Archive for the ‘1’ Category

Obama’s Unseemly Hucksterism – A Waste of Political Capital?

March 19, 2010

During the past week we have been subjected to repeated sales pitches from our “Huckster-in-Chief” in a desperate attempt to convince us that he is still the Obama of the 2008 campaign, and that we are still the same malleable, adoring throng who will enthusiastically back any program he touts – in this case bad health care reform.  Mr. Obama’s rhetoric has left me wincing and looking away in embarrassment.  Doesn’t he realize that our relationship has changed?

Today, for example we were treated to the vintage campaign Obama “Let me be clear – now listen up y’all,” introductory gauntlet.  Somehow it was as if all the nuances and details that we have learned over the past year regarding health care reform and its pitfalls should suddenly be ignored and simplified into “populist-speak.”  The result was surreal, and as gratingly out-of-place as fingernails on a blackboard at a physics lecture.  The President went on to say that “We have heard every ridiculous argument against this bill…”  Clearly the President is ignoring the innumerable previous versions of this bill whch were indeed amended in response to those “ridiculous arguments,” in a vain attempt to obtain a half-way decent bill that might have some small chance of succeeding.  If those arguments had not been raised, the current bill would now be even worse!! 

The President’s claim that these many arguments can’t possibly have merit, and must have been raised by the opposition with the purpose of denying progress to the American People, and of aiding the Insurance Companies is also ludicrous.  The real reason that so many, many objections have been raised to the health care reform bills is that these bills are so overambitious in their scope – because they attempt to tweak and control so many aspects of the “health care system,” all at the same time.   The bills  have attempted to cover everything from the “self-esteem” of handicapped children, to the intricate formulae for the utilization rate of MRI machines in rural areas and everything (and I do mean EVERYTHING)  in-between.   This soup-to-nuts approach is one of the main reasons that the Administration’s inappropriate attempt to call this monstrosity “Health Insurance Reform” has never caught on. And, of course, this is also the main reason that so many criticisms have been launched against the bill – because it is so seriously flawed in so many ways.

The attempts made in the bill to define and control these infinite disparate aspects of “health care,” are theoretical, at best, but, mostly, just uninformed, (or tremendously underinformed) amateurish guesses.  The result is a bill that, although several thousands of pages long, is basically no more than a concept paper for some actual health care reform bill which is not yet written.  For example, the bill is full of “pilot programs” for many untried delivery and reimbursement systems that seem to have been drafted without the help of professionals in these various areas.  Essentially, these pilot programs are “feasibility studies.”  To anyone with a background in design, this is a signal that we are still very, very early in the development of a design for our reformed health care system, and that, in fact, prudence might well dictate that we should consider performing these “feasibility studies” FIRST and let them inform our ultimate design (bill-writing) efforts!! 

Instead, the Administration would have us hurry up and sign on to this tremendously flawed and uninformed effort and then wait years to find out whether any of it is even partly worthwhile.  Even the discovery of what works and what doesn’t will be extremely difficult in the environment of this bill – basically the bill tweaks everything at once, so it is difficult to see which tweaks are working and which are not.  The proponents of each tweak will be pointing fingers at the others, and blaming them for failure to improve health care quality and costs.  This is yet another aspect of the “politicization of health care” discussed in another post.  Just as economists are always able to justify their theories and blame outside factors for any unpredicted results, so the partisans for each program will be able to justify their program and protect it from deletion even if it appears to be a miserable failure.  There will always be one more tweak to perform that will set the program right and tap into its full benefit to Society.  Because there is no way to measure the truth of their claims,  the result, will be massive inefficiency and waste that might have been saved by using a more scientific, incremental approach. 

This is all by way of circling back to my original point – No, Mr. Obama, these anti-bill arguments weren’t raised to help insurance companies – they were raised because the bill is so underinformed – so lightweight in terms of technical merit, and so short-sighted in terms of heading off unintended consequences.  And the reason there are so many arguments is because the bill is so overreaching and attempts to do way too many different sorts of things. Bottom line?  Almost all of the many major objections raised against these bills do indeed have merit, and many more of equal merit have probably simply escaped our notice.   The bills are just that bad.  

And Mr. Obama is equally underinformed and bad at promoting them.  This week, listening to Mr. Obama’s regrettable interview with Brett Baier of Fox, I was struck by the President’s impatience and bad faith.   Some of my observations regarding President Obama previously addressed in the post https://reformhealthreform.wordpress.com/2010/02/02/process-vs-policy-mr-obama-and-ms-pelosi/ were definitely reinforced by this interview.  Specifically, Mr. Obama’s indifference to Constitutional considerations, and his “ends justify the means” mindset are tremendously amplified by the Baier interview.  In fact, this recent interview totally erases any of the grace points in his interview with Diane Sawyer where he intimated that perhaps his Administration may not have “gotten the process right.”  By contrast, in the Baier inteview, Mr. Obama disparages the process as unimportant – it’s something he doesn’t even need to try to get right!!  And it is also, according to Mr. Obama, something the American People don’t care anything about!  This is a total turn-around from his previous explanation of the Scott Brown victory,  that Americans had been turned off to the virtues of the bill due to the dirty process!!  Wow, if he actually believes his new spin, I can’t help but think that this is a man every bit as disconnected and “bubble-ized” as the critics claimed that George Bush was!!

Even worse, the President was petulant in his refusal to acknowledge that he had called for “an up-or-down vote,” and insistent that whatever mechanism the Congress would devise would, by definition, be an adequate test of support for ” My health care proposal.”  Simply stunning in its circular, insular nature, and almost delusional in its framing of the bill under consideration as “my health care proposal,” a proposal which has never existed!  In fact, one of the real criticisms of this whole process has been the lack of input provided by the Administration as to what it wanted from the reform effort.

This has been a bad week for the President featuring gracelessness, divisiveness, and bad-faith that we thought he had left behind at an earlier phase of the debate.  At this point, no amount of happy “populist speak” inane rhetoric will soon erase our picture of a win-at-all-costs individual with no visible moorings to precedent, Constitution, or even to ideology.  In this graceless push for some bill- any bill at all- by any means at all- the President has expended a huge amount of political capital on what might have been, with proper management, a popular reform effort.  Regardless of the outcome of health reform in Congress, It is hard for me to see how the President can erase the negative images he has now created and how he can effectively unite the Nation behind the rest of his agenda.

The Skeptic

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Response to Mr. Obama’s 3/8/2010 Campaign Speech

March 8, 2010

I wrote the following on my local rag’s blog space today to respond to President Obama’s persistent misrepresentations and, dare I say, falsehoods, regarding health care.  It is a quick response, but it is to the point, and so far has been well-received

“President Obama has long ago lost all credibility on the issue of health care reform – he just needs a bill – any bill – to save face. He repeatedly says things that just aren’t correct, and he repeatedly tries to give us villains to blame for his own failure to understand and manage the politics and realites of health care reform.

I remember one time Nancy Pelosi admitted “Even if everyone likes their insurance – we just can’t afford to do that.” This is the real truth – “we” –  the Government, lol –  is going broke, and needs to tap into the private insurance pools to keep afloat.  Currently they do this by shorting doctors and hospitals on Medicare and Medicaid fees. These docs and hospitals need to make up the difference by charging more for the care they provide to the privately insured. Naturally, insurance companies keep having to raise premiums to defray the extra charges placed on their customers to make up for the shortfall in Government payments.  

Contrary to Mr. Obama’s rhetoric, insurance company profits, as a percent of premiums received, have not gone up – they are still in the range of 5% – far below the profit that big PhRMA will get under its deal with the White House over the next 10 years. Additionally, State laws have traditionally required insurance companies to be only around 70% efficient and to hold large financial reserves as a safety net. The proposed bills would supersede State laws and make the insurers run at 85% efficiency – i.e. run much closer to financial disaster – just like their Wall Street cuzs. That was such a good idea wasn’t it? Hey let’s just bankrupt the insurers too! Then we can bail them out – or buy them up.

Of course, for Medicare patients there is no help in sight. As you may know, the Mayo Clinic in Glendale AZ (originally praised by Mr. Obama as a great health care example) has stopped taking Medicare patients because they are losing 50% of costs on each patient. The proposed health care bills will cut even more out of the fees paid by Medicare. In theory, everyone will have “coverage,” but actual access to health care will be rationed by the hospitals and doctors who are getting crushed. Soon, no one will even want to be a doctor.

Welcome to ObamaCare.”

The Skeptic

Not with a Bang… Seminar Signals End of Administration’s Headlock on Healthcare

February 27, 2010

Upfront, the Skeptic needs to admit, that rather than watch the health care seminar held February 25 at the White House, the Skeptic elected to watch the semi-finals of women’s curling at the Vancouver Olympics. You know – curling – that somewhat more obscure and less exciting version of shuffleboard where a “stone” is slid upon the ice and then directed by “sweepers,” who melt the ice in the desired direction of travel. After reviewing the actual text and proceedings of the White House meeting, the Skeptic is now prepared to defend his choice of women’s curling as the more productive use of his time. 

 However, that is not to say that the outcome of the meeting is not historic – it is.  It marks the end of Phase I of the Administration’s health care reform effort – the big omnibus comprehensive all-Government approach.   Unlike other critics, I am not going to bash Mr. Obama’s performance – not too much anyway.  In fact, compared to his other outings (such as the embarrassingly bad speech to the joint session of Congress last Summer) this time, Mr. Obama betrayed some slight knowledge of the subject matter at hand.  His fellow Democrats, however, were generally ham-handed in their presentations and detracted from the discussion.   The anecdotal tales of health care tragedies were particularly ineffective – whenever Mr. Obama criticized the Republicans for using “talking points,”  one could not help but be struck that the Democratic use of tales of personal tragedies  to infer large scale systemic failure of the American health care system was by far the most egregious example of the overuse of talking points by either side. 

But none of this truly explains the dynamic of what took place for the Republicans, and what did not take place for the Democrats at this meeting.  In a nutshell, the Democratic presentation was simply not news – we have heard it all literally dozens of times before.  The Republican position was news – unless you are a follower of blogs or alternative media, you had simply never heard the Republican position before, and were not aware of the plans for bills that had been submitted to Mr. Obama by various Republican Senators and Congressmen.  In fact, when Mr. Obama admitted to having read these plans, he effectively silenced one of the big lies being promulgated by his Administration – that those opposed to the Senate and House bills have no ideas or plan of their own. 

In fact, after the summit was complete, commentator after commentator focused on the Republican presentation and expressed surprise at its cogency.  Why?  because they are focusing on the NEWS value out of this summit.   Basically, the Administration made a huge miscalculation in not understanding that both the Public and the news media are now immune to the stock, droning, half-truths that have been endlessly spouted by one Administration official after another – mainly by the Spouter-in-Chief, himself!!

(to be continued)

Health Care Process vs. Policy: Mr. Obama and Ms. Pelosi

February 2, 2010

Recently,  Mr. Obama was asked by Diane Sawyer about his failure to live up to his repeated campaign promises to put  Health Care Negotiations on CSPAN for all to see.  Mr. Obama’s response was that this was just an example of  his Administration being so busy during the past year “getting the policy right”, that they did not pay sufficient attention to the “process.”  Furthermore, he proceeded to throw Congress under the bus by saying that it was not he, or his Administration, that had made those disgusting backroom deals, but Congress,  and that he only regretted that he had not been able to make Congress work better through this process. 

Not only is the latter statement untrue  (the Administration has done nothing but cut secret deals with special interest groups – Drug Companies, AARP, Hospital Associations, Labor Unions etc etc from the very beginning of this “process”), but the statement about “process” vs. “policy”  is especially telling.  In Mr. Obama’s world, clearly “policy” is “gotten right” (i.e. determined and dictated) by the Government, and “process” is mere window dressing to reassure the Public that this dictation is taking place under some legitimate Constitutional authority.  In his answer to Ms. Sawyer, the President is merely restating  the classic apology that laudable “ends” (policy objectives) justify shabby “means” (process)!  To someone who thinks like this,  the (democratic) “process” has no inherent importance and must, sometimes, regrettably,  be sacrificed to accomplish “policy” objectives.  Does this surprise anyone?  Don’t we all know by now that this is exactly who Mr. Obama is, at heart?  

If you want to understand the Massachusetts election result, this is the heart of it:   The Public disagrees with the President – the Public doesn’t like the idea of surrendering their lives and well-being  to the single-payer intentions of ideologues like Dr. Ezekiel Emanuel and  Jacob Hacker, who inform the Administration’s allegedly compassionate health care policy via a grim assortment of cost curves.  To the Public, the “process” is not mere window dressing – it is their chance to have a say IN DETERMINING THE POLICY!!!  This is universally true for all proposals that make drastic changes in areas that strongly affect people’s lives.  People are stressed by major change, and they need to be involved in the “process” upfront.  The Public wants its Government to listen to their legitimate concerns, AND THEN TO ADJUST THE POLICY TO ADDRESS THESE CONCERNS!! 

This is why Mr. Obama’s promise of CSPAN coverage resonated so well with American voters – they thought that, even though they weren’t a drug company or a labor union, they might have a virtual “seat” at the table, and at least be able to see clearly what was being devised for them so they could react to it and have input to the process through their Congressional representatives.  Instead, huge bills were written behind closed doors by lobbyists and staffers.  The bills were so long and the language and references to other bills were so confusing that even members of Congress could not understand the contents. 

As a result, there was a flood of conflicting representations about what was in the reform measures – to the extent that the average citizen could not discern the truth. For example, Mr. Obama continually insisted that “you will be able to keep your doctor and your insurance,”  while those of us who had read the House bill, and disagreed with the President’s statements, were characterized as fear-mongering tools of the insurance companies.  We felt like we had gone through the looking glass – into some “true-is-false” world –  it was just that clear that the President was not being truthful.   Sure enough, on January 30,  2010, Mr. Obama finally admitted that some provisions had indeed “got snuck in” the bills that would “violate that pledge” (aka his “lie”) re: keeping “your doctor and insurance.”  This initial and continuing flood of misinformation (on both sides admittedly) was accompanied by the President’s impatient and persistent insistence on an immediate end to the debate!  How could anyone reasonably expect the Public to trust this “process?”

Any management team knows that major reorganizations require obtaining buy-in from stakeholders.  This is just management 101.  And Obama himself, although totally lacking in management experience, originally seemed to instinctively understand that transparency would be a good idea.  So what happened?   I believe that, once elected, our “New, young President” began to believe that he was so very popular that he could take the electorate for granted and bypass both “process” and “policy” checkdowns by using his charismatic appeal.  He believed that the only stakeholders he needed to buy off were the large associations of hospitals, pharmaceutical companies, unions etc. as mentioned above.  (Memo to Prez for future consideration:  This “charm factor” doesn’t work for issues of vital personal concern to ordinary folks that don’t enjoy the same vast resources and exemptions from Public Laws that you do). It was a classic case of overreaching and of misreading his own electoral mandate.  Now Mr. Obama is trying to blame everyone else, from Insurance Companies to the Congress to the Public themselves, for his own failure to (a) understand the political realities of the process, (b)  listen to opposing voices and alternate solutions from both professionals and from the Public (c) get involved in devising the actual bills, (d) keep Congressional pork and Executive Branch bureaucracy to a minimum, (e) maintain transparency as to what will be required of citizens, what they will get, and what it will cost (no accounting tricks or leveraging of hidden costs onto states or individuals) and (f) put away ideological purity, and put together something practical that might actually have a chance of working at a reasonable cost.  In short, he failed to manage health care reform in even a minimally competent manner.  

An example of the Presidential  incompetence?  I can still remember President Obama arrogantly declaring upon his return from one of his innumerable trips last Summer, that he noticed that while he was gone there had been ” a lot of Chatter out there about health care.”  This is how the President characterized legitimate Public concern and dissent about an issue that touches not only their pocketbook, but also their very flesh and blood – as “Chatter”!  What a disastrous attitude!   And what a misreading of Public sentiment!  Throughout the process I think that Mr. Obama has consistently been “dismissive, even derisive” of the Public will on the issue of health care. ( However, the Skeptic is extremely doubtful that the American Public will ever get the same kind of apology that Mr. Obama has given the rest of the world for America’s alleged “derisiveness”.)  In fact, I believe the origins of the Public outcry regarding health care can be traced to Mr. Obama’s attitude and actions, not to Congress.  President Obama has fumbled the handling of “the health care debate” from the very beginning.  As a result, “ObamaCare” is now less popular than “HillaryCare” – a fact for which, Mr. Obama has only himself to blame. 

And now he seeks to distract us from the pain, suffering, and corruption embodied in the health care bills by belatedly focusing on the issue of “jobs.”  Just how stupid does he think the Public is?  Well, let me remind everyone once again about the lesson of Massachusetts, which reverberates long, long after the health care debate was supposed to have been settled.  It turns out that we, the Public, are not that stupid after all.  And we are not going to forget either the President’s object – to dictate every aspect of health care through regulation, guideline, or bureacratic fiat – nor his attitude – that we disagree with him simply because we are uninformed, or, perhaps, just plain stupid.  What a losing combination!  This guy is dragging Democratic members of Congress straight down to electoral hell.  The only question is how far will they follow him on this journey?

Now for Speaker Pelosi – a relatively minor Jester in the King’s court.  Recently, in fulfillment of her role as Jester, Ms. Pelosi was heard to utter the following pearls of wisdom regarding the health care legislative process:

“We will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high, we will pole vault in. If that doesn’t work, we will parachute in.”

Yes, on the face of it, and considering the limited intellectual powers of the source (can anyone say “moron?”), this is quite amusing. A lot has been made of the incongruity of the physical image of Rep. Pelosi pole vaulting, perhaps over the dark gate of Mordor, (erected by evil Insurance Companies, no doubt) into the promised land of Universal Health Care.

The Skeptic, however, is extremely disconcerted by the Speaker’s statement. Surely, the “gate” and the “fence” are metaphors for obstacles to passage of the health care bills. The main such obstacle is, in fact, not some insurance company cabal, but rather the legitimate objections of the American Public to Government-mandated health care. Then certainly, the vaulting “pole” and the “parachute” represent ways to get around this obstacle – parliamentary gimmicks such as reconciliation or disassembly/reassembly tactics whose sole object is to circumvent the normal democratic “process” and to nullify Public opinion on this issue.

 Here we have the “process” vs “policy” dichotomy taken to its extreme. While the President seemed somewhat regretful about “process” failures in his Sawyer interview, the Speaker is unabashedly enthusiastic in promoting anti-democratic “means” to accomplish her liberal, (and therefore totally virtuous) “ends.” I find the Speaker’s mindset more myopic and frightening than the often dredged-up bogeyman of Conservative religious fervor, because her righteous crusade is accepted by many as “progressive” and “forward-thinking.”  In fact, it represents a huge step backwards to a time when we lacked a Constitution that holds the promise of a Nation of Laws, not Men.

In my opinion, elected officials like Nancy Pelosi represent a real danger to the democratic Institutions that we rely upon and cherish as the source of our Strength and Liberty. Mr. Obama is not that far behind her. Fortunately, the citizens of this Country are growing aware of this danger and, as evidenced by the Massachusetts election, are prepared to defend our great traditions of Democracy and self-determination at the ballot box!

Yes, Mr. President, Ms. Pelosi, “let us be clear!” – we are indeed going to do health care reform!  But we are going to do it our way – legally – doing the process correctly – not by creating false villains like doctors and insurance companies to confuse the Public and thus lead them to betray their own best interests.  And not by empowering a huge bureacracy and an array of special interests, vastly more powerful than any insurance company, to enrich their coffers while we lose our right to choose our coverage, our doctors, our treatment, and our end-of-life.

Take heart! Thanks to the People, there is still hope!

The Skeptic

Post-Massachusetts Letter to my Congressperson

January 22, 2010

The following is a letter I have written to my Democratic Congressperson in the wake of the Massachusetts election.  Rest assured it has already been answered by a boilerplate response touting the virtues of the House bill.  They still just don’t get it.  At this point, I am actually rooting for them to go the secret meeting and reconciliation route – this will maximize the voter backlash in November.  Also, the use of unprincipled tactics to pass the bill will help to justify overturning it  in the future.

Here is my letter, (which was hastily written and which I am now tempted to edit):

 “Dear Congressperson

Perhaps it has escaped your notice that I was correct in predicting the price that Democrats will pay at the polls due to the stinking, mismanaged, corrupt mess embodied in the Congressional Health Care bills.  

You need to pay attention because this is coming your way as well.  Don’t be misled by the spin apparati who are trying to say that Massachusetts is unique because the citizens already have universal health care and therefore the bill was not important to them.  This is patently untrue – Mass has many, many retirees and poor citizens who depend on the FEDERAL Medicare and Medicaid programs.  They are scared about what will happen to their future health care under the proposed bills. This fear has come out as anger.

With good reason.  Perhaps you know that recently the Mayo Clinic in Glendale AZ reluctantly decided to not accept Medicare patients.  Why?  Because they already lose about 50% on every Medicare patient they accept due to the low fee reimbursement schedule!  This fee gap will be accelerated by the baseline Medicare cuts in the Congressional Health Care bills and further accelerated in future cuts made by the “Independent Medicare Advisory Board” included in the Senate Bill. This Board is mandated to make recommendations for Medicare fee cuts per an annual schedule – neither house in Congress is allowed to fulfill their Constitutional duties regarding controlling the purse strings – per the bill they are forbidden to contest the Board’s recommended Medicare fee cuts and they would simply be “out of order” if they tried to change the rules back to regain control of the purse strings!!  Simply unbelievable – Congress is providing itself a ready-made excuse for the draconian Medicare cuts to come.  Constituents shouldn’t blame them or vote them out for denying them access to health care!  Their hands are simply tied by the provisions of the law, you see! 

Knowledge that reduced access to health care is built into the proposed bills is part of the reason why older people are terrified of health care reform and why they are deserting the Party in droves.  Try to recall a few short months ago that the Mayo Clinic was repeatedly lauded by President Obama for their cost-effective approach to health care.  Now, the Clinic’s financial inability to maintain services for Medicare patients is handwriting on the wall for all to see – especially poignant proof of the disaster that awaits us all under Government-mandated health care. By the time I am eligible for Medicare benefits, (7 years from now) I fully expect to find a “Medicare Ghetto” underserved and eschewed by doctors and medical institutions.  On the basis of  a recent sham amendment, Congress will try to claim that they have not cut “basic benefits,” but, in effect, this will be a lie because Congress will simply have  forced health care providers (by cutting their fees) to be their proxies in cutting the services provided to patients.  In fact, many elderly patients will probably not even be able to find a doctor to serve them (check the CBO projections).

This is only one of the problems with the proposed health care bills.  Another is the severe shortfall in the out years for States resulting from the expansion of the Medicaid program without sufficient Federal support (another abrogation of Federal responsibility in the name of making these phony programs look “revenue neutral.”) In fact, States (who are already being consumed by Medicaid expenses) will be forced to raise State and local taxes and fees and to cut other programs, like education and public safety, in order to make up this shortfall.   Oh wait – I forgot didn’t I – some  States won’t have increased costs after all because their Senators have been bribed with offers of Federal support to pay the additional Medicaid burden in perpetuity.  Have you gotten our State a good deal, Representative?  I guess not – you didn’t hold out long enough – you just couldn’t resist french-kissing ObamaCare on the very first date!

 As I said before, the proposed health care bills are a stinking, mismanaged (and corrupt) perversion of the legislative process. 

 I could argue that you need to listen to me because I am a 30-year FDA alum – a Public Health Pro and I know this stuff cold.  But perhaps it will have more impact if I tell you to simply listen to the people of Massachusetts.

They aren’t just angry – they are afraid – afraid of you and the second-rate, non-sustainable health care you intend for them and theirs. I want you to think about that. And hopefully you might then think about a middle road toward improvement, rather than destruction, of our health care system.  

 Sincerely,”

The Skeptic

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

“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

Letter to Senators Considering Reid’s Health Care Bill This Weekend

November 19, 2009

Forgive the Skeptic for becoming sidetracked by everyday life, company, housecleaning, car repairs etc. etc.  I’m back now – sorta

Below find my letter, hastily written today, and sent to 14 Senators – two from my state and 12 that are “swing votes” from various states, including:

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/contact/,

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/ 

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

 

I have not “prettied up” the letter – it remains as I wrote it, with all its shortcomings, but I stand by its major points. 

I encourage all to write their own letter, or to borrow part of mine and make it their own.  This vote in the Senate is up for grabs – unlike the House vote.  The House often votes to reassure their Democratic base, while actually counting on moderation by the Senate.   Even so, the margin of victory in the House was razor-thin.  I think this means the Senate may feel empowered to vote this bill down!  Encourage them to do so – give them an incentive – the loss of your vote!  Here’s my letter –

 

“Senator X,

I notice that the recommendations made by the U.S. Preventive Services Task Force regarding decreased emphasis on early detection of breast cancer via mammography were made without the benefit of having even a single oncologist on the panel. 

 I believe that this kind of bureaucratic finding is not at all limited to breast cancer, but rather is indicative of the kind of consideration that will be given to Public Health under the new Government-mandated health system proposed by (Substitute) H.R. 3590 now being considered by the Senate.   In fact, I believe that once these sorts of Government recommendations start becoming mandated policy, for every anecdotal horror story regarding lack of insurance that has been trotted out by political hacks in the last six months, there will be 100 actual horror stories regarding lack of access to life-saving health care under the “reformed” system.  While Congress will congratulate itself on providing increased health care insurance COVERAGE there will, in fact, be substantially decreased access to actual health CARE – and, yes, this includes decreased access by the poor, elderly, and needy – perhaps more so than by those that have the wherewithal to escape from this wretched and ill-conceived plan.

 Especially at risk will be access to specialized care.  The health care reform measures developed by both houses target specialists and disincentivize them from studying and practicing.  In time, we will lose even our capacity to provide such care to any except the ultra-rich – there simply will be so few such specialists that their services will be essentially unavailable.  Pharmaceutical companies will prosper because the bills under consideration will encourage (often palliative) “pill medicine” by general practitioners in place of more costly therapeutic interventions that we currently see performed by specialists. 

 Also at risk will be the elderly.  Medicare is being severely cut, and many doctors and other service providers will not want to accept Medicare patients because they will be forced to “self-ration” care to these patients.  In effect, if uncorrected, these bills will create a “Medicare Ghetto.”  I note that the recent “Doctor fix” legislation admitted that the cuts were too steep by $247 billion.  This bill was voted down because of the 10-year price tag, but it will need to come back in shorter term format or the “Medicare Ghetto” will become a reality. 

 This brings up the minor matter of cost – not only does the $247 billion need to be added to the balance sheet, but also the true long-term, steady-state costs based on expected per year revenue vs. benefits paid as opposed to the current weighted estimate based on initial deferral of provision of benefits.  Part of the cost of this program is also in the cost shifted to states, the cost shifted onto medical device and drug companies, and the cost shifted into premium increases for individuals and families.  In fact, all of the costs will ultimately be shifted to individuals and families.  There is no free – that is one of the misrepresentations made about these bills. 

 This brings me to one of my “gut” objections to these bills.  They have been promoted based on lies and distortions in the great tradition of American populist rhetoric – from Mr. Obama’s claims of heartless doctors performing lucrative amputations instead of preventive care, to a Florida politician’s assertion that those daring to criticize these disastrous bills just want people to “die quickly,” the whole debate has been a sham debate aimed at our worst fears and weaknesses.  The stronger the rhetoric, the weaker the bill – and these are no exception. 

 Ironically, this week it appears that it might just be the Government that wants women to “die quickly” from breast cancer, and is discounting the benefits of preventive care.  Is it fair of me to say that?  Of course not, but it is fair to say that the Preventive Services Task Force finding illustrates our worst fear regarding Government-guided health care, and highlights the inherent clash of interests between the individual patient, who only desires quality health care, and the Government-guider/provider, whose primary goal is to conserve resources for the bureaucracy and for other, more worthy, categories of patients.

 I guarantee with total confidence based on my years inside the U.S. Public Health Service, that if the Government is vested with the huge range of powers proposed in H.R. 3590, this basic conflict will lead to a nightmare of inefficiency and consequences, intended and unintended, that will decrease the quality of health care for all Americans. 

 I urge you to consider other options – options that actually have a chance of working – next year!!! You don’t even need to wait until 2013 as the current bills suggest!!  If health care is in such crisis, you could help Americans next year if you would only consider a more modest approach that doesn’t add hundreds of billions of bureaucratic inefficiency to an already bureaucratic system – if you would work to improve and extend coverage rather than creating an intrusive and meddlesome system that will change our relationship to our doctors and to our Government and which will lead to the destruction of our health care system. 

 If you care about the health of Americans and about the future of this Country, I ask you to vote “no” on cloture for (substitute) H.R. 3590.

 Thank you for your time.

 Respectfully,”

The Skeptic

Glimmers of Understanding?

October 17, 2009

In the last several days, a vague understanding of the health care disaster we face seems to be coming from an unlikely source – Senator Harry Reid.  On Thursday, Senator Reid stated that the cost of the proposed health care reform “bill” would be “two trillion dollars.”   In view of the fact that no actual legislation has been drafted and that the initial CBO scoring was based on pure guesswork, with some creative accounting thrown in, Senator Reid’s guess is a much more honest assessment.  (Part of the fudge factor in the CBO estimate is the immediate counting of tax revenues, whereas the expenses do not start until 2013 – thus there are 10 years of taxes and only 6 years of expenses in the CBO estimate, making the proposal appear more sustainable than it truly is). 

Yesterday, Senator Reid penetrated to another level of the problem – the fact that the proposed reform counts on fee cuts of 25% to doctors performing Medicare procedures.  These cuts, in fact, are at the heart of the proposed system – forming its basis for fiscal solvency; but more than that, as Mr. Reich pointed out in his now famous audio clip, one of the three essential philosophical pillars of the program is “We’re gonna let you (Seniors) die.”  If you have any doubts about that, look at  Dr. Ezekiel Emanuel’s resource curve published in the Lancet in January, 2009.  This curve shows your probablility of receiving costly medical intervention as a function of your age under Dr. Emanuel’s “socially responsible” medical system (for more information see “Obama’s Health Rationer in Chief” in the links section) :

 

 [mccaughey]

As you can see, Dr. Emanuel’s vision is that seniors would be about half as likely to receive therapeutic intervention as a 10 year-old, and about one-fourth as likely to receive treatment as a “productive” 20 to 40-year old.   This is not just some byproduct of the reform measures – Dr. Emanuel is a key Obama advisor, and his vision informs the Administration’s philosophical approach to health care reform – this “cost effective” apportionment of resources is the very essence of the envisioned reform effort.

Yesterday, Senator Reid stated that the short-changing of doctors fees under the proposed reform measures would lead to Seniors being unable to get adequate care, or perhaps even to see a doctor.  He also stated that this situation needed to be “fixed.”  Even Speaker Pelosi agreed that doctors fees needed to be revised “over ten years.”  The problem?  This pricetag for maintaining doctors’ fees is $200 billion to $300 billion, and would ruin the vaunted “revenue neutrality” of the Baucus “vapor bill.”  The solution?  Senator Reid intends to bury the doctor fee put-backs in a separate bill that will follow later – after Public attention has moved on to another subject.  Perhaps Democrats are unaware that there are folks like myself who will insist on calling Public attention to this tactic, but, more likely, they just calculate that what the Public thinks simply doesn’t matter.  

UPDATE:  The Doctor fee put-backs were actually voted on in a separate Senate bill on Thursday October 21, and the bill went down to defeat 53-47 with all 40 Rs and 13 Ds voting “no” on a motion to bring the bill to the floor (13 votes short of the 60 required for action). This defeat was largely based on reluctance to embrace the $247 billion pricetag.  Unlike other pundits, however, I do not see this as a resounding defeat for the Administration.  Congress still intends to go forward with some separate bill which addresses the doctor fees, they will just do it in smaller increments of 1 or 2 years to keep the apparent costs low, and to deflect public attention from the fact that health care reform will not save any money.   

While I am somewhat encouraged that there appear to be at least some lawmakers who are starting to understand the reality of the system and who are starting to become alarmed at how it will impact our access to treatment, it is still discouraging to see how they are trying to hide this reality and the true costs from the public.  Clearly, the Doctor fee issue should be folded into any health care reform bill, including its cost for the full 10 year CBO scoring period.

Nevertheless, two months ago, such an admission by Senator Reid regarding reduced access by Seniors would have been impossible, and if the Congress had acted at that time, we would now be stuck with a truly horrible bill.  As I have stated before, we critics  have actually won the health care debate.  We are just having difficulty getting the word out.  We can only hope that more honest conversation will continue, and that ultimately pragmatism will prevail sufficiently to spare our lives, our economy, and our freedoms.

The Skeptic


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