Archive for December, 2009

December Letter to Senators

December 11, 2009

This week I again wrote a brief note to several key Senators.  It pounds on the issue of women’s breast cancer screening because it is this issue, more than any other, which has given the Public a real glimpse of the rationing of Health Care that would result from the Reid Bill, and of the real possibility that unknown bureaucratic entities, such as the U. S. Preventive Services Task Force, can be elevated by this Bill into potential “death panels.”   The Democratic Senate hoped to lay this issue to rest by passing the Mikulski Amendment, but I am not through telling this “cautionary tale” because it effectively indicts Government-mandated health care, big-time, in the court of Public opinion.  The fact is, the Mikulski Amendment just adds more layers of Federal requirements, and doesn’t address the basic problem inherent in surrendering Americans’ health care choices to the complex, unchecked, bureaucracy outlined in the Reid Bill.

Here are my selected Senators:

Sen Collins (R-VT) http://collins.senate.gov/public/continue.cfm?FuseAction=ContactSenatorCollins.Email,

Sen Snowe (R-ME) http://snowe.senate.gov/public/index.cfm?FuseAction=ContactSenatorSnowe.Email ,

Sen Nelson(D-NE)  http://bennelson.senate.gov/email-issues.cfm,

Sen Lieberman(D-CT) http://lieberman.senate.gov/index.cfm/contact/email-me-about-an-issue,

Sen Lincoln (D-AR) http://lincoln.senate.gov/contact/email.cfm,

Sen. McCaskill (D-MO) http://mccaskill.senate.gov/contact/,

Sen Hagan (D-NC) http://hagan.senate.gov/?p=contact,

Sen Conrad (D-ND) https://conrad.senate.gov/contact/webform.cfm,

Sen Pryor(D-AR) http://pryor.senate.gov/contact/,

Sen Tester (D-MT) http://tester.senate.gov/Contact/ 

Sen Webb (D-VA) http://webb.senate.gov/contact.cfm

and Sen Landrieu (D-LA) http://landrieu.senate.gov/about/contact.cfm

For Senators Snowe, Collins and Lieberman, I tailored the letter slightly to soften the “We’ll throw you out next time” language at the end – lol. They probably don’t need to hear that since they have been fairly staunch in their opposition to this bill. 

Feel free to use this format and send it to your own Senator – or to the ones I have listed above.  In fact if you roll over the Senators’ addresses above, you will see a preview of their contact pages, and if you click on the link, the contact page should come up, and you can write your own message.  This is convenient, since some of the  contact pages are hard to find.  Don’t be afraid to write to Senators who are not from your state – the Senate is the senior, deliberative, body and has a more National scope than the House.  Besides, these folks are voting on issues that personally concern you, and that will affect your life and health!  Don’t hesitate to contact them!

So here’s my note:

“Senator,

Last week we finally found out what Senator Reid and Speaker Pelosi have meant by their endless mantra about health care “competition and choice.”  This became clear as we witnessed three amendments proposed to the Reid Bill – one to fix shortcomings regarding women’s preventive medicine issues such as breast cancer screening (brought on by the recent recommendation by the U.S. Preventive Services Task Force- USPSTF – and by Section 2713 of the Reid Bill, which would effectively make even bad USPSTF decisions like this one the Law of the Land), and two other amendments which attempted to reduce the drastic cuts to Medicare called for in the Reid Bill.

In effect, what we saw last week was the Imperial Senate, swapping roles with Caesar in the Roman Arena, giving one special interest group – Women – a “thumbs up,” so they might be suffered to live (at least until the Bill passes), and giving another special interest group – Seniors – a “thumbs down” as the lions of the Medicare fee schedule rationing bureaucracy are unleashed upon them! 

So, clearly, here we have spirited “competition” between various special interest groups for the scarce health care resources being rationed under the new system, and also sage and just “choice” by the Government (perhaps the Senate, or even some entity as fantastically competent as the USPSTF)  regarding which, if any, of the various interest groups are worthy of being permitted to have access to these resources!  This scenario totally fulfills the vision of “choice and competition” voiced by Senator Reid and Speaker Pelosi, don’t you think?!?  It’s brilliant! I just never understood it before! 

Speaking of “choice and competition,” the real reason for my letter is to let you know that what we badly need in this health care reform process is a true “competition” of ideas – ideas which thusfar have not been included in the bills, and many of which have not even been allowed consideration. You need to find a better, less monolithic alternative to the proposed legislation – read the polls – this is what the Public wants.  If you will not entertain this “competition” of ideas regarding even this issue of historic importance, but just continue to embrace the “same old” everyday Beltway conformism to political dogma, then I say that the Public will have to make a “choice” at the next election cycle. I promise that I, and other opinion leaders like myself, will be doing all we can to influence that “choice.”

“Choice and competition,” Senator – what say you? 

Sincerely,”

The Skeptic

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“Choice and Competition”

December 7, 2009

Last week we finally found out what Harry Reid and Nancy Pelosi have meant by their endless, droning, sideshow barker mantra of  “competition and choice.”  This became clear as we were treated to three proposed amendments to the Reid Bill – one to fix shortcomings regarding women’s preventive medicine issues such as breast cancer screening, and two others which attempted to reduce the drastic cuts to Medicare included in the Reid Bill.

The first, the Mikulski Amendment, passed, and for that we are thankful because this amendment prevents women from being denied coverage for mammograms.  This denial of coverage would have been the direct result of the empowerment by Section 2713 (page 17) of the Reid Bill of the recent arbitrary and unfounded rating (by the U.S. Preventive Services Task Force -USPSTF) of mammography as a “C”-rated procedure.   The second and third (McCain )Amendments went down to defeat and only a weak proxy amendment to not cut “guaranteed Medicare benefits” was passed.  This sham fulfills the deal made with AARP (in return for their support for ObamaCare) to kill “Medicare Advantage” programs in order to enable AARP to step into the vacuum and offer a similar product to Seniors. 

This marks beginning of the final scramble for exemptions and loopholes to enable special interest groups to retain greater access to scarce health care resources under the proposed health care rationing system than the rest of us, who do not have active lobbyists to represent our interests to our elected “representatives.”  I say “final scramble” because it is clear that a great deal of scrambling has already taken place (during the bill-writing process) to cut favorable deals for a number of special interests, such as AARP, drug companies, hospital organizations etc.

In effect, what we saw last week was the Senate, swapping roles with Caesar in the Roman Arena, giving one special interest group -Women – a “thumbs up,” so they might be suffered to live (at least until the Bill passes), and giving another special interest group – Seniors – a “thumbs down” as the lions of the rationing bureaucracy are unleashed upon their ancient butts!  (Looks like the Senate had to make one of those “difficult end-of-life decisions” we’ve been hearing about – lol).

So, clearly, here we have spirited “competition” between various special interest groups for the scarce health care resources being rationed under the new system, and also sage “choice” by the Government (perhaps the Senate, or even some entity as fantastically competent as the USPSTF) as to which of these interest groups will be permitted to have access to these resources!  This totally fulfills the vision of “choice and competition” articulated by Senator Reid and Speaker Pelosi, don’t you think?!

Stay tuned, this farce is only going to get funnier.  We will need to keep our sense of humor because, unfortunately, health care will become much, much worse.

The Skeptic

The Politicization of Access to Health Care?

December 2, 2009

A few days ago several women Senators stood in the well of the Senate  and supported an amendment to the Reid Health Care Bill that would “fix” the developing crisis regarding breast cancer screening.  Incredibly, they tried to “spin” the Public that the amendment is necessary because the health of American women is at risk due to unfair practices by insurance companies!  In the words of Senator Mikulski “For many insurance companies, simply being a woman is a pre-existing condition.  Women pay more and get less.”  Thus the Senators tried to gloss over the shortcomings in the Reid Bill that made this amendment necessary.  Rather than admit the bill is basically and deeply flawed, the Senators merely proposed additional layers of complexity to address the specific area of womens’ health.   

This myopic and dogmatic belief in an ever more complex and meddlesome Government-mandated system, with layer upon layer of tweaks to control and correct outcomes, seems to be central to the Democratic Party’s approach to health care.  The truth is that the current Government health care bureaucracy is already way over its head and is essentially incompetent at administering even its current health care responsibilities.   In fact, this very incompetence is the cause of the current breast cancer screening debacle.  Is it possible the Senators think that the Public  has already forgotten that this current crisis was caused by an already existing GOVERNMENT entity called the U.S. Preventive Services Task Force (USPSTF) and NOT BY AN INSURANCE COMPANY!?! 

OK, let’s review.  The USPSTF, a Government-appointed panel advising DHHS on the practice of preventive medicine, recently declared that mammography for women under 50 years of age was rated as a class “C” procedure.   Astoundingly, this decision, which contradicts the recommendations from many other medical groups, was apparently made without a single oncologist on the panel.  Unfortunately, under the Reid Bill, the USPSTF decision, no matter how arbitrary and unfounded, trumps other recommendations because USPSTF decision-making is codified in Section 2713 of the Senate health care bill:

“a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for—(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;”

This means that  under the Reid Bill, insurers, both Public and Private, would not be required to provide coverage for mammograms to women under 50 years of age.  In the super-competitive, low profit  environment being mandated by the new bills, insurers will not be able to afford to offer coverage for such non-required items.   Thus, under the Reid Health Care Bill, The USPSTF decision would effectively deny access to mammography for women in the age range from 40 to 50. In her press release, Senator Mikulski admits  “The pending bill doesn’t cover key preventive care for women, such as annual women’s health screenings for women of all ages.”  What would be the effect of  this lack of coverage?   The USPSTF itself estimates that 19% of cancers currently detected in women in this demographic would not be detected under the new guidelines.  Senator Mikulski goes well beyond this figure and states  “Studies have found mammography screenings decrease breast cancer deaths among women in their 40s by over 40 percent.”   

But Senator Mikulski and her cohorts in the Senate still fail to see the more basic threat revealed by the current breast cancer screening debacle – A decision by the USPSTF, or other Government entity, which  under our current system is merely an arbitrary and ill-informed recommendation which doctors and insurers may choose to regard as just bad advice, has the potential, under the Reid Health Care Bill, to become a death sentence!   And such arbitrary fiats are not limited to breast cancer screening , but could be issued regarding any preventive medicine procedure!  What happens under the new system when there is a similar arbitrary USPSTF decision regarding children, or old people, or people with a rare and unpopular disease?  In short, what happens when rationing is imposed on a group that is not a key interest group and that does not have Senators who are eager to stand up and fight for it?  Will there be a Senator with me in the Doctor’s office when my Doctor consults the Law, the Regs, and the USPSTF guidelines, and then informs me I am not eligible for some early detection diagnostic procedure that might save my life?

The need for the Mikulski amendment reveals the basic immorality inherent in Government-mandated health care.  This Amendment has (temporarily) “fixed” the problem of access to preventive procedures only for a politically important subset of patients -women – but the basic problem remains in the bill.  As a result, the rationing of health care resources which is built into the Reid bill will just be pushed off onto those groups of patients that do not have such strong lobbying factions and active political advocates.   In effect, we may be seeing the beginning of the politicization of access to health care.  If followed to its logical conclusion, this will lead to a new health care order – one which replaces the traditional free-market “cost-based” rationing with “interest group-based” rationing.  As we gain experience with this new model, I suspect that we will look back and marvel at how fairly and humanely the much-maligned free-market system has worked for us all. 

Ultimately, when it comes to health care, we are all just “single person” interest groups – our medical situation is personal and unique.   As I have stated before, our goal as individual patients is simply to obtain quality, life-preserving, health care that suits our personal needs, whereas the goal of a Government-mandated health care system is to conserve scarce resources for the bureaucracy, and for other, more worthy groups of patients than us.  The Mikulski Amendment just brings this brutal fact into sharp focus.

The Skeptic


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