Tuesday, February 23, 2010

Change you can't refuse

King Barack (Big JuJu) Obama's messianic obsession with making the government the gatekeeper of your health care marks him as the most dangerous president the United States has had in our lifetimes, and possibly ever. It's not just that "health care reform" — a nebulous, ever-shifting plan that possibly no senator or congressman has read in its entirety — is designed to ultimately place every American at the mercy of government paper processors for their very lives. That's bad enough.

What is even worse is the way this demented administration has shut out every external reality, taking no heed of the evidence that this is a deeply unpopular plan, one that has so far failed of passage despite King Barack's mob having to bribe members of his own party (Senators Mary Landrieu and Ben Nelson) with special favors for their states, paid for out of taxpayers' money, to vote for it.

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From ABC News:
White House officials today publicly made it clear that should Thursday’s bipartisan health care reform summit not result in a legislative kumbaya, with Democrats and Republicans setting aside differences to come together on a bipartisan bill, Democrats are likely to pursue a legislative path for finishing up the bill that includes using controversial “reconciliation” rules in the Senate, requiring a majority vote instead of the 60-vote threshold that has become par for the course.
Maybe the "reconciliation" strategy is technically legal. It is still an all-out assault on the opposition, the kind of gloves-off attack King Barack won't allow against real enemies in Afghanistan. The man-god will call Republicans to the table this week to work out an agreement of the "be reasonable, do as I say" kind. Should that fail, as it almost surely will, then it will be time to call in an air strike.

Onward to the inevitable triumph of socialism! Victory at all costs! Unconditional surrender of the American people the only goal!

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Despite its decline in quality under the Murdoch reign, the Wall Street Journal can still marshal words to powerful effect at times:

"The President's Proposal," as the 11-page White House document is headlined, is in one sense a notable achievement: It manages to take the worst of both the House and Senate bills and combine them into something more destructive. It includes more taxes, more subsidies and even less cost control than the Senate bill. And it purports to fix the special-interest favors in the Senate bill not by eliminating them—but by expanding them to everyone.

The bill's one new inspiration is a powerful federal board that would regulate premiums in the individual insurance market. In all 50 states, insurers are already required to justify premium increases to insurance commissioners, who generally have the power to give a regulatory go-ahead, or not. But their primary concern is actuarial soundness and capital standards, making sure that companies have enough cash to pay claims.

The White House wants to create another layer of review that will be able to reject any rate increase that is "unreasonable or unjustified." Any insurer deemed guilty of such an infraction by this new bureaucracy "must lower premiums, provide rebates, or take other actions to make premiums affordable." In other words, de facto price controls.
Nothing could make clearer the mindset of the Obama-Pelosi-Reid axis: any problem caused by real-world factors is an opportunity for the government to step in and rule by decree.

That's what's alarming. What's sad is that the present U.S. health care system does have problems that need attention. Insurance companies have too much control over medical practice: they drive doctors barmy with paperwork and make them spend half their time (or their staffs' time) justifying treatments their training and experience tell them their patients need. Malpractice suits can result in ludicrously large jury awards or force doctors and hospitals to settle so as to avoid further litigation costs.

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We should eliminate all barriers to insurance companies competing nationwide and put sane limits on their control of treatment. Reform tort laws to make legal compensation for actual malpractice reasonable, not a million dollar lottery, so that a large portion of the country's health care spending doesn't go to tort lawyers. We don't have to destroy our health care system, which with all its troubles is among the world's best, to fix it.

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9 comments:

Sheila said...

Yes, our health care system does have problems: the number one problem is over-regulation; the number two problem is a despoiled American populace both deifying doctors and wanting something for nothing. Health care is neither a right nor a privilege - doctors provide a service which consumers purchase. It is incumbent upon the purchaser, as always, to do his due diligence. Not all doctors are competent, not all agree, and their diagnoses sometimes amount to not much more than educated guesses. Too many people (among them a large proportion of the elderly) view doctors as gods, and their pronouncements imperial edicts. Too many doctors are somewhat technically-savvy intellectual elites, educated beyond their level of intelligence (masquerading as wisdom). Why do most people question a car salesman far more than they do their doctor?

At the same time, too many individuals run to the doctor at the first sign of a sniffle, asking for a magic pill to cure all of their often self-inflicted ills (eating too much and exercising too little prime among them), all at a $10 copay, of course. If I want good service, I expect to pay for it, and I also demand it as a condition of my patronage. I don't have the time or desire to attend medical school, so I'm paying someone else (who did pay and put in the time and effort) to acquire that knowledge and utilize it on my behalf. The office and the staff and the machinery and the medications and the education aren't cheap. Our society has a basic problem in how it regards certain professions as "callings," and a schizophrenic relationship regarding reasonable pay for such. If a teacher or doctor is supposed to be pursuing a higher human good (rather than be in it for any sort of capitalistic remuneration), then we seem to believe they should be willing to work for whatever we want to pay. If those same teachers or doctors want to argue that they're special "professionals" and demand remuneration based on their supposed level of expertise, they then bristle at their competency being judged by their results. You can't have it both ways, folks. Is it a job or not? Are we servile patients or paying customers? The whole relationship is skewed here.

I'm terribly tired of hearing people argue they can't afford their sixteen different medications (usually for high blood pressure, adult-onset diabetes, high cholesterol, and other weight-related ailments) so the doctors and the rest of society must subsidize it - via either insurance companies or government regulation: there's only a difference of degree. I have chosen to purchase an extremely high-deductible plan to cover catastrophic care only (no, I'm not paid for by my spouse's employer) and I use nothing more than basic annual exams (for which I rightfully bear the cost) and yet my premiums rise every year because of everyone else for whose cancer and diabetes and fertility treatments I am expected to pay. Health care is an individual responsibility and health care providers are serving paying customers. This whole faux debate is fueled by outrage of a society raised to believe they are OWED by everyone. I believe in responsibilities just as much as rights, and I believe in free will above all. Please reframe any future comments or essays under those terms and perhaps we can eliminate the entire argument (and the entire system of insurance and everyone being responsible for everyone else's health).

Okay, now bring on all the sob stories, the accusations that I'm not a Christian, the arguments that I'm just too young to understand (I'm over 50) or that I have no compassion. I prefer reasoning over emotional outbursts, which is what I expect to hear in response to my rational argument.

Rick Darby said...

Sheila,

You've raised several complicated issues here, and I claim no particular expertise and certainly have no perfect answers. I'll touch on a few of your points.

Good medical care is expensive, there's no way around it. It cannot be made "free" — the only question is who pays. If the government provides so-called "free" health care, the cost is actually borne by taxpayers, with a major mark-up for the jobs program that government administration inevitably becomes.

All a society can do is try to enable the greatest number of people to buy insurance whose price is not artificially inflated by limited competition and the tort lawyers' lobby. And while the insurance companies should have some ability to refuse to pay for unproven and elective treatments and brand-name meds for which generics are available, they should otherwise not be empowered to make medical decisions.

You say: "I'm terribly tired of hearing people argue they can't afford their sixteen different medications (usually for high blood pressure, adult-onset diabetes, high cholesterol, and other weight-related ailments) so the doctors and the rest of society must subsidize it - via either insurance companies or government regulation: there's only a difference of degree."

You are talking about very serious conditions that can result in heart attacks, stroke, loss of limbs, and other annoyances. If your implication is that they are the patient's responsibility because they are too lazy to exercise, that is true only partly and for some people. Most need the meds prescribed for those conditions. Without insurance, they are financially out of reach for many.

You may object to paying insurance whose rates are influenced by covering people who are less healthy and poorer than you are, but that is how insurance works. The covered people who do not receive payouts enable the company to pay claims. Your good health history, if that is your situation, does get you lower premiums when you buy insurance for yourself. And you can, as you have, buy a high-deductible plan.

I agree that individuals are responsible for their own health, up to a point. I for one try to research my medical issues as best I can — including learning about alternatives and preventatives such as supplements. But as you say, we can't all go to medical school, and while I have occasionally switched doctors when dealing with one who struck me as a paint-by-numbers physician, I generally go along with their recommendations. As the English say, "No sense to keep a dog and bark yourself."

David said...

I commented today on a story about the generic-drug approval process, which seems badly broken. With all wild spending by the Obama administration, they haven't seemed able to come up with a few tens of millions of addditional dollars to help relieve the bottleneck..which would clearly have a signficant impact on costs.

A *real* executive knows how to locate hinge points which can make a big difference for a relatively small investment...a fake executive prefers to posture about grandoise visions.

Sheila said...

Rick - thanks for your measured response. I agree that, although one's health is primarily one's own responsibility, there are limitations and there are diseases or inherited conditions or accidents that are beyond one's control. I'm aware that the whole premise of insurance is shared/minimized financial risk, but I'm arguing that those who feel entitled to so-called "cadillac" coverage and yet balk at paying more than a minimal copay (plenty of public service unions in that category, including supposedly selfless school teachers) need to rethink what the basic nature of insurance is. By all means, let's have more competition and tort reform. Let's also have a way to compare doctors' prices and their records of patient care and/or success. I'm arguing for market-oriented health care and educated consumers making informed choices, and while catastrophic coverage is what most insurance was initially instituted to provide, people now expect insurance to cover all sorts of optional or personal expenses. Just as illegal immigrants go to the emergency room because they can't be turned away and aren't compelled to pay, people with the most comprehensive health care coverage argue against paying higher premiums for known risk factors or behaviors on one hand, and for the most wide-ranging coverage with minimal cost on the other. This is unrealistic and unsustainable. Human nature being what it is, people will take advantage of whatever they can, and will justify it as their right. Interesting how our local Primacare (where I often take my children because my insurance cost there is the same and my wait time is usually far shorter than for their private pediatrician) is far less crowded, now that it requires payment and proof of insurance prior to treatment, instead of subsequent to it.

I have switched doctors on a number of occasions for my children, for various reasons. In one case the physician refused to provide future service and dropped me as a patient, regardless of payment (they had just stopped accepting our insurance carrier and I had asked about the possibility of a negotiated fee, but they instead suggested I should go to their "free" clinic for my infant's vaccinations), because I voiced opposition to the free clinic he operated for illegal immigrants. In other cases I have had physicians insist my children had nothing more than a cold, but when I insisted on an x-ray they conceded there was a sinus infection. No, I'm not a physician, but I am a highly intelligent individual who knows a reasonable amount about my own and my children's ailments, and I'm tired of doctors with an inflated sense of importance (and accustomed to totally compliant patients) dismissing my common sense or my questions. I am paying for a service, not supplicating a god. And for those who may assume otherwise, I have an excellent relationship with a number of doctors, based on mutual respect and open communication, which I'm arguing is the inherent right and responsibility of all patients and should be the basis of the health-care debate.

Rick Darby said...

David,

A *real* executive knows how to locate hinge points which can make a big difference for a relatively small investment...a fake executive prefers to posture about grandoise visions.

It's so much more exciting to be a visionary touched by magic than an analyst who can get the most benefit with the least expense and disruption.

Rick Darby said...

Sheila,

I respect what you say. We can probably agree that rewarding individual responsibility when using available medical care would be a winner, and removing care from politics (especially national partisan politics) and the trial lawyer spoils system would be a big help.

MnMark said...

Does anyone else find themselves consciously trying to enjoy the good things of life right now because of a sense that sometime in the not-to-distant future, the economic and political environment is going to become much more unpleasant than anything we've lived under in this country since the Civil War?

The progressive/socialists' "long march" through the institutions by and large succeeded; their demographic efforts to dispossess American whites through non-white immigration look like they're going to succeed; and now the two great ideological worldviews - collectivism and individual freedom - look like they're headed for a showdown here in the U.S. Collectivism won in Europe a long time ago, but it's been a tougher battle for the collectivists in the U.S. because of the cultural emphasis on liberty and individual freedom and capitalism that has been at the center of the American worldview. But now white American traditionalist/conservatives have nowhere to retreat, and the intrusions of the collectivists are on the verge of becoming too enormous to shrug off any longer. No wonder the political sphere is becoming polarized; the progressives, with the voting block of non-whites and young whites brainwashed by the progressive-controlled educational and media institutions, are no longer a fringe group and their big man, Obama, is in power. It's a good thing that Obama is determined to force through his socialist changes...it's bringing things to a head in a way that would not happen under a more incrementalist, moderate progressive like Hillary. Go ahead, Obama, force the issue. Push it, pass health care via reconciliation, start fining people for not buying health care, bankrupt the government, do it all. Bring it all on now, and help wake up my people.

Rick Darby said...

MnMark,

Does anyone else find themselves consciously trying to enjoy the good things of life right now because of a sense that sometime in the not-to-distant future, the economic and political environment is going to become much more unpleasant than anything we've lived under in this country since the Civil War?

I can't speak for anyone else, but I'll try to answer from my standpoint.

Yes, it's looking like a showdown is in our future.

My own response is not to "enjoy the good things of life right now" any more than usual. I appreciate the good things we experience in our temporary existence in a physical body. But the more I read of history, which is one of my interests, the more I understand that most of the time mankind has lived under difficult and often threatening conditions.

The era of relative peace, security, and consumption that characterized American life in the 1950s to 1990s -- an era that has ended (although many have not caught up to the change) -- was an aberration, albeit a pleasant one.

We are now in a time of trial. The historical norm has us in its jaws again. But groups can respond creatively to crisis, as can individuals. Not only politically, although political commitments are demanded of us (much to my irritation, being naturally inclined to the artistic and intellectual sphere); but spiritually as well.

Do you imagine that Jesus and the Christian mystics of the Middle Ages lived in an easy world? Or the Buddha? They all had to pay their dues in the world of time and space, but they transcended it.

Aldous Huxley said something to the effect of: Even though we know better, we must pretend that this world of everyday, lower-mind reality is all there is. My interpretation is that how we act amid the storm of sense perceptions affects the lives of others lost in this dark sink of ignorant consciousness, and in turn, the condition of our own souls.

As much as I would prefer not to have to, I will act for the good of my loved ones and my country as I understand what is right. I will not seek pleasure to blot out the resulting anxiety.

MnMark said...

Well I suppose my phrase "the good things of life" made it sound like I am advocating some kind of "drink now for tomorrow we die" sort of libertine excess.

Actually what I had in my head when I said "Does anyone else find themselves trying to enjoy the good things of life right now..." was things like not having to worry about the secret police dragging me off, or being able to still easily find groceries for sale at the store at a price I can afford, and running water and electricity that is reliable, and no mobs in the streets (well not in my neighborhood anyway), and being able to get my money out of the bank. That kind of stuff. Just the everyday luxuries of American life that we've taken granted for a long time. I find myself thinking "I should enjoy these things now. It may be the case that there is time coming when I'm going to be hungry and afraid a lot."