Archive for the 'Health Care' Category

Last week was a week for the conspiracy theories. First, we had Benghazi and the hearings which interviewed career State Department officers, most of whom probably vote for Democrats. The fact that they were ordered not to talk to Congressmen and denied any attempt at help when under attack, even from as close as Tripoli, invites speculation about motive. Peggy Noonan, a little unusually, hits this one out of the park.

Since it is behind a pay wall, I’ll quote a few bits.

What happened in Benghazi last Sept. 11 and 12 was terrible in every way. The genesis of the scandal? It looks to me like this:

Because of that, it could not tolerate the idea that the armed assault on the Benghazi consulate was a premeditated act of Islamist terrorism. That would carry a whole world of unhappy political implications, and demand certain actions. And the American presidential election was only eight weeks away. They wanted this problem to go away, or at least to bleed the meaning from it.

That sounds about right to me.

Read the rest of this entry »

Politico:

Lawmakers, aides may get Obamacare exemption
 
Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama’s health care overhaul, sources in both parties said.

Who could have seen this coming.

The talks — which involve Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner (R-Ohio), the Obama administration and other top lawmakers — are extraordinarily sensitive, with both sides acutely aware of the potential for political fallout from giving carve-outs from the hugely controversial law to 535 lawmakers and thousands of their aides. Discussions have stretched out for months, sources said.

It’s all “extraordinarily sensitive”. I wonder why.

A source close to the talks says: “Everyone has to hold hands on this and jump, or nothing is going to get done.”

Safety in numbers. If this deal goes down it’s a good reason to vote out every member of Congress.

Read the whole thing if you feel inadequately cynical.

This is part of a letter I just sent to my employees:

*In speaking with the owners of (company A) and (company B), both times the conversation turned to health insurance. With the “Obamacare” legislation being passed and coming into effect, we are not only going to be taxed on our current health insurance, but our insurance rates will be skyrocketing, yet again. (other business owner), myself, and the owners of (company A) and (company B) just looked at each other and said – and I quote – “we don’t know what we are going to do”. Note that this is not a political statement in any way, I am simply sharing with you the reality of the situation.

We have always considered “free” health insurance to our employees to be one of the massive benefits we like to provide, but if these increases go through as expected, the model will simply be untenable.

There may be decreased coverage, employee contributions, decreased profit sharing, and/or a combination of all three, or perhaps something else. We are not sure where this will take us, but we will do the best we can to come up with the best solution for everyone. Just be aware that there is a possibility of changes in the future. You will have ample notification and time if and when any changes are made.*

The train is coming down the tracks.

Recently I was reading how a professor at the University of Illinois at Chicago was arrested for bringing an unloaded handgun to work, and that it made the news media. I reflected briefly on the fact that you can bring a loaded, concealed gun with you in most places in many states in the US and it wouldn’t be news, it would in fact be normal activity, for instance in the adjacent state of Indiana.

Meanwhile, in California, it is common for people to smoke marijuana openly as is discussed here. Needless to say, this behavior would get you immediately arrested in many states particularly in the south and midwest.

Taxation is also highly variable on a state and city basis. New York and California have some of the highest taxes, particularly on income beyond a particular level (progressive taxes). On the other hand, states like Florida and Texas have a much lower level of taxation and a much freer business climate in terms of regulation.

Without getting into the hottest of hot-button issues, clearly there are differences in the types of marriages and reproduction rights / right to life on a state by state basis. These differences are narrowing in some areas and getting wider in others.

Some states have “right to work” laws which massively limit union power, and have flourishing and expanding manufacturing economies as a result. Visit Alabama, South Carolina, and Texas to see where all the former manufacturing might in the midwest and Northeast and West Coast migrated to (if it didn’t go to China or overseas). The enacting of “right to work” laws obviously sends an important signal to business leaders whether or not a state is a friendly place to do business for incremental investment (along with taxation).

The “fracking” revolution has unleashed vast wealth in some states, and in other states it has been banned or severely curtailed. Meanwhile, California is going in on its own with carbon regulations and highly aggressive “green” energy targets, while other states are heavily reliant on traditional (and cost effective) technologies.

The differences on a state-by-state level on these different dimensions seem large and growing. They are much more subtle (though often correlated) with the Red / Blue analysis. An attempt to classify these vectors could be done as follows:
Energy Freedom – the ability to extract and use cost effective technologies (like natural gas, fracking, and coal) and a state’s willingness to invest more for reliability or the requirement to use expensive (green) technologies and curtail energy use even at the expense of industry competitiveness and reliability. California is likely on one end and Texas is on the other side, although many others have large freedom including Pennsylvania.
Safety Freedom – the right to defend yourself at home, in transit, at work and during study or whether that is assumed by the state. Sadly the most restrictive is Illinois and there are many candidates on the other side throughout the south and midwest (Indiana).
Personal Substance Freedom – the right to smoke, the right to drink, and the right to use various drugs or stimulants. Some odd states (like Colorado) are leading the way on this, it isn’t always the traditional Red / Blue divide.
Freedom to Work & Hire – the right to work and not be forced to join a union, and this is also tied with local laws and practices that limit the ability to hire and fire and direct hiring or limit firing in various dimensions.
Freedom to Build / Live / Rent – Houston is famous for having very limited zoning while other states and municipalities have highly restricted zoning practices. The New York co-op concept also severely limits new entrants along with rent control. These laws can also include whether you can work or have a business in your home. While subtle, these practices can have a large impact on prices and how the region functions.
Freedom From Excessive Taxation – Some level of taxation is necessary for government to function but high tax levels have severe intended and unintended consequences of under investment and evasion. Taxation includes state, local, city, sales, estate, property, and “sin” taxes. These vary significantly by area but are highest in California and the East Coast and likely the lowest in the South.
Freedom of Marriage Choice – A larger portion of states are recognizing marriages beyond the traditional marriage, and this varies by state
Freedom of Reproductive Rights – There are a wide variety of approaches and trends on a state level and then there are practical impacts, as well. This is highly variable by state in practice
Freedom on Medical Rights – an emerging model will be how each state approaches new medical practices and funding methodologies, along with the practical availability of doctors that subscribe to the state’s controls and funding methods. This area will grow exponentially in the near future

I believe that these sorts of analyses on a state by state level are much more useful than the traditional Red / Blue view (although they are often correlated) and when you start to dig in to the differences on a state and municipal level they are staggering, particularly when you view the extremes.

It would be interesting and useful to begin to put together the various data sets to analyze states and municipalities along these continuums, and others that I’ve likely missed.

Cross posted at LITGM

UPDATE: Here is one solution.

This week Europe blew up. The media haven’t caught up yet, because they are what they are. But the markets are catching up fast.

So European voters fled to the fascists to express their rage and despair. Imagine one out of four US voters going for Lincoln Rockwell, and you get the idea.

Read the rest, as they say.

Belmont Club has an unusually good post for yesterday. I could say that more than once a week, if truth be known. This one is quite to the point on Sequester Day.

The NHS, which its creators boasted would be the ‘envy of the world’, has been found to have been responsible for up to 40,000 preventable deaths under the helm of Sir David Nicholson, a former member of the Communist Party of Britain. “He was no ordinary revolutionary. He was on the hardline, so-called ‘Tankie’ wing of the party which backed the Kremlin using military action to crush dissident uprisings” — before he acquired a taste for young wives, first class travel and honors.

The NHS is dealing with the shortage of funds by pruning its tree of life, so to speak. He also does not tolerate anyone telling the truth about it.

it emerged he spent 15 million pounds in taxpayer money to gag and prosecute whistleblowers — often doctors and administrators who could not stomach his policies.

The public money spent on stopping NHS staff from speaking out is almost equivalent to the salaries of around 750 nurses.

It has recently been noted that NHS staff no longer recommend their own hospital for family members. Also one quarter report being harassed or bullied at work.

The other half of the equation involves the youth.

The European Youth will remain outside the Death Pathways for some time yet. But they will spend the time waiting for their turn at affordable, caring and passionate medicine in poverty and hopelessness. With the exception of Germany youth unemployment in Europe is over 20%. “A full 62% of young Greeks are out of work, 55% of young Spaniards don’t have jobs, and 38.7% of young Italians aren’t employed.”

Unemployment exceeds even our own Obama economy for failure. Read the rest of this entry »

As the old Billy Joel song goes; that is, a fair portion of a civil society is built on trust. Or at least – a large portion of the citizens in that society not only trust each other, but they generally also trust the civil institutions, too. There is an assumption, albeit slightly frayed around some edges that our institutions are generally benign and have the well-being of the larger public at heart. We assume, or did in the past, that laws are passed for our benefit, that rules are instituted for the same reason, that our elected leaders did, or at least mostly made a convincing pretense of representing the interests of their constituents, and not those of lobbyists bearing large favors. Read the rest of this entry »

I don’t think George Will meant to be cruel when he wrote his recent article “The Time Bomb in Obamacare?” but he was and it is a recurring conservative mistake. Will focused on the law and the constitution. He found a bomb and he imagines he is a good bomb squad officer by analyzing the bomb and figuring out how it is going to blow up. What he missed, and it is crucial, is the vital step of clearing away the civilians. That is a cruel oversight and hurts the conservative cause. You have to make sure that people understand that there is a bomb and which direction to run so they do not get blown up.

The immediate threat for ordinary people is not Obamacare’s constitutional status, but what it will do to ordinary american’s access to care. Institutions that are caught in the payment squeeze will triage because otherwise they go broke and close, which would maximize suffering. Triage means that the lack of funds will cause them to try to maximize who they can save and cut off who they can’t afford to save. If you are going to be triaged, you need to know and you need to make alternate arrangements to pay cash, figure out how to live without needed care, or get your affairs in order. The later people figure this out, the more pain, suffering, and death Obamacare is going to cause.

Nothing George Will said about the law is wrong. By focusing on the Constitution and the law to the exclusion of the upcoming suffering of the people he ended up reinforcing a pernicious stereotype, one conservatives would do well to lose. Ultimately, the conservative focus on the law and the Constitution has the effect of reducing suffering and increasing the happiness of the people. This approach would be greatly increased in effectiveness if conservatives would directly say so instead of assuming people already knew. A great many people do not know and the conservative brand is suffering for it.

Here’s a Rudyard Kipling poem which isn’t as well known as some of his other ones:

There were thirty million English who talked of England’s might,
There were twenty broken troopers who lacked a bed for the night.
They had neither food nor money, they had neither service nor trade;
They were only shiftless soldiers, the last of the Light Brigade.

They felt that life was fleeting; they knew not that art was long,
That though they were dying of famine, they lived in deathless song.
They asked for a little money to keep the wolf from the door;
And the thirty million English sent twenty pounds and four !

They laid their heads together that were scarred and lined and grey;
Keen were the Russian sabres, but want was keener than they;
And an old Troop-Sergeant muttered, “Let us go to the man who writes
The things on Balaclava the kiddies at school recites.”

(read the whole poem here)

What reminded me of this poem?

This story.

Apparently, in 2012 the average time to complete a VA disability or pension claim was 262 days, up from 188 days in the prior year and far above the official target of 125 days. More at Nextgov.

I’m not very impressed with the excuses offered by the VA for this situation:

VA officials attribute the backlog, defined as claims in the system for more than 125 days, in part to higher demand by veterans returning from 10 years of wars in Iraq and Afghanistan with severe and complex injuries.

A Texas Veterans Commission official noted that the agency is caught in a “perfect storm” of claims from veterans of recent wars and those from aging Vietnam and Korea veterans whose disabilities are worsening.

But wasn’t this all predictable? Obviously wars cause injuries, and better battlefield medical attention means that more wounded soldiers will survive and hence need extended care. And wasn’t the higher claims rate “from aging Vietnam and Korea veterans” largely predictable from simple demographic analysis? I’m reminded of the saying about a British railroad from several decades ago:  ”Despite its frequency and general regularity, Sunday morning seems to consistently catch this railroad by surprise.”

The above remark about the railroad notwithstanding, private enterprises generally seem to be able to deal with fluctuating demand and other problems quite well. There is almost always food in the supermarkets, despite droughts, crop failures, logistical problems, strikes, etc etc. The electricity is almost always on despite storms and electrical failures. And while businesses generally do a better problem than government at dealing with daunting arrays of problems, some government agencies do manage to deal with demand increases and fluctuations far better than the VA seems able to do with these disability claims. Somehow the FAA manages to conduct air traffic control safely and effectively despite the increased demand that occurs in holiday seasons and the varied and often nefarious effects of the weather. The military itself often manages to quickly deploy forces and equipment to far-distant locations. Why has the VA been unable to modify its processes to provide resolution of disability claims in a timely manner?

Sad and disturbing.

There is information still coming to light about this awful case. Early reports, such as the name of the shooter and the alleged murder of the father, were predictably wrong. It turns out that the shooter, named Adam Lanza, a 20 year old with a history of odd behavior and some evidence of mental illness, such as autism, was living with his mother who was his first victim. There are a number of suggestive reports, that she decided to “stay home to care for” her 20 year old son.

The treatment of severe mental illness in this country has been altered for the worse by a movement that began in the 1960s when mental illness began to be described as a “civil rights ” issue. Several books and movies described abuse of power in commitment of the mentally ill. The first such movie was “The Snake Pit” in which a young woman is committed for what sounds like schizophrenia. The treatment of the time (1948) can be seen as barbaric but there was nothing else available. She did recover, although we know that without adequate treatment, recovery from schizophrenia is unlikely.

The movie that really devastated the mental hospital system was called “One Flew Over the Cuckoo’s Nest” and starred Jack Nicholson.

The movie was powerful in showing the Nicholson character as a guy who just is “different” and harmless.

Read the rest of this entry »

It’s already underway and will only get worse. J.E. Dyer’s analysis is worth reading:

It’s one thing when advertisers seek to drive emotional connections with lite beer, pick-up trucks, and air fresheners. It’s something else when the government hires advertisers to drive emotional connections with government policies and institutions. This goes far beyond the old-fashioned “good government” idea of providing information to citizens. In its essence, it differs not at all from a Stalin-era poster hyping the Soviet government’s policies to a beleaguered Russian people.
 
…
 
Advertising is a dangerous thing in the hands of the armed state. I am no more in favor of Republican administrations spending a lot of money on it than of Democrats doing so. With Obamacare, we have reached the fork in the road. A government with the powers conferred by Obamacare cannot, on principle, be trusted to “advertise” its policies to us. The inevitable descent into untrustworthy propaganda has already begun. Until Obamacare is repealed, it will continue to get worse.

Joel Runyon was working on his Mac at a coffee shop in Portland, when an older man sitting next to him asked him how he liked Apple. Resisting the temptation to politely return to his work, Joel engaged the guy in conversation…it turned out he was Russell Kirsch, who was lead designer of the first American stored-program computer (the SEAC) and was also a pioneer of computer image processing. Read about Joel’s conversation with Mr Kirsch at the link, and then read his followup post 7 things I learned from my encounter with Russell Kirsch.

Conversations with strangers can of course expose you to boringness (yes, it’s a word, I checked) and/or weirdness, but they can also often be interested or at least revealing. I was on an Air France flight back from Paris once…the aircraft had to be changed at the last minute and the new plane was not configured with First Class, so those who had reserved FC seats had to be satisfied with Business Class (which, in my experience at least, is nothing to complain about on Air France.) The guy sitting next to me was very, very upset that he didn’t get the First Class seating he had been counting on. In an attempt to get him to talk about something else, I asked him what he did for a living.

Turned out the guy was a professional Communist, on his way back from some kind of Communist meeting.

Here’s another interesting story about a chance conversation. In 2009, an American neurosurgeon overheard a conversation between two former Israel Air Force officers who were talking about flight simulation. He joined the conversation, and the eventual result was a collaboration that led to the founding of this company, which develops systems for surgery rehearsal.

Another interesting story of a chance conversation: see the second comment on this post at Tom Peters’ blog.

For those interested in the history of technology: Russell Kirsch’s SEAC, completed in early 1950, was built by the National Bureau of Standards for use of researchers and engineers who were chomping at the bit for computer capacity and were tired of waiting for more-ambitious planned machines such as EDVAC and UNIVAC. SEAC’s memory capacity was only 512 words (numbers or instructions), but it was applied to a wide range of problems, including lens design, tables for navigation, and design calculations for the hydrogen bomb. The computer also supported early digital imaging work, with the first digital image being a picture of Kirsch’s son.

More about the SEAC project here.

The Democrats rebranded socialized medicine as “single-payer” medicine so as to confuse people without the time to track all leftwing code words. They did the same thing for their own name in the ’80s, changing from “liberals” which was associated with the raft of failed leftwing policies of the 1970s, to “progressives.”

It’s a good example of their contempt and disdain for the American people. They think, “People are so stupid that if we call something by a different name, one without negative connotations, they will support something they otherwise would have opposed.” (Remember, leftists rationalize that you are their inferior and that they must always manipulate you for your own good.)

It doesn’t work long term, of course, because words acquire the connotation of the phenomena they label and not the other way around, e.g., idiot, moron and retarded were all originally words invented by doctors and scientist trying to create kinder, gentler and more scientific terms to describe people with subnormal mental processes. But the condition of being subnormal is viewed as negative so any word used to describe that condition becomes negative and eventually a playground pejorative.

Deceitful words are highly dangerous in politics. No less a luminary than Confucius himself wrote that the first act of good governance is to name things honestly. This is more true in a democracy where people have to know what they are voting for.

“Single payer” is a deceitful phrase not only because it attempts to rename something in order to confuse the people but also because under socialized medicine, everyone pays. It’s just that what you pay and what you get are unrelated. It’s only “single payer” from the perspective of the health care providers because they are the only ones who ever get paid.

Read the rest of this entry »

Obama was much more animated and his supporters will be happier tonight.

I think Romney was more impressive but I am a partisan. What surprised me was a focus group collected by Frank Luntz that decided that Romney won overwhelmingly. These were Obama voters in 2008. Their comments were very interesting. One woman supported Obama because of his comments about contraception. She was pretty much alone.

Obama said some things that will be in RNC ads next week.

1. He said that oil and gas leases were increased on public land during his administration. That is not true and Romney called him on it. Chris Wallace checked the facts and Romney was correct.

2. He said that Romney would raise taxes on the middle class and he had cut them. I don’t think anyone believed him. Romney did a good job, better than the first debate, in explaining his proposals.

3. The was only one question on Libya and Obama lied about what he said the day after the attack. That was foolish and we will see the Rose Garden statement many times before the election. He mentioned terrorism but the connection with Benghazi was not made. For weeks after, Obama and his underlings, especially Susan Rice the first black UN ambassador, kept offering the story of the anti-Muslim video.

4. The concerns about Candy Crowley as moderator were well based. She cut off Romney multiple times and Obama talked right past the clock. He ended with 7 more minutes of time. In addition, contrary to the agreement, Candy Crowley inserted herself into the questioning and supported Obama in his assertion that he had described the attack on the Benghazi consulate as terrorism. She later, after the debate was over admitted her mistake. That will be a topic until the election.

5. There was a dumb question about an “assault weapons ban.” Romney did well to note that automatic weapons are already illegal, a detail that escapes most Democrats, like Diane Feinstein

All in all, I thought Romney did well and Obama improved his performance from last time, although at the cost of a number of falsehoods that will provide fodder for the large Romney ad budget in the next two weeks.

There were several exchanges on immigration policy and education but these were the highlights for me.

Today, the Sunday morning TV shows on politics demonstrated the response of the Obama campaign to Romney’s debate win last week. Paul Krugman, who looks more and more like a political cheerleader and less like an economist, led the charge. The topic was the “five trillion dollar tax cut.”

The Obama campaign is already backing away from this claim, but let’s consider it.

This “five trillion dollar tax cut” figure is arrived at by taking his statement that he will cut rates by 20% and limit deductions. Multiple the total tax revenue per year by 20% and you get five trillion. This same reform was done in 1986 and the result was a 15 year economic boom. The results are discussed here.

Twenty years ago today (2006), President Ronald Reagan signed into law the broadest revision of the federal income tax in history. The Tax Reform Act of 1986 — the biggest and most controversial legislative story of its time — had lawmakers, lobbyists and journalists in Washington in an uproar for two years. Despite nearly dying several times, the measure eventually passed, producing a simpler code with fewer tax breaks and significantly lower rates. The changes affected every family and business in the nation.

Of course the Congress undid it over the ensuing years. We all expected that. What about Romney’s plan ?
Read the rest of this entry »

To any Doctors, medical researchers or biologist out there.

I’m working on a little medical db app for patients to record and communicate the apparent location of symptoms in three-dimensional space. I’ve code named the app “Hypochondria.”

I was inspired by my own experiences having trouble communicating with doctors. One time my spouse almost got a gall bladder infection missed by a doctor who interpreted her description of the pain as superficial back pain instead of being deeper in the abdominal cavity itself. I think such miscommunications occurs often, especially across language and cultural barriers.

I’ve been trying to find both images and a coordinate system that naive patients can use to map and log the apparent internal location of pain or other symptoms. I expected that there would be some public domain images because I’m pretty sure I’ve seen them before on either medical forms or back in college.

I just need simple related outlines, that show:

• Coronal (right-to-left or x-z plane),
• Sagittal (front-to-back or y-z plane )
• Transverse sections (left-to-right and front-to-back cross section or x-y plane ).

Read the rest of this entry »

Iowahawk

For the vast majority who did not pay attention over the past few years, they found out that Obamacare’s individual mandate was a tax with the release of the US Supreme Court decision. That’s just fine for a brick layer or a clerk. It isn’t their job to think about such distinctions. It is the job of those in government. So when did Nancy Pelosi find out? When did President Obama find out? Is the date they found out so late as to consider it a measure of political incompetence that should weigh down their re-election campaign?

Is anybody asking these people these questions?

Liberals who are pessimistic about the prospects in the Supreme Court this week for the Affordable (or is it Abominable?) Care Act, known as “ACA,” have been preparing the ground by publicizing surveys measuring the unpopularity of the Court. Liberals who are optimistic, such as former speaker Nancy Pelosi, predict that ACA will be upheld 6-3.

The 6-3 breakdown comes from the result in Gonzales v. Raich, 545 U.S. 1 (2005), in which the Supreme Court held that prohibiting the cultivation of marijuana for personal medicinal use was within Congress’s powers under the Interstate Commerce Clause. To the dismay of many conservatives, Justice Antonin Scalia concurred with the majority. His concurring opinion shows how to apply the Commerce Clause to something as far from interstate commerce as ACA’s individual mandate.

And the individual mandate is very far from interstate commerce. An individual is not engaging in interstate commerce merely by refraining from buying health insurance. He is not engaging in commerce. He is not engaging in anything. That puts the individual mandate beyond Congress’s commerce power but not necessarily beyond Congress’s powers.

The Supreme Court has said that Congress has the power to regulate the channels and instrumentalities of interstate commerce as well as activities that substantially affect interstate commerce. Justice Scalia said in his concurring opinion in Raich that the power to regulate activities that substantially affect interstate commerce does not come from the Commerce Clause alone but from the Commerce Clause plus the Necessary and Proper Clause. The Necessary and Proper Clause has extended the Commerce Clause pretty far. Scalia wrote that “Congress may regulate even noneconomic local activity if that regulation is a necessary part of a more general regulation of interstate commerce.”

As disturbingly vast as that power might be, the Supreme Court would have to extend it even further to reach non-economic local inactivity. That extension may or may not be “necessary” to make ACA effective, but is it “proper”? At oral argument Justice Scalia posed that question to Solicitor General Donald Verrilli:

Necessary does not mean essential, just reasonably adapted. But in addition to being necessary, it has to be proper. And we’ve held in two cases that something that was reasonably adapted was not proper, because it violated the sovereignty of the states, which was implicit in the constitutional structure. The argument here is that this also is — may be necessary, but it’s not proper, because it violates an equally evident principle in the Constitution, which is that the federal government is not supposed to be a government that has all powers; that it’s supposed to be a government of limited powers. And that’s what all this questioning has been about. What — what is left? If the government can do this, what — what else can it not do?

The solicitor general (who didn’t do such a bad job overall) replied that the individual mandate does not invade the sphere of state government but, despite several follow-up questions, did not answer the question of whether the individual mandate improperly invades the sphere of individuals. Justice Kennedy pressed further, saying that “to tell the individual citizen that it must act . . . changes the relationship of the federal government to the individual in a very fundamental way.” General Verilli replied that the individual mandate is predicated on the individual’s unavoidable participation in the health care market.

That appeared to be enough for Justice Breyer, who in the course of rambling questions in search of a defense of the act, asked whether one enters the health care market simply by being born. Four justices seemed to find such a limitless premise for federal regulatory power troubling. They, along with Justice Thomas, may also find it improper.

Should that happen, leftists, with their newfound conviction that judicial review is anti-majoritarian, will switch into their outraged and indignant mode. How dare the Court strike down an act because it isn’t proper after Obama and the Congress decided that it was?

The answer will be that the Court is merely giving meaning to the outermost boundary of congressional power. What hangs in the balance this week is whether the powers of Congress are in theory limited but in practice infinite.

The Supreme Court will rule on the constitutionality of Obamacare this year. The arguments and the issue which got the most publicity was the individual mandate. I don’t actually care much about this although it may well violate the Constitution. There are far worse things in the legislation and they should be emphatically rejected by the Supreme Court. The worst of the issues is discussed in detail here. This is a really frightening piece of legislation and I cannot imagine that the Court will let it stand. Of course, given the absence of argument, the Court will have to find this hidden provision itself.

Perhaps nothing in the Obamacare legislation embodies the top-down, command-and-control nature of Progressive healthcare more than the Independent Payment Advisory Board (IPAB), a 15-member panel of “experts” to be appointed by the President. There are three particular features of the IPAB that illustrate this fact: The IPAB will control all healthcare spending, public and private. The IPAB has been awarded near-dictatorial power. And the IPAB is designed to be a nearly immutable entity.

How is this accomplished ?

Specifically, Section 10320 (in the Managers’ Amendments portion of the legislation) grants the IPAB, beginning in 2015, the authority to limit all healthcare expenditures, that is, all healthcare expenditures, and not just expenditures by Medicare or government-run programs.

To emphasize this expanded authority, Section 10320 changes the name of the “Independent Medicare Advisory Board” to the “Independent Payment Advisory Board.” It directs the IPAB, at least every two years, to “submit to Congress and the President recommendations to slow the growth in national health expenditures” for private healthcare programs. Furthermore, it designates that these “recommendations” may be implemented by the Secretary of HHS or other Federal agencies “administratively” (that is, without any action by Congress).

Thus the federal government can control, under penalty of criminal prosecution of doctors, private health care spending ! This goes well beyond Medicare and Medicaid. It will prevent, unless stopped, people from spending their own money on health care.

That is not the worst of it. The IPAB cannot be changed or repealed by Congress. This is unprecedented in US law. Even the ill-advised Prohibition Amendment, promoted as another moral obligation by progressives after World War I, could be repealed by another constitutional amendment.

A quick reading of Section 3403 might leave one with the impression that the IPAB is a sort of Mr. Rogers of healthcare – a mild-mannered, friendly, always-helpful, but ultimately undemanding agent for good. This is the impression imparted by the first few paragraphs of the Section, which paint the new entity as an “advisory” board, whose main task is to develop “proposals” and “advisory reports,” which “proposals” and “advisory reports” would solely consist of various “recommendations,” that ought to be “considered” for the purpose of cost reduction.

Read the rest of this entry »

(With apologies to the Obama perpetual re-election campaign. Other people have had a go at this concept – I think The Life of Brian is one of the funniest, but I wanted to have a go at this myself. )

3 Years Old – Under President Eisenhower, Celia stays home with her younger brother, as her full-time work-at-home Mom helps her get ready for school by reading aloud to her, supervising her playtime and providing a secure home environment. She will join thousands of students across the country who will start kindergarten ready to learn and succeed.

17 Years Old – Under President Nixon, Celia takes the SAT and is on track to begin applying for college … which college program includes two years at a local junior college capped by two years at a state university – a public university system that the taxes paid by Celia’s parents over the years have subsidized. The public high school which Celia attends is in a working-class suburb, but offers academically enriched courses for those students who qualify for them.
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In Britain, an 83-year-old woman has been told that she must find a new medical practice, because travel to the one she has been attending for the last 30 years involves an unacceptable carbon footprint.

When I was a medical school junior, we had a rotation on the Neurology service at LA County Hospital. One of my classmates was planning a career in neurology but the reason it was so popular with the students like me who were interested in surgery was that we got to do tracheostomies. A number of patients with severe neurological lesions would require respirators or had trouble with airway secretions requiring a tracheostomy. This was our one chance to do surgery, even a minor procedure as things go. It was good practice and I later did a lot of tracheostomies, some quite difficult and rushed.

Our resident was a very interesting guy named Dick Boggs. He was tall and looked a lot like Orson Welles did when he was young and making “The Third Man.” Boggs was quiet and aloof but let us do trachs and work up any patient we wanted to. I had some very interesting cases. One was a woman who showed all the signs of alcoholic neuropathy, which is very similar to diabetic neuropathey. It was a popular rotation for juniors. Boggs was popular among the residents and was elected the president of the Interns’ and Residents’ Association, which under his leadership took on some of the characteristics of a union.

At the time, intern and resident pay was very low and, aside from a new dormitory that was built for single house staff, we were on our own. I was married with one child, born in March 1965, so I was really on my own. My wife quit her job as a teacher in January 1965 and I was working after hours doing histories and physicals at private hospitals for $7 per hour. Fortunately, my tuition was covered by scholarship but living expenses were tight. We lived on $200/month contributed by our parents, $100 from my father and the same from Irene’s parents. Half of that went for the rent of our two bedroom house in Eagle Rock, near Pasadena. I’m spending some time on details to emphasize what Boggs accomplished for us all.

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Stand Up For Religious Freedom

The Nationwide Rally for Religious Freedom is being held Friday, March 23 at noon, local time, outside federal buildings, Congressional offices and historic sites across the country. The theme for the Rally is “Stand Up for Religious Freedom—Stop the HHS Mandate!”

Nationwide Rally Locations and Info

Chicago: Federal Plaza, 50 W.Adams, Friday, March 23, Noon.

Click on the link to find a location near you.

If you haven’t already purchased the Archdiocesan Directory for 2012, I would suggest you get one as a souvenir. On page L-3, there is a complete list of Catholic hospitals and health care institutions in Cook and Lake counties. Each entry represents much sacrifice on the part of medical personnel, administrators and religious sponsors. Each name signifies the love of Christ to people of all classes and races and religions. Two Lents from now, unless something changes, that page will be blank.

Francis Cardinal George, Archbishop of Chicago, on the HHS Mandate.

RTWT. The column from the Cardinal is very good, though too fatalistic.

This vicious thing can be stopped and rolled back.

In medicine, an iatrogenic disease is one that is brought on by a medical treatment itself. An example would be when a physician treating a minor condition fails to properly wash his hands and as a result gives the patient an infection more serious than the original problem.

It strikes me that iatrogeny also occurs in the management reporting and control systems of businesses and other types of organizations. A particularly awful example was reported in Britain a couple of years ago: hospitals were being measured on time from a patient’s entry into the emergency room until the time that patient was seen by a physician. It appears that in quite a few cases, the optimization of that measurement for the hospital was achieved by leaving the patient in the ambulance, in some cases for as much as five hours, so that the clock on the measurement would not start until the criterion was certain to be achieved.

So a measurement intended to improve patient service had the opposite effect. It directly caused unnecessary pain and danger to the individual ER patient who was kept in the ambulance while harming the effective utilization of expensive vehicles and skilled personnel, while at the same time providing upper management with a distorted picture of what was really going on.

Smirk not, fellow capitalists. While this particular example of iatrogeny was perpetrated by a government entity, plenty of examples can also be found in the private sector. Indeed, I saw an interesting example in a Target store just the other day.

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