James Madison, Sarah Palin, and HR 3200
Posted on August 15, 2009
Filed Under General Rationing Issues, Uncategorized |
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“It will be of little avail to the people, that the laws are made by men of their own choice, if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood…” - The Federalist #62, James Madison (a founding father, the primary author of the Constitution, and a founder of the Democratic Party)
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Much has been made by right-wing gadflies of the fact that most of our Congresspersons have not read the healthcare reform bill under consideration by the House of Representatives, HR 3200. The argument goes: Given that HR 3200 proposes to fundamentally transform our healthcare system - a vast system that influences the life and death of all American citizens, and that consumes 17 or 18% of our economy - then before our elected representatives vote yea or nay on such a vital bill, they should consider it their sacred obligation to read it first.
DrRich will admit to having originally shared this opinion. But then he spent a couple of days attempting to read selected sections of the bill himself, in order to answer specific questions he had about those sections. (For instance: Does Section 1233 actually mandate end-of-life consultations for old people, or merely arrange for the option? Does Section 122 allow DrRich to continue his self-pay, high-deductable, catastrophic health insurance plan, or does it declare such plans illegal?) Now that he has made this effort, DrRich’s advice to our legislators is - don’t waste your time. For, even if you spend months parsing the convoluted grammar, numererous cross-references, and ambiguous language of this bill, you will not be able to answer even the simplest of questions about what it “really” says.
This is not just because the bill is complex and difficult. The Federalist Papers, for instance, are complex and difficult, full of classical allusions, archaic constructions, and difficult concepts. But with a little time and effort one can readily discern their meaning, and one comes to appreciate the full depth and remarkable persuasiveness of the ideas Hamilton, Madison and Jay were espousing. This is because at their bottom, the Federalist Papers actually say something.
Not so HR 3200. It is complexity for complexity’s sake. When one parses out all the legalese, cross-references, and unnecessarily tortuous syntax, one is often (if not in each and every case) left with nothing concrete. To a great extent, the meanings of large sections of HR 3200 are not merely difficult to ascertain, but are fundamentally indeterminate. It has no definite meaning. It is designed for ambiguity.
This is legislation designed to create a legal framework under which huge cadres of unelected, politically-appointed policy mavens and bureaucrats will determine - by publishing hundreds of thousands of pages of regulations, rules, and guidelines - what our new healthcare system will look like. And until those regulations and guidelines are actually created - and this “creation” will be a never-ending process rather than an act - anybody claiming to know the precise nature of our new healthcare system under HR 3200 is engaging in one of the following: lying, projecting one’s own wishful thinking, or extrapolating on the perceived behaviors and beliefs of those who (one surmises) will finally get to make up all the rules.
So nobody voting for HR 3200 will possibly be able to say with any degree of certainty what they are voting for, or what, precisely, a healthcare system will look like that comes from this bill.
This is what makes the debate so difficult. On one side, we have politicians telling us all will be well. We will finally insure 47 million Americans currently without insurance; we will reduce the cost of healthcare without affecting quality; we will not raise taxes to do so; those happy with the insurance they have now can keep it. And the actual language of HR 3200 (at least arguably) may not explicitly contradict any of these claims.
On the other side, we have politicians arguing the opposite on all these points. And HR 3200 seems quite consistent with their predicted outcomes as well.
The fact that the language of HR 3200 is completely consistent with either of these interpretations reduces the debate to a series of “Uh-huhs” vs. “Huh- uhs.” The ultimate meaning of HR 3200, by design, is completely open, and finally, will only be determined by armies of commissions, regulators and bureaucrats once it becomes law.
Which brings us to Sarah Palin.
Sarah Palin is the public figure who has crystallized one of the major concerns about healthcare reform, and she did it with a single phrase: Death Panels.
Her accusation, DrRich surmises, is as follows: Once healthcare reform provided by HR 3200 is implemented, the healthcare system will come to be arranged in such a way that life and death healthcare decisions for at least some Americans will be determined by a body of public officials (though odds are high that, if this turns out to be the case, such a deliberative body will choose some name other than “Death Panel”).
And while proponents of HR 3200 may not have learned it yet, they cannot just write this accusation off as being patently absurd. The fact is, Palin’s accusation has struck a chord with a substantial proportion of the American population. And so, instinctively if not intellectually, the notion of government-run death panels is not out of the question for Americans.
Simply calling Sarah a raving, low-brow, red-state, cave woman, who has been bitten by one too many rabid polar bears, does not fix this problem.
Proponents of HR 3200 are going to have to go far beyond mere ad hominem attacks (against Palin, Limbaugh, Hannity, Beck, etc.) and even beyond ad populem attacks (against the great numbers of fascistic, terroristic, un-American right wing mobsters who keep showing up at the town hall meetings) to win this argument. They are going to have to argue logically against the logic that makes death panels seem plausible to so many Americans.
And it is, in fact, genuine logic.
Let DrRich explain:
1) A key premise of healthcare reform - all the hand-wringing about uninsured Americans and quality improvement aside - is to control costs. President Obama has said so himself quite explicitly several times, and quite correctly. If we don’t get healthcare costs under control, we cannot sustain our American society. It is a matter of survival to reduce runaway public spending on healthcare.
2) Instead of reducing costs - all protestations about monitizing efficiencies and reducing waste aside - the reform plans under consideration now will actually increase spending (according to the non-partisan CBO) by at least $1.5 trillion over 10 years.
3) Because everyone understands that Job One is to reduce spending, but at the same time the proposal in front of us does just the opposite, it follows that the necessary and unavoidable reduction in spending will have to be accomplished by some unspecified means.
4) The carefully tailored ambiguity of HR 3200 very clearly leaves the unspecified means of cost-cutting to unelected regulators, bureaucrats and commissions.
5) By leaving the cost-cutting to unspecified people using unspecified methodologies, our elected officials have explicitly invited wild speculation on the part of the unwashed masses on just where and how the cost-cutting will be accomplished. So our politicians have no right to criticize the masses when such speculation begins to take place.
6) The tactic of ramming complex and massive bills through Congress, under cover of sundry “emergencies,” before anyone has a chance to study those bills, works well enough when the bills are quickly passed. But when the ram-bill tactic fails, and people actually have a chance to view the proposed bill before it is voted on, and in so doing perceive an abomination - the natural result will be anger and paranoia among the people. Therefore, stirring up the people into anger and paranoia ought to have been foreseen as a clear risk by those who adopted the ram-bill tactic. They should have been prepared to deal with this reaction by some better means than insulting the now-angry, now-paranoid population into even more anger and paranoia.
7) And finally, given the widespread speculations, anger and paranoia now circulating among the people (reactions which were triggered, DrRich reminds his readers, by the substandard behaviors of our elected representatives), and considering that the pro-abortion movement (including proponents of late-term abortion), the end-of-life movement (which strongly advances assisted suicide and euthanasia), and the radical green movement (which seems to consider western civilization, if not humanity itself, a cancer of the biosphere), have all found happy homes within the current administration, then the fear that individuals who hold such agendas dear will find their ways onto the commissions, regulatory bodies, and guideline agencies that will determine where to cut healthcare costs, is entirely predictable and understandable.
Proponents of HR 3200 will get nowhere by denying the legitimacy of such concerns, or insulting the people who have them. There is a path of logic that leads to these concerns, and to dampen them, proponents of HR 3200 need to be willing to take explicit steps to assure that the feared outcomes will not be possible.
Now, whatever you may think of Sarah Palin, realize that she has experienced personally what it is like to cross some of those people of quality who (many now fear) will be determining who gets what in our new healthcare system. Specifically, DrRich is referring to those who have the conviction that Palin had a duty to abort her son Trig. For failing in this duty, she was attacked last fall not only by fringe nut-groups, but also by reputable professionals and professional organizations. The very idea that a woman who chose to bear and raise a Down syndrome baby would be elevated to a position of public prominence was considered, in very many polite quarters, an affront to modern and enlightened civilization. These people would have hated Palin even if she spoke with a Boston accent and was a regular reader of The New Republic.
So for DrRich it is easy to see where Palin gets the idea of death panels. Save for the minor fact that it had no legal standing at the time, she stared a would-be death panel in the maw herself last fall. For her, the possibility of death panels must seem very real. And judging from the public reaction to her phraseology, the possibility resonates with many other Americans, as well.
And even though HR 3200 does not explicitly create death panels or anything like them (at least that DrRich has been able to find), it does create a new healthcare system desperate in its need to cut spending, and whose character will be determined by people other than our elected representatives, people who will be given immense power, and who (one must be forgiven for suspecting) will likely have personal and political agendas of their own. So, given the fiscal realities, and the political proclivities of some of the advisors closely associated with our current administration, the notion of something like a death panel might not be as completely crazy as we all might hope.
And like it or not, that terminology has served to electrify the public, and has given form to their instinctual but heretofore poorly-focused misgivings about exactly what our elected representatives have brought to our doorstep in HR 3200. Leave it to Sarah Palin, inarticulate though her critics assure us she is (but wonderfully focused by her own encounter with the beast), to come up with the galvanizing slogan.
Like Jimmy Madison said, way back when, voluminous and incoherent laws do not avail the people. For voluminous and incoherent laws must always achieve their manifest form at the hands of the unnamed and unelected and self-interested officials who decide how to implement them. If our representatives insist on pushing such laws upon us, our representatives are practicing bad government. It behooves us - the people, in all our incoherent anger and indignation - to bid them to stop, and if they won’t stop, to put them out at the first opportunity.
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36 Responses to “James Madison, Sarah Palin, and HR 3200”
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Dr. Rich,
As always written with great clarity and grounded in history, thanks! I have to disagree that the discussion is solely about costs — it is also about doing no harm (quality) and a more equitable system (access) in the wealthiest country in the world. Ot has been subverted by political interests to focus on costs only, but you and I both know that this is making mockery of people’s pain. I am also somewhat floored by your assertion that Palin was condemned for having NOT aborted her son with Down syndrome — that would indeed be a thuggish cave-man attitude. I would love to know where you have seen it, so as to understand what fringe groups we need to beware.
As you know, I have talked a lot on my blog about harm of over-medicalizing and overuse and misuse of healthcare. I appreciate the opportunity you provide for a further discussion of these issues.
Marya,
I agree that the discussion is not solely (or even mainly) about costs. However, “costs” is unquestionably The Big Issue - even President Obama has said so several times - and the issue of costs fundamentally underlies all the discussions of all the other important issues. This is what covert rationing is all about (pretending you’re trying to do one thing, while all the while actually trying to do another.)
I wrote a post last fall about the Palin’s duty to abort, and if you click on some of the links in that article you will get a bit more color around the issue. Here it is: http://covertrationingblog.com/general-rationing-issues/the-duty-to-abort
I also appreciate your open mind on all this stuff, and your willingness to discuss them civilly.
Rich
(nodding my head in agreement and enjoying the Federalist Papers references)
Why the US healthcare reform debate doesn’t actually primarily focus on - er - healthcare - is another blog post, I hope….
I didn’t know those “self-pay, high-deductable, catastrophic health insurance plans” still existed any more. They do? Where do you get them? Are they priced within reason for people who don’t earn as much as doctors? How bad does something have to be before it’s “catastrophic?” You mean a fat person actually could be insured against a broken leg?
Perhaps, this will help. In the legislation Section 1233, look at (f)(i), which states: “Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—…(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.”
Further down:
“(5)(A) For purposes of this section, the term `order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that— (i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order…”
Then, to ensure doctor’s compliance with this actionable order:
“(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-…(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment. (B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary….”
To better understand this coalition of stakeholders under the Secretary of HHS guiding these orders, turn to the stimulus bill, where a new Federal Coordinating Council for Comparative Clincial Effectiveness Research under the Secretary of HHS was created. If you don’t mind, I’ll share this link:
here.
here.
Excellent post and I love the quote.
To defuse this, all the President and his allies need to do is amend the bill in clear terms which abolish the objection. They wrote it, they can amend it. Why have they not done so?
Note: My comment was regurgitating an idea I read, but I can’t recall the origin.
Sandy,
I agree that if death panels materialize, they will more likely do so in the “CER” committee, rather than anywhere else. And that was created in the stimulus bill, not HR 3200.
Rich
Great essay. Thanks for continuing to turn out important insights and commentary.
You’re right that HR 3200 doesn’t explicitly dis-allow “Death Panels” and therefore people may be “reasonably” concerned that such a device may be implemented to ration care. But there are near infinite numbers of rationing devices that are not strictly prohibited by the bill about which the opposition could go on fear mongering about for years. It’s unreasonable to expect the bill to specifically address each one of these potential concerns.
These so-called “pro-abortion”, “pro-euthanasia” groups are a fringe minority. Their views are almost entirely unrepresented in the medical profession and are scarce among politicians. There will always be crazies who’s radical views can be drawn upon for fear mongering, but the likelihood of these viewpoints actually working their way into healthcare reform seems unlikely to me.
Last point, as most elderly people are covered by Medicare, the government has theoretically had the power to create “death panels” for the last 4 decades, and it hasn’t happened yet. Nothing about HR 3200 really changes this.
In the end, I don’t think you can combat paranoia, fear mongering, conspiracy theories and the like with reason. Those who believe them are almost by definition immune to logical deconstruction.
Aren’t the lifetime caps on insurance payouts “death panels” too, then?
I just see a lack of reform as a continuation of covert rationing, as opposed to open rationing in a “public plan” option.
Everything there is to fear (and there is a lot, I read every post made here and on JFS and have for a long time, and I don’t disagree with you guys) is already here to some extent and going to keep getting worse either way, but is worse under the current system than it would be under an open rationing system. Everything that could get worse will just get worse under insurance company management with decisions made behind closed doors.
First off your defense of Palin is silly. Palin lies, and democrats don’t know how to respond to lies. Let’s leave it at that.
And since you’re not an economist and obviously not paying close attention you might want to read this about the CBO study.
And follow the links as well.
http://balkin.blogspot.com/2009/07/politicized-prognostication-at-cbo.html.
Ironic that Palin felt pressured by some made-up elitist left wing nut-jos to abort her son Trig because he was unworthy. She bravely CHOOSE to sustain her pregnancy. She does not feel any other woman in America should have the same choices she does.
Putting James Madison and Sarah Palin in the same sentence was very kind of you.
Matt,
I have attempted to show, with a 7-point sequence, how there is a path of logic to the objections some people are having to HR 3200, even if some of those individuals may be a little inarticulate in public forums.
The first step toward successful negotiation is to try to understand the position of one’s opponents. If one cannot (or refuses to) acknowledge that one’s opponents have some legitimate rationale for their views (however flawed it may be), then the option of negotiation (i.e., seeking a mutually acceptable common ground) is removed, and the only remaining choice is (after demonizing them) to attempt to force one’s will upon them.
If the ambiguity in HR 3200 is inadvertent and not intentional, then at least some of the “irrational” fears of opponents could be overcome simply by amending the bill to make impossible some of the outlandish outcomes opponents fear. Since (as you point out) none of this stuff is possible (much less desired) anyway, it seems to me there would be little to lose by doing so.
In this light, it does remain a bit puzzling that scores of proposed amendments meant do do just that have been handily defeated.
Rich
Jupe,
We are in agreement that covert rationing by insurance companies has been very, very bad. I would only add that covert rationing by the feds has also been very, very bad. However, you will find that I am always going to be more troubled by the prospect of the government controlling the covert rationing than I am by insurance companies doing so. This is because, in contrast to mere companies, the government can always enforce its will upon us by means of legal violence.
I am with you that if we need to ration healthcare (and I believe we do), the only way to do it is with complete openness and transparency.
Rich
Dear Name (required),
For starters, your calling my defense of Palin silly is silly.
And while you are correct that I am not an economist (I assume you are), my understanding is that not all economists agree on important issues every time, and even among these very smart people there is room for disagreement. This being the case, when I consider that Mr. Elmendorf of the CBO was heartily approved of by Ms. Pelosi and Mr. Reid, it is difficult for me to believe that he is a “plant” from the Reagan era. Also, since his conclusion (that one cannot fold in 47 million more people into the system, while maintaining full services for the ones already there, without increasing cost) makes eminent empirical sense, I do not find the fact that you and some other economists say otherwise to be dispositive.
Rich
Reality Rounds,
As nearly as I can tell, while I did place these two names in juxtaposition in the title of this post, it appears to me that the only place in this entire blog where they appear in the same sentence is the one that you wrote. Talk about irony.
Rich
Dear Dr,
I guess that means you didn’t read the links, since you didn’t respond to the data. You do know what data are, yes?
Elmendorff of the CBO:
“In CBO’s judgment, the probability is high that no savings would be realized. There is also a chance that substantial savings might be realized. Looking beyond the 10-year budget window, CBO expects that this proposal would generate larger but still modest savings on the same probabilistic basis.”
And there’s more!:
http://www.politicalaffairs.net/article/articleview/8812/
Even CBO Director Douglas W. Elmendorf admitted the CBO’s report was incomplete. In a blog post at the CBO’s website, on July 18th, Elmendorf wrote, “The figures released yesterday do not represent a complete cost estimate for the legislation.” The report was limited to federal revenue and payments.
The CBO is not mandated to predict savings to the economy as a whole, so that the resulting decrease in personal expenditures are excluded. And on, and on.
Health care is rationed now. Ever heard of the Texas Futile Care law? It allows the government to pull the plug AGAINST THE FAMILIY’S WISHES. Who signed it? Governor George W Bush.
Google “Tirhas Habtegiris.”
Also, here’s the OECD data for expenditures on health care. Look where the US is.
http://www.oecd.org/dataoecd/46/2/38980580.pdf
Again, it’s called data.
Dr Rich,
What are the chances that the private insurance companies will openly and transparently ration, though? Their whole gimmick is pretending they don’t ration and pretending to sell “the sky is the limit” coverage.
I agree that Medicare has been doing very, very badly, too, and their disingenuous obsession with “quality” is creepy and gross. But since it is government, we can demand change and demand that they come clean about how they set reimbursements, etc. But I don’t think it’s going to be very effective until streamline the “risk and resource pool” of the young and healthy with the old and healthcare-needy.
We need to restructure the whole deal. I think a two-tier system (or 3 or 4 tier, even) would be a very American compromise. Everybody who wants or needs it can get on the public plan in all it’s overt-rationing glory, everyone who wants it can get whatever sort of extra private coverage they want, or pay out of pocket to see a retainer doc they like, etc.
I mean, this is inevitable, anyway, isn’t it? Like you noted, the insurance companies backed Obama. It would appear it’s probably easier and more profitable to be BCBS in the UK or something.
Instead of just opposing reform across the board, why not instead advocate the best way of doing it?
Demand transparency, inform people about the need for tort reform, watch vested interests trying to work their way into guideline development like a hawk, etc.
Jupe,
You and I are a lot closer than you might think. This blog is about covert rationing, so does not address solutions very often. But in my book and on my website I have written extensively about how to fix healthcare in a uniquely American way - and it sounds like it’s not unlike what you’re proposing. Here’s a link if you’re interested: http://guthealthcare.com/fixing-it/an_american_solution_to_the_healthcare_crisis.html
Rich
Name,
So THAT’s what data looks like. Thanks.
I am aware that Mr. Elmendorf released some damage-control statements after the President had a one-on-one with him, following his unfortunate testimony to Congress. The ethics of the President “coaching” the supposedly non-partisan CBO, of course, is a whole ‘nother topic.
I am aware of the Texas law. Never said my problem is specifically with the Democrats or Mr. Obama. I say, a pox on both their houses.
Rich
Dr Rich, I know we’re very close to being on the same page. I’ve read your whole GUTH website several times and agree with you. That’s why I’m perplexed by your opposition to the present reform proposal. It absolutely has the potential to realise your vision. We just need to pay very, very close attention to the meat that is later added to the bones. And accept the fact that there’s going to be an endless turnover of bad decisions and good decisions coming from “the rationers”.
I would guess that sites like yours and JFS are increasing in popularity as of late, and that’s because people are waking up to the harsh realities. With more people having internet access, and with the advent of Google Scholar and pubmedcentral, people’s scientific literacy will increase as well, and I think “we the people” will have a degree of power to fight against the blind ideologies and other corrupting forces that threaten to keep the rationing decisions terribly unwise and unfair.
Either way, reform is coming one way or another. I think it’s probably better to work with the process sooner rather than later. I don’t think most Americans need to see people dieing in the street or whatever to accept the need for rationing as a reality.
“As nearly as I can tell, while I did place these two names in juxtaposition in the title of this post, it appears to me that the only place in this entire blog where they appear in the same sentence is the one that you wrote. Talk about irony.”
You got me. I should have said “title.” And to think I put Madison and Palin in the same sentence. I must shower now.
Jupe,
A chief advantage of the kind of tiered healthcare system of the sort you and I envision is that it takes as much of the rationing as possible out of the hands of insurance companies and the feds, and places it in the hands of patients themselves. Thus, externally imposed healthcare rationing is minimized. For this to happen, we need a system that allows patients to make many of their healthcare decisions themselves, with their own money.
To put it simply, over the past 6 months I have come to deeply distrust the people pushing this reform program, and I am not at all confident that they are of a mind to allow Americans to spend their own money on their own healthcare. I think they want to outlaw HSAs, high-deductible insurance plans, retainer practitioners, and any other kind of self-pay arrangement. I believe they want complete control of everything.
I cannot be sure of this, of course, because they deny it. But I can no longer ignore their actions, which are not only consistent with this view, but are best explained by it. The clincher for me was a) the mad push to pass their healthcare reform plan before the August recess, before anybody had a chance to realize what was being done, and then b) reading HR 3200 itself, which (for reasons I have described in this blog post) is an abomination.
A few weeks ago I would have agreed with you - that the Obama plan sounded like as good a place as any from which to start moving toward the kind of open and transparent rationing that will minimize the harm done by unavoidable rationing. Now I fear that this particular plan, after being turned over to the unelected bureaucrats and commissioners, would so quickly centralize control of the healthcare system as to utterly preclude evolution to a tiered system that might allow us to develop a means of relatively palatable and equitable open rationing.
But even beyond this, HR 3200 continues a very disturbing practice (begun, by the way, under President Bush) of ramming bills through Congress that are “voluminous and incomprehensible,” and that greatly centralize control of major segments of our economy and our society, and vastly undermine the American contract. I think healthcare is very important, but it is not the most important thing. Preserving the freedom and autonomy of the individual, as our founders established, is the most important thing our generation can do for those that will follow us.
Rich
Dr. Rich,
Thank you for writing this insightful piece. I am emailing the link to others, since I think your view that the bill is purposefully incomprehensible and ambiguous is unique and probably correct. Keep up the good work and may your star continue to rise.
That’s what data is, yes. But you still don’t read much and you return again to the ad hominem.
Obama is a coward, true enough. But then again, I want single payer, and no rationing. We have it now, and there’s no need for it.
Dr Rich,
I started to type out a detailed response about how banning retainer practices, etc would not be in the best interest of third party payers.
But the more I think about it, the more I can see someone somewhere wondering if doctors who might be operating outside of the “guidelines” might not, say, properly scold people for being close to overweight (or whatever).
And then those patients might develop an expensive, “preventable” problem and end up being dumped on “everyone else” to pay for.
It’s a plausible and terrifying possibility, but I think Americans would flip out. I don’t think even the most liberal among us would want to see private practices and insurance banned, and we wouldn’t re-elect someone who passed something like that through. If it ever happened, it would be quickly repealed. Canada might have been ok with it, but we’re more like the UK.
And I think our immediate need for a public plan option outweighs that speculation.
But that’s just my opinion, and I do understand your perspective. The control-hungry, lifestyle police, “blame the sick” advocates are numerous and powerful. But their power ends at the point where they’d wish to remove freedom. The American spirit is bigger than them, and American values are even more powerful.
I followed your link in another post to Junkfood Science and read the excerpt that was supposed to be so confusing, that was going to allow the creations of “death panels” and found it pretty clear: A medical practitioner that can sign an advanced directive can bill for a counseling session to explain such things every five years, or more frequently if the patient developes a new condition that warrents such a session. The bill is very detailed in what such a counseling session should include and what specifically it means by advanced directive. What is so hard about that? I also understand that this has been included in medicare for a while with complete support by the very same politicians who warn against it now. As a nurse in a burn unit I can attest to the need for everyone to understand the details of advanced directives, and not just for the elderly.
You say that you are more afraid of government “rationing” that private insurance “rationing” because of governments ability to put you in jail. Fair enough, but the refusal to pay has the same effect either way. Of course, private insurers make money by collecting premiums but NOT paying for health care. Why should our health be at the mercy of those whose interest is in essentially ripping us off if the legally can? Why should private insurance be at the heart of our system, as opposed to the periphery? As long as that is the case, I believe that no significant improvment can be accomplished.
I went to you post about Sarah Palin being condemned for not aborting Trig and was not convinced. I read some of the rudest of the rude left wing blogs and have never heard this - it looks to me like another straw man.
Jupe,
You are probably right. In fact, I think you are. I am just trying to do my bit to bestir that American spirit while there’s still time.
Rich
I don’t get the hype on the Death Panels. Nowhere in HR 3200 or in any bill before Congress is the right of a patient to pay for private care abrogated. Insurance may become heavily regulated, but even if HR 3200 were to institute a Death Panel, this would still leave the option for a senior to pay for private healthcare services. If you really want that hip replacement so bad at 85, buy it yourself!
On another note, I will be very dismayed if the bill that passes doesn’t include a mandate that all health care providers publicly publish rack rate pricing. This doesn’t have to be a heavy burden - a doctor should be allowed to simply provide an hourly rate (throw out $5000/hr if you’re afraid of undercutting yourself!) if pricing each procedure is too onerous. Even with this sort of rudimentary pricing information, patients will for the first time be able to make more informed decisions.
Thanks for putting the logic behind Palin’s comment in bullet form. The logic is there, and “Death Panels” is an entirely accurate phrase for it. To sputter “there are no death panels in the bill, she’s lying” is to miss the point of Palin’s contention: she believes death panels are a probable result of the bill. She is not uttering “misinformation”; she is uttering an opinion. Behind it is the conservative distrust of government bureaucracies to do anything but authoritarian mischief.
I agree with her.
I suppose one could respond to all this by calling her (us) names, and thus prove to us that the reform advocates are the smart ones, and the resistors are the dumb ones. Good luck with that. Doesn’t seem to be working too well so far, but maybe there is some genius strategery behind the “Palin is a moron” approach that we are just too simple to appreciate.
Also, someone pointed out that Medicare has not rationed end of life care up till now. and that is evidence that the new plan would not, either. Duh. Medicare’s cost curve is unsustainable.
“This is legislation designed to create a legal framework under which huge cadres of unelected, politically-appointed policy mavens and bureaucrats will determine - by publishing hundreds of thousands of pages of regulations, rules, and guidelines - what our new healthcare system will look like. And until those regulations and guidelines are actually created - and this “creation” will be a never-ending process rather than an act - anybody claiming to know the precise nature of our new healthcare system under HR 3200 is engaging in one of the following: lying, projecting one’s own wishful thinking, or extrapolating on the perceived behaviors and beliefs of those who (one surmises) will finally get to make up all the rules.”
The is more to the point than a million other words that have been wasted on this debate. This bill is not a health care system, or a health care reform program; it is permission slip for a for a new federal agency, filled with new federal wonks, to design a health care system, the details of which are approved by the voters sight unseen. It is the stimulus-palooza over again.
I’m beginning to note a tactical pattern.
Dr. Rich,
Thanks for your emails (above).
When Palin wants to find a flaw. She attacks like a person that is possessed.Palin uses “DEATH PANEL”
when she could have used another phase. She wants to frighten and put fear in the people. In my view that is evil. When she gets into a debate she puts terror in the poor souls that hear her. This can start a riot and threats can lead to murder.
The only way that I can see it is that she doesn’t have the intelligence to keep up to the rest. So she thrusts forth words that are evil. (Unless of course another person is writing words of intelligence.)
There is no need to reform health care at all. If our corrupt legislators will stop playing to special interest, government subsidies recipients the UN and other foreign countries and end the free trade agreements that have decimated our industries and the U.S. economy and return us to the position of the most industrialized nation on earth we will reduce unemployment, reduce the deficit and enable everyone to get jobs and provide their own insurance if they choose to pay for coverage.
Sarah Palin is a woman with a very strong character and personality that is why i like her.