Friday, August 28, 2009

Bart Supak on Obama Care and Abortion

Congressman Stupak, from Michigan's Upper Peninsula, on Obama dancing around on Abortion coverage in HR3200.
In the meantime, Stupak says that Obama's statements during recent public events signal one of two things: either he does not fully understand the current House bill, which Stupak maintains has the effect of publicly funding abortion, or "if he is aware of it, and he is making these statements, then he is misleading people."
Things look clearer from the North woods. No Hyde Park logical loops tangling clear thinking. The bill is what it is. Defend it, don't muddle it.

Wednesday, August 26, 2009

Reply to Rev Cyn; Reply to Rev John

Responses to Reverends not keen on debate.

Rev John commented at 5:27,
Doctors can and should do the counseling, Bill. The already are, they’re already reimbursed for it. 3200 is not creating anything all that new. If you don’t trust your current physician to do that consult with you, find a physician you trust.

[quoting me in earlier post] And you think these guys aren’t exploring AI?

C’mon, Bill. We all know Skynet was a military proj ect.
John, if Doctors were allowed to bill Medicare for an End-of-life consult the backers of HR3200 wouldn't have to write a section to allow it. HR3200 allows them to bill every five years. Of course they can do that now. So can you. So can I. But none of us can bill and get reimbursed for it. Only Doctors will be allowed; once every five years.

As for AI in Health Care. It's called Decision Support Systems. It's lucrative business.

As for Rev Cyn,

On Socialism,
Socialism: Not the same as Communism. Not the same as Fascism. It is an economic philosophy, like capitalism, not a political philosophy, like democracy. Democratic socialist countries abound. Capitalistic fascist societies can exist, too.
Fellow Worker Murf and myself the only UU's I know who were into the Red Lifestyle. It was a lifestyle. It was a Religion. We had a hymnal. We had saints. It was far more than a economic philosophy. I'm sure there are other UUs who had similar Marxists pasts. As for Socialism today, I'd call myself a Tony Blair style Socialist. I suspect Blair not every UU's favorite, nor Rev Cyns. So who knows what a Red is today.

More Rev Cyn on lying,
"Keep My Existing Insurance":

I wish you couldn't. I would like a single-payer system which covers the whole country. I would like universal health care. But the fact is, I'm not going to get what I want: you are. You can keep your existing insurance under the plans that are being proposed. Anyone who tells you differently is lying.
Well the opening sentence expresses a lot of Americans fears with HR3200. The fervent supporters wish Americans would give up their insurance and plunge into the single payer. They know what's best for all. HR3200 creates a seemingly powerful incentive for organizations to opt out of Health Insurance as a benefit and pay the 8% tax to the Health Exchange instead. So that looks the plan. Not a lie; just the forecast.

This bill could easily set a cap on what any employer is going to pay for health benefits at 8% of payroll, and let everyone go to the Gov Plan (or Coop for that matter). So to assert Americans can keep their insurance while forcing every entity paying a health benefit to revisit that 8% threshold flies in the face of common sense.

I don't know how clergy will fare here. There are often loopholes for them, but I'm guessing every Church, especially those strapped for cash, is going to balance the costs of keeping that expense, or opt for that 8% and tell their Minister to go to the Gov Plan.

So our Ministers could be some of the first experiencing the Gov Plan. It's either going to be the future of most Americans (if passed), or the plan of last resort; sort of a larger Medicaid. Depends on the Gov Plan benefits package, and whether employers feel a need to attract employees with better plans.

And, as a guy who cut-his-accountants-teeth on Medicare / Medicaid billing systems, I can assure all standing up this system will not be easy too. Cash for Clunkers was easy programming. The specs for this thing daunting.

More in a bit, after I finish getting my resume ready for the next decade's Ross Perot/EDS to get a piece of that action administering this monstrosity...

...while humming When I was a lad in 1906, I joined a band of Bolsheviks. I sang that song with a ring so true, that now I'm in the prisons of the GPU. And now he's in the prisons of the GPU.....

One day I'm going to write down the songs of America's Trotskyists.

BLAGO JUDGE: Sealed materials show there's an ongoing probe

I think it's PG who asks me every so often about when we're going to hear about Obama and Blagojevich.

Well, here's from Natasha Korecki's Blago Blog yesterday
The federal judge overseeing the case of former Gov. Rod Blagojevich refused to make public wiretaps in the case, saying it was clear to him that "there is an ongoing investigation."

U.S. District Judge James Zagel, in a recent opinion, ruled against a bid by CNN to release secret transcripts and secret recordings in the Blagojevich case. While he didn't indicate the nature of the ongoing probe, he said a review of matters under seal made it clear that releasing the information could damage the government's investigation.

"I have examined the sealed materials that are the subject of this motion and
am satisfied with the government's contention that there is an ongoing investigation," Zagel wrote in a recently publicized opinion.

"I am further satisfied that disclosure of these materials at this time may frustrate the investigation and thereby jeopardize the integrity of the search for truth. I emphasize that the issue is whether the disclosure of these materials is warranted now; I am not deciding that this is a sealing in perpetuity, or even for an extended period of time."

The U.S. Attorney's office would not comment on Zagel's remarks.
So, the trial starts June 2010, a $9 trillion deficit projection, and a war going badly in Afghanistan, and a Fanatic in Tehran building nukes. A badly crippled Obama with his staff on tapes in Zagel's court room and Fitz still rummaging around.

A giant catastrophe America's headed for with this crowd in DC.

Sunday, August 23, 2009

John Kass at Freddy's Deli, Cicero, Illinois

Freddy's where I go for lunch sometimes. We order Freddy's Lasagna for family events. Jimmy's Meats was across the street and I used to go there for Jimmy's Bohemian marinated pork roasts.



Kass also has a column on Jimmy's in today's trib.

Mary Laney: Who Else From Health Care Will Be Thrown Under the Obama Bus?

Mary Laney writing over at the Chicago Daily Observer on Dr. James Madara resignation from U of C Hospital,
The hit list is getting longer. Former Obama fundraiser Tony Rezco convicted. Reverend Jeremiah Wright disowned. Bill Ayers disavowed as a close ally. Illegal immigrant aunt estranged. Former friends Governor Rod Blagojevich and US Senator Roland Burris iced out.

It’s getting crowded under the Obama political bus. And now another person is taking a big fall under it – this one, Michelle Obama’s former boss in Chicago. In fact, this is the man who approved raising Michelle’s salary in Chicago – for “Community Outreach” — from $150,000 to $370,000 – a giant salary hike that was granted, curiously, just as Barack Obama was elected U.S. Senator from Illinois.

What makes this even more compelling is that this “toss under the bus” is directly tied to health care—and Michelle Obama’s dubious plan for it – in Chicago.

Matthew Continetti: The Angry White Liberal

Contineetti's opening and conclusion from The Angry White Liberal,
We've spent the month of August talking about alleged right-wing rage, but it's really time we started discussing the Angry White Liberal. When things aren't going his way, the Angry White Liberal wails and gnashes his teeth, rends his garments, and hurls invective at the opposition. His rhetoric and prose is so heated, it's gotten to the point where you need to put on oven mitts before opening the paper. He is so convinced of the righteousness of his positions that he lashes out uncontrollably at anybody who disagrees with him. For the Angry White Liberal, dissent is anathema. Antagonism is illegitimate. Only conformity to prevailing liberal opinion is enough to still his rage.
[***]
The Angry White Liberal directs his fury not only at conservatives. Another target is the Obama administration itself. After all, the White House has been unable to convince a majority of Americans that liberals are right and their health care reform is necessary. Comedian Jon Stewart opened a recent Daily Show by saying, "Mr. President, I can't tell if you're a Jedi--10 steps ahead of everything--or if this whole health care thing is kickin' your ass." In the Washington Post, Robert Kuttner blamed Obama's economic team, which is "far too cozy with Wall Street." For columnist Richard Cohen, Obama's "klutziness" has hampered reform. MSNBC host Ed Schultz said the White House was "dazed and confused." His colleague Rachel Maddow thinks the Democrats are "too scared of their own shadow."

All this vituperation, this unrelenting urge to discredit opposing views, builds and builds. It's uncontainable. Inconsolable. First the Angry White Liberal blames conservatives, then Democrats, then Obama . . . before you know it, he'll be blaming the entire country for the failure to pass "comprehensive health care reform." Everyone, that is, but himself.
Recall LBJ's observation that the only difference between Liberals and Cannibals is Cannibals don't eat their friends.

Saturday, August 22, 2009

Michael Tomasky: The moral case: establish the principle

My comment over at Tomasky's blog.
The original Social Security act established the principle of the government pension.

That's supposed to be a moral principle? It's a tactic towards the goal of secure retirements.

Americans today are deeply skeptical of the government than in the 1930s.

The principle is --and I don't think it's a particularly moral one-- people need a little coercion to save for retirement. Government will do it for them. Liberals want a big gov agency. Conservatives say lets try something like IRA / Personal Savings Accounts (keep Gov's hands in this small).

Same with Health Care. Some people don't want insurance. Gov should make everyone pool their risks. ObamaCare wants big health exchanges, gov't written health care protocols. Conservatives say lets step back and ask if there is a less intrusive way to accomplish the same task.

The moral goals so to speak are the same: secure retirement, secure health care. The means to those goals are the morality of how the Government should nudge people towards them.

Friday, August 21, 2009

Krauthammer on HR3200's Sunstein Nudge on end-of-life

Krauthammer on HR3200's Sunstein Nudge on end-of-life.

Having been close to similar decisions on continuation of care I share K's scepticism about the piece of paper as a conveyor of wishes or much of a factor in a family's decisions; and I certainly think the Doc --often times the guy the family thinks fumbled care in the first place-- the last guy I'd want to see offering (or getting reimbursed) the consultant. This is what Ministers (and Lawyers) do.

Palliative care by the way something the system ought to do once the patients chosen to discontinue treatment. It's not part of the consult reimbursed in HR3200.
So why get Medicare to pay the doctor to do the counseling? Because we know that if this white-coated authority whose chosen vocation is curing and healing is the one opening your mind to hospice and palliative care, we've nudged you ever so slightly toward letting go.

It's not an outrage. It's surely not a death panel. But it is subtle pressure applied by society through your doctor. And when you include it in a health care reform whose major objective is to bend the cost curve downward, you have to be a fool or a knave to deny that it's intended to gently point you in a certain direction, toward the corner of the sick room where stands a ghostly figure, scythe in hand, offering release.

Thursday, August 20, 2009

retired doc's thoughts: Ambiguity in Legislative language in HR 3200 may be there for a reason

Woke up at 3 AM with fuctional specs for the claims processing system for the Gov plan turning in my head. Visions of companies dumping employees into the Gov Plan and taking the 8% tax instead, claims rolling in for a yet to be defined benefits plan. Contracts being let to the Blues to process this whole mess. Congressionals rolling in..powerpoints for Congress to explain the blow ups and backlogs. 'Cause as the retired doc notes, all the details have yet to be written.
Everyone with any interest in the proposed health care legislation should go here to read DrRich's latest blog entry in which he tell us what the ambiguity in the house bill is really all about.

I have blogged briefly before on the ambiguity and cognitively impenetrable nature of HR 3200 and suggested that is was not due to ineptitude of the authors of the bill and their inability to clearly put in words what they were proposing. As DrRich points out it is ambiguous for a reason.

The reason is that the lack of meaning will be supplied by the rule making processes of the various government agencies and this will be an unending process as opposed to a one time rule setting.
Deliberate because there is no other way an overhaul this comprehensive can be spelled out in a law. It all falls on the shoulders of the nameless folks who draft the regs, and then implement the procedures.

NakedEmperorNews: The Absolute Fascist Nightmare. ‘Charming Liar’: Progressives Turn on Obama as Air America Exposes ‘Fascist’ Drug Deal

Greg Palast: Obama on Drugs: 98% Cheney? HT RBO

The whole Health Care overhaul reeks of Chicago Way tactics. Bring the players in and cut the side deals. There were more deals made here for sure. This is just the tip. Nice to see the rest of the world finally awakening to the sorts America's sent to Washington.
August 11: Christiane Brown talks with Greg Palast on Air America Radio about POTUS’s backroom deal with Big Pharma. Wait for the money quote: “It makes me puke that we have just been ‘Cheneyed’ by a guy named Barack Obama.

The Chicago Way

Don Rose writes NO-lympics for Me,

A few weeks back an old friend called to say he could get me $25,000 from Very Important People if I would “blog in favor of the Olympics.”

For those of you who may have been comatose in Central Waziristan for the past year or two, bringing the 2016 games to Chicago is something Mayor Daley wants more than oxygen itself.

“I am still agnostic on the Olympics,” say I.

I wonder if this is Stimulus money?

Obama, Abortion, and Health Care Overhaul Fabrications

From the Weekly Standard. Obama's getting way too cute with the wordsmithing. If the plans allow elective abortions, then defend it; don't pull the Green Shade Stuff below.
In fact, the Capps Amendment passed by the House Energy and Commerce committee would require the establishment of at least one plan covering elective abortions in every federally-subsidized exchange, and it gives the HHS Secretary the authority to include abortion coverage in the public plan and requires that the public plan cover abortion if the Hyde amendment (which bans funding of abortions through Medicaid) is repealed.

Supporters of the Capps Amendment argue that in theory the amendment would require an abortionist to be paid out of the premiums contributed by the individual (not with the federal subsidies). So, say, an individual contributes $500 to purchase an insurance policy, and the federal government provides that individual with $3,000 in taxpayer-subsidies. When the bill comes due from the abortionist, he will theoretically be paid out of the $500 contributed by the individual.*

This is a distinction without a difference. Without the federal subsidies the individual would not have access to a plan that covers abortion -- i.e. without the taxpayer-subsidies many people would otherwise be paying full price for an abortion out of pocket.

Currently, health insurance plans for federal employees cannot cover abortions. Their premium dollars cannot be segregated and used to purchase abortions. Pro-life leaders call this a "bookkeeping scheme". Can any intellectually honest person call it something else? As Reason's Jacob Sullum wrote, "The Democrats might as well tell the anti-abortion taxpayer that they won't use his money to kill fetuses, which will be done only with money from taxpayers who have no compunctions about the procedure."
What are we to make of stealth Liberalism? A Liberalism which can no longer argue what it believes in public?

Wednesday, August 19, 2009

Axelrod's Gold Mine

When I was a kid, we'd say, if you're so smart, why aren't you rich? Axelrod's smart. Win or lose the Chicago Way means getting a cut. Read Firms with Obama ties profit from health push.

Sowell: Whose Medical Decisions?

Sowell's latest: Whose Medical Decisions? In a few years Historians will find Sowell and Krauthammer the two with the greatest insight to our times.

Prez Obama: 'God's partners in matters of life and death' oder Gott Mit Uns.

via Washington Jewish Week,
President Barack Obama needs some outside help pushing health care reform, and he's turning to rabbis to get it.

In a morning conference call with about 1000 rabbis from across the nation, Obama asked for aid: "I am going to need your help in accomplishing necessary reform," the President told the group, according to Rabbi Jack Moline, who tweeted his way through the phoner.

"We are God's partners in matters of life and death," Obama went on to say, according to Moline's real-time stream.
What in the world kind of partnership could Obama mean here? I hope for a merciful God. I certainly don't feel God as my partner.

Read on and find,
Eyebrows were also raised by the choice of hold music that played to rabbis before the call began.

"First mistake," Moline tweeted, as he waited for the call to begin. "Music on hold is 'Deutschland uber Alles,' " a classical German anthem, the lyrics to which in part say, "Preserve and protect our Kaiser, our land."

(The music was chosen by the company carrying the conference call, not the White House or the RAC.)
Don't blame that fumble on God, but could this story get any weirder?

Update: It gets weirder. Via Politico,
"We are God's partners in matters of life and death," Obama said, according to Moline (paging Sarah Palin...), quoting from the Rosh Hashanah prayer that says that in the holiday period, it is decided "who shall live and who shall die."
Dems want to railroad HR3200 through, than their best bet is to muzzle this guy.

Update: A take over at First Things

Last Rites @ Chicago's Sixth Prez


More pics over at Lee Bey's blog. The Congregation still lives over in a newer building a few blocks away. This structure was close to the long gone First Universalist in Chicago. Sixth Prez went through a number of lives as did the neigborhood around it. Everything torn down and rebuilt.

Sixth Prez reborn as a Baptist Church, then finally left empty. The grand edifice to expensive to maintain for just about any Congregation today. Chicago Public Radio said yesterday effort to restore it as a community center had failed and it would soon be demolished. (Makes sense because there is no community around it any more. Just Prairie waiting for the developers come the economic upturn.)

Churches have life cycles. They don't keep chugging along obvious trajectories.

Liberalism runs out of Gas

Obama, Axelrod, Jarrett, and Rahm did Health Care reform the Chicago Way. Get the heavey hitters into a room: Phrama, AARP, AMA, HIA; make all the side deals, and then push the bill through without hearings or public review.

Springfield's ways gone to DC. Assume the Bosses and Regular Party Goodfellas will bring the voters along. Dress it up in Progressive lingo so the Lake Front Goo Goos and Hyde Parkers can sleep easy. That's the way we do it in Illinois.

So this blows up in their faces and strips Liberalism bare. Goldberg from Why 'Obama-Care' is Failing,
Lashing out at the town hall protesters, playing the race card, whining about angry white men and whispering ominously about right-wing militias is almost always a sign of liberalism's weakness -- a failure of the imagination.

The left, broadly speaking, has been attacking conservative talk radio and all it allegedly represents for the better part of 20 years now. When Bill Clinton needed a convenient villain, he attacked Rush Limbaugh. When Bush emerged victorious from the Florida recount, liberals concluded that what they really needed was their own version of Limbaugh. Last March, at the first sign of resistance from congressional Republicans, Obama immediately complained that the GOP was Limbaugh's lap dog, and both the White House and much of the press corps went into anti-Limbaugh campaign mode.

It's funny how these supposed champions of the Enlightenment can't grasp that people can disagree with them for honest reasons. Instead, we simply must be Limbaugh's automatons, which is to say racist, fascist thugs.

In addition to the slander, such complaints are monumentally, incandescently lame coming from a party that controls Washington. Indeed, according to liberals themselves, these evil-mongers are a tiny minority, a bunch of "Astro Turf" frauds. So why not ignore them and get on with the work you were elected to do?

Well, because they can't -- or won't.
The wheels fall off Obama's Liberalism and the whole of Liberalism as we've known it comes to an end. Liberals sense that, repackage themselves as Progressives, yet there still stuck with can't and won't when it comes to getting anything done. It's a failure of imaginiation, a spent Liberalism.

Bryon York: For the Left, war without Bush is not war at all

Why I hated to see the vote on he Peace Making resolution get tabled. Afghanistan seems headed south and UU's seem to have put any framework for talking about War on the back burner. York writes,
Not too long ago, some observers worried that Barack Obama would come under increasing pressure from the Left to leave both Iraq and Afghanistan. Now, it seems those worries were unfounded. For many liberal activists, opposing the war was really about opposing George W. Bush. When Bush disappeared, so did their anti-war passion.
An email from Michael Yon this AM,
Greetings from Afghanistan,

There is every indication that this war will become worse than I saw in Iraq. Very dangerous here. Too much happening to explain quickly. Will require ongoing series of dozens of dispatches.
and a link Do Americans Care about British Soldiers? Pretty incredible story.

Tuesday, August 18, 2009

Dupage Illinois Democrats: Medicare for All

A weird sort of mailer from the Dupage Democrats.

Single Payor never got a fair hearing, or much of any kind of hearing, because the Democratic Congress chose not to hold any hearings. Medicare for all doesn't fly because Unions aren't about to give up cheap Cadillac Health Plans to participate in Medicare.

What's wrong with Healthy Americans Act and a tax credit for all? Break the employer based benefits system and make Health Insurance available to every individual American with a tax credit? Heading back to square one certainly makes sense. There is no salvaging HR3200.
CALL AND WRITE TODAY
Back to Square one
MEDICARE FOR ALL!

First Single-Payer doesn't even get a fair hearing, then the Public Option is off the table too?

CALL RIGHT NOW and KEEP CALLING UNTIL YOU GET THROUGH!!


The White House:

Phone: (202) 456-1111

This link will enable you to send a letter to the President.
http://www.whitehouse.gov/contact/



Senator Dick Durbin

Phone: (202) 224-2152 Washington DC
(312) 353-4952 Chicago

This link will enable you to send an email letter to Senator Durbin:
http://durbin.senate.gov/contact.cfm



Senator Roland Burris

Phone: (202) 224-2854 Washington DC
(312) 885-3506 Chicago

This link will enable you to send an email letter to Senator Burris:
http://durbin.senate.gov/contact.cfm



Rep. Peter Roskam

Phone: (630) 893-9670 Bloomingdale
(202) 225-4561 Washington DC

This link will enable you to send an email letter to Congressman Roskam:
http://www.house.gov/formroskam/email.html




Rep. Judy Biggert

Phone: (630) 655-2052 Willowbrook
(202) 225-3515 Washington DC

This link will enable you to send an email letter to Congressman Biggert.
http://judybiggert.house.gov/ContactJudy.aspx


PLEASE WRITE TO info@dupagedemocrats.com
after you make your calls and give us a brief synopsis of your call!
PAID FOR BY THE DEMOCRATIC PARTY OF DUPAGE COUNTY (630-629-1125)

Democratic Party of DuPage County
1000-7 Rohlwing Rd | Lombard | IL | 60148

Sunday, August 16, 2009

Orthopods responding to Obama demagoguing

The Orthopods respond back to a Prez frighteningly out of touch with American Health Care Industry.
Statement from the American Academy of Orthopaedic Surgeons Regarding Comments from President Obama

The American Academy of Orthopaedic Surgeons (AAOS) is profoundly disappointed with President Obama's recent comments regarding the value of surgery and blurring the realities of physician reimbursements. The AAOS represents over 17,000 US board-certified orthopaedic surgeons who provide essential services to patients every day. As President Obama has said, "Where we do disagree, let's disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that's actually been proposed." In that spirit, we would like to bring some clarity to his comments and underscore the value that orthopaedic surgeons bring to Americans every day of every year.

First, surgeons are neither reimbursed by Medicare, nor any provider for that matter, for foot amputations at rates anywhere close to $50,000, $40,000 or even $30,000. Medicare reimbursements to physicians for foot amputations range from approximately $700 to $1200 which includes the follow up care the surgeon provides to the patient up to 90 days after the operation. Moreover, orthopaedic surgeons are actively involved in the preventive care he mentions. We are a specialty that focuses on limb preservation whenever possible and when it is in the best interests of the patient. Our approach to amputation follows the same careful, thoughtful approach, always with the patients best interest as the primary focus.

It is also a mischaracterization to suggest that physicians are reimbursed "immediately." The AAOS itself, along with numerous other organizations, has testified in Congressional hearings investigating the delays in reimbursement by Medicare and other payers that create additional administrative burdens making it more difficult to provide access to care for patients.

As President Obama continues to pursue the health care reform agenda, we implore him to disengage from hyperbole and acknowledge that health care delivery can only be improved by recognizing that health care is a system in which orthopaedic surgeons play a crucial role. With $849 billion of our national economy impacted by musculoskeletal conditions, orthopaedic surgeons provide care that improves lives and puts people back to work. Pediatric orthopaedic surgeons provide life-altering care to our nation's children and play an invaluable role in ensuring Medicaid patients have access to needed services. Military and civilian orthopaedic surgeons provide care to our service women and men which preserves limbs and has improved survival rates over past conflicts. Orthopaedic trauma surgeons perform limb- and life-saving procedures and help to ensure that our communities have the medical services that we all deserve. Total hip and knee replacement surgeries are now two of the most successful operations in medicine through a predictable reduction in pain, restoration of function, and return of patients to both work and activities of daily living. And we are working every day to ensure that medicine provides Americans with disabilities the quality of life to which they are entitled.

The AAOS is committed to improving the American health care delivery system and increasing health care coverage. The most expedient way to accomplish health care reform is to ensure that the debate is based in fact and reflects the value of the services that all physicians, including orthopaedic surgeons, provide.

Saturday, August 15, 2009

Obama Care, Clinical Guidelines, and the Meaningful Use of Electronic Medical Records

Below is a slide from the Department of Health and Human Services's Health Information Technology committee displaying the Meaningful Use Matrix.

The stimulus act included funding to pay providers for the Meaningful Use of Electronic Medical Records and the committee's task is to define just what Meaningful Use should mean. The Matrix is their start.

A lot of money rides on this. Note the 2015 Goals include Efficiency measures for both outpatient and inpatient care to-be-determined. How HHS plans to measure efficiency, and the fates of providers HHS finds inefficient should be fodder for hearings.



Mr. Blumenthal, Dr.Perlin, Dr. Halamka; just what do you folks have in mind here for efficient Health Care? It's vast powers the Stimulus Bill has granted to you. Your task deserves some careful attention from those of us who are going to be at the receiving end.

Here are the 2011 measures for a flavor of where they're headed and the cohorts soon to be subjected to 2015's efficiency metrics.

WSJ: Emanuel's Brother Becomes a Target

WSJ today on the emergence of Zeke Emanuel in the debate on Health Care Reform. Article omits Zeke's seat on the newly formed Federal Coordinating Council for Comparative Effectiveness Research Membership funded under the Recovery Act.

Watch 'em 'cause these folks have the potential for very far reaching impacts on the way Medicine will be practiced.

I implemented a system once to monitor provider adherence to practice guidelines and an angry Doc told me if you built two hospitals: one staffed by Physicians, and the other staffed by Accountants (me); which hospital will have the fuller parking lot?

I jokingly responded about a hospital built by faith healers. I thought they'd do better marketing and get all the patients.

But my angry Doc well aware that the next step could easily be attaching adherence to reimbursement. The Accountant becomes Auditor/Cop and shuts down the Hospital contributing less "value".

A lot of power here in the hands of a few unelected people with the only the assurance their supposed professional/academic/evidenced pass impartiality.

No mention of compassion or empathy on their site either.

PS Faith Healers got me thinking here because they're my concern with this evidenced based panel. Guessing the Faith Healers will have the more well funded lobbyists, I'm worried they'll sway the panels, write the guidelines, and will all end up getting a laying-on-of-the-hands as evidenced-based-best-health-care-value, instead of the CABG we need.

Cynical, well, I'm from Illinois where shaking down Hospitals, and influence peddling the Illinois Health Planning Commission was what providers experienced. The only evidence needed was show me the donation to my campaign.

Spying for the Zionist regime of Israel and insulting sanctities

A picture of the spies and sanctity insulters at left. via the BBC
"The trial of the seven Bahais accused of spying for the Zionist regime of Israel and insulting sanctities will be held on Tuesday," Hassan Haddad of the Tehran's prosecutor office said, the official Iranian news agency reports.

Woodstock Memories

I guy I know recalls.

Friday, August 14, 2009

Scott Gottlieb: Obama and the Practice of Medicine

Good column by Gottlieb on some more out-of-touch comments.
On the defensive because of an increasingly skeptical public, President Barack Obama has recently spoken extemporaneously about his health plan. In doing so, he has revealed his lack of understanding about aspects of medical practice and the reasons for rising health-care costs.

One theme the president has focused on is doctors' motives. During a prime-time press conference on July 22, the president referred to a doctor who muses that she makes "a lot more money if I take this kid's tonsils out"—even if the child might not need surgery. Responding to a woman whose spry 100-year-old mother was given a needed pacemaker despite her age, the president said a few weeks earlier (at an ABC News town-hall event at the White House) that doctors should let patients know that sometimes "you're better off not having the surgery, but taking the painkiller."

Mr. Obama's clinical scenarios represent an excessive—if not erroneous—take on how doctors are influenced by financial incentives. This jaundiced view on medical decision-making may explain why programs the White House is proposing to lower health-care costs rely on the direct regulation of medical decisions. If Mr. Obama is serious about lowering costs, he'll need to reform the economic structures in medicine—especially programs like Medicare.


Also the Prez on diabetic Foot Amputations,



And the Surgeons respond. Never tangle with guys who like to start work at 5am.

Statement from the American College of Surgeons Regarding
Recent Comments from President Obama


CHICAGO—The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight.

Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.

Three weeks ago, the President suggested that a surgeon’s decision to remove a child’s tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what’s right for the patient.

We agree with the President that the best thing for patients with diabetes is to manage the disease proactively to avoid the bad consequences that can occur, including blindness, stroke, and amputation. But as is the case for a person who has been treated for cancer and still needs to have a tumor removed, or a person who is in a terrible car crash and needs access to a trauma surgeon, there are times when even a perfectly managed diabetic patient needs a surgeon. The President’s remarks are truly alarming and run the risk of damaging the all-important trust between surgeons and their patients.

We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care.

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 74,000 members and is the largest organization of surgeons in the world.

Zeke the Geek: Where civic republicanism and deliberative democracy meet

Part of Obama's problem is Chicago politicans don't give a hoot about policy, and ideas, and thoughfulness. They're all about getting deals. Lining up the players for a bill, getting the donations kicked in, divvying up the boodle and contracts. They bring Rahm's brother on to dress things up a bit but no body bothers to read the guy, because, well, in Chicago real players are dealers, not readers.

So seniors sit on the internet and read stuff like this, Where civic republicanism and deliberative democracy meet, from Zeke in 96,
"This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citi- zens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with de-mentia."
Whoa... time to head to the public forum called the Chicago Regular Democratic Ward Organization office and commit to selling enough tickets for the Ward Committeemen's golf outing to get my name on the clout list for health care before I end up on Zeke's de-mentia list instead.

Section 1233 End of Life Consults

The strange thing to me about incentivizing the clinician through the payment system to do these consults is the Docs last guy I'd go to for end-of-life advice.

I'll ask the doc my odds --I ask the odds of going south on any intervention-- but my fear is a Doctor's "hero" training. He'll want to do extraordinary interventions because that's what he was trained to do.

Worse, I'll find myself an interesting case and he'll keep me going for research; a study for his paper (Chicago has a lot of academic medicine.)

I'd turn to my minister and others for advise on seeking or refusing more care; not my provider.

Krauthammer: More Health Care Nonsense

Krauthammer writing what every Health Care analyst knows: Primary Care isn't cheap. It's better care, but you better be prepared to pay for it, and you better have specialty care access because you create a lot of referrals. You're not prepared with specialists and you'll get queues. Anyone touting this model as cost savings is telling you pure bunk.

Rev Morales, Clout, and Pay-to-Play

Rev Morales uses a fine old Chicago word in his Friends letter on Health Care Reform: Clout. Len O'Conner named his biography of the former Mayor Daley Clout. It's what makes Chicago and many of its suburbs go.

Right now where going through the scandals of Clout lists the University of Illinois kept for admissions. Lists of kids with Clout behind them the University would admit when it probably shouldn't. Corruption certain to seep into any reforms that create waits and lists; at least as long as Chicago Pols keep the lists.

Another Chicago term is Pay-to-Play. The practice of vendors kicking points to Politicians in return for preference on Government contracts. It's exactly what the Pharmaceutical lobby is doing kicking in $150 million for the ObamaCare TV ads, and the billions in savings Obama said Pharmaceuticals had promised him at that NH Town Hall.

That's Pay-to-Play in Illinois. Money vendors put down on the table in anticipation of lucrative contracts.

Robert Reich (perhapes one of Rev Morales demogoges on reform? Morales never says who those are. He owes us that.) wrote of the deal with big Drugs,
When the industry support comes with an industry-sponsored ad campaign in favor of that legislation, the threat to democracy is even greater. Citizens end up paying for advertisements designed to persuade them that the legislation is in their interest. In this case, those payments come in the form of drug prices that will be higher than otherwise, stretching years into the future.

I don't want to be puritanical about all this. Politics is a rough game in which means and ends often get mixed and melded. Perhaps the White House deal with Big Pharma is a necessary step to get anything resembling universal health insurance. But if that's the case, our democracy is in terrible shape. How soon until big industries and their Washington lobbyists have become so politically powerful that secret White House-industry deals like this are prerequisites to any important legislation? When will it become standard practice that such deals come with hundreds of millions of dollars of industry-sponsored TV advertising designed to persuade the public that the legislation is in the public's interest? (Any Democrats and progressives who might be reading this should ask themselves how they'll feel when a Republican White House cuts such deals to advance its own legislative priorities.)

We're on a precarious road -- and wherever it leads, it's not toward democracy.
It's the road towards Illinois, and the giant cesspool of Illinois corruption spread throughout the nation. That's where the road leads.

Update: The deal here.

Chicago's Cardinal Bernadine response to HCFA's 1977 memo on the enormous cost savings from end-of-life counseling

Cardinal Bernadine's response to the 1977 memo. Note the next paragraph on the money to be saved on unwanted births by funding abortion.

I started work with HCFA the following year as a Medicare Auditor. The first day of the Principles of Medicare Reimbursement class the instructor told us a lot of people thought Medicare was for the aged, but he liked to think of it as the Accountants Retirement Act.

Cardinal Bernadine wrote:
'The message is clear: government can save money by encouraging old people to die a little sooner than they otherwise would. Instead of being regarded with reverence, and cherished, human life is subject in this view to a utilitarian cost-benefit calculus and can be sacrificed to serve fiscal policy and the sacred imperative of trimming a budget.'

“With three states having legalized physician-assisted suicide, this provision could create a slippery slope for a more permissive environment for euthanasia, mercy-killing and physician-assisted suicide because it does not clearly exclude counseling about the supposed benefits of killing oneself.

“Health care reform that fails to protect the sanctity and dignity of all human life is not reform at all.”
I pass the Cardinal's grave twice a day over at Queen of Heaven cemetary. It must be quaking with HR3200. America's back to 1977.

HT Boehner July PR here.

Thursday, August 13, 2009

retired doc's thoughts: What might Hayek have said about Ezekiel Emanuel's "fair distribution of life years"

I studied Veblen at Grinnell and know little of Hayek, but I think the Doc makes the right Dx here,
“…the conception of a ‘value to society’ is sometimes carelessly used even by economists… there is strictly speaking no such thing and the expression implies [a] sort of anthropomorphism or personification of society…Services can have value only to particular people (or an organization), and any particular service will have very different values for different members of society. To regard them differently is to treat society not as a spontaneous order of free men but as an organization whose members are all made to serve a single hierarchy of ends (Law, Legislation and Liberty, vol. 2., p.75).

Tuesday, August 11, 2009

Dismissed them on psychiatric grounds

From an E J Dionne column a few years ago as some prepare to excuse themselves from the difficult work of judgment and argumentation.
But reading Brown [Richard Hofstadter's biographer] is also a reminder of where Hofstadter may have misled the very liberal movement to which he was devoted. There was, first, his emphasis on American populists as embodying a "deeply ingrained provincialism" (Brown's term) whose revolt was as much a reaction to the rise of the cosmopolitan big city as to economic injustices.

Many progressives and reformers, he argued, represented an old Anglo-Saxon middle class who suffered from "status anxiety" in reaction to the rise of a vulgar new business elite. Hofstadter analyzed the right wing of the 1950s and early 1960s in similar terms. Psychological disorientation and social displacement became more important than ideas or interests.

Now, Hofstadter was exciting precisely because he brilliantly revised accepted and sometimes pious views of what the populists and progressives were about. But there was something dismissive about Hofstadter's analysis that blinded liberals to the legitimate grievances of the populists, the progressives and, yes, the right wing.

The late Christopher Lasch, one of Hofstadter's students and an admiring critic, noted that by conducting "political criticism in psychiatric categories," Hofstadter and his intellectual allies excused themselves "from the difficult work of judgment and argumentation."

Lasch added archly: "Instead of arguing with opponents, they simply dismissed them on psychiatric grounds."

Obama Care Death Panels

From Lee Siegel's Obama's Euthanasia Mistake for UUs who think those opposed to HR3200 are yahoos on the wrong side of love.
For those of us who believe that the absence of universal health care is America’s burning shame, the spectacle of opposition to Obama’s health-care plan is Alice-in-Wonderland bewildering and also enraging—but on one point the plan’s critics are absolutely correct. One of the key bills under consideration in the plan—sympathy for limitations on end-of-life care—is morally revolting. And it’s helping to kill the plan itself.

Make no mistake about it. Determining which treatments are “cost effective” at the end of a person’s life and which are not is one of Obama’s priorities. It’s one of the principal ways he counts on saving money and making universal healthcare affordable.
Read the whole thing and espeically the roots of Obama's thinking from the U of C's Posner and Sunstein.
Where is Obama coming from? Why is such an apparently humane man considering embracing a utilitarian initiative straight out of Victorian England? A good part of the explanation has to do with the University of Chicago Law School milieu that Obama comes out of. By far, the most influential figure in that world is Judge Richard Posner, who teaches law at Chicago and publishes streams of pompous, robotically written books that are much praised and little read.

Judge Posner is both an enthusiastic advocate of euthanasia and an energetic eugenicist. He once wrote of Oliver Wendell Holmes’ ideas about eugenics—Holmes believed that a just society “prevents continuance of the unfit”—that “we may yet find [Holmes’] enthusiasms prescient rather than depraved.”

Cass Sunstein, who is Obama’s nominee for regulatory czar, is a disciple of Posner and believes in what Time magazine describes as “the statistical practice of taking into account years of life expectancy when evaluating a regulation.” In other words, Sunstein believes that the lives of younger people have a greater value than those of the elderly. This, obviously, would have a radical bearing on end-of-life considerations.

Monday, August 03, 2009

I am demonstrating to get my vote back. شیرزن ایرانی در روز 25 خرداد

This 85 year-old Iranian says she is marching to protest the stolen election.
HT Gateway Pundit

What would UU's say to the homeless?

Spent Saturday night as backup to the social worker at our communities homeless shelter. The three Evangelicals guys who normally cook breakfast Sunday AM, and then lead a service for those wishing to stay, took off for the summer. So no service, or bacon and eggs.

Should we UUs take up the task? What should we do and say? When I've stayed for the Evangelical service it's been guitar music and a Bible lesson. Homeless often very Bible literate.

Sunday, August 02, 2009

Iran: Nightly Protests, August 1&2, 2009



John Stossel on Canadian Health Care

I'm always looking for clinical benchmarks. Canada not the place to look.



Update: A PDF file from the Canadian Dermatology Association: 6-month wait to see a dermatologist By Chuck Poulsen Sunday, July 13, 2008
Although skin cancer rates continue to rise in Canada, there is a severe shortage of dermatologists. In the Okanagan, just one dermatologist serves Kelowna and Vernon. Dr. Carmel Anderson‘s waiting list is six months long. She has stopped putting names on her cancellation list because that has too many names on it to make a cancellation appointment even remotely possible except for those at the top. The Canadian Dermatology Association said only between 600 and 700 dermatologists are available to treat the country‘s population of more than 30 million.
Read the whole thing. This is what price controls do too supply. In this case, the supply of Dermatologists. Americans wouldn't tolerate this.

Update: Colonoscopy Wait Times in Canada. PROLONGED WAIT TIMES FOR COLONOSCOPY IN CANADA: THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY (CAG) ENDOSCOPY QUALITY INITIATIVE (EQI) PILOT PROJECT

Wait times for many patients referred for colonoscopy exceed the CAG-recommended maxima. Wait times for FOBT-positive patients are somewhat shorter but access to care remains unacceptably prolonged for those with symptoms of serious GI disease. The EQI program provides a valuable, point-of-care data collection tool to evaluate delivery of care for patients with digestive diseases.
Indication N Total Wait Time = WT_T (days) Median (75th / 90th centile)
(a) IBD flare 25 102 (170/531)
(b) Gastrointestinalblood loss 169 110 (189/294)
(b) Positive FOBT 22 34 (84/205)
(b) Diarrhea 87 132 (221/344)
(c) Family history of colon cancer 150 163 ( 329/480)


Or, Non-emergency surgeries in Nova Scotia, 2007

CANSIM - Results
Table 105-30011,2,3,4,5,6,7
Median waiting times for specialized services, by type of service, household population aged 15 and over, Canada, provinces and territories, occasional

Survey or program details:
Canadian Community Health Survey - 3226
Health Services Access Survey - 5002

Geography=Nova Scotia
Type of specialized service2,3,4=Non-emergency surgeries6
Median waiting times for specialized services, occasional Characteristics8,9,10,11,12 2007
Number of persons 58,391
Low 95% confidence interval, number of persons 49,278
High 95% confidence interval, number of persons 67,505
Median waiting time, weeks 4.3
So half of those 58k folks in Nova Scotia waited over 4.3 weeks to see their doc. Take look. It's all online.

Can you hear them ? شما می توانید آنها را بشنوند؟

From the Iranian Rooftop Project,