Thursday, June 18, 2009

Disagree with Obama and you become a target

The media are Obama's stormtroopers

We haven’t lived in President Obama’s America for long, but already we are witnessing a strange new phenomenon: Previously apolitical figures and organizations find themselves demonized, and then forgotten, with the speed, fury, and transience of a summer thunderstorm.

For most of his tenure at CNBC, Jim Cramer was a fairly apolitical creature. First and foremost a stock-market guru, Cramer stated that he eventually split from his partnered show with NRO’s Larry Kudlow “because politics is not my inclination . . . I just really don’t care for [the topic].” But Obama’s early moves spooked the market, and Cramer — who strongly and vocally supported Obama in last year’s campaign — called out Obama and Treasury Secretary Tim Geithner, lamenting the “invisible Treasury secretary” and “the most, greatest wealth destruction I’ve seen by a president.”

Suddenly, Jim Cramer became a much bigger figure. Suddenly, he became a regular butt of jokes on The Daily Show, and host Jon Stewart ripped into Cramer during their “interview.” Suddenly, the New York Times felt compelled to spotlight Cramer’s bad stock predictions and declare, “his personal brand has taken a beating in the last month.” Media Matters felt the need to establish a new site, “Financial Media Matters.”

In recent months, the market has improved some, and Cramer has been less vocal in his criticism of Obama — and, strangely enough, he’s no longer considered so worthy of mockery by the usual suspects. The host retains his same manic, relentless, over-the-top style; but for some reason, when he stopped criticizing the president, major media voices lost interest in ridiculing him.

The latest entity to be subjected to this Two-Minute Hate is the American Medical Association (AMA).

Americans generally like their doctors. Sixty-seven percent rate their physicians’ ethics and standards high or very high; the only professionals with a more favorable rating are nurses, grade-school teachers, pharmacists, and military officers. Most Americans don’t really think much about the AMA, and it seems likely that if the organization objected to a health-care reform proposal, patients would at least want to hear them out.

Last Wednesday, the AMA offered its most detailed response to President Obama’s health reform plans. The association disagreed with Obama that “creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans. . . . The corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”

Later in the day, the AMA clarified its position: “The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of the public plan that are currently under discussion in Congress.”

But it was too late; the group’s apostasy was already a matter of public record. Suddenly, Media Matters felt the need to refute the notion that the AMA’s position might be that of America’s doctors, insisting that the group “speaks for less than one-third of doctors.” Coverage of the AMA’s announcement often implied that doctors don’t join because they disagree with the association’s stances, when in fact the trend in the profession has been for doctors to join organizations based on their medical specialty.

At the Daily Kos site, contributors argue that “the AMA is just as much a relic of a by-gone era as the little black bag.” One declared that the time has come “to ask our own doctors to stand firm against the AMA or revoke their membership with AMA due to their opposition to a strong, robust Medicare-like public option.” Another post carried the none-too-subtle headline “All Together Now: ‘Screw You, AMA!’”

By way of comparison, there was only one Kos diary that mentioned the AMA in March, and none in April; but since the recent health-care announcement, there have been 18. A switch has been flipped; the organization is now worth paying attention to and criticizing.

“When President Obama addresses the AMA today, he will be speaking to a group that is acting more like a typical Washington special interest than one that is concerned about the health and well-being of all Americans,” said David Donnelly, national campaigns director of Public Campaign Action Fund.

No less than the New York Times editorial page has warned that perhaps you shouldn’t trust your doctor: “There is disturbing evidence that many do a lot more than is medically useful — and often reap financial benefits from over-treating their patients. No doubt a vast majority of doctors strive to do the best for their patients. But many are influenced by fee-for-service financial incentives and some are unabashed profiteers. . . . When President Obama speaks at the annual meeting of the American Medical Association on Monday he will need all of his persuasive powers to bring doctors into the campaign for health care reform. Doctors have been complicit in driving up health care costs. They need to become part of the solution.”

Had the AMA backed the public option, or remained neutral, would that editorial have been written?

When the AMA endorsed gun control and climate change, few Democrats or liberals felt that a group of doctors was meddling outside its area of expertise — even though few of the AMA’s members are criminologists or environmental scientists. Now, when the group warns that a legislative proposal threatens to greatly worsen the current system for providing care — and thus affect the AMA’s central mission — it is suddenly unrepresentative of the nation’s doctors, a “relic,” a “typical Washington special interest,” and “in fact complicit in driving up health care costs.”

If the AMA isn’t supposed to weigh in on an issue such as this, why does it exist? If it won’t look out for the interests of its membership, who will?

A political strategist who influenced Barack Obama once taught, “Pick the target, freeze it, personalize it, and polarize it.” Opposition from doctors could be fatal to the Obama plan; indeed, it represents the single-most dangerous threat to his vision of health-care reform. A politician voting “no” could always justify his decision by saying he trusted America’s doctors more than the administration. (Obama addressed this in his June 15 speech to the AMA in Chicago: “Americans — me included — just do what you recommend. That is why I will listen to you and work with you to pursue reform that works for you.”) So the AMA finds itself getting the Cramer treatment — rapidly elevated out of relative obscurity and turned into the public enemy du jour.

Polite as it seemed, Obama’s speech represented an ultimatum. He said he wanted to work with the organization — but recent history suggests that if the AMA doesn’t play ball, some of the president’s allies will continue dragging it through the mud.


Medical freedom or medical Fascism?

On Thursday I marched with lovers of liberty against the greatest threat to American patients in the history of our country: the rise of Medical Fascism. Some may wonder - what happened to socialized medicine, isn't that the great threat? While it is true that there are attempts to socialize medical care, the fact is that the power players in Washington are ready to set the rules and then hand the keys of health care spending over to large health insurance companies. This is the definition of fascism: the state decides what corporations will do and the corporations do their bidding while making a profit. As it turns out the very corporations making the profit also control the government. That is why I marched with members of the 912 project in Tampa today to spread the message that the government and large corporations should not control your health care dollar: you should.

Some may wonder how medical fascism could possibly come to pass with a democratic president. It is simple, Obama and Congress want to "solve" the problem of unaffordable health care. They want "Universal Coverage." They want to do it this year while they still have a political capital and the votes in Congress -- all to get re-elected later. They know that creating a "single payer" system will be politically impossible. That is why protesters from "Health Care Now" are also trying to get a "Medicare for All" plan on the table: Congress knows it can't deliver on such a promise. So the answer will be to look conciliatory and turn to the insurance industry for the "rescue". They will be willing partners. The Government will find some way to include them -- either through mandated health insurance purchase or heavily subsidized health insurance vouchers. The problem is that even if the large corporations are paying for health care they will still ration care since there is no amount of money that will satisfy the needs of the many interests. However they will take over through a new sort of socialized medicine "American style" or medical fascism.

The United Health Group recently indicated that they could save $500 billion in health care spending simply "by sending patients to less expensive, more efficient doctors, reducing hospital visits by the elderly and cutting unnecessary care." I am a physician victim of tactics mislabeled "efficiency" by United Health Care -- and so are my patients. I perform surgery of the neck for pinched nerves to treat arm pain. United Health Care believes that such patients should receive no more than about $17,000 worth of care. They noted that of seven patients I operated on, they received about $22,000 worth of medical care. They thus rated me as "inefficient" and actively worked to steer patients away from my practice by offering lower co-pays to patients and lower premiums to employers if they used the "efficient" doctors. They put me lower on available physician lists and forced my and my office staff to spend hours to have a non-neurosurgeon approve an MRI or even surgery! No matter that seven patients is far too low a number to calculate such an average or that 90% of the dollars went to hospitals where I have no control of the cost of services there. Such practices will become common place and will worsen when medical fascism becomes the norm. Your doctor will be forced to comply or forced to go out of business -- the patients lose, the doctors lose, the government and insurance companies win.

There are immense pressures to tell doctors how to practice medicine -- all to save the government and large insurance companies money. They would increase their profits by ensuring a patient doesn't receive advanced chemotherapy for breast cancer -- as is now done in England. They would intimidate doctors into ordering fewer MRI's that may be needed for early diagnosis or to not offer hip or knee replacements to older patients. The path to get there is different, but we will have the same sort of system as in England. These sorts of rationing protocols will be established by the "Federal Coordinating Council on Comparative Effectiveness" that was secretly created in the "Stimulus" bill earlier this year. This council is modeled after the rationing committee "NICE" setup in England.

One of the President's key advisors on health care is Zeke Emanuel, brother of his Chief of Staff Rahm Emanuel. Dr. Emanuel is a bioethicist who writes in his blue print for health care reform "Health Care Guaranteed" that the most advanced radiation treatment for prostate cancer costs $42,000 compared to the about $11,000 of more basic radiation. In public talks he dismisses the value of the highly targeted radiation stating that its "only" benefit is decreased side effects from about 13% to 5%. But that is entirely the point of doing the more advanced and more costly radiation: to minimize side effects so higher doses of more curative radiation can be delivered. It appears he is okay with more than twice as many people having rectal bleeding and painful prostate and rectal inflammation after radiation -- as long as it saves money for someone else. Zeke Emanuel also advocates creating a national sales tax (A Value Added Tax) that is the same means of financing health care in socialized systems in Europe. Only, in America, the health insurance corporation will get the money and you will be denied care as they get a large profit. Even if the government keeps the money to spend on health care, they will simply ration the care since there will never be enough money to pay for everyone. As long as Americans don't pay for their routine, annual health care out of pocket, they will constantly see every test and treatment as "free" and order more. That is where medical inflation comes from and is the source of the real crisis. The question for Americans is: do you trust government or insurance company to make the decision on what treatment to receive for you or would you rather make the decision yourself based on the advice of your doctor.

American deserve better than what is currently envisioned in Congress. They don't deserve Nancy Pelosi, Harry Reid, Max Baucus and others to meet in locked rooms and deliver a secret health care reform bill that will be voted on after three days of token debate. Americans deserve lower cost insurance and to be in charge of their own health care spending. Americans deserve the right to buy a less expensive insurance plan from another state or to pay actual cost if they are young and healthy, not increased cost to cover older and sicker patients. They deserve an individual tax break to buy health insurance, not just from their employer where they will get locked into a job. Americans should have greater access to "Super" health savings accounts where an employer can put tax free money in their account and they can use it to find a doctor they want. They can find a doctor that will spend time with them and help them understand their choices and what test or treatments they really do and don't need. After they use their health savings account, they should be covered by low premium, high deductible catastrophic health insurance. This would be a protection against the rare expensive medical conditions one may experience during their lives. If Americans want an expensive health insurance plan that pays for every visit they can buy that too. If they want an HMO that caps how much will be spent on care -- that is another free choice for them. In other words, Americans deserve medical freedom, not medical fascism.

To get medical freedom you will need to fight for it. Join up with your local tea party group for marches across the nation on Medical freedom planned by July 4th. Let Congress know you want medical freedom, not medical fascism.


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