they will be under ObamaCare.

    All you have is ad hominem and invective, loooser!!!!!

    daleyrocks (1d0d98)

  13. Intelliology is just fine with blatant lies being used to sell this plan. Welcome to the real world, where political vultures pick over the slowly dying corpse of our liberty.

    Mr. Pink (a2684c)

  14. “Some of people’s concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple.”

    Yes, Barcky, you lied. In doing so, you employed one of your favorite rhetorical techniques where you completely mischaracterize your opposition’s position, and then argue against that strawperson. Turns out, these panels existed, and your budget people are planning on using them.

    JD (cc3aa7)

  15. Turns out that the evil corporations that made the write-downs according to the law that Waxman was going to haul before his little committee were absolutely correct in doing so. I am looking forward to hearing from all of the Dems that Castigated John Deere, Caterpillar, Verizon & AT&T for following the law.

    JD (cc3aa7)

  16. That comment comes from the fantasy world in which there is nobody between you and your doctor.

    I don’t live in a fantasy world, but I can assure you that there is nobody between me and my doctor. I go to his office, he sees me and recommends a course of action, I write him a check…and that’s all there is to it.

    You should try it some time.

    Some chump (1dd11d)

  17. Intelliology illustrates, as he so often does, the manner in which Democrats intend to deal with the fact that the legislation and the arguments in support of it were fraudulent. Calling opponents “liars” when in fact they were the ones lying.

    Intelliology and his ilk earned their reputation for dishonesty.

    SPQR (26be8b)

  18. SPQR – Ironic, no, that the people that were wailing, gnashing their teeth, rending their garments, and calling people liars were the ones that were, in fact, lying?

    JD (cc3aa7)

  19. One troll falls. Another troll rises! All in the service of Defending the D, at any cost.

    And it will cost plenty.

    Eric Blair (a58f1d)

  20. Interesting, or dishonest, that the Medicare actuary report that indicated costs would be significantly higher than claimed, and would put great stress on the system was kept from the public until after HCR was voted on? According to the HHS staffer in the link below, the White House had that report a full week before the vote, and just kept on lying lying lying to the American public.

    http://gatewaypundit.firstthings.com/2010/04/breaking-news-dems-hid-damning-health-care-report-from-public-until-a-month-after-vote/

    JD (cc3aa7)

  21. And the sad part, JD, is I don’t this is about health care at all. It’s about power and partisanship.

    Eric Blair (87090a)

  22. They have embraced lying as a legitimate political tool. Notice how when you say Obama lied about ___ they respond with “but Bush lied about ____”? That’s the tell, no refute or defense of the lie just a justification for it.

    Mr. Pink (a2684c)

  23. Mr Pink – It is doubly ironic when they do that, because usually they are lying about Bush lying 😉

    JD (cc3aa7)

  24. There are two things that I don’t think can coexist very long:

    1) A medical system where doctors are increasingly forced to do things because of a bureacrat rather than their own judgement

    and

    2) A legal system that holds the doctors responsible for bad outcomes of treatment they were forced into.

    The “only answer” will be for docs to work directly for the govt. on their terms to escape risk of litigation.

    I’ll give one example.

    Twenty five years ago when I was a resident, it was considered standard of care to see a person started on an anti-depressant within a week, or at most two. This was done for many reasons, among them to encourage follow through taking the medication and problem solving any side-effects, etc. Another major reason was because it was well understood that sometimes people actually increase their risk of suicide as they improve (people who didn’t have “the energy” to do something about wanting to kill themselves now would). [It is also true that the drugs used 25 years ago were much more dangerous in an overdose than the newer ones in the last 15-20 years].

    Well, since the newer drugs are “safer” in overdose as well as the financial and time constraints of the medical system it became more common for that follow up visit to be in a month, rather than 1-2 weeks. Guess what happened, everybody freaked when it was realized some people (especially adolescents, known for their emotional stability and impulse control [sarc.]) committed suicide. Everybody in the press and the trial lawyers association went berserk when this came out, as if it was some new phenomenon.

    It wasn’t really new, and had more to do (I think) with change in the medical system for the bad than the newer drugs per se. And the best answer was not new black-box warnings or scary articles or suing the pants off somebody, but was to return to standards of medical practice that were normative 15 years earlier.

    In my mind the majority of cost-benefit analyses in healthcare are two-fold; one, the idea of playing cost-benefit analysis with human life is quite different than cost-benefit analysis of two approaches to a construction job or manufacturing something; and two, when cost-benefit analysis is done the factors included are very limited and inadequate to describe the overall situation (like trying to assess “global warming” without looking at the sun’s effects).

    They say you can’t fool all of the people all of the time, but so far they’ve done a good job of fooling enough of the people enough of the time.

    MD in Philly (0f793a)

  25. To the trolls both posting and lurking: The crucial difference is between an insurance company’s denial of payment and the government’s restriction of care, is that the insurance company cannot fine the doctor thousands of dollars and threaten prison. Also, in the former, the patient can choose to pay out of pocket.

    Teflon Dad (adcb71)

  26. MD in philly:

    Very informative post. Thanks.

    rtrski (192cf0)

  27. MD in Philly, you are correct that BHO and his cronies sold a bill of goods to the American public. But the problem is two fold: (i) a focus on how things sound or feel, rather than fact; and (ii) GWB and statist Republicans messing things up something fierce. I would add that the MSM treated GWB most unfairly (compare their behavior toward politicians with Ds or Rs after their names), but GWB gave them plenty of ammo. Most Republicans I know don’t adore GWB, and never did. Compare that to some of our Obama-ites.

    The good news is about the polls. People are waking up. And the Democratic statists are doubling down on their arrogance and foolishness. Which is nice for me, and hopeful for all of us.

    As for BHO, I am reminded of the Jung quote: you are what you do, not what you say you will do.

    It’s something I chide myself about a lot. But the POTUS should really spend some time thinking about that quotation. It appears he never has, throughout his life, when you look at his record.

    By the way, is it really true that BHO has played more golf while President, now, than GWB did in two administrations? I seem to remember that GWB was a doofus for playing so much golf.

    I’m just saying.

    Eric Blair (fbdd84)

  28. Teflon Dad – They do not care about such distinctions, however important they may be.

    JD (cc3aa7)

  29. Eric- I pretty much agree with you. People are waking up to the fact that his promises are only so much hot air, whether enough will in time will be seen. I sure wish more news agencies would wake up, both reporters and editors/managers/owners.

    As far as golf goes, I wouldn’t be surprised. I remember GWB purposefully cutting back because of the appearance of him golfing while soldiers are at war. How much of that was because of the press treatment and how much he would have done anyway I don’t know.

    Yes, for GWB to be seen golfing was evidence he was “out of touch” and “didn’t care about the typical American”, when Obama golfs it shows he’s “a cool person who does things just like us and doesn’t let the pressures of being president get him down”. The contemptible and disingenious partisan hacks view of the world.

    MD in Philly (0f793a)

  30. /Spits/ at them. Yet more non-doctors making medical decisions. That’s how we got into this mess!

    htom (412a17)

  31. MD – Not sure if I will be able to find it, but a couple weeks ago, I read an article when the reporter had the temerity to write that Barcky even being able to golf in such trying times is proof of the strength of character, that the world cannot weigh him down.

    JD (cc3aa7)

  32. #24 MD in Philly:

    The “only answer” will be for docs to work directly for the govt. on their terms to escape risk of litigation.

    I don’t see the problem. Worked great in the Deutsche Demokratische Republik, didn’t it?

    EW1(SG) (edc268)

  33. Comment by JD
    Absolutely, thanks. My puzzle is the epistemologic quandry of knowing whether such a writer realizes what they are doing and believes it, realizes what they are doing, realizes it is unfair, and does it anyway, or is totally clueless on what they’ve done. But I guess to wonder at that too long is about as useful as contemplating why the chicken crossed the road, or less so.

    I don’t see the problem. – Comment by EW1(SG)
    I guess I’m just overreacting again, thanks for helping me regain perspective. 😉

    MD in Philly (0f793a)

  34. MD – I think it has to be a combination of the first two scenarios you described.

    JD (cc3aa7)

  35. Welcome to the real world…. where there are already mega-conglomerates who already decide your course of treatment.

    Even if this were true, those making the decision about my treatment are people I can fire if I don’t like the job they are doing.

    More important, you can sue them. Try suing HHS.

    One development that worries me is the attempt to pass a law in Massachusetts that requires doctors to see Medicare and Medicaid patients as a condition of license renewal.

    Right now, here and in Canada, the alternative to government medicine is developing in private practices that accept only cash or credit cards. This is illegal in Canada but that law is not being enforced since the supreme court ruled that a health plan is not health care. It has taken 25 years for this development in Canada and they had the alternative of coming to the USA for care. Many Canadians even bought US health insurance.

    We won’t have that option. I think very soon, unless there is a dramatic change in Congress in November, it will be necessary for the Medicare beneficiaries (Funny how those euphemisms appear in government programs) to start thinking about a private-private doctor for primary care. That means one of the retainer practices that are appearing everywhere. If you want to be in control of your life, literally, you will need a doctor that you pay and whose interest is in you, not the bureaucrats.

    That Massachusetts is now trying to make opting out illegal is a very ominous development. If you are a Medicare provider, cash practice is illegal. Every doctor would have to be a Medicare provider to be licensed and that would make it illegal to accept cash payment for a service that is not allowed by Medicare. The whole point of the cash practice is to avoid the rationing and allow the patient to choose what they are willing to pay for. It is also illegal to accept payment in addition to the Medicare payment, which already at a level that does not pay overhead.

    Somewhere, I once read a metaphor for this. It was the rounding up of cattle to go to the slaughter. The cattle drifted along to avoid those cowboys whooping and hollering at the periphery. Soon, far in the distance, fences appeared. Since they were far off and since the cattle were already headed in a direction that did not encounter the fence, they continued along, encouraged by the cowboys. Soon the fences began to get closer as the neck of the funnel appeared ahead. Soon, the narrow path into the loading ramp appeared but it was too late to try to turn back. Ahead was the cattle car and the slaughter house.

    We still have room to turn around.

    Mike K (2cf494)

  36. Higher costs and Death Panels…you mean the President lied ???

    Again ?!?

    (shocked I tell you, shocked)

    Pons Asinorum (770c6d)

  37. This is politics and power at its absolute worst. Having this appointed panel to do the dirty work is so much easier and less politically dangerous to politicians than forcing elected lawmakers to vote on rationing and medicare cuts.

    Obamacare must be repealed. It is not fixable or tweakable in its present form.

    elissa (b8aaf9)

  38. My mind reels! Obama lied? Pelosi and Reid lied? Goodness gracious!

    As I recall, in an early incarnation of the bill the provision creating the Independent Payment Advisory Boards was specifically worded by the drafters of the legislation as to make the IPABs immune to future attempts by Congress to alter their authority or dismantle them.

    Does anyone know if that was in the final bill? If so, then the Republican claims that they will forgo repealing the entire law in favor of just stripping out unpleasant sections will leave in place one of the most egregious provisions.

    When you marry the IPABs with the likes of Dr. Zeke Emanuel’s guidance to the Obama administration that money spent on health care for those younger than 15 or older than 55 is wasted from a “societal value” perspective – you get a glimpse into how the death panels will work. Adjust for pre-existing conditions and potential for future drains on the Treasury via Social Security claims, guess who won’t be seeing much beyond palliative care being authorized?

    But all is good since we’ll soon legalize 12-20MM illegals and will be able to provide for their health care. I wonder if the motor-voter act will be extended to allow for voter registration when you first apply for medical care?

    in_awe (44fed5)

  39. Woah! You mean Sarah was right? Death panels and higher cost?

    Next thing you’ll tell me is that Tawana Brawley never got raped.

    Vivian Louise (eeeb3a)

  40. Where is there anything in that statement about death panels? Does anyone around here know how to actually read??

    He’s talking about cost containment not being dependent on politics. About it being built in to the program to see to it that it’s not abused and that their is an emphasis on quality as opposed to quantity or wholesale billing by hospitals that overcharge Medicare.

    Go back to sleep, morans. Health care reform has passed and you and Sarah Palin and the TP idiots still suck.

    Assclown Doodyheads (f0d390)

  41. it seems appropriate that someone with such a delightfully descriptive name would be against a product as useful as Toilet Paper…

    😀

    redc1c4 (fb8750)

  42. Thank you Assclown for helping the “morans” to see the light with your unassailable argument for Obamacare. Of course, some of us who post here are not named Moran, nor are we even of Irish descent.

    elissa (b8aaf9)

  43. Assclown, nope, that’s not at all true. Its clear that he’s using euphemisms to refer to reducing costs by eliminating specific treatments seen as not cost effective. Not that Obama and Democrats did not also attempt to double count “cost savings” of cuts in Medicare reimbursements. That was a different fraud.

    Typical of your incompetence at spin.

    SPQR (26be8b)

  44. Assclown Doodyheads

    Thanks for contributing, and we have a question that perhaps you can help us with.

    At #33 I offered:
    My puzzle is the epistemologic quandry of knowing whether such a writer realizes what they are doing and believes it, realizes what they are doing, realizes it is unfair, and does it anyway, or is totally clueless on what they’ve done.

    JD says a combination of the first two, what do you say?

    Since we know you read and take your political discourse seriously, you would know from #24 and other comments that in essence such death “panels” already exist, but typically in a small and informal manner. The big question is that as long as it it private citizens and private corporations doing it, we can hold them accountable through the courts if and when they get out of hand, the feds, no such luck.

    So, do you really believe the foolishness you voice in #40, or do you realize the falsehoods but share them anyway??

    MD in Philly (0f793a)

  45. Actually, Assclown, it’s far worse than “death panels”. It’s an executive branch that now has the power to make laws (statutory power) which Congress can rescind only if the executive allows it (the President must approve of Congress undoing the statutes).

    I’d love to see a Constitutional challenge based on separation of powers.

    Some chump (d2605b)

  46. Oh, and I love how Assclown rails about everyone else’s intelligence while misspelling “morons” and “there” in the same comment. Nice going!

    Some chump (d2605b)

  47. “…move towards a health care system that is based on quality and efficiency rather than quantity. Everyone agrees that we can no longer afford to just pay for quantity, that is, a fee for service system where doctors and hospitals are reimbursed based on volume.”

    He’s clearly talking about rationing. Rationing will result in cleverly named panels of people who will decide who gets what treatment. Those are life and death decisions made by government bureaucrats. You can’t sue them; you can’t pick them; you can’t pay for your own care. And the congress likely will be or already is exempt. And since the cost is going to be higher than advertised, the “quality” aspect of his argument will also leave the building with Elvis.

    quasimodo (4af144)

  48. A side question-

    How many people here can easily get an appointment to see their doctor when they want to? I certainly can’t, and it has steadily gotten worse. Truth is the typical family doc would love to have several urgent issues each day handled by a nurse over the phone rather than have the extra patients added on to an already full schedule. Inappropriately heightened patient volume is rarely the issue, I think most primary care docs would love to have at least 10-20% less patients on their schedule, have a little more time with each patient, maybe be more efficient in taking care of issues when they are preventable, and still be busier most days than they would like to be.

    MD in Philly (0f793a)

  49. ***I am looking forward to hearing from all of the Dems that Castigated John Deere, Caterpillar, Verizon & AT&T for following the law.***

    I’m pretty sure they cancelled out that session, JD, after realizing it was a no-win approach for the Dems and that said companies would come loaded for bear with inconvenient facts.

    Tully (4dce1a)

  50. Dr. Ezekiel Emanuel, health care advisor to President Obama – in his own words:

    “Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example Is is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.”

    “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost control, more for show and public relations than for true change,” (Health Affairs Feb. 27, 2008).

    Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association, June 18, 2008).

    He explicitly defends discrimination against older patients: “Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years” (Lancet, Jan. 31, 2009)

    Dr. David Blumenthal, another key Obama adviser, agrees. He recommends slowing medical innovation to control health spending.

    Blumenthal has long advocated government health-spending controls, though he concedes they’re “associated with longer waits” and “reduced availability of new and expensive treatments and devices” (New England Journal of Medicine, March 8, 2001). But he calls it “debatable” whether the timely care Americans get is worth the cost.

    Source: http://www.nypost.com/p/news/opinion/opedcolumnists/item_PU6S0iok2FbS368B7d7mAM;jsessionid=38D8AAABCA8B875E5EB8F35410D061D8

    I could go on, but any sane person gets the point that equal access to medical care will be determined by these boards telling doctors (under threat of economic and civil penalties)what treatments are “appropriate” for any given person or class of people. Note the insidious insertion of societal value and “costs to others” as a determining factor in providing medical care. I guess that is what progressives deem as fair.

    in_awe (44fed5)

  51. Whenever it is FREE their are usually shortages.

    Welcome to the USSR 1972

    HeavenSent (a9126d)

  52. I really am miffed at the way they structured this. Obviously to constrain the inevitable change of power from congress going against the wishes of the people. Now the representatives who want to change law or simply refuse to endorse death panels see the US President having ‘the inertia’ in legislative power.

    This would be similar to Bill Clinton writing an executive order giving the Senate some executive power just before W took office.

    And while I realize it’s not going to be overturned, it should not be tolerated. Each branch is defined in the constitution. The legislature sets funding. The House should be able to defund this mess if they choose to go that route, for example.

    This wouldn’t be an issue if our leaders simply honored the people’s wishes and were more responsible in how they write our laws.

    Dustin (b54cdc)

  53. Price is the greatest allocator of resources; rationing by governmental edict can only make a situation worse, as there is no single repository of information that can enable a bureaucrat to devise the most efficient response to a problem.
    http://www.washingtonexaminer.com/opinion/columns/Sunday_Reflections/Progressives-can_t-get-past-the-Knowledge-Problem-89780997.html

    AD - RtR/OS! (2ebc1d)

  54. You ain’t seen nothin’ yet. Rasmussen has been reporting that support for ObamaCare has continued to decline in the face of rosy expectations of a bump following passage.

    No bump, and voter opinion is running about 58% against the bastard legislation, and as the truth seeps out what little support remains will continue to wither away, like Congressional Democrats at a Town Hall meeting.

    ropelight (5b604f)

  55. Tully – Bingo. However, I think that all of the Dems, every last damn one of them, that wailing and moaned and accused those companies of devious and nefarious activities should have to make a very formal and very public and very sincere apology to all of the companies.

    JD (37e9a1)

  56. Will never happen JD, except perhaps as they’re cleaning out their desks come December.

    AD - RtR/OS! (2ebc1d)

  57. I’m wondering if, at some point, the death panels will have cheat sheets with a D or R next to the patient requesting services? I don’t know how they would treat the I’s.

    Rochf (ae9c58)

  58. @50 In_awe — here is the pdf of that Lancelot article partially authored by our nation’s Health Czar, Ezekiel Emanuel. It is a document I have linked several times before — something I did because it is so disturbing when coupled by the fact that Dr. Emanuel is a high-ranking government official appointed by the President and serves as one of his direct reports.

    His document reads like a “Eugenics for Dummies” manual and serves as a model for modern-day leftist justification of government intrusion into the life-and-death decisions formerly made between family members and physician. In short, it justifies the power of the government to make such decisions based on values that the government prizes. I found this piece disturbing and with overwhelming moral equivalencies to other such justifications throughout history (modern and ancient), which always rendered horrific results; same philosophy, different names.

    It is astounding that this man who holds such views was not rejected outright, but instead was accepted and embraced by this Administration.

    Almost certainly, the leftist leadership currently in charge of our country means well and intends to improve the quality of life of our country (and through us, the world by means of example), it is nevertheless shocking that they do not acknowledge the historical failure made by such philosophies in the past (given the academic credentials of many in the Administration, one might suspect it is not a matter of ignorance but of arrogance and weak mindedness). Neither does the current leadership acknowledge the enormous success that the philosophy of Liberty has had on our country – that this path is the best means towards prosperity for the most people and towards meaningful hope for the rest.

    Pons asinourm (770c6d)

  59. Pons…I think this quote pretty much sums up what we are dealing with:

    Tutto nello Stato, niente fuori dello Stato, nulla contro lo Stato.

    AD - RtR/OS! (2ebc1d)

  60. Perhaps I am just a hopeless liberal, but this objection seems pretty weak to me. Its not rationing of a market good, its “rationing” of medicare – a government benefit. Do you want the government to pay for any treatment a medicare beneficiary and his doctor request? And if so how do you expect to pay for that?

    TomO (e4c9be)

  61. Well TomO why would this plan be designed then to funnel people into the government plan if this was a government benefit?

    Mr. Pink (bb8267)

  62. Good grief. I should’ve expected that reference would’ve gone right over your heads:

    From one of those classy, well educ-ma-cated, Tea Party rallies:

    Morans

    Morons.

    Assclown Doodyheads (f0d390)

  63. Yeah! What does the doctor know about it, anyway? After all, it’s not about the patient’s health; it is, as noted in the post, all about “the future of our fiscal health“.

    Icy Texan (96cb63)

  64. @60 TomO — Given that Obamcare is really about Heath Care Reform (a premise that I disagree with but set aside for the sake of your question), let’s examine two systems:

    In one system, goods are distributed in a highly efficient system based on consumer earnings and provide for an ever expanding system replete with incentives for attracting the best and brightest, for encouraging high risk research, for creating an adaptable value supply chain, for incentivizing the advancement for the state-of-the-art, for reducing costs, and for ultimately making a consumer driven system (i.e. if one wants more, the natural incentive is to earn more).

    In another system the goods are distributed via rationing based on centralized planning and contain costs by decree, which disincentives the best and brightest for participating, which discouraging high risk research, which creates a stagnate and wasteful supply chain, which makes it impractical to advance state-of-the-art technology, which raises taxes, and which ultimately makes for a dependent and entrenched bureaucratic system (i.e. if one wants more, there is no natural incentive is to earn more).

    Obviously real Health Care Reform is needed, but Obamacare makes the system worse not better — more people will suffer and the resulting system is incentivized to reduce quality and resources, not expand them.

    Pons Asinorum (770c6d)

  65. @59 AD — sadly, agreed (we sure seem to be going in that direction).

    Pons Asinorum (770c6d)

  66. There would never be a need to worry about hospitals overcharging Medicare, Assclown, if there were no Medicare. They are saying, “Great news, everybody! We’re going to be paying out less of your hard-earned tax dollars; but we promise [*fingers crossed*] that your level of care will be just as good, if not better.”

    And if they do as promised, but the program still winds up in the red? What then?

    Icy Texan (96cb63)

  67. Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association, June 18, 2008)

    Somebody who says that should have their license taken away by the medical board. That would have been the opinion of any reputable physician prior to the one. I wonder what the letters to the editor said in the following weeks.

    He also thinks Jesus was mistaken when He said, “Do unto others as you would have them do unto you”.

    MD in Philly (0f793a)

  68. Comment by Assclown Doodyheads

    We’re still waiting for your response to #44.

    TomO-

    I’ll assume you ask in good faith. “Rationing” here means that an administrative official “somewhere” makes a largely arbitrary decision as to what kind of medical services will be available to who. You and your mother and her doctor may want “X”, but somebody else will have said, “No, you can’t have that”, as if they have one d— clue as to the details of the situation.

    A less obvious example Is is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.”

    Are you willing to let a clerk hundreds of miles away tell you and your doctor what services are “reasonable” for your child?

    MD in Philly (0f793a)

  69. Some Chump… you described a situation (going to a doctor and then writing a check) in which no insurance exists. Well… cheers to that.

    Intelliology (00d844)

  70. I’d love to have a system where I was allowed to buy purely catastrophic care coverage at a reasonable fee, and paid cash for all of my routine care.

    It is Democratic legislation at the state and federal level that has prevented me from being able to engage in that transaction with a “real” health insurance company. I’m forced by government intervention to buy bloated policies that have coverage I would not voluntarily pay for – policies that are no longer actuarial insurance but inefficient pre-paid medical care.

    SPQR (26be8b)

  71. Blame the democrats. It is easier that way, SPQR.

    Intelliology (00d844)

  72. Wow! Assclown *and* Intelliology in the same thread, both acting like, well, what they are.

    Just out of detox, apparently.

    Eric Blair (1ec03c)

  73. Blame the democrats. It is easier that way, SPQR.

    Intelliology – Exactly. They eliminated the choice they claimed they were creating.

    daleyrocks (1d0d98)

  74. The fact that the legislation I’m referring to had Democratic sponsors, and was enacted with largely Democratic votes is just an inconvenient fact.

    But then, it is not like I expect an honest response from Intelliology given his well-earned reputation.

    SPQR (26be8b)

  75. I found a report of another annoying item in the faux healthcare insurance reform legislation. The tax code is amended to require businesses to write 1099’s for every entity with which they do more than $600 worth of business.

    That will probably triple my tax preparation costs at the end of the year.

    Thanks, Democrats, I’m really looking forward to November.

    SPQR (26be8b)

  76. Comment by MD in Philly — 4/27/2010 @ 2:37 pm

    What they, those who defend ObamaCare, fail to realize (or just plain lie about) is that the “Medical Board” that reviews “GrandMa’s” condition and recommendation for treatment, will probably never see her name. Her diagnosis, along with her statistical vitals, will be entered into a computer program, and if she falls within the parameters established for treatment, she will get that treatment; if she doesn’t, she won’t – or she’ll receive some alternative treatment that has been “determined” to be more relavant to someone in her medical/age catagory.

    It is like the scrappage programs that are run for auto’s in many countries, and that the Statists would like to initiate in the USA:
    You can have a fifty year old car that has been restored to better-than-factory-new, but because of its’ age, or the type of vehicle it is, to the crusher it goes – and it would take an Act of Congress to over-rule some bureaucratic determination.

    AD - RtR/OS! (2ebc1d)

  77. Comment by SPQR — 4/27/2010 @ 4:50 pm

    Just another reason to repeal ObamaCare, and the 16th-Amendment!

    AD - RtR/OS! (2ebc1d)

  78. Has Idiotology had an honest comment yet?

    JD (c1a2b8)

  79. Comment by AD – RtR/OS

    Absolutely.

    It was hard enough in the flesh to get the docs to pay attention to my 95 year old grandmother, who had been mowing her own lawn past 90. The choice given by the local MD was to do nothing, or do nothing. From 600 miles away I arranged a transfer to another hospital where they took care of her gallstones with a 45 minute procedure by endoscopy.

    MD in Philly (0f793a)

  80. Some Chump… you described a situation (going to a doctor and then writing a check) in which no insurance exists. Well… cheers to that.

    No, not necessarily. I could be describing a system with an indemnity/reimbursement insurance. I pay my doctor, then submit the bill/receipt to my insurance company. My doctor is completely out of the loop when it comes to my insurance.

    It’s the way nearly everyone operated circa 1970.

    In any event, I showed that there are systems where no one gets between you and your doctor, which completely disproves your assertion in your first comment on this thread.

    Some chump (dc6dff)

  81. It was less of an assertion and more of an asspull, Some chump.

    JD (c1a2b8)

  82. Lots of responses, but you all seem to talk about Obama Care generally, which I am not defending here (although I admit I would, but I see that as a close question, I am just baffled by opposition to attempt to reign in exploding medicare entitlement spending). I am specifically asking what is the objection to medicare “rationing” (if you can really call government benefit cuts rationing) – which is what Orzag is defending in the video. So you can’t really claim that its a choice between a private market or a rationed one; unless you are in favor of abolishing medicare (which if you are, fine, but its not realistically on the table and wasn’t the relevant choice this year). Its a choice between Gov’t paying for whatever a patient and her doctor ask – or the gov’t setting some criteria for things it won’t pay for. Given that we simply can’t afford projected medicare spending at current tax rates what is wrong with setting up a system that determines things the gov’t wont pay for? And if you take that position what else do you want to cut to get the money (note social security and the military are the only plausible options), or how high do you want taxes to go? Also, you are always free to get private health insurance instead of medicare or supplemental insurance or just pay cash.

    TomO (9781ed)

  83. Comment by TomO — 4/28/2010 @ 3:48 am

    I am just baffled by opposition to attempt to reign in exploding medicare entitlement spending
    — Because in their noble attempt to ensure that all of this entitlement spending doesn’t break the budget, this Independent Payment Advisory Board will be in the exact same position as the “heartless insurance companies that deny claims”; you know, that thing that liberals hate so much. Instead of the profit motive, it will be the “break even” motive that leads to bureaucrats deciding what tests and procedures the patients really need. And the criteria they will use? Gee, I can’t possibly imagine [sarc.] how the talk about death panels came about.

    I am specifically asking what is the objection to medicare “rationing” (if you can really call government benefit cuts rationing) – which is what Orzag is defending in the video.
    — Of course you can call it “rationing”, because that is exactly what it is. If instead of paying out to cover what the medical professional deems necessary you only pay out a certain amount, based on the need to provide monetary “rations” to pay for the care of others (while making sure that the money does not run out completely) then the only thing you properly can call it is RATIONING. The objection, as noted above, is that the decision on what care is needed will be made by a bean-counter instead of a doctor.

    So you can’t really claim that its a choice between a private market or a rationed one; unless you are in favor of abolishing medicare (which if you are, fine, but its not realistically on the table and wasn’t the relevant choice this year).
    — My argument is that there isn’t all that much difference between the two . . . except that Medicare, where you have NO CHOICE but to be a client, has no incentive to ‘fight for your business’ in a customer service and product quality sense. As for abolishing Medicare, see my #66 above.

    Its a choice between Gov’t paying for whatever a patient and her doctor ask – or the gov’t setting some criteria for things it won’t pay for.
    — What if “whatever a patient and her doctor ask” is for the proper care to save her life, and the advisory board says, “Sorry, that’s too expensive,” or, “That’s too much to spend on one person”?

    Given that we simply can’t afford projected medicare spending at current tax rates what is wrong with setting up a system that determines things the gov’t wont pay for?
    — Why have it at all if it, A) is not cost effective; and, B) does not pay for everything that is needed?

    And if you take that position what else do you want to cut to get the money (note social security and the military are the only plausible options), or how high do you want taxes to go?
    — Because S.S. and Defense are the only areas of the budget with enough funding to offset this monstrosity? And, of course, we don’t want taxes to go higher at all. You’re actually making a pretty good case against this spending all on your own.

    Also, you are always free to get private health insurance instead of medicare or supplemental insurance or just pay cash.
    — That’s right. People that have been gouged out of money from their paychecks in order to fund Medicare have the “freedom” to pay even more money, from what remains after those FICA and income taxes have been taken out, in order to actually receive proper care.

    Icy Texan (0cfaa3)

  84. #62 “Get a Brain! Morans”. That sign was not from a TEA party event. It was taken in 2003. Morans is James Morans a rep from Virgina, opposed to the Iraq war.

    Good try linking that to a TEA party event.

    Corwin (ea9428)

  85. I am specifically asking what is the objection to medicare “rationing” (if you can really call government benefit cuts rationing)

    Why would we not call rationing rationing, TomO? It happens in every system set up like this.

    Given that we simply can’t afford projected medicare spending at current tax rates what is wrong with setting up a system that determines things the gov’t wont pay for?

    Let’s see if we can correct this for you – Given that we simply can’t afford projected medicare spending at current tax rates what is wrong with adding 30,000,000 people to the government healthcare rolls? What could possibly go wrong?

    Also, you are always free to get private health insurance instead of medicare or supplemental insurance or just pay cash.

    I am already paying for mine, and several others. Why should I have to get back in my pocket and pay even more because your silly pipe dream fails?

    JD (d55760)

  86. TomO,

    It seems that you either didn’t read what I posted, or I didn’t communicate well, or you’re really not interested in a give and take for understanding.

    First, I will deal with a general topic that you do not mention, but lurks in the background.
    ALMOST NO ONE THINKS THINGS ARE GREAT AND THAT WE SHOULD DO NOTHING!!
    Sorry for the shouting (not really) but that was Obama’s #1 public reason to push the bill, that things were a “crisis” and it was “this bill or nothing”.

    Everyone is for making a system better, more efficient, and as money saving as possible.

    Obama’s claim was we would have better and more efficient care, more people covered, for less money, and “no one would come between the doctor and his/her patient”.

    That overall construct isn’t believable, and it was a lie, and in the above he’s admitting it.

    Now, if Obama came right out and said, “We just can’t keep using medical resources the way we have been, as a society we need decide on firmer guidelines on what we think is reasonable to pay for.”, he at least would have been speaking truthfully. He did this a few times off script, with taking the cheaper of the red and blue pills and blasting doctors for “taking out tonsils” and “amputating feet” for money when it wasn’t needed. And we know how well that went over.

    The bottom line is he thinks the best way to cut medicare spending is to decrease the number of things medicare will pay for, and medicare already rejects twice as many requests as the private insurers do already.

    Back in the 80’s “they” thought the way to limit medical costs was to limit the enrollment of medical schools, that the costs of healthcare were driven by too many doctors needing to do too many unneccessary procedures. That worked out real well [sarc.]. Costs kept going up and noe we don’t have enough primary care docs, and often one needs to wait months before you can see the proper specialist.

    Today a person can have gall bladder surgery and virtually be back to work in a few days. This is done with expensive equipment that took many hours and significant financing to develop and produce. But in return the typical patient spends less time in the hospital and misses fewer days on the job. If one counts the savings in lost productivity maybe those new intsruments aren’t so expensive after all, but I doubt if the number crunchers look at that big of a picture.

    Maybe if 80 year old grandma gets her hip replaced she can continue to watch her grandchildren part of the day when the parents are at work. But then, that would diminish the need for govt. sponsored daycare and after school programs, employment would go down, and families would have a better chance of instilling their own value systems in their children, and we certainly don’t want that to happen.

    MD in Philly (0f793a)

  87. The questions come down to, first, whether ‘rationing’ occurs for everyone or just those under the Government plan? And second, if it is just for those under the Government plan, than how long before that same justification is used on all plans (since, as we’ve seen on many occasions from the Feds, once they have a hold on something – they want full control).

    If the Goverment was not involved with any Health Care except creating national clinics; basic low-end care, then the Free Market would control costs.

    Corwin (ea9428)

  88. construction jobs these days are on demand because the construction business is booming again`-*

    Health Medicine : (edfb9f)

  89. Spam spam spam spam spam

    Milhouse (ea66e3)

  90. milhouse

    thanks for the heads up on the spam. sigh.

    Aaron Worthing (e7d72e)

  91. Hey is there a way that i can get new posts sent to my email?

    lgv training prices (446b8b)

  92. I was very pleased to find this website. I wanted to thank you for your time for this wonderful post!! I definitely enjoy reading it and I have you bookmarked to check out new stuff you blog post.

    sabian cymbals (f3d08c)


Powered by WordPress.

Page loaded in: 0.4925 secs.