Tuesday, July 21, 2009

Cry wolf [Three updates]

[Updated July 28, 2009, about 8am: I have more to say about Section 1233 of HR3200 and have done so in a series of (so far) four posts:

A sting, a smell, an apology, and a really long footnote

Speaking in tongues

You claim that mish-mash is a defense?

Now I can sleep

All these posts in the series are filed under the category “Me And 1233”.]

[I've now updated this twice once with a response to comments by JohnMc and once with a link to something Grim wrote. Both updates are at the bottom of the post.]

[An Instalanche, an Instalanche. Welcome, everyone.]


The Right leaning blogs are up in arms over a provision in HR3200, the House’s health care bill. According to the New York Post (emphasis mine):

One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."


The Post’s interpretation of Section 1233 has been picked up by a whole armful of bloggers. See Grim’s Hall, Little Miss Attila, and RedState, for example. Instapundit has linked to RedState. Meanwhile The Anchoress links to Catholic Online which refers to an interview Betsy McCaughey did with Fred Thompson in which she claims (at about 1:20):

... and one of the most shocking things I found in this bill - and there were many - is on page 425 where the Congress would make it mandatory, absolutely required, that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner. How to decline nutrition, how to decline being hydrated, how to go into hospice care. And, by the way, the bill expressly says that if you get sick somewhere in that five-year period, if you get a cancer diagnosis, for example, you have to go through that session again. All to do what’s in society’s best interests or your family’s best interests and cut your life short.


Um, no. That’s not what HR3200 says. Here’s the short version of what it really says:

The section under question is Section 1233 of HR3200 (the House health care bill) and it is amending subsection s(2) of Section 1861 of the Social Security Act (42 U.S.C. 1395x). Section 1233 of HR3200 adds new sub-paragraph (FF) to the list of what Medicare will pay for as defined in Section 1861 of the Social Security Act.

Section 1233 is saying that Medicare will pay for an "advance care planning consultation" no more often than once every five years unless the patient's health status changes as a result of certain diagnoses or the patient is admitted to a nursing home, long-term care facility, or hospice. Such a consultation may result in a written directive about care and that directive may include information about such areas as antibiotics and intravenous feeding and hydration as well as the usual DNR instructions and any wishes with regard to facility transfer.

In other words, Section 1233 is creating a new type of “treatment” that will be paid for by Medicare. It will only pay for one such consultation every five years unless the patient’s health status changes, in which case Medicare will pay for a consultation when that change occurs. This is not a mandate; this is a new entitlement. It may not be an entitlement everyone likes but it is still something extra for those on Medicare.

Here’s the long version in which I show you how to follow the trail yourself:

You can access the House’s health care bill (HR3200) via THOMAS. Say you want to search by bill number and enter “HR3200” in the search box. Say you want “Text of Legislation”. Click on the hyperlink for “SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.” This section is amending Section 1861 of the Social Security Act (42 U.S.C. 1395x) by adding a new subparagraph (FF).

Now take a look at the Social Security Act. You can find the home page for it here. Click on the hyperlink for “Social Security Act Table of Contents”, then click on the hyperlink for “Title XVIII Health Insurance for the Aged and Disabled”, then on the hyperlink for “Sec. 1861. Definitions of services, institutions, etc.”

I’ve sent you the long way around because if you just start with Section 1861 you don’t really know where you are. If you want to go straight to that Section simply click here.

Hunt down the page until you find the centered heading “Medical and Other Health Services”. Directly under that is subsection (s) which begins:

(s) The term “medical and other health services” means any of the following items or services:
(1) physicians' services;
(2)(A) services and supplies (including drugs and biologicals which are not usually self-administered by the patient) furnished as an incident to a physician's professional service, of kinds which are commonly furnished in physicians' offices and are commonly either rendered without charge or included in the physicians' bills (or would have been so included but for the application of section 1847B);


and goes on to list 31 “medical and other health services” concluding with:

(DD)[450] items and services furnished under an intensive cardiac rehabilitation program (as defined in subsection (eee)(4));[451]

(EE)[452] kidney disease education services (as defined in subsection (ggg));


before moving on to subparagraph (3) which deals with diagnostic X-rays.

Section 1233 of HR3200 will add:

(FF) advance care planning consultation (as defined in subsection (hhh)(1));


to the bottom of that list. It will also add the definition in subsection (hhh)(1) at the very end of Section 1862, below subsections (ggg)(1-4) which define “Kidney Disease Education Services”.

In other words, “Advance Care Planning Consultation” will be no more “compelled” than the “intensive cardiac rehabilitation program” listed in (DD) or the “kidney disease education services” listed in (EE). The five years is a limitation not a requirement: Medicare will not pay for such a consultation more often than once every five years unless:

there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.


This doesn’t mean Medicare will pay for more frequent consultations for individuals in facilities but rather that it will pay for a consultation when they enter such a facility even if their previous consultation was less than five years previously.

Section 1233 of HR3200 also amends Section 1848(j)(3) of the Social Security Act to include the newly defined (FF) in the list of services that will be paid for. It then amends Section 1862(a) to make it clear Medicare will not pay for advance care planning consultations that take place more frequently than allowed (that is, every five years except in the case of a significant change in health status.)

Section 1233 of HR3200 then requires the Secretary to include:

quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.


while also requiring the Secretary to publish the metrics he plans to use and invite public comment on them.

Section 1233 of HR3200 concludes by requiring the Secretary of Health and Human Services to include information about these changes to the Social Security Act in subsequent editions of the Medicare & You Handbook.

So Advance Care Planning Consultations are not compelled, required, or mandated. Is it weird they’re in this bill? Maybe, maybe not. Section 1233 is part of “Subtitle C - Miscellaneous Improvements” under “TITLE II - MEDICARE BENEFICIARY IMPROVEMENTS”. Subtitle C includes:

SEC. 1231. EXTENSION OF THERAPY CAPS EXCEPTIONS PROCESS.
SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
SEC. 1234. PART B SPECIAL ENROLLMENT PERIOD AND WAIVER OF LIMITED ENROLLMENT PENALTY FOR TRICARE BENEFICIARIES.
SEC. 1236. DEMONSTRATION PROGRAM ON USE OF PATIENT DECISIONS AIDS.


In addition to these changes to Medicare, a lot of the other parts of this bill also deal with Medicare. So it’s entirely possible that having Medicare pay for Advance Care Planning Consultations is an idea that’s been kicking around for a while and got stuck in this bill along with, say, Section 1231 which seems to provide a longer term of coverage for kidney related conditions. It would be nice to ask someone involved in drafting Section 1233 why they decided to include this. I can believe there were requests for it. If my aunt had had such a consultation with her doctor, in which she could have made it crystal clear that she wanted all the stops pulled out as long as there was any hope at all, she might be alive today. Furthermore, Section 1233 says that the Secretary’s reporting metrics must “measure both the creation of and adherence to orders for life-sustaining treatment.” In other words, if you say you want the doctors to do everything to keep you alive then theoretically someone will be watching to be sure they do so.

What makes this benign explanation hard to accept, of course, is the perception that the Left is quite comfortable with - and possibly even enthusiastic about - not “wasting” health care dollars. Obama’s exchange with Jane Sturm back in June doesn’t totally support this perception but it doesn’t do much to challenge it either - particularly if all you hear from it are his comments about not considering a patient’s spirit when making medical decisions and, even worse, that horrible sentence fragment: “maybe you're better off not having the surgery, but taking the painkiller.” Furthermore, Obama explicitly talks about living wills:

But, look, the first thing for all of us to understand is that we actually have some choices to make about how we want to deal with our own end-of-life care. And that's one of the things, I think, that we can all promote. And this is not a big government program. This is something that each of us individually can do, is to draft and sign a living will so that we're very clear with our doctors about how we want to approach the end of life.


Given all this, I can see why those on the Right would find it easy to believe Democrats would write a health care bill that requires the old and the ill to sit down with their doctors and talk about how to end their lives. Nonetheless, if the goal is to convince voters who are waffling on the health care bill to call their Congressmen and oppose it then the Right’s decision to put forth a specious claim about such a serious matter was a very bad mistake.

Here’s how this plays out. The Right claims the House health care bill will force old people to sit down and talk about end of life issues including - as McCaughey put it - declining nutrition and hydration; the wafflers are appropriately horrified; it turns out not to be true. How much attention are those same wafflers going to pay when the Right argues that, okay, the bill doesn’t exactly require such consultations but it does say the government will pay for them and, hey, look what Klein and Yglesias and Obama himself are saying about this stuff? My guess would be, not much. After the stronger claim has been discredited no one is going to be interested in the weaker but more credible claim; the Right has blown its euthanasia cred by, yes, overreaching.

Even worse this mistake is strike two. Strike one was the Right’s claim that:

Right there on Page 16 is a provision making individual private medical insurance illegal.


It turned out that once you got to page 19 you were allowed to buy individual coverage “as an Exchange-participating health benefits plan.” Compared to such coverage being outlawed, the Exchange sounds so good no one even seems to care what it is. Without such a comparison, some of those wafflers might be inspired to ask, “What the heck is the Exchange?” If the Right wants to credibly oppose HR 3200 - or any universal health care bill - it needs to be very sure of its facts in the future. The next error is strike three.

And it’s not like there’s nothing real to oppose. I think the Democratic plan to overhaul the entire health insurance system is a big - and unnecessary - mistake. I certainly think that trying to pass a bill this huge so fast almost guarantees disaster somewhere down the road. If nothing else, can we at least agree we won’t go any further with it until THOMAS is able to give us a Summary? You know, HR3200 in a semblance of plain English?

More specifically, I think it’s almost certain the decision to pay for advance care planning consultations will result in big problems. As I said over at Grim’s:

If this bill passes there's no doubt in my mind that sleazy operators are going to start doing cable TV ads offering to help seniors meet their counseling "requirement" or suggesting seniors should get "everything they're entitled to" under Medicare. Those same sleazy operators are going to sit down with the seniors for 5 minutes, have them sign some bogus document that has nothing to do with what they really want but is still legally binding, and bill the government for the work. I predict 3 months after the bill passes before we start hearing stories of seniors who were not treated as they actually wanted because they signed a badly done advance directive.

I'm also sure some care facilities are going to pretty much coerce their patients into these counseling sessions to make some more money. Of course those facilities have an incentive to make the resulting advance directives as optimistic as possible - if the patient dies, the facility stops getting paid.


Apart from these financial scams, I do see that the advance care planning consultations can become the first step in a slippery slope and take seriously the concerns of those who fear they could lead to government-encouraged suicide and euthanasia. However, none of the very real problems with HR3200 or with Section 1233 make an untruth true.

It’s distressing how much the claim that Section 1233 compels end of life counseling reminds me of the claim that Sarah Palin quit as mayor of Wasilla without finishing out her term. The story about Palin is a deliberate lie, of course, while the story about Section 1233 seems to have started as an honest error, but the two stories share many of the same characteristics. Both fit perfectly into desired images: Palin is a quitter; the Democrats want to euthanize old people. Both spread quickly, repeated over and over by people who didn’t bother to check the accuracy of what they were saying - including people who should have known better. Neither one passes the most rudimentary smell test. And there’s no place to go to say, “But that’s not right” with any hope that the truth will be spread as far as the lie. Or even any hope that those doing the spreading are interested in knowing what the truth really is.

*****

Updated, July 22, 2009, around 10:45am

In the comments, JohnMc thinks I’ve missed the forest for the trees and raises some specific issues. Responding to him got long enough - and I think important enough - to warrant an update to the post.

A doctor will consult on the legal aspects and also provide applicable paperwork


Not really seeing that. (hhh)(1) provides for (among other things):

B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.


But F(i-iii) limit these types of consultations to States with a standardized “program for orders for life sustaining treatment”. That is, physicians must do the check-off thing in (hhh)(1)(A-E) only in States that have created check-off type programs - including standard forms - for end of life issues and that train their practitioners on how to tell patients about these standardized programs.

So if I have my own living will drafted by my attorney the State will refuse to recognize it? (F)(I)(iii)


No. (iii) is a list of the requirements a State must meet to be considered to “[have] in effect a program for orders for life sustaining treatment”. Only in States that have such a program in place - and “in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings” - will practitioners be required to include the specific items in (hhh)(1)(A-E).

Here’s the deal. I live in New Jersey. If I go to the hospital, they ask me if I have an advance directive. If I say no, they ask if I want one. If I say yes, they hand me a form that asks a few basic questions, I check the boxes, and that gives them a rough idea of when to pull the plug. However, I have both a living will and a medical power of attorney. So I don’t check the form, I just give them a copy of those documents.

Bottom line: This bill requires that certain standard areas be covered in a consultation if and only if the State the patient and practitioner are in has established a standardized program for end of life issues, including forms that are legal without the help of a lawyer. Nowhere does it say that creating your own documents with your own lawyer is not allowed, not legal, or not acceptable.

Of course you didn't address it but what is being missed in all this is that any of the current bills (there are three in the docket) all have implied rationing.


First, that little “Of course”? Kind of ugly. I have very strong convictions about the importance of assuming good will even on the part of those with whom I disagree. I appreciate the same assumption from those who disagree with me.

Substantively, I certainly understand that fears about rationing are well-founded. Once you accept that medical care taking an increasing percent of the GDP is a problem - which I’m not sure I do - and you realize that better treatment means higher costs - which I realize very well - and you realize that older people and sicker people need more care - which I realize very, very well - you’re going to be stuck with rationing as the only way out. Fear of rationing is a perfectly valid reason to oppose this bill and any similar health care bill. It is NOT a perfectly valid reason to misinterpret the bill or - worse yet - to deliberately misstate what’s in the bill.

As for missing the forest for the trees, I did not set out to argue HR 3200 is a good bill. Nor did I say that slippery slope concerns were not valid. What I said was that the claim of mandated, required, compelled end of life counseling was inaccurate.

I short while ago I was reading a blog where an argument was raging over whether Sarah Palin billed rape victims for evidence kits. (Yes, recently. Yes, still.) One of the commenters didn’t seem to think it mattered what the facts were: the story was intended as an emotional truth. I’m apparently one of the few remaining people on the face of the earth who thinks emotional truth is not the same as actual truth and not even within shouting distance of fact. If we all define our own truth based on what “feels” accurate then we really are living in a postmodern world where, as Brad Holland put it:

Postmodernists believe that truth is myth, and myth, truth. This equation has its roots in pop psychology. The same people also believe that emotions are a form of reality. There used to be another name for this state of mind. It used to be called psychosis.


*****

Updated, July 22, 2009, around 6pm: Grim and I had an email exchange about this post and I he has posted a large portion of that exchange at his blog. I think it's an interesting view of this issue and one I would never have thought of. Grim argues that the Right is taking the correct tack rhetorically. Read the whole thing here.

Grim's logic and argument are impeccable as always and all I can offer by way of rebuttal is this (also from our email exchange):

The only point I can bring up that may mean you're wrong about the Right being right to pursue this tactic is the asymmetrical force levels. If it is the case that most of the media is heavily tilted in favor of Obama, in favor of the Democrats, and in favor of this bill (or one similar to it), it will be difficult for the Right to be heard making these charges and it will be easy for the Democrats (with the assistance of the media) to cast those charges as the deranged ravings of Rove-Cheney type politicians who will tell any kind of lie to get their own way. Imagine if the Right had attempted to do to Obama what was done to Palin: spin fantastic tales out of half-truths at best, thin air at worst. They would never have gotten traction. We'll see if they can get traction on the health care bill.

108 comments:

cokaygne said...

Wow. Great post. Nice to see someone actually reads this stuff. Perhaps you are the one that Diogenes was looking for.

Anonymous said...

Very good job! You probably now know more about the bill than the congressmen voting on it! Your dispassionate review of the issues hit the perfect tone for me. Thanks!

leishman said...

Well....yeah....but, but, but what about when they start running out of Soylent Green? Huh? What about then??? Don't you think it will become mandatory???

Chuck Pelto said...

TO: Elise, et al.
RE: Out of Curiosity

You seem to have read this better than many.

Where in the bill does it say that "Advance Care Planning Consultation" will NOT counsel people to take The Big Black Pill?

I'm all too familiar with the obfuscation the government uses in naming of names to confuse people as to the real function of legislation. If you doubt this, look at the naming of "Card Check".

Regards,

Chuck(le)
[The Truth will out....but sometimes it takes some REAL digging to get to it....]

NMP said...

Thank you for taking the time to read and explain that section on Advance Planning. That one was easy to believe as it is a good thing to do; just not a good thing for the government to compel which makes it exactly the sort of thing the government likes to compel. Nice to know it isn't compelled -- at least not yet.

I had a more difficult time believing the section about eliminating private healthcare and tried to read that section of the bill and essentially came to the same conclusion. I still don't like the idea of having to be forced into an Exchange Qualified Plan -- talk about stifling innovation.

But I totally agree with your premise -- no straw men that can be disproved and this thing is just way to big with too many potential problems to pass so quickly.

Pseuss said...

Of course, the real problem is that we don't know what's in the bill. The people voting on it don't read it unless a bigwig lobbyist has some problem with it. And we can't trust the MSM to summarize it because of its close ties with the Obama admin.

Bill Peschel said...

While it's true that the bill doesn't ban private health care, it does provide an environment in which businesses will be happy to dump their employees into it.

The mechanism is simple, according to the AP article: "A government-sponsored plan is among the options available through the exchange, with premiums estimated 10 percent lower than private coverage."

Bingo! You've introduced an incentive that private coverage can't match. And of course, these lower premiums will not be supported by more efficient delivery of services, but by cranking up the printing press.

tyree said...

Thanks for the clarification. I guess this points out why it is even more important for Congress and the Senate to read this stuff before they vote on it.

JohnMc said...

All I can say is missing the forest examing the tree. That and NMP hits it on the head. First to Sec 1233 itself. Ok, fantastic that it says that a consultation will be paid for. But I notice a couple of clauses there. a) A doctor will consult on the legal aspects and also provide applicable paperwork. Hmm. When did doctors become practitioners before the bar? b) That States shall address a standardize form of documentation. So if I have my own living will drafted by my attorney the State will refuse to recognize it? (F)(I)(iii)

Of course you didn't address it but what is being missed in all this is that any of the current bills (there are three in the docket) all have implied rationing. The govt will have a constant dollar view of health care in the face of the largest american population retiring right in the middle of it. You can't have a constant dollar regimen, an ever rising retirement population and NOT have rationing as a result.

That is the reality of it.

Elise said...

Wow! Look at all these comments. Thanks for stopping by everyone. Let’s see.

Perhaps you are the one that Diogenes was looking for.

Wrong gender (or is it “sex”). But thank you - that was a great compliment.

You probably now know more about the bill than the congressmen voting on it!

If every blogger in the United States picks just one little section and figures it out then by, say, Christmas we’ll all now what’s in it. You’re very welcome and thanks for the attagirl.

but what about when they start running out of Soylent Green? ... Don't you think it will become mandatory???

I suspect we’re going to run out of energy before we run out of Soylent Green. Then we won’t be able to make Soylent Green no matter how many elderly the government decides to shuffle off to Buffalo. (No offense to Buffalo.)

Where in the bill does it say that "Advance Care Planning Consultation" will NOT counsel people to take The Big Black Pill?

The same place it says the elderly don’t HAVE to get “kidney disease education services”. Look, I take your point about obfuscation: Card Check is an excellent example. If the "Advance Care Planning Consultation" provision end up in the final pill - and there is a final bill - I hope all those who are up in arms about how horrible this provision is will devote time and energy to monitoring its implementation. And if I may get a little soapboxy: To me all of this is a dynamite argument for a small, smaller, smallest Federal government: we’re all in trouble when the Federal government is “too big to keep an eye on”.

That one was easy to believe as it is a good thing to do

I assume - since you sound extremely reasonable - that you believe advance planning for end of life care is the good thing; not deciding to off oneself for the good of society. And you’ve summed up my premise perfectly - and so briefly. Now there’s a gift.

Of course, the real problem is that we don't know what's in the bill.

Yup, that’s the real problem - this thing is huge and from the little I’ve read of it, seems filled with cross-references. Do you know what reading Medicare legislation does to the eyes - not to mention the brain? That’s a big part of why I’d like to wait until I can see a summary on THOMAS. At least we’ll know someone has read the bill and attempted to figure out what it all means.

As for not trusting the MSM to report on it, I do think they are, shall we say, inclined to fawn over Obama. I think the bigger problem is that once you believe a health care bill is needed you’re disinclined to look at the actual bill too closely. You take the position I’ve seen some pundits take on the health care bill (and on Waxman-Markey) that the substance isn’t important: what matters is getting something passed so we’ll have the infrastructure (read “9 zillion new government agencies”) in place. We can tweak the details later. If we assume the MSM believes a health care bill is needed - and I think that’s largely a valid assumption - there’s no incentive for them to do any real research on it. Plus it’s all boring anyhow.

(Does anyone think it’s a bad sign that my AppleWorks spell-checker doesn’t recognize “Diogenes”?)

Elise said...

More comments. Okay, another decision. At what volume do I stop answering each one. On this post, probably not until they hit 500. If I ever get another Instalanche, I’ll be more blase.

While it's true that the bill doesn't ban private health care, it does provide an environment in which businesses will be happy to dump their employees into it.

Yup and I’ve written about that in some detail here. As I tried to make clear near the end of my post, I am fully aware of the problems with this bill. I simply prefer to focus on the ones that really exist rather than on red herrings.

I guess this points out why it is even more important for Congress and the Senate to read this stuff before they vote on it.

Absolutely. And, again, I’d like to see a THOMAS summary of it. Even if those voting on it won’t read it, at least those of us who elected those voting on it will have a fighting chance of figuring out where the pitfalls are.

First to Sec 1233 itself.

This is just cruel - now I have to look at the bill again. I’m kind of surprised I don’t have it memorized. Once I put together my response to your comment, JohnMc, it was long enough to go in as an update to the post so that’s what it’s going to be. Give me a few minutes.

Duncan said...

I'm not sure that the forced Exchange system doesn't qualify as "government" medicine. The basic plan is mandatory and designed by the Feds. Only 3 plans can be offered - Regular, Plus, and Premium. All plans are under contract with the "Exchange". Such exchanges are considered government entities.

Not much market choice left there.

Elise said...

Duncan, you may very well be right and I hope more attention can be paid to stuff like the Exchange. I can tell you, however, that I'm not reading another section of that bill. I've done my bit.

Plus as JohnMc points out there are other bills floating around. (I was aware of the Senate version but didn't know there were still two more being seriously considered - I'd appreciate pointers to them.) Anyhow, what is really needed is a *final* version of a bill AND a plain English summary of that final version, easily available to everyone for a reasonable amount of time.

Maybe we need a formula that says the longer the bill, the longer it has to sit around in its final form. For HR3200 that formula would probably work out to about 3 years of perusal time.

Dave said...

I don't know what your educational background is, but I wish more of my grad students thought and wrote as clearly as you do.

Nicely done.

I'll be back.

Elise said...

Dave, that one comment made every single word I've written on this blog worthwhile. Thank you.

Dave said...

Should have read your front page first. ;->=

"My formal education was in Quantitative Analysis and Research Design and Methodology in Political Science."

That gives me great pleasure. Guess what I teach (well, part of the time, anyway)?

Where did you go to school?

Keating Willcox said...

Facts
1. Half of US healthcare is essentially private funded, decision between MD, patienst and insurers.
2. 80-85% are happy with their care
3. Medicare doubles the expense of many procedures.
4. All US Govt healthcare, VA, Indian reservation, are dreadful and expensive.
5.Private health care has given us incredible longevity in spite of lifestyle.
6. There is no good reason for any government at all in the private health care system.
7. Obama wants single payer, and his plan will force it over time.
8. Exchange insurance such as we have in MA are dreadful and expensive.
9. Everyone should call every member of congress every day and tell them that we want no change at all to private health care, and no increase in govt health care, period.

Elise said...

Dave,

My name is still unusual enough and my alma mater is small enough that I'd be pretty easily identified by anyone who ever knew me and I prefer at least a semblance of anonymity for a variety of reasons. Drop me an email if you want to get into this more.

Anonymous said...

Why criticize the Right on this, rather than place the blame squarely on those ramming through thousand plus page legislation so quickly that Congressmen and their staff haven't read it?

Do you seriously doubt that there are legions of draconian items in this legislation?

Elise said...

Keating Wilcox -

There are elements of your list I don't know enough about to have an informed opinion on. What it brings up for me, though, is the need to have a discussion about Medicare.

After all, Medicare is a government run health program. Do we want to do away with Medicare? If so, where do we think people over 65 are going to get health insurance? By definition, they're high risk. Do we want to force them into the private market and if no one will insure them, just shrug and say, "Too bad." Do we say we hate government health insurance except when it's Medicare?

It's fine to say we should raise the age for Medicare but, first, would people over 65 but not yet old enough to be eligible for Medicare be able to get health insurance and, second, that just means you get government health insurance at a later point in life. It doesn't resolve the basic conundrum of hating government health insurance but living with Medicare for old people.

A very sticky wicket.

Elise said...

Why criticize the Right on this, rather than place the blame squarely on those ramming through thousand plus page legislation so quickly that Congressmen and their staff haven't read it?

Well, first, because that's your battle not mine. You're concerned with the legislation; I'm concerned with the truth. Second, I'd like to think of conservatives as the good guys. In my world view - narrow as it is - the good guys not only tell the truth, they're careful about the truth.

I paint with a small brush on this blog most of the time. It's what I'm good at and it's what interests me. I don't think it's an unimportant effort. If nothing else, it immunizes me against beginning to believe that the ends justify the means.

Do you seriously doubt that there are legions of draconian items in this legislation?

Of course there are draconian items in this legislation. If Duncan is right about the Exchange, that's pretty draconian. To me, though, that's exactly why no one needs to make stuff up about this bill in order to make it look bad: what's already there is more than enough reason to oppose it.

Chuck Pelto said...

TO: Elise
RE: Heh

Where in the bill does it say that "Advance Care Planning Consultation" will NOT counsel people to take The Big Black Pill?" -- Chuck Pelto to Elise

The same place it says the elderly don’t HAVE to get “kidney disease education services”. -- Elise in reply to Chuck Pelto

This statement is just more obfuscation.

Look, I take your point about obfuscation: Card Check is an excellent example. -- Elise

Good on you. At least you recognize the problem at play here.

If the "Advance Care Planning Consultation" provision end up in the final pill - and there is a final bill - I hope all those who are up in arms about how horrible this provision is will devote time and energy to monitoring its implementation. -- Elise

Stop me if you’ve heard this one before.....

An ounce of prevention is worth a pounding of cure. -- Benjamin Franklin (paraphrased)

What’s my point?

That this whole package looks to me like something out of science fiction I’ve read over the last 40 years: Logan’s Run, Larry Niven tales of ‘recycling’ humans for their body parts for transplants, etc.

Sure. We can ‘monitor’ how they implement such p[r]ograms. But once the mechanism is in place, I’ve witnessed how....

Bad law is more likely to be supplemented than repealed. -- Oaks' Laws

Something to do with the Arab proverb about a camel, a nose and a tent.
And if I may get a little soapboxy: To me all of this is a dynamite argument for a small, smaller, smallest Federal government: we’re all in trouble when the Federal government is “too big to keep an eye on”. -- Elise

So....

....tell US why it seems to me that you just contradicted yourself?

If we allow the federal government to start [mis]managing all health care—and make NO MISTAKE about it, that’s what this bill would do—how do you expect to keep the government ‘small’ enough to keep an eye on it?

Regards,

Chuck(le)
[I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them. -- Thomas Jefferson]

Elise said...

I'm just going to ignore your first set of statements. I'm not prepared to get into an argument about the difference between what is allowed, what is required, and what is forbidden. Moving on.

So....

....tell US why it seems to me that you just contradicted yourself?


I think you're the only one you can explain why it seems to you I contradicted myself and I believe you have done so in your comment.

However, I did not contradict myself. I said in my original post that the claims about this bill *requiring* end of life counseling were incorrect. I also said I thought overhauling the health system was a big and unnecessary mistake. I did not advocate passing this bill or including this provision; what I said was that if this bill passes in this form I hope someone will keep an eye on how this provision gets implemented - just as I would with any provision in any bill that I found undesirable.

I didn't advocate for bigger government and I didn't advocate that this bill be passed so I don't see why my preference for smaller government contradicts anything.

Furthermore, I agree that an ounce of prevention is worth a pound of cure. You may recall that part of my problem with making false claims about this bill is that it undercuts the Right's ability to oppose it credibly. I don't see the difference between your remarks about camel's noses and tents and my stating that I see the slippery slope problem.

You seem to think that because I oppose a *tactic* of those who oppose this bill I must support the bill. You are mistaken.

Jimmy J. said...

End of life care is a big issue in Medicare. I'm 76 and will soon be looking at many of the issues. Most of us would much prefer to live in our homes and just go to sleep one night and not wake up. Unfortunately, a fairly large percentage of we old timers do not go quietly into yon night.

A case in point would be my older brother. He was diagnosed with COPD at age 65. For five years he was treated as an out-patient but grew steadily worse. His first near death experience occurred in his early 70s. He did not have a health care directive and when the hospital asked his wife, she said, "Save him if you can." I was at the hospital during this episode. He was far closer to death than life, but, after five days of being hooked to all kinds of machines and pumped full of life saving fluids and drugs, he recovered and was sent home. This was the first of eight near-death episodes that occurred over the next five years before he finally could not be saved. Fortunately, he was insured by Kaiser and, except for a $200 copay, these cost him nothing. However, the cost of each episode was probably in the $300,000 - $500,000 range. The difficult issue to deal with was that he was never more than a bedridden invalid after his first episode. His quality of life was quite low and he expressed his wish to die to me. However, his wife would not allow such a thing as just pulling the plug. On one hand I'm thankful he got all that care and that his wife's wishes were met. On the other hand, I can see how this is an enigma to a system that is beginning to drown in the cost of end of life care.

I have a medical durable power of attorney and do not want heroic measures taken unless the doctors can assure a 75% chance that I can rcover beyond being an invalid. As each person has their own ideas on this issue makes it just that much more difficult to arrive at some kind of policy that will be compassionate and save money at the same time.

People keep making outraged noises about healthcare rationing. IMO, healthcare has always been rationed to some extent. As an example there are several levels of Medi-gap insurance policies. The more expensive have more benefits. Those who can pay get more care. It has always been that way. The same is true of housing and food. Both are rationed by ability to pay. Why would we expect healthcare to different?

Chuck Pelto said...

TO: Elise
RE: Ignorance Is NOT ‘Bliss’

I'm just going to ignore your first set of statements. I'm not prepared to get into an argument about the difference between what is allowed, what is required, and what is forbidden. Moving on. -- Elise

I’m not surprised by your avoidance, e.g., ‘obfuscation’.

RE: Moving On (Part 1)

So....

....tell US why it seems to me that you just contradicted yourself?

I think you're the only one you can explain why it seems to you I contradicted myself and I believe you have done so in your comment.
-- Elise

I can explain it. Indeed. I think I will....a bit later in this missive.

RE Moving On (Part 2)

However, I did not contradict myself. I said in my original post that the claims about this bill *requiring* end of life counseling were incorrect. I also said I thought overhauling the health system was a big and unnecessary mistake. I did not advocate passing this bill or including this provision; what I said was that if this bill passes in this form I hope someone will keep an eye on how this provision gets implemented - just as I would with any provision in any bill that I found undesirable. -- Elise

Actually. I think you DID contradict yourself.

You wish to emphasis the ‘requiring’ aspect of ‘killing yourself for the good of society’ you side-stepped, i.e., ‘obfuscated’, the business of ‘killing yourself for the good of society’.

Why is this particularly significant?

Oh....probably something to do with the comments I tossed in about ‘bad law’ and ‘camels noses in tents’.

It’s just a real pity you don’t quite ‘get it’. [Note: I have to wonder just how old you are.]

RE: Moving On (Part 3)

I didn't advocate for bigger government and I didn't advocate that this bill be passed so I don't see why my preference for smaller government contradicts anything. -- Elise

Heh....

....please re-read my comment at Moving On (Part 2)

RE: Moving On (Part 4)

Furthermore, I agree that an ounce of prevention is worth a pound of cure. -- Elise

Good on you.....

You may recall that part of my problem with making false claims about this bill is that it undercuts the Right's ability to oppose it credibly. -- Elise

You think that this bill’s proposal for “Advance Care Planning Consultation” DOESN’T deal with The Big Black Pill?

Are you REALLY that ‘dense’? Or are you just being ‘obtuse’?

You already admitted you recognize how the government buries the truth of a matter in the title of their ‘acts’. You’re painting yourself into a corner here.

I don't see the difference between your remarks about camel's noses and tents and my stating that I see the slippery slope problem. -- Elise

Actually, by not resisting this bit of egregious government expansion, you are, de facto, supporting it. And, based on all I’ve seen here—so far—you’re not resisting it.

Getting the ‘picture’ here?
RE: Moving On (Part 5)

You seem to think that because I oppose a *tactic* of those who oppose this bill I must support the bill. You are mistaken. -- Elise

Good on you, again.....

But, despite your claim that I’m “mistaken”, you’ve offered absolutely NOTHING to support your alleged stance that you are opposed to this legislation.

Please disabuse me of that understanding. Show US the missives you’ve sent your Congressional delegates expressing your opposition.

Regards,

Chuck(le)
[The Truth will out......]

Chuck Pelto said...

P.S. I'm intrigued by your use of the term "Moving On". It reminds me of that organization, "Move On"....

Elise said...

A very thoughtful comment, Jimmy J. I think the example of your brother - who would have preferred less intervention - and my aunt - who would have preferred more - illustrate exactly how difficult this issue is. In many ways, it is a terrible disservice to us all that the wisdom of the elderly and the ill straightening this out beforehand has been tainted by its association with a universal healthcare bill and by its association with those who are perceived - rightly or wrongly - as taking human life too lightly. The result seems to have been a conviction that discussing end of life issues must always mean opting for little help and a quick exit. What such discussion should mean is that each of us decides for ourselves whether we want to fight as long as possible or let nature take its course at some point.

Your point about rationing is excellent and one I’ve made in comments on another site. We do ration now based on ability to pay, not as unfairly as liberals claim but more so than conservatives sometimes acknowledge. I think the fear is that this bill (or any similar one) means the government will be doing all the rationing rather than what we have now: the marketplace leavened with some governmental help for the truly needy. Which form of rationing people prefer has to do with ideas of fairness, effectiveness, and utility as well as morality.

I’ve been playing with the idea of a quick post along these lines and I think I’ll do that next. Not until tomorrow, though. Real life is about to intrude on my little blog world.

Thanks for helping me focus my thoughts on what I want to write about next. I was wandering aimlessly through my “Stuff to write about” folder when my email beeped. Saved by the bell.

Chuck Pelto said...

TO: Jimmy J
RE: Truth!

IMO, healthcare has always been rationed to some extent. -- Jimmy J

It's all a matter of where with all of the individual and capabilities of the system.

However, with THIS proposal, the GOVERNMENT gets ITS hand into the situation....deciding who lives and who dies.

And three guesses as to the way they'll 'approve'.....

....first two don't count.

Ever read any of Jerry Pournelle's Falkenberg's Legion series?

Regards,

Chuck(le)
[Science fiction writers foresee the inevitable, and although problems and catastrophes may be inevitable, solutions are not. -- Isaac Asimov]

Elise said...

P.S. I'm intrigued by your use of the term "Moving On". It reminds me of that organization, "Move On"....

Ah, the old "she's an Obama-loving progressive in Palin clothing" innuendo. I would probably have refused to play even if you hadn't added that but now it's definite. I'm done with you. Please stop posting comments - although you're welcome to actually read some of the other posts I've written over the past year. You can probably even figure out how old I am if you pay close attention.

Chuck Pelto said...

TO: Elise
RE: "She"??!?!?!

Ah, the old "she's an Obama-loving progressive in Palin clothing" innuendo. -- Elise

You're a 'she'? My fault for not checking the bios. Oh well.....ask me if I REALLY 'care'. After all....you're supposed to be a 'liberated woman', eh?

Welcome to the REAL world, babe.

And as for 'progressive'....

....I've had a LOT of experience with those Communists. Indeed. When they offered a series of seminars on 'leadership development' and I started asking 'interesting' questions about gross contradictions....

....they suddenly changed the venue and didn't send me information on where they were meeting.

You're a 'progressive'?

Regards,

Chuck(le)
[The Truth will out.....]

Chuck Pelto said...

TO: All
RE: Heh

Please stop posting comments -..... -- Elise

Typical 'progressive' approach to open debate.....

Regards,

Chuck(le)
[The Truth IS out.....]

Chuck Pelto said...

P.S. Be advised....

...this site-topic-thread has been captured for future reference.....

Elise said...

Typical 'progressive' approach to open debate.....

I'm not a progressive (what part of "read what I've written previously" do you not understand). I asked you to stop posting comments because either you're a troll; or I can't express myself in a way you understand; or you're a shape shifter. Whichever of those is the case, it's pointless for me to try to continue to tell you something you're bound and determined not to hear. I really, really don't want to turn on comment moderation so I'm hoping you'll either give up (if you're troll or a shape shifter) or accept that for some reason we simply can't communicate effectively.

Thank you.

P.S. Be advised....

...this site-topic-thread has been captured for future reference.....


I have no idea what that means.

Anonymous said...

Elise wrote ... "your battle not mine ... I'm concerned with the truth" blah blah blah.

Anyone concerned with having the truth emerge from the legislative process would hold very highly the notion that a thousand page plus piece of legislation requires time, review and deliberation.

I read the draft bill cover to cover a couple of weeks ago, and as a lawyer, could fairly interpret its (then) provisions. It didn't take that long, maybe a quarter of the time it takes to read an average novel, to get a solid handle on the bill.

I think it horribly deceptive to the American people that the Democrats say "you can keep your insurance" under this plan. The grandfather provisions are not for any existing structure of insurance, it is simply for a plan in place. The insurer is not obligated to renew it, can't issue new policies (draft two weeks ago), and can't change *any* item of coverage or premium. That's not grandfathering, in any sustaining way. These plans will phase out in a number of years. For employer sponsored plans the grandfathering explicitly phases out after five years (draft two weeks ago).

The "exchange" reads like the California run power "exchange", and we all know how well that served California early this decade.

You cannot sell insurance in the "exchange" unless it meets the government standard, meaning a complete federalization of the minimum standard and delegation to an Obama administrative agency. (Go unitary executive!). It is expected, among other things, to include abortion coverage. (Has the transgendered community has weighed in yet?)

This "exchange" makes it illegal to sell insurance based on pre-existing conditions. It subjects participating insurers to involuntary assignment of uninsureds, so that the public option can pawn off those gravely ill, so we all have to pay for it.

It is a highly regulated host of horrors. Is it really a respect for "truth" that has you harping about comments by some uninformed conservatives?

Chuck Pelto said...

TO: Elisa
RE: Yeah....

I'm not a progressive.... -- Elisa

....Right.

And I'm not a retired lieutenant colonel of infantry who is aiborne-ranger qualified.

What was it some former president said....

If it looks like a duck and it quacks like a duck....

You're the one asking me to no longer post my comments calling you out.

Something to do with "Looks like a progressive" and "Acts like a progressive".

Why is that?

Regards,

Chuck(le)
[The Truth is out....]

Elise said...

Anyone concerned with having the truth emerge from the legislative process would hold very highly the notion that a thousand page plus piece of legislation requires time, review and deliberation.

I do believe it requires time, review, and deliberation and I've said so. What I don't believe is that I'm obligated to write about what's important to someone else. If you've read through the bill I think you would be doing us all a service to post what you've found in as much detail as you can find time for. I write about what catches my eye and I think everyone who blogs should do the same.

M. Simon said...

The EPA says CO2 is a pollutant. Where was that in the law?

Well you see there is law and there is regulation.

And what happens if you cost the government too much money?

Obama says forget surgery - we can give you a pill - video at the link.

Now you know why the provision is in the Bill. The government would prefer you had a DNR to save them money.

But I'm glad to see that there are still some who believe the G-Man when he says: "We are from the government and we are here to help."

Elise said...

M. Simon -

I agree that Congress handing blank checks to the Executive branch in the form of "make up whatever regulations you think will work" is a bad and dangerous idea. I almost fainted when Henry Paulson said, "Give me $700 billion and I'll worry about that rest" but that was simply the most blatant example. It's understandable, of course: when government does everything, Congress can't really manage it. So - again - smaller Federal government would be nice.

The video you link to is of the exchange between Jane Sturm and Obama. I talk about that exchange in my post.

M. Simon said...

And no - I'm not Chuck Pelto. But i do think along similar lines.

The deal is - regulators will determine what the consultation includes.

===

and since you are a small gov. type I'll assume you know that the government was supposed to evaluate marijuana as medicine after the classification laws were passed. What is it now - 20 years? 30 years? Still no evaluation let alone reclassification. Despite law suits etc.

You see - what ever you think the law is - the government doesn't have to follow it. Why? Sovereign immunity. You can sue an insurance co. for malpractice. The government? Fuhgeddaboutit.

M. Simon said...

Obama told you how the law will work. If not now soon.

And you are still trying to put the best face on it?

OK. Fine. You are young and naive. I expect that with 20 or 60 more years of experience you will get it.

You want to fix this horror? Make the government waive sovereign immunity with respect to all provisions and regulations associated with this bill.

Otherwise I wouldn't trust a word of it.

Cassandra said...

I'd like to think of conservatives as the good guys. In my world view - narrow as it is - the good guys not only tell the truth, they're careful about the truth.

I paint with a small brush on this blog most of the time. It's what I'm good at and it's what interests me. I don't think it's an unimportant effort. If nothing else, it immunizes me against beginning to believe that the ends justify the means.


************

Elise, this is why I've always looked forward to your comments. They are unfailingly well thought out, factually accurate and insightful.

Oh, and Chuck, stop acting like that Whack-a-Mole who continually pops up his hand in class until everyone is forced to stop what they're doing and pay attention to him.

Elise has been uncommonly patient with you but your ad hominems are off topic and add nothing to the discussion. You're just proving her point about some people's dogged determination to sacrifice honest criticsm at the altar of partisan hackery.

Oh, and calling me a feminist or Obama lover will only ensure derision. I will say that you displayu an unusually masterful grasp of Teh Won's rhetorical tactics: if you can beat 'em on the merits, go straight for the insult every time.

Sheesh. Congrats on the Instalauch Elise. Well deserved.

M. Simon said...

And you didn't even mention a bit linked to this provision (not directly) The Cost Effectiveness Board (or whatever they call it).

It doesn't matter what is in your living will. If they decide you are not a producer they are going to let you die or give you a hospice cocktail to speed things along.

Of course you can't put that in a bill. That is what the government has regulators for.

Magic word "chessed" look it up in Hebrew:

http://en.wikipedia.org/wiki/Chesed

It means kindness - it will be interpreted put you out of your misery.

Cassandra said...

One more point: Elise is making a pretty narrow point here: those who claim the bill mandates rationing or Advance Planning sessions need to take their own advice and read the bill.

Trying to set up a sweeping straw man that forms no part of her post or criticizing her for "attacking the Right" does nothing to refute the point she actually made. It does, however, provide ample support for the notion that the facts don't matter to you.

If, as she says, you want to argue it's a bad bill or that OTHER features of same will lead to rationing, go right ahead. But be honest enough to admit that Elise isn't arguing those points :p

Chuck Pelto said...

TO: M Simon, et al.
RE: Soverign Immunity

You see - what ever you think the law is - the government doesn't have to follow it. Why? Sovereign immunity. You can sue an insurance co. for malpractice. The government? Fuhgeddaboutit. -- M Simon

THERE'S a way to get rid of malpractice suits. All the doctors work for the US government.

I wonder what that poor airman who lost both of his legs recently thinks of HIS 'situation'.

Regards,

Chuck(le)

Chuck Pelto said...

TO: Cassandra
RE: Sorry....

Oh, and Chuck, stop acting like that Whack-a-Mole who continually pops up his hand in class until everyone is forced to stop what they're doing and pay attention to him. -- Cassandra

...but, in the words of the immortal Dread Pirate Roberts....

Get used to disappoinment.

Regards,

Chuck(le)
[The squeaky wheel and all of that rot.....]

P.S. Lenin referred to it as The Principle of the Few.....

Chuck Pelto said...

P.S. By the by....

....in my frosh year in college, I was the subject of a psych study on negative reinforcement. By 'subject' I mean, in a group of buddy-fockers, everythink I said was 'rejected out of hand'.

They wanted to see how people reacted to that.

After the research project was explained to me in detail....

....I took the lesson to heart.

Ever since then, when faced with stupid rejection.....I go on the offensive....as long as I have the factual data to back up my comments.

What do YOU do when faced with 'resistance'?

Cower?

Regards,

Chuck(le)
[Let us go forward in our mission and our duty. Fearing God and nothing else. -- Winston Churchill]

P.S Out of curiosity.....

....have 64 men trusted YOU with their very lives?

M. Simon said...

And there is an abortion provision in this bill.

What happens when the Government regulations make it mandatory under their "best practices" committee?
Babies that are too premature. Babies with bad genetics. (Downs syndrome would be a good one - odds are such a baby will never be a producer). And a hundred other problems. We know drug addiction has a genetic component and that genetic component is about 1/2 the cause of addiction the other half is environmental.

The government could save a lot of treatment costs by aborting 20% of all babies (the approximate frequency of the associated addiction genes).

We will no longer be people. We will be cattle for breeding working and dying. Will this come all at once? Of course not. They will turn the heat up very slowly so as not to agitate the frogs.

And it will all be promoted as a way to lower taxes.

Chuck Pelto said...

TO: Cassandra
RE: As If....

Oh, and calling me a feminist or Obama lover will only ensure derision. -- Cassandra

....I gave a rat's fourth-point-of-contact.

Regards,

Chuck(le)
P.S. Be advised.....

....I've been abused by the BEST. And you don't hold a candle to Colonel 'No Slack' Stack....

Chuck Pelto said...

TO: M. Simon, et al.
RE: I Guess....

We will no longer be people. We will be cattle for breeding working and dying. -- M. Simon

...these people have never watched THX-1138.

Regards,

Chuck(le)

Anonymous said...

OK, at elise's request, here are a few notes I took, as I read the early sections of the health care plan (draft 2 weeks ago)

major mandates unfold over 5 years after president pulls "trigger", at his absolute discretion, but beginning no later than 2013.

individual plans "grandfathered". but: can't admit any new insureds beginning shortly after "trigger". can't change *any* element of the plan, what's covered or rates charged, for any reason (except the insured moving), forever.

employer sponsored plans are also "grandfathered", and able to admit new employees, but the exemption expires in a short period of years.

other than "grandfathered" plans, it is illegal to offer insurance outside a government controlled "exchange" (a la the california energy market).

all future individual and employer sponsored coverage must derive from the "exchange".

in the "exchange": it is illegal to underwrite out any applicant or deny coverage for a pre-existing condition, to fail to provide coverage mandated by federal government minimum standard, or to vary rates more than 2x based on age. only factor permitting wide premium differentials is location.

minimum standard is a rolling definition set by new federal agency with wide latitude to include new mandates or narrow coverage.

public option sits in the "exchange" as an "honest broker", to keep prices "fair" and the system "efficient". public option must be included among alternatives offered by employers to employees. public option to price premiums based on best actuarial practices, which translates into a requirement of disclosure of sweeping and universal medical data to governmental authorities from all sources public and private, in a manner to be defined by administrative agencies with wide latitude to publish implementing regulations.

employers required to provide coverage -- in businesses as small as 10 employees. individuals required to hold health insurance, directly or through employment, either "grandfathered" or via "exchange" (so it meets federally mandated benefit package requirements). otherwise government imposes tax to fund appropriate premium plus a penalty.

government has right to "randomly" assign and fold any uninsured person into any private "exchange" plan, or to put that person into the public plan,

Elise said...

Thanks for the review, anonymous. I just don't see how the "no denial of coverage for pre-existing conditions" can work. Why would anyone buy health insurance until they need it? In which case, what it means "insurance"? And the whole "my doctor tells the government about my health" thing gives me the cauld grue. I'm not even happy about the questions on the census - I sure don't want everyone in Washington knowing what kinds of meds I'm taking.

Cassandra said...

I go on the offensive....as long as I have the factual data to back up my comments.

Well, you certainly got the "offensive" part correct. Full marks:

CHUCK: ....You're a 'she'? My fault for not checking the bios. [or, apparently, thinking before you made the unsubstantiated - and wrong - crack about her age. Oh well, 2/2 wrong means at least you're consistent :p]

Oh well.....ask me if I REALLY 'care'. After all....you're supposed to be a 'liberated woman', eh?

Welcome to the REAL world, babe.

Hmmm... could this be the real reason folks tend to ignore you?
Savor the incandescently fact free truthiness of your arguments :p

Ay yay yay.

Anonymous said...

Elise, what you're missing is that when the plan is fully implemented, everyone is insured. Insurance is not exactly a "right", it's more accurately a requirement. If you don't buy the insurance yourself, the government effectively buys it for you, and you (or your employer) will be taxed to pay the premium.

It will be illegal any longer to sell an individual insurance policy without opening the doors wide to anyone, despite their pre-existing conditions.

If a grandfathered plan, only employer paid plans have any freedom to admit new insureds on old underwriting standards, and that phases out in 5 years. So again, what I believe Hillary Clinton called "one of the civil rights causes of our generation, fighting to end the scourge of discrimination for pre-existing conditions" is legislated out of the insurance market.

The government has the power to randomly assign the uninsured to insurance sold on the "exchange" (the only insurance that can after that any longer be sold). So the nation's insurance market becomes a single pool, with the only differences recognized by law being (i) age and (ii) location.

(The location distinction is not only reflective of differences in cost of living across the nation, but to make sure that trial lawyers get protection for the higher medical costs in jurisdictions with vastly higher rates and levels of malpractice liability).

(I don't know whether the 2x premium by age variance is still in there, it was one of the most outrageous provisions of the old bill).

Elise said...

Ah, anonymous, got it. I see your point I think: because everyone will be insured no one will have the option to not buy insurance. That would mean the pre-existing condition stuff would only apply to the phase-in period of the bill when we have hordes of the uninsured roaming the streets like packs of wild dogs. Right?

How is the government going to be sure everyone is insured? If someone doesn't work or works cash-only with no documents or is simply a homemaker, they aren't going to show up on the government's radar via employment which sounds like the gateway. How do the Feds plan to find them?

Anonymous said...

I see nothing in the proposed legislation that would deny anyone (whether a citizen or noncitizen) all the benefits of the public plan just because the person remained off the grid until a hospitalization. There might be an issue of paying back taxes, if any. It's not clear that the unemployed (including illegals) with no other source of income will pay anything for full benefits under the public plan, net net.

There is hardly a phase-in period regarding pre-existing conditions. The public plan, and any newly sold individual plan, is free of any meaningful underwriting based on medical history from the git-go.

The 5 year window for employer sponsored plans does not free every employer in the nation from the obligation to offer the public plan. In fact, they would have no obligation to provide any other insurance.

I can think of an exception under federal law: a multi-year union contract providing specific insurance benefits, signed under the auspices of the Labor Relations Act. With the current crowd in Washington, that is quite likely the reason for the phase out provisions, they would not want to pre-empt union benefits negotiated prior to the economic downturn.

Elise said...

Chuck, I deleted your latest comment. I'm not willing to have one commenter call another commenter an idiot. If you want to repost without the insult, feel free.

Elise said...

I see nothing in the proposed legislation that would deny anyone (whether a citizen or noncitizen) all the benefits of the public plan just because the person remained off the grid until a hospitalization.

Yes, that's what was rattling around in the back of my brain. Didn't Clinton and Obama go round and round about this? She wanted to force everyone to have insurance, he wanted to let people sign up whenever, she asked what would happen if someone waited to sign up until he was sick, he said that person would pay some kind of penalty or back fees, she said, "great, you're in the hospital and the government in dunning you". Do I remember that correctly?

So it sounds like basically the government will enroll everyone they can lay their hands on and if they miss you, you just sign up when you need to.

When I talked about a phase-in, I was thinking of the period between when the bill passed and when it was fully implemented, everyone signed up.

employer sponsored plans are also "grandfathered", and able to admit new employees, but the exemption expires in a short period of years.

My eyes slid right over this the first time around. This is the 5-year thing? What happens at the end of five years? No more employer plan, no more new employees enrolled?

Unions. There's a theory floating around somewhere that exempting union plans is a back-door way to get more unionization. Sort of card check via health insurance, I guess.

Anonymous said...

The 5 year phase out is of employer plans outside the "exchange" framework.

My suspicion is that it's an attempt not to override union plans in place during the longest conceivable cycle of contracts blessed under the Labor Relations Act. Just speculating.

Again, after that, employer sponsored plans can include the public plan and any "exchange" plan the employer's chooses to offer its employees. Again, these will be plans where it is not legal to utilize any underwriting standards other than age and location, it will be illegal to exempt or refuse to insure because of pre-existing conditions.

Essentially, every plan in place in the country right now, it will be illegal to offer. A regime without the possibility of pre-existing conditions standards is just not the same healthcare system, period.

It means that the "minimum" standard will effectively become the "maximum" standard.

If a plan offers benefits significantly better than the maximum standard, those suffering the worst ailments would simply step up to buy the plan upon the advent of their illness, injury or condition. The insurance plan will not be able to underwrite them and deny them the policy.

It will not be possible to construct insurance policies with enhanced benefits for cancer, cardiac, you name it, and charge people more on a risk premium basis. Those with those conditions, emergent, would show up and demand the policy.

It would not be possible to construct policies to provide enhanced end-of-life benefits for those who are willing to pay more because they "want the surgery, not the painkiller" in all instances. Again, those who live much longer than they expected, and suddenly decide they'd rather have coverage for unlimited surgery, can show up and demand the policy.

In other words, it's an end to allowing people in their 20s, 30s and 40s to lock in coverage for conditions that might emerge in their 50s, 60s, 70s and beyond, pay a little more, and know that they're getting better benefits two decades hence.

Anonymous said...

"If a plan offers benefits significantly better than the maximum standard, those suffering the worst ailments would simply step up to buy the plan upon the advent of their illness, injury or condition. The insurance plan will not be able to underwrite them and deny them the policy."

Sorry, that should read "minimum".

Anonymous said...

And remarkably, we're talking here about the *private* option.

Cassandra said...

I don't know about y'all, but I'm playing a drinking game.

Chug every time The Won tells a whopper.

*hic*

My apologies, Elise, if I was out of line on your site. I should not have allowed my annoyance to get the better of me. If you want to delete my comments as well, I will not be offended :)

Elise said...

If you're really playing that game, Cassandra, it will be a miracle if you're still sober enough to read this, but no, you were not out of line. I have no objection to people going at it hammer and tongs. I just think throwing around words like "idiot" neither advances the discussion nor provides the onlookers with any entertainment.

More generally - that is, for everyone's attention - commenters will probably be able to get away with more directed at me than at other commenters. For example, I'd object if a commenter called me an idiot and request that they watch it in the future but I wouldn't delete without warning for a first offense.

This is most definitely NOT a blank check for insults and bad language directed at me. I do have a comment policy and I don't have any desire to run one of those sites where everyone apparently shows up simply to see who can be the nastiest today. Criticism is fine, telling me I don't know what I'm talking about - as long as you can back that up - is fine, presenting another viewpoint is fine. Ideally, I would hope to learn at least as much from my commenters as they learn from me. And having someone say they think I did a good job counts as my learning something.

Elise said...

Anonymous, you've given me a lot to think about and most of that thinking is going to have to wait until tomorrow. I do want to clarify something. (I'll probably dream about this stuff so my dreams might as well be accurate.)

Your reading of the bill is that to begin with employers can continue to offer whatever plans they have now or they can switch to the public option or they can switch to one of the Exchange plans (three levels, right - Ferrari, Cadillac, Volkswagen beetle) or they can not offer any health insurance and pay the penalty. After the five-year period, employers will only be able to offer either the public option or one of the Exchange plans or nothing with a penalty. If they were offering a private plan that is not an Exchange plan, they must drop it.

Individuals who don't get health insurance through their jobs can keep their current private insurance, switch to the public option, or switch to one of the Exchange plans. They will not be forced to give up their private non-Exchange plans after five years (leave aside for the moment whether such plans can survive economically). However, if they don't have private insurance when the plan goes into effect, they will only be able to purchase an Exchange plan or the public option. In any case, they will have to have some type of health insurance (assuming the government can find them).

Do I have all that right?

Anonymous said...

Insurance companies are free to withdraw policies, and very likely to do so with a prohibition on attracting new customers for historical lines, and the "frozen in place" requirement to fit within the grandfathering clause.

What policy of private insurance have you ever heard of that kept premiums and coverage completely unchanged, even one year at a time? Do that, the grandfather provision is voided, and the entire line of insurance is made illegal in the United States of America.

Private companies are free to withdraw sponsored policies offered to their employees. An exception might be union sponsored plan under a multi-year collective bargaining agreement.

Existing employer sponsored policies will not be made portable by the plan.

The bill provides gargantuan motivations to both insurers and employers to move quickly to "exchange" only plans.

So I would not say that any American is guaranteed to be free to keep his or her policy for a second. And you can't say that these "exchange" plans are anything but a completely new system, to be designed and micromanaged by bureaucrats in Washington -- setting minimums, allocating the uninsured among pools, and keeping the door open to the sick and aged if any private policy dares to rise too far above the federal "mini-max".

Elise said...

I'm turning comment moderation on overnight. It will be off and comments released no later than 11am EDT on Thursday.

Elise said...

Comment moderation is off; comments will once again post immediately.

Anonymous said...

Good morning.

Mickey Kaus's reaction to Obama last night:

Here we're dramatically changing insurance (no more "preexisting conditions") and insuring the uninsured and creating a health care exchange and promoting a public option...

Doesn't that undermine the reassuring message that if you like your health coverage, nothing will change? Sure. Nothing will change except the entire health care delivery system! Which is going to be redesigned! By experts!

...

[I]t's hard to see how Obama hasn't given a flashing green light to non-trivial tax increases on middle class families. ...


http://www.slate.com/blogs/blogs/kausfiles/archive/2009/07/22/obama-s-gratuitous-overreach.aspx

Elise said...

I like Kaus' summation very much. (Actually I usually enjoy Kaus but I rarely read him unless sent there by someone else.) Grim's argument notwithstanding, that's what I would hammer away at if I were charged with opposing the health bill.

I'd use Kaus' quick round-up of everything that's going to change, then I'd point out that all this is to help less than 10% of the population while taking away the insurance that the vast majority of people are satisfied with. Surely, I would declaim, surely there must be a better way to help that 10% without damaging the care of the other 90%. And without further burdening our struggling middle class with more taxes and yet still leaving a crushing tax burden to our children, grandchildren, and great-grandchildren.

Anonymous said...

What the Kaus summation leaves out:

Let's take Obama at his word, that he won't approve a plan unless it "bends the cost curve".

"Bending the cost curve" is code language for cutting Medicare. The Obama plan means drastic cuts to Medicare.

Whole live preventative medicine -- which the Left thinks government can somehow impose on consumers (by denying alternatives?) -- cannot meaningfully bend the cost of end-of-life care for twenty or thirty years.

So the plan will have to slash benefits in place for Medicare recipients. No longer will a broad menu of extraordinary end-of-life procedures be at the discretion of you and your doctor.

Obama is already talking about creating a "commission" of unelected "experts" to make these tough decisions. Does this make more palatable extreme cuts to Medicare?

The other major broad cost category is preemie care. Will the government "commission" also establish standards for which premature children will live and die, using cost arguments?

Democrats have fought economic calculus in environmental regulations for forty years. Cost benefit analysis, in that instance, militates against command and control. But in the case of medical care, the Democrats have turned the rhetoric on its head, because they favor concentration of government power.

Elise said...

I think your point about using cost benefit analysis in health care but not in environmental regulation is an excellent one.

The cost issues in health care really need a full airing. Either we're willing to spend whatever it takes to provide as much health care as possible or we're not. If we are, we're almost certainly talking about health care eating up more and more of the GDP. Per Greg Mankiw, that might be a perfectly rational decision. But so far the Democrats are getting away with saying it is absolutely essential that we get health care costs under control.

Chuck Pelto said...

TO: Elise
RE: Heh

Chuck, I deleted your latest comment. I'm not willing to have one commenter call another commenter an idiot. If you want to repost without the insult, feel free. -- Elise

Typical 'progressive' approach to debate.

Regards,

Chuck(le)
P.S. Don't feel like the 'Lone Ranger'.....lots of other 'progressives' do the same.

Indeed, Lenin and Stalin did that to 3.1 people who refused to kowtow to their version of 'political correctness'.

P.P.S. Just remember this....

....whenever I'm 'engaged' in discussions of this sort, I ALWAYS capture the commenting thread to detect your nefarious form of 'debate'.

Chuck Pelto said...

TO: Elise
RE: Heh

Chuck, I deleted your latest comment. I'm not willing to have one commenter call another commenter an idiot. If you want to repost without the insult, feel free. -- Elise

Typical 'progressive' approach to debate.

Regards,

Chuck(le)
P.S. Don't feel like the 'Lone Ranger'.....lots of other 'progressives' do the same.

Indeed, Lenin and Stalin did that to 3.1 people who refused to kowtow to their version of 'political correctness'.

P.P.S. Just remember this....

....whenever I'm 'engaged' in discussions of this sort, I ALWAYS capture the commenting thread to detect your nefarious form of 'debate'.

Elise said...

Chuckie, you're stuttering.

Indeed, Lenin and Stalin did that to 3.1 people who refused to kowtow to their version of 'political correctness'.

You know, I had heard about all the people they killed but I had no idea they deleted insulting blog comments from 3.1 people. Why, they should be ashamed of themselves.

Please feel free to capture this comment thread although it's not necessary: it's right here. See? Should you elect to discuss my nefarious behavior in some forum, I simply ask that you include a link back to this post so whoever reads your version can read the whole thread.

And thank you for calling me a "progressive". I'm going to forward that along to a couple of very liberal friends of mine so they can start their Fridays with a good laugh.

Anonymous said...

I haven't seen my question of last evening posted. Perhaps it is being moderated. At the risk of being repetitious, I will ask it again.

I spent quite bit of time trying to find the correct wording or inference of the Social Security Act to which you linked to dispel my (and other conservatives') fear of mandating of end of life counseling.

Eventually my eyes wore out and my brain also.

If we are wrong in our interpretation, I'd appreciate it if you could copy the exact paragraphs that modify Sec. 1233 of HR 3200 to your blog piece as an update. It would be a great public service for those of us getting lost in the various paragraphs, sub-, and sub-sub- sections!

I can then forward those to the people to whom I sent the alarm about mandatory counseling.

Margaret

Anonymous said...

I think I answered my own question -- I was looking for the overarching wording within the SS Act, not in the paragraph within Sec. 1233 that refers to "limitation"

"`(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1)."

However, could "limitation" in this case also be construed as meaning that a physical and related discussion do not satisfy the requirement to have those 5-year full consultations?

I hope I'm not paranoid, but I do not trust the Left (i.e. Daschle et. al.) who fully intend to deny care to seniors under the rationale that they've had a good life and are costing too much at the end.

Margaret

Elise said...

Margaret -

I don't know why your first comment didn't post. Comment moderation is not activated but I still double-checked - there are no comments awaiting moderation. I've heard Blogger gets odd when the number of comments gets large but I don't think that happens until around 200 comments. At any rate, thank you for reposting.

I'll be happy to post the complete text of the two sections - I'll do it as a separate post and put a link in this one.

This is a mess to follow as you've discovered. There is no place in either HR3200 or the Social Security Act that specifically says end of life counseling is *not* mandatory; there is no place that says it *is* mandatory. Instead the mandatoriness of end of life counseling must be discovered by looking in two places:

First, Section 1233 of HR3200 does not itself mandate the counseling so there is no mandate contained in the House bill itself. Instead, Section 1233 adds a new treatment to the list of treatments in the Social Security Act.

Second, if you look at the section of the SSA that is being amended you see that the list of treatments are not required treatments but simply the treatments that Medicare will pay for under certain conditions.

The paragraph you quote (3(A)) means exactly who you think it means. I think you're raising a variation of the initial point brought up by Chuck Pelto although much more helpfully. Section 1233 of HR3200 does *not* say end of life counseling is not mandatory. It also does *not* say it is. My problem with assuming that means it is - or will be - mandatory is that none of the other treatments on the list that end of life counseling will join are mandatory. Thus I do not see any way end of life counseling can be considered mandatory based on what's in HR3200.

In other words, why would end of life counseling be mandatory when other treatments in the same list - such as kidney treatments - are not mandatory?

I'll get the Sections up before the end of the day today. If I have time I'll also do what Congress should have done and show what the amended section of the SSA will look like if the bill passes.

Anonymous said...

Elise,

Thank you for your careful explanation of your reasoning about Sec. 1233 of HR 3200 based on its reference to the SS Act which refers to payment for medical services none of which are mandatory.

I owe you another explanation -- I know why my first post didn't make it is because I didn't do the word verification! I was pretty tired when I was doing the research and missed doing it. I realized this after I reposted but didn't want to confuse my next post by beginning with that given that my post was already long enough.

I mention this now because I realize that you are spending time searching for a cause -- I was the cause!

Margaret

Elise said...

Margaret - Thanks for letting me know what happened with your comment. I wasn't exactly hunting high and low but I was developing a tendency to check for comments trapped in moderation.

It's good to know things are working as they should. As a former applications programmer, I sometimes find it incredibly frustrating to have to depend on packaged software that I can't get into the guts of.

I'll get the texts of the Sections up later today.

Elise said...

Okay, I've run into a problem trying to post the Sections of HR3200 and the Social Security Act. Blogger is stripping all the leading spaces out of them which means everything is aligned left. Without the indentation, it's even more difficult to figure out what the bills are saying.

If anyone is interested, I'll go ahead and post them but I don't think it's going to do much good. I'll think about whether there's any easy way to make the formatting readable but I don't know what it would be.

A commenter at Grim's pointed me to an easier to read version of HR3200. It's a pdf that you can access here.

Judy said...

I've been a registered nurse for 50 years and I'm currently doing chart reviews in physician offices. Most primary care offices have Advance Directive Policies and should ask patients, over age 40, if they have an advance directive such as a Living Will or a Durable Power of Attorney. The practitioner should dicuss this issue with patients while the patient is well and thinking rationally, and not wait until there is an actual end-of-life decision to consider.

Elise said...

Judy - Your comment is serendipitous, indeed. I'm just finishing up another very long post about Section 1233 in which I clarify my thoughts about the value of end of life planning. I've finished writing it but since it's almost 2am here I'll need to wait until tomorrow to read it again and make sure it isn't pure mountain gibberish. It will be up by end of day tomorrow and I hope you'll take a look at it. I'll post a link to that post in this one.

Elise said...

Well, I though I'd finished that new post last night but by the time I got back to it today I'd thought of lots more stuff to say. It's now turned into the post that ate Chicago so I need to split it up into smaller chunks - I'll probably get four posts out of it.

We've got bad weather rolling through - pea-sized hail an hour ago and there's another cell on the way. So I'll hope to start getting some of them up tomorrow.

Chuck Pelto said...

TO: Elise
RE: Rather....

Chuckie, you're stuttering.Elsie

....Blogger has a 'speech impediment'.

And, additionally, you can't recognize repeating oneself from 'stuttering'.

In truth, I speak VERY plainly. So well that I can be heard above the roar of the four turbo-prop engines of a C130 by ALL of the other 63 other paratroopers on the plane as we're about to put our 'knees in the breeze'.

Something to do with being (1) a jumpmaster and (2) capable of calling cadence for a battalion of airborne-infantry.

Hope that helps, babe....but I have my doubts....

Regards,

Chuck(le)
[God is alive....and airborne-ranger qualified.]

Elise said...

Okay, I've gotten that really long post split up into four parts. I have hyperlinks to all of them at the top of this post. The one where I talk about the value of end of life planning is the fourth one, called "Now I can sleep".

Anonymous said...

Thank you for your patience. I would have given up long ago. We need people like you. normal

bibmomma said...

Excellent explanation and back up references. I received one of the "alarmist" emails yesterday from a Conservative who was swallowing the hysterics. Your blog gave me clear and easy to understand facts that allowed me to de-bunk the email. Thank you for your dedication, easy to read blog and factual posts.

Elise said...

Anonymous @ 9:14 and bibmomma - You're more than welcome. I appreciate your letting me know you found this helpful.

Jack Reidy said...

Truly enjoyable reading both your posts and the comments. It is nice to read a serious discussion rather than a diatribe trying to make a point (R is good, D is bad or the reverse).

I'm a retired computer programmer/data analyst so I suppose we think somewhat alike. I started my own blog about a month ago
( http://www.jackreidy.com/blog/ ) and mostly comment on genealogy but occasionally get into current events.

DC said...

I stumbled across this while trying to help a friend explain to her aunt that no, they're not planning to euthanize old people. Very well-put; a heck of a lot easier to understand than the bill itself! (Damn it Jim, I'm a biologist, not a lawyer...)

I agree, it's not a great idea to try and overhaul the whole system so quickly. There's pretty much guaranteed to be problems, and I'd rather see them trying to dig the country out of debt first, but like you said- assume good will. Odds are good, the bill wasn't written with malicious intent, just misguided intent.

And I say that as an Obama supporter. Heh.

Elrig Ciles said...

Interesting blog topic. The comments' discussion go all over the place but that's the nature of the beast I guess. I loved the reference to Soylent Green - just like movie references.

At least you're getting attention - that's good.

Just one note on the speed of reform: the speed is not warranted by the need for intelligent analysis before reforming health care (or in the case of the US before forming a health care system). The speed is required to overcome inertia and active lobbying AGAINST any kind of a rational and equitable health care system.

Crises allow change.

The French got a pretty good health care system (best in the world according to WHO) because government, unions (workers, management, doctors), activists and corporations all agreed on the need and sat to negotiate back in 1958. In the US, there are powerful constituencies which would kill any rational negotiated effort. So you need speed and momentum to make it happen.

Not ideal but necessary.

Marie Tuttle said...

Thanks so much for your explanation of Advance Care Planning. I do feel better about that issue.

One major concern I have for our family as well as any other Civil Service or Military retiree is this:

For many years we have been
retired and have our Health Insurance through GEHA and now Medicare also. We pay a portion of the monthly premium (about 1/3) and the GOVERNMENT pays the other 2/3. Now.... if this government health coverage becomes law, I feel that it would be just a matter of time (and not that much time) before the government SWITCHES us to the new health program to save $$$$.

Is there anywhere in this bill that protects Civil Service retirees and Military retirees from this happening?? We do not want to switch. We presently have no co-payment, no 'Gap' period and an excellent prescription mail-in plan through GEHA (Medco).

I have asked this question to several people via the internet, including Hannity,Glen Beck and others with no response. I am hoping that you might find a way to address my concerns either personally or on your website.

Thank you in advance for any help you can give me in this matter.

Sincerely,
Marie Tuttle, Woodsboro, TX

Catherine said...

Sorry, you're not convincing me. What starts out as the exception usually becomes the rule. Since I don't trust this president one iota (he reeks of insincerity and duplicity), why on earth would I trust him with my life?

I am not a right-wind extremist or a Republican. I read for myself, looks at a person's track record, and follow time-tested truths. I see no truth here...on any level. The greatest lie obama tells us is that "nothing will change and that we can keep our own insurance." It just won't work out that way, mark my word.

These elitists really do think we're stooopid.

Wee Willie said...

Thank you so much for your insightful work. I, too, actually read the bill (HR3200) and it was tough to understand. I'm a retired engineer, not a lawyer. My first impression horrified me that the government was apparently mandating "end-of-life" counseling. Appeared Orwellian. Your explanation, relating to the SocSecAct as just an additional "covered treatment" scales it way back for me. Still a worry, but not nuclear.

Congrats on dealing with Chuck(le). He started out on-point but seems to be wandering as he works hard to get your goat. Don't need him.

For me the biggest issue is one you started with. This is way too big and complicated to get right, especially in a hurry. So our concerns must not be "straw men" but real and major issues. The biggest problem with "central planning" or socialism is that of details. It's way too complicated for the government to make, or even be involved in the myriad details of the successful pursuit of our lives. We all make mistakes, but it must be up to us to get it right and live with the consequences of our decisions.

Our government has a critical role in seeing that we get complete and honest info. And that competition for our choices live up to their promises. But we have the best and greatest country in the history of the world because we are free to live our own lives and support those that we love and care about. Let's do NOT fool with that!

Elise said...

Jack, it’s always good to have another computer guy around. I do lean Right (after a lifetime of leaning Left) but I try not to assume they’re all bad and we’re all good.

DC, I’m always a sucker for a Star Trek reference. A friend of mine who read this post and some of the earlier comments said he thought the real issue was trust. Nobody trusts anyone else any more. I’m afraid he’s right and wonder how we can live with each other that way much less get anything actually helpful done.

The speed is required to overcome inertia and active lobbying AGAINST any kind of a rational and equitable health care system.

Okay, but you’re assuming facts not in evidence, namely that HR3200 represents a rational and equitable health care system. Beyond that, I think this is a matter of preference and - for lack of a better word - national character. I prefer incremental, jerry-rigged changes from my government; they’re a lot easier to back out of if they turn out to be disasters. As for national characters, I remember that my PoliSci classes used France as a classic example of a country where the central government is all. One of the basic questions that we don’t even seem to address any longer is why the heck we need national health care. Why not let each State decide how it wants to handle things? States like New Jersey get lots of health care goodies and very high prices; States like Texas (I assume) get a less all-encompassing health care system and lower prices.

Elise said...

Marie, I’m afraid I don’t know the answer to your question. You can try calling your Representative and see if he can help you. There’s also a Texas-based blogger who is a lawyer; he doesn’t post often but you could try emailing him and see if he’s interested in tracking this down:

http://beldar.blogs.com/beldarblog/

You can also try MaxedOutMama. She’s read all of HR3200 and although I disagree with her reading of Section 1233 I’ve found other stuff she’s posted makes lots of sense:

http://maxedoutmama.blogspot.com/

Really, this is something your Representative should be able to tell you. And if he can’t - or somebody can’t - then no one has any business even thinking about voting for this bill.

If you can't get any satisfaction from your national representative, try your State representative. He might not know but he might know who could help you.

Elise said...

Catherine, all I wanted to convince you of is that Section 1322 does not mandate end of life counseling. Certainly your evaluation of any piece of legislation should include your own judgment about how you think the legislation will be implemented and what you think the effects will be down the road.

Elise said...

Wee Willie, I’m glad I could help talk you down from nuclear. Chuck, well, I’ve decided to think positively about him. After all, I figure I’m not really a blogger until I have a troll.

As for the rest of your comment, I couldn’t agree more.

Neil Moss said...

Good job. I too have been reading the bill. Unfortunately, like yourself, I have no clue what is really in the bill any longer now that the house and senate have been working on their own models. I can see me visiting with my senator over the recess asking pertinent questions only to be told those have been changed.

As I am retired my ral concern is that the new bill seems to make an effort to rob from medicare to support the new healtcare program. Where does that leave me after all these years, since Johnson, of payinng in?

Elise said...

I have no clue what is really in the bill any longer now that the house and senate have been working on their own models.

This is just insane. I know this is how things have worked for a long time now but that doesn't make it any less crazy. There should be a law (and I gather someone has introduced one) that a bill, in its final form, has to be available to the public (not to mention our Congressmen) for at least a week before it's voted on.

As for robbing Medicare to pay Public Option, I don't know. If you've got a citation I'd love to see what they're talking about.

stan said...

Just thinking logically here.

Democrats are the party of tax and spend.
the highest taxes are on the richest 1% who own more than 50% of the wealth the country.

Republicans are the party of tax cuts and giving it back to that same 1%.

When OBAMA care goes in, and costs get too high what do you thing they would do
related to that issue of wanting people to die after age 65?

1.democrats would raise taxes on the 1% to pay for the underfunding.

2. republicans would most likely cut taxes and funding.

so it just seems to me that people over 60 have more to fear from OBAMA care if the republicans ever get power back

Elise said...

so it just seems to me that people over 60 have more to fear from OBAMA care if the republicans ever get power back

Except that since the older you are the more likely you are to vote Republican, it’s just as logical to argue that Republicans will do everything in their power to provide superb health care for the aged in order to keep them healthy enough to vote for as long as possible.

More seriously, I think the elderly are already exposed to the whims of Medicare funding. That is, the choice between raising taxes or cutting services if Medicare costs go up exists now. Things like the House health care bill don’t change that basic fact one way or the other. It may increase the elderly’s exposure somewhat - I read (but have not verified for myself) that it may make Medicare Advantage less affordable or less available - but almost everyone over 65 already depends on a steady stream of revenue from the government in order to get health care.

You do, however, point up something that often gets overlooked when people are considering a new program, new legislation, or - especially - handing new power to the government and particularly the executive branch. What sounds like a great idea when your side is in power may produce results quite unlike what you want when the other side retakes the government.

Pat said...

Thank you for the Excellent comments!!!! Now, like you have the nothing better to do, can you abbreviate them so that I can forward them as a rebuttal to the ridiculous emails I get about this? I've been trying.... :) Pat

Elise said...

Pat - Here's the briefest I can do. I put this together for something else.

The section under question is Section 1233 of HR3200 (the House health care bill) and it is amending subsection s(2) of Section 1861 of the Social Security Act (42 U.S.C. 1395x). Section 1233 of HR3200 adds new sub-paragraph (FF) to the list of what Medicare will pay for as defined in Section 1861 of the Social Security Act.

Section 1233 is creating a new type of “treatment” that will be paid for by Medicare. It will only pay for one such consultation treatment every five years unless the patient’s health status changes, in which case Medicare will pay for a consultation when that change occurs. Such a consultation may result in a written directive about care and that directive may include information about such areas as antibiotics and intravenous feeding and hydration as well as the usual DNR instructions and any wishes with regard to facility transfer. This is not a mandate; this is a new entitlement. It may not be an entitlement everyone likes but it is still something extra for those on Medicare.

“Advance Care Planning Consultation” will not be required any more than the “intensive cardiac rehabilitation program” listed in (DD) or the “kidney disease education services” listed in (EE) are.

tune2a440 said...

If all is well with this bill, I suggest we not create Congress, Bureaucrats, the President, and all persons not currently included in the rationing MUST be INCLUDED. They may have the same care as the rest of us. After all, they currrently get to pass legislation determining their own health care, retirement, and perks; this is a privilege none of the rest of us are honored to receive yet have to pay for. If it's ok for us, then it's ok for them.

tune2a440 said...

If all is well with this bill, I suggest we not create Congress, Bureaucrats, the President, and all persons not currently included in the rationing MUST be INCLUDED. They may have the same care as the rest of us. After all, they currrently get to pass legislation determining their own health care, retirement, and perks; this is a privilege none of the rest of us are honored to receive yet have to pay for. If it's ok for us, then it's ok for them.

Elise said...

I certainly don't think "all is well" with this bill.

I definitely agree that if the government creates a public option then members of Congress, everyone in the Administration, and all the Supreme Court Justices should have to participate.

Anonymous said...

The lengthy explanation of P 425 of the Health Care Reform is something that should not be marginalized when Seniors across the nation are very concerned. The words for restricted healthcare for seniors has not been determined by a bureacrat yet, so what we are looking at is a 1018 page bill that will allow the government to plug in whatever it takes to meet budget without regard to treatment needs. That's what the concern is that is known as rationed or restricted health care. I watched C-Span for several days while Waxman and the Democrats voted down 22 Republican amendments most of which would have corrected or clarified HR 3200. It was a lousy political game them VS us during this committee meeting and because of the Pelosi and Company mindset the health reform that we ned will blow up instead of being written in a totally intelligent manner. Most Democrats and Obama have shown that they want to push a very bad bill down the throats of most Americans who object to this current form of reform malfeasance.

Elise said...

I agree that HR3200 is a bad bill. However, when it comes to Medicare service cuts, I would worry more about the proposed Independent Medical Advisory Council Act of 2009 than about HR3200.