Tuesday, March 02, 2010

Dems' Health Strategy Doesn't Add Up to a Win

"More talk, no deal" was The Wall Street Journal's headline on Thursday's Blair House health care summit. "After summit flop, Democrats prepare to go it alone on Obamacare," proclaimed the headline here at The Washington Examiner. These were appropriate verdicts if you viewed the summit as an attempt to reach bipartisan agreement or even a limited consensus.

But that of course was not why Barack Obama convened this unique colloquy. He did so as part of an attempt to pass some Democratic health care bill, somehow, through both houses of Congress -- and to discredit the Republicans who opposed the bills passed by the House in November and the Senate in December.

In that he seems to have failed. The Atlantic's Clive Crook, who supports the Democratic bills, concluded that "the Republicans did not come across as the party of no. They looked well-informed, pragmatic and engaged in the discussion. It was the Democrats who leaned more heavily on talking points, and seemed evasive and unspecific."

Kevin Drum, blogging for the left-wing Mother Jones, agreed. "My take is that the summit was basically a draw, but with a slight edge to the Republicans. They didn't have to win, after all. They just had to seem non-insane, and for the most part they did. What's more, Obama missed a chance to provide a punchy 60-second sales pitch for the Democratic plan."

Obama and the Democrats face problems with both public opinion -- their bills are hugely unpopular -- and with legislative procedure. The problem with public opinion has been undeniable since Republican Sen. Scott Brown's victory five weeks ago in Massachusetts. The problem with legislative procedure is more complex.

Democrats could theoretically solve that problem by having the House pass the Senate bill in toto, ready for Obama's signature. But Speaker Nancy Pelosi, who has proved herself a fine vote-counter, doesn't have the votes. Last month, she said "unease would be the gentlest word" to describe House Democrats' resistance. They understandably don't want to cast votes for the Senate's Cornhusker Kickback and Louisiana Purchase.

In November, Pelosi had 220 votes for the House bill. The one Republican is now a no, one Democrat has died, one resigned last month, and another turned in his resignation Friday. That leaves her with 216, one less than the 217 she needs.

There is another problem. The Senate bill lacks the amendment sponsored by House Democrat Bart Stupak banning abortion coverage, and Stupak says that he and about 10 other Democrats will accordingly vote no. That leaves Pelosi around 205. She may have commitments from former no voters to switch to yes (especially from three who've announced they're retiring), but she doesn't have more than 10 other votes in her pocket -- or she wouldn't have accepted the Stupak amendment.

So the House wants the Senate to go first and pass changes to its bill through the reconciliation process that requires 51 rather than 60 votes. But Senate Budget Chairman Kent Conrad says that you can't use reconciliation on a bill that hasn't already become law. And reconciliation is probably not available on abortion issues.

All of which reminds me of Alaska Sen. Ted Stevens' attempt to allow oil drilling in the Arctic National Wildlife Reservation in 2005. Stevens got it in the reconciliation process in the Senate, where it had 51 but not 60 votes. But House Republicans couldn't get it into reconciliation, even though a majority of House members were for it. The Senate could pass it by reconciliation but not regular order; the House could pass it by regular order but not reconciliation. Result: It never passed.

There are two differences here. ANWR drilling would have little effect on most Americans. The health care bill would affect almost everybody -- by raising taxes, cutting Medicare spending, abolishing current insurance -- as Republicans pointed out in Blair House.

The second difference is that ANWR drilling was reasonably popular with the public, and there were majorities in both houses for it. Neither is true of the Democrats' health care bills today.

Last month, we were told that Obama would switch his focus from health care to jobs. But Democrats have spent February and seem about to spend March focusing on health care. It's hard to see how they can navigate the legislative process successfully -- and even harder to see how they turn around public opinion. Summit flop indeed.


"Individual Mandate" at Core of ObamaCare is Unconstitutional, New Report Concludes

Arguments by backers of President Obama's health care proposals that the U.S. Congress has the constitutional authority to mandate that individual Americans purchase health insurance through the 16th Amendment to the Constitution, which permits the federal income tax, are incorrect.

So concludes a new "What Conservatives Think" publication, "Is a Health Insurance "Individual Mandate" Constitutional?" written by policy analyst Matt Patterson of the National Center For Public Policy Research. Among the findings:

* Both the House and Senate versions of ObamaCare contain penalty taxes on Americans who do not have government-approved health insurance, the so-called "individual mandate."

* Such a tax would function as a direct, or capitation, tax, as opposed to a tax on activity, such as excise or income taxes, and would therefore fall outside Congress' authority to tax income granted by the 16th Amendment to the Constitution.

* The Constitution places strict restrictions on Congress' power to lay capitation taxes under But Article I, Sec. 9, which reads "No Capitation, or other direct, Tax shall be laid, unless in Proportion to the Census or Enumeration herein before directed to be taken."

* Exemptions for some people built into the Senate bill's individual mandate tax would make it impossible for ObamaCare to meet this strict constitutional standard.

Says Patterson, "Some of the finest legal minds in the country have concluded that the enforcement provisions of ObamaCare's individual mandate would violate the both spirit and the letter of the U.S. Constitution. Apparently, President Obama and members of Congress think they are smarter than these scholars - and smarter than the authors of the Constitution."

"Is a Health Insurance "Individual Mandate" Constitutional?" is available online here


Countdown to health insurance nationalization

The “debate” over what to do about the serious problems in the medical system has been pretty lame, with strange economics, chicanery, and demagoguery run rampant. The minority party’s pitiful offerings and compromises are documented in an article I wrote here. The majority’s several variations on a nationalization theme have provided grist for many other articles. (See this list.)

Watching each side’s advocates on television gives one the impression that they would say anything to score points with the uncritical viewing public.

Case in point: Keith Olbermann of MSNBC. I only single him out because I happened to catch his “special comment” Wednesday night, the night before the big bipartisan show — excuse me, summit. Olbermann has much in common with his fellow progressive talkers, though he does add an extra dash of self-righteousness that sets him apart.

At any rate, Wednesday night Olbermann told the sad story of his seriously ill father, which I will not go into except to say I wish him a speedy recovery. (You can read the text or watch the video here.)

I will, however, comment on the parts of the television host’s story that veer into public policy. Olbermann has made no secret of his wish for the government to assume control of the medical system, and he has not hesitated to demonize anyone who takes the opposing position. (He calls them “ghouls.”)

“Death Panels”

His first truly perplexing contention relates to the “death panels” that some Republicans and conservatives made such a big deal over when the medical overhaul bills were first trotted out. You’ll recall that several prominent critics of the bills claimed that the government would be authorized to set up an entity with life-and-death decision-making power over the elderly. It wasn’t true. No such entity was called for. What the House bill did was add end-of-life counseling to the list of Medicare-covered services. By the letter of the bill, a patient would have to request such consultation from a doctor, but would not have to pay for it out of pocket. This was hardly mandatory counseling, much less a death panel, but it should be noted that nonconservatives Nat Hentoff, Charles Lane, and Eugene Robinson were troubled by even that small degree of government involvement in this sensitive area.

Robinson of the Washington Post (a frequent friendly guest on Olbermann’s program) wrote last year: "If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending…. [I]t’s understandable why people might associate the phrase “health-care reform” with limiting their choices during Aunt Sylvia’s final days."

In his Wednesday comment Olbermann, who does think such fear is delusional, couldn’t resist taking one more shot at the death-panel mongers, but he stretched the point beyond recognition. After relating that he had discussed end-of-life care with his father and then with a doctor in the hospital after his father said he wanted no more treatment, Olbermann said: "And as I left that night the full impact of these last six months washed over me. What I had done, conferring with the resident in ICU, the conversation about my father’s panicky, not-in-complete-control-of-his-faculties demand that all treatment stop, about the options and the consequences and the compromise — the sedation — the help for a brave man who just needed a break… that conversation, that one — was what these ghouls who are walking into Blair House tomorrow morning decided to call “death panels.” Your right to have that conversation with a doctor, not the government, but a doctor and your right to have insurance pay for his expertise on what your options … that’s a quote “death panel.”"

Okay, deep breath, Keith. No one has used the term “death panels” in connection with what you did that night. No one opposed consultation about end-of-life care. The fear-mongering about death panels was reprehensible, but it referred to something real: government’s declared intention to assume control of health insurance in order to lower the country’s medical bill. If the government pays for the medical services of the elderly (and many others) and is determined to lower that bill, it is reasonable to wonder if it will apply pressure to deny care in cases where it may appear that further services are pointless. After all, it was Barack Obama who first raised the issue last year when he told the New York Times Magazine, after his elderly grandmother, who had terminal cancer, got a hip replacement shortly before dying,
Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. … I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here…. Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance.

Praise Medicare! Finally, Olbermann had this to say about the financing of medical care in general:
[My father has] got Medicare and a supplemental insurance and my out-of-pocket medical bills over the last six months have been greater than my Dad’s have. And why in the hell should that not be true of everybody, in every hospital, in every sick room, in every clinic, in this country? What is this country for if not to take care of its people? Because whatever I’ve been through these last six months and whatever my Dad’s been through, not once were our fears or our decisions amplified by the further horror of wondering how in the hell we would pay for this. What about families having these conversations tonight about kids? Or about uninsured adults?

Here Olbermann pretends the “country” is something separate — complete with a separate bank account — from the individuals who comprise it. Has he not heard that Medicare has a $37 trillion unfunded liability and will be broke before too long? Does he think putting everyone on Medicare would make it fiscally sound?

Olbermann must be unfamiliar with the law of scarcity, for he shows no sign of realizing that even if the government devoted 100 percent of GDP to paying medical bills, some people would end up going without “enough” and a “death panel” would have to be set up to ration services. He can’t be bothered with such details when people are suffering. (No, the free-market alternative would not ration care. See this.)

More important, when Olbermann says the purpose of the “country” is to take care of its people, has it occurred to him that his proposal requires the use of physical force against peaceful individuals? No, I’m sure it hasn’t.


Fifth of British men turned down for prostate cancer screening

The NHS hates diagnostic tests. They cost money

A fifth of men in at-risk age groups who ask their GP for a test used in the diagnosis of prostate cancer have their requests turned down, a survey has revealed. Seven out of 10 men are unaware they even have the right to ask for a blood test, which for some could be a life saver. Men from less affluent backgrounds were more likely to be uninformed about the test, the results showed. They were three times less likely to request a PSA (Prostate Specific Antigen) blood reading than men from higher socio-economic groups.

John Neate, chief executive of The Prostate Cancer Charity, which commissioned the poll, said: "Our survey highlights the critical role GPs play in providing balanced information to men about the PSA test. "It is completely unacceptable that so many men at risk of prostate cancer are unaware of their right to request a PSA test. "We must move swiftly to a position of 'universal informed choice' where all men are made aware of their right to request a test and to be given clear information about its usefulness and limitations so they can decide whether having the test is right for them. "We are working intensively on proposals for how this can best be achieved and plan to make these public over the coming months."

PSA is a protein that can leak out of the prostate gland and tumour cells. Its detection in the blood is usually the first step on the road to treatment for a patient with prostate cancer. A man with an unusually high reading will have a biopsy sample of tissue removed to provide a definitive diagnosis. However the PSA is not on its own an accurate indicator of cancer, leading many experts to oppose its use as a screening tool.

Mr Neate said: "For many men, undergoing a PSA test could expose a slow growing cancer which may never cause a problem - even without treatment. "At the same time, for men with an aggressive cancer, who have no symptoms of the disease, the test may be the only way the disease will be identified at a time when effective treatment can be offered. "The decision on whether to have the PSA test must therefore be made by men themselves - based on unbiased advice about its pros and cons."

The Prostate Cancer Charity will use this month - designated Prostate Cancer Awareness Month - to shine a spotlight on the disease. For the survey, a random sample of 1,000 men aged 50 and over were interviewed across the UK.


Australia: Government-employed surgeons forced to go on leave to save cash -- while patients wait

SURGERY waiting lists could blow out even further as overworked surgeons are forced to take leave so hospitals can dig themselves out of the red. "To hell with the patients," was the message, said one frustrated Brisbane surgeon, who felt pressured to abandon his patients.

Queensland Health has issued denials, but Salaried Doctors Queensland President Dr Don Kane is adamant. "Many, if not most, of the hospitals across the state are over budget," he said. "When budgets are in trouble, I'm not surprised they are resorting to this. "They aren't concerned about surgeries. The budget is what's precious."

The SDQ also said hospitals were tightening overtime rules and delaying the filling of critical vacancies. Patients are being left on surgery waiting lists or without consultations. In November, medical staff at Rockhampton Base Hospital were told by their district chief executive all overtime had to be pre-approved.

"That's rubbish," Dr Kane said. "I can tell you SDQ has a lot of issues at the moment with Queensland Health." Dr Kane said his organisation, which represented 3000 doctors, was not opposed to the Government controlling expenses, but was sick of money being squandered on consultants and questionable programs and services.

Waiting lists for high-risk patients who should get operations in 30 days were getting worse, he said. "The Government has got its head in the sand and the minister is asleep at the wheel."

A Queensland Health spokeswoman denied surgeons were being forced on leave and admitted there were "negotiations" going on with those who had hefty time accrued. "The department is committed to meeting its obligations for employee welfare and its financial performance," she said. Asked about the financial status of hospitals, she said "I can't tell you that."

The SDQ said it was likely medical officer locums were not being used to replace surgeons on leave. "Their locums have dried up and locums are a very expensive option," Dr Kane said.

A Queensland Health spokeswoman said locums were a "relevant option" available for replacing staff, but hospitals "wouldn't automatically take a locum on."

The Courier-Mail reported in May, 2008 that top surgeons were being forced to stop working for up to six months as patients waited even longer for operations. Queensland Health had allowed doctors to rack up months of leave but demanded they take it all.


1 comment:

medicine said...

A Queensland Health spokeswoman denied surgeons were being forced on leave and admitted there were "negotiations" going on with those who had hefty time accrued. "The department is committed to meeting its obligations for employee welfare and its financial performance," she said. Asked about the financial status of hospitals, she said "I can't tell you that."