What is Missing in the ObamaCare Car? The Chained Driver

So Obama is a used car salesman trying to sell a clunker that somehow escaped the Great Cash for Clunkers Buyout of his first term in office.  Well, I have nothing against used car salesmen in the private sector.  What is missing in this cartoon is the very critical fact that Obama is forcing us to buy this clunker.  And it is not just inoperable, but the buyer is chained to it.

Obama or any would-be tyrant like him controls the chain and they can ration our health care in any way they wish.  Obama is abrogating to himself the power to throw us under the ObamaCare car and kick out the blocks holding it up at his will.  Can you imagine the magnification of his power then?

You vota fer me or I kicka ofer these blocks!

I see you are alive and have diabetes.  Well, you pay 70% taxes or I cut off your treatment, since you have no social value unless you are paying your fair share of taxes. 

Hey, Grandma, you are too old to have social value, so we are going to stand by while you die because you cannot afford the mandated insurance that provides 10 essential health benefits you do not need and still afford treatment of your common elderly health problems.

This is our future under ObamaCare

Dr. Smith, a young urologist in Great Britain was misdiagnosed three times for breast cancer by National Health Service General Practitioners and examined once by a Cancer Center in Oxford and told she had a benign cyst. Soon after, it was discovered the pea sized cyst was the size of a golf ball and the cancer had spread into her liver and spine.  Chemotherapy, radiotherapy, and hormone therapy have failed and she has 18 months to live.  She was months from her wedding.

Her condition is now stable and doctors believe she could potentially live for ten to 20 years with the tumours in her spine if they could operate to remove her liver cancer. It must be shrunk first, but normal chemotherapy has failed to do this.

Dr Smith has been told she needs Selective Internal Radiation Therapy (SIRT), a new treatment in which millions of tiny radioactive beads are injected into the artery which supplies the cancer, to deliver targeted radiation.

The treatment was approved in Europe in 2002 and has been used to treat 15,000 patients worldwide, including up to 300 in Britain. But Dr Smith's primary care trust in Ryde has refused to fund it because it has not been fully approved by the rationing body, the National Institute for Clinical Excellence (NICE).

The treatment costs 23,000 pounds and her regional zone in the NHS will not allow it, though other regional zones do.  Each zone has to ration the care provided to stay within their expenditure allotment.  Without the treatment, the NICE and her regional zone of the NHS have condemned her to death.  But, nice people do not talk about death panels.

Given the shortage of doctors in America, perhaps a hospital here should make her an offer.  They could offer to pay for her medical care in exchange for her agreeing to practice with them for a period of time during which she would pay the practice back.  I doubt the monolithic NHS in Great Britain has the flexibility to do the same, however much sense it would make.

Krugman: Advisory Panels will Reduce Costs with Rationing

Paul Krugman, the Progressive economist writing for the New York Times and a major spokesman for the Progressive viewpoint, said on ABC News Sunday during the show "This Week" that

The People on the right, they're simultaneously screaming, 'They're going to send all the old people to death panels,' and 'It's not going to save any money.

The advisory panel which has the ability to make more or less binding judgments on saying this particular expensive treatment actually doesn't do any good medically and so we are not going to pay for it. That is actually going to save quite a lot of money. We don't know how much yet. The CBO gives it very little credit but, but most, most of the health care economists I talk to think that's going be a really, uh a really major cost saving.

Krugman is saying that the ObamaCare program will have to ration medical care more than it presently is rationed in order to save money.  It will do so with advisory panels whose decision is close to that of the Grim Reaper in finality.  The patient and the doctor and the patient's family will have little to no say.  The advisory panel's decision is "more or less binding."  It is dictated.

Note the sleight-of-hand in his first statement in which he concatenates the critic's statement that rationing will occur and it will result in more deaths with their statement that ObamaCare will cost a lot more money and raise premium prices in such a straw-man way as to make the statements appear to be contradictory.  Yet, it is elementary, my dear Krugman, to note that the latter statement of ObamaCare raising net costs does not mean that ObamaCare will not take desperate measures to ration really important care in life and death situations in order to free up money to pay for the much added costs of people seeing a care provider for their many sniffles.

So, as I have noted many times, ObamaCare must ration medical services.  Of course medical services are always rationed.  They used to be rationed by a combination of the ability to pay and the willingness of doctors to provide the truly needy with free or greatly reduced cost care.  Now they will be rationed by an Obama advisory panel of government bureaucrats, who will come between the patient and his family and the patient's doctor, who will not really be the patient's doctor at all, because the doctors will all be owned by the government.  Now, how many times did Obama and his horde of allies tell us that "No one will come between you and your doctor."?????

While it is true that medical care is and always must be rationed, there are very important further differences in which care will be rationed.  ObamaCare will measure its success in the number of doctor visits made to address the sniffles.  There will be many more such visits to the doctor than now because people will not have to pay out of their own pockets for those visits.  They have also committed ObamaCare to much more preventive medicine, even though this also drives cost up, contrary to their claims.  The extra sniffles visits and the preventive medical care will drive the total cost of medical care sharply upward.  At least partially compensating savings will have to be made.  Now, where can savings be made?  Given the ObamaCare commitments, the only time to save lots of money is when most medical expenditure has occurred in the past.  Very rationally, this has been when the care was most needed to extend life and is usually encountered with older people or babies.  Obama and his friends have made it very clear in unguarded moments in the past, that they do not like the fact that so much medical money is spent on babies and the elderly.  They have argued that babies and the elderly have little social value.  They have complained very bitterly about this, but by hiding it in general statements such as Americans spend too much on health care during the recent debates.

So, the advisory panel will look at cost to life extension and future life quality and decide what procedures are worth it, given the budgetary constraints of ObamaCare.  Procedures that were worth the effort to doctors, their patients, and their insurance companies will now be deemed not worth it.  There must be added savings to compensate for the sniffles and the preventive medicine.  The advisory panel will have to decide that grannies and babies who used to be worth the medical effort to save are not now worth the medical effort to save.  However much, the Progressives do not want these panels to be called Death Panels, they are tasked with the necessary job of pulling the plug on granny or your newborn baby.  The plug will have to be pulled much more frequently than we as free people ever allowed it to be pulled.  Now that all value decisions are to be made on a collective basis, your granny and your baby are worth much less in the future than they were in the past.

So, the reality is that just as the Progressive tries to hide the fact he is a Socialist behind a deceiving name implying he is the Angel of the Future Better Society, his Advisory Panel is exactly what Sarah Palin called the Death Panel.  The Advisory Panel serves the purpose of the Grim Reaper, who must cull society of its weak members.  The Weak are Expensive and not Worth it to the Collective.  And on and on, they will insist that we are not fair in identifying them as Socialists.

Our granny may be weak, but when she was our granny, she was loved and she was valuable.  Under ObamaCare, our granny is just a nationalized wee little bit of the Collective.  She is no longer your granny.  She is old and weak and not much regarded by the Collective.  Granny is now very expendable.  So is your newborn baby, if your baby has a serious health problem.  Get used to it.  Or, man the barricades and fight as you have never fought before to save your granny and your future babies!

This is not the time for Summer Soldiers, this is the crisis that can only be met by Winter Soldiers!  We must stand for the equal, sovereign rights of the individual to life, liberty, and the pursuit of happiness.  We must realize that our individual rights and our individual values mean nothing to any too powerful government.  They never have in all of history.  Our Founding Fathers and the Framers of the Constitution knew this very well.  They gave us a Constitution which tightly constrained the federal government with very limited powers in order to protect our individual rights and values.  Our federal government has pushed and pushed to expand its powers far, far beyond those given to it in this wonderful Constitution.  The People have not stopped them in this expansion of government power to this time.  Will you finally become the Winter Soldier for Freedom to save your granny and your future baby?  If you will not, you consent to their being expendable.

Our Illegitimate, Fascist Socialist Federal Government

The House of Representatives has signed the Senate health insurance takeover bill and Obama will now sign it.  There is an intention to make some amendments to this bill, but in essence it will remain the same.

Americans are now to be forced at the point of a gun to buy health insurance mandated by the federal government.  The government will dictate what services are to be covered and many aspects of what will be charged for those services.  The government will dictate when and to whom these services will be provided, since it must ration health care severely.  Of course, it will bring on the rationing a bit slowly so that We the People will stay in the ever hotter water just as frogs do if the heat is turned up gradually.

What has been accomplished with this health insurance takeover bill?  We have been lied to over and over by the Democrats that our health insurance costs will go down, but they will actually go up greatly for almost all of us.  Companies will have to reduce employees' take-home pay in order to pay still higher health insurance premiums for their employees.  Or, they can drop such coverage and pay the fine, which makes no sense, because it converts something of value to employees as compensation into something of value to neither the company nor the employee.  Still, companies will take this option in some cases rather than to be subject to further hassles from the IRS about whether the employee health plans meet the government specifications.  In fact, the IRS management may mean that if a health care insurance premium payment is a day late, companies will be hit with the fines and interest that they are hit with for late payroll tax payments.  The main reason small companies go out of business relates to cash flow issues and the most rigid cash flow issues of all are payroll taxes.  Adding to this cash flow problem will drive more companies out of business and cause more to go to the lower tax penalty cost on health care insurance since that rigid payment will be easier to make than the larger rigid ever-escalating cost of the government-mandated health insurance plan.

The quality of health care will go down.  I discussed some of the reasons for this in my last post.  There are many other reasons, but some of them I have discussed in earlier posts and others will be discussed in future posts.  Health care rationing must become more severe, as I have discussed in numerous earlier posts, such as this one.

But, the main thing we have lost is a government that protects our individual right to our life itself.  It is now transformed into a fascist socialist government which claims we have no individual right to our own lives.  We have lost government protection of our right to manage our own health to preserve our lives, as an exercise of our liberty, and to allow ourselves a chance to actively pursue our own individual happiness.  We now have a socialist government which plans to heavily interfere with our exercise of this right by putting us under the armed and intrusive surveillance of the IRS and well over 100 government agencies, all of whom are mandated to make many of our health decisions for us.  We can be sure that this tangled web of power-seeking bureaucrats will evolve their role in that decision process to be ever more dominant with time.  Not only will we be enslaved to these many agencies, but we will have no possible way of knowing and complying with the almost innumerable requirements which will be put upon us.  Even if we could know them all, we could not comply, because these agencies will put contradictory requirements on us as surely as the sun will rise tomorrow.  With equal certainty, many of us will die long before we manage to comply with their mandates, because many illnesses will not wait long enough for us to comply.  Implicit in all of our loses, is our loss of the effective ownership of our own bodies.

Socialist governments are always hot to control three aspects of our lives.  They insist on controlling the education of the People, so they can control them and teach them to serve the state.  Obama has made it very clear that he wants even more control of the American education system than government already has.  He wants to control the funding for all student loans for college, the curriculum, and the research money for colleges to control the faculty.  Obama is in tight with the socialist teachers unions on the control of American education as well.

Socialists seek control of commercial activity, so they can control the People's productive work and their jobs.  The redefined interstate commerce clause and the failure to enforce property rights, contract rights, and commercial association rights have long been used to wrest considerable control of the private commercial sector and to extort it.  Obama has shown a socialist commitment to this purpose with his takeover of banks and financial institutions, the takeover of GM and Chrysler, the legislation on credit card use, and Senator Dodd's proposed new regulations on financial institutions and for "consumer protection."  Legislation promoting more unionization of the private sector will be next.  Many administrative rulings have already helped the unions, as has some stimulus bill money.  The effort to gain control of our energy use with the false claims of the catastrophic man-made global warming scare has been followed by the absurd EPA ruling that CO2 is a pollutant.  The socialists claimed the environment justified this further death grip on the private sector and this opened many more avenues for extortion.

Finally, every socialist government lusts for the bodies of it citizens.  It must possess them.  They always pretend to offer medical services as a concern for the welfare of the People in order to take over control of the very continuation of their lives.  By taking over control of their health care, they make the People fundamentally dependent in the most subject way.  The government gains control over how long people live and how much pain and suffering they will be subject to.  This is an immense power.  The power-hungry socialist loves this kind of power and again such power is very useful as a tool of extortion.

The evil of this mindset is beyond recognition to any rational, benevolently joyous individual who thinks that life on Earth should be and can be a wonderful and rich adventure.  We cannot comprehend it, but we can see that it is there.  Evil people do indeed exist and they exist in fairly large numbers.  The Framers of our Constitution were very aware of this and this is why they neither trusted to a democracy nor to any oligarchy of elitists.  They gave us a representative government and insisted that even that government live within the tight constraints of our Constitution.  That Constitution was written to so limit the powers of government that it was not supposed to be able to do anything more that protect our inalienable, sovereign individual right to life, liberty, and the pursuit of happiness.  Our Founding Fathers had already established the principle that no government was legitimate which did not protect these individual rights and do so equally in the Declaration of Independence.  They had already told us that a People have the right, and even the duty, to rebel and throw off the shackles of any government that violates the rights of the individual.

Our present government has made it clear that it has no intention of limiting its powers to those given it by the Constitution.  Obama told us long ago that he does not like the Constitution because it does not allow redistribution of income and forced servitude of individuals.  Indeed, our federal government has not limited its powers to those of the Constitution for a long time.  But, this government has set a new standard as a terrible tyranny.  It could not be more clear that this government intends to respect the individual rights of the People to life, liberty, and the pursuit of happiness not at all.  It clearly has its jackboot squarely on each of our necks and intends to crush any individual who does not meekly and docilely serve the socialist state.  Obama really meant it during the election when he said that service to the state was going to take on new meaning during his presidency.  He is using every trick of demagoguery, misdirection, lying, and extortion he learned as a Saul Alinsky community rabble-rouser to make the federal government a socialist tyranny.

Many of the American People have never put up with tyranny.  But, when the tyranny was Great Britain, there were Tories who were docile.  America today is full of Tories.  They are called Democrats.  The Obama government and the Democrat Tories have declared war on our most fundamental American value that the People, each and everyone, has the inalienable individual right to life, liberty, and the pursuit of happiness.  These are not collective rights.  These are rights each of us holds individually.  I have the right to my life and all aspects of its management.  I have the right to my liberty.  I have the right to choose my values and to manage my own life in accordance with those values.  I have the right to think for myself and to take action based on my own individual judgment.  I own my body, my time, and my labor.  I have the right to act in pursuit of my own happiness.  I have the right to manage my own health choices.  You also have these rights equally.

When the federal government has declared war by using arms and the threat of arms to deprive me of my individual rights, it has performed an act of war on me.  It has done the same to you.  Every individual has the right to defend his rights from those who use violence and extortion to deprive them of those inalienable rights.  Anyone who does not defend his rights is not really an American.  I am an American and I believe completely in the inalienable rights our Founding Fathers believed in and I believe completely in the Constitution which the Framers set up to protect our individual, inalienable rights.  I intend to defend the Constitution against this tyrannical onslaught of fascist socialism.

As the tyranny of Great Britain mounted before the American Revolution, the Founding Fathers and those who joined them, frequently disobeyed the illegitimate laws of Great Britain.  This might mean they did not always put the required stamps on their playing cards, pay the tax on windows, or they might dump tea into Boston Harbor, or they smuggled in goods to avoid tariffs.  Americans today often exceed the speed limit and round a few corners on reporting all of their income, but most of us obey the laws as best we can.  But, some laws, such as those requiring us to report our health care insurance to the IRS, we ought to start massively disobeying.  It is time to start telling this government that we will not bow docilely and place our necks under their hobnailed boot.  It is time to defend our individual rights and our Constitution with some civil disobedience.

In 2010, we must turn out of office every Democrat possible in the House of Representatives and the Senate.  We must replace these members of the socialist party with someone who has at least some commitment to our Constitution and to our inalienable individual rights.  I am sure we will not always get a really good choice, but we must still teach tyrants the important lesson that we will turn them out.  If we work with the Tea Party enthusiasts, we will be able to find many candidates who are at least a marked improvement over the present socialists of the Democrat party.  We must not let up, since we must turn out even more socialists in the election of 2012 and then we must become very serious about rolling back the socialist state.  We must return government to the role of protecting, not violating, our inalienable individual right to life, liberty, and the pursuit of happiness.

Doctors and the ObamaCare Shortage

The Medicus Firm, a national physician search firm based in Dallas and Atlanta, polled physicians about ObamaCare and its effects on them.  They reported the results in the New England Journal of Medicine.  Key results include:

• 62.7% of doctors believe health reform is needed, but want targeted and gradual legislation, not the massive ObamaCare bill.
• 46.3% of primary care physicians (family and internal medicine disciplines) believe ObamaCare will either force them out of practice or make them want to leave medicine.
• 72% of doctors believe a public option will have a negative impact on medical care.

According to the Health Resources and Services Administration of the Dept. of Health and Human Services, there were 306,100 primary care physicians in 2005 and there were 511,400 Non-Primary Care specialist physicians in 2005, for a total of 817,500.  ObamaCare will depend upon these physicians to deliver the increased medical care that ObamaCare is supposed to provide to 32,000,000 more people.  About 15,000,000 of these people are expected to be added to Medicaid, which is a program a great many physicians will not participate in now or will not accept new patients from that program.  Who does this tyrannical Democrat government think will provide these services?  Many physicians are already also declining Medicare patients, though that program has paid somewhat better than has the Medicaid program.  However, the scheduled cuts in Medicare payments even as more and more Baby Boomers will soon enter it and need more medical care must surely cause the Medicare program to shift even deeper into underpaying doctors for their services.  The huge deficit growth of the federal government must further push it to making still lower Medicare and Medicaid payments to doctors.  The terrible condition of many state governments will also decrease their ability to make their expected and required Medicaid payments.

The net result is obvious, unless you are a pig-headed, pie-in-the-sky, other-worldly Democrat!  Doctors are going to be very unhappy.  Probably more than they now think even, as the reality of these much lower payments set in, as the tangle of myriad federal agencies start giving the doctors incredible increases in paperwork and contradictory requirements, as the number of unhappy patients pile up in their waiting rooms, and as the reality of having even less time per patient than the already inadequate time now causes them to lose all confidence that they are able to do their work in a manner consistent with professional standards, they will become seriously depressed.

When their work comes to be the source of depression, many will leave the profession.  The claim that 46.3% primary care physicians will do so or will be unhappy should be taken very seriously.  Many physicians will retire early.  In fact, there is clear evidence that many have already been unhappy enough with the pre-Obama
Care medical profession that they have been retiring early already.  We can learn more by looking at the age distribution of physicians according to the Health Resources and Services Administration.

First, note that despite the growing population of the U.S. from 2000 to 2010, the number of physicians in the three younger of the five categories dropped.  This trend is expected to be the case in 2020 also.  The only age group of doctors with an increase from 2000 to 2010 is the 55 to 64 year old group.  These doctors are close enough to retirement age and probably largely well enough off, that they can readily retire if ObamaCare is passed later today, as it now appears it likely will be.  Many of these doctors will indeed retire early and that means they will not be practicing in the 65+ age category either in the near future.  Many of the doctors already in the 65+ age group will quite immediately.


Now let us look into the future to the 2010 projection.  Note that the projection is rather optimistically expecting the future number of physicians in the 55 - 64 age group to remain as high as it is now.  This would mean a larger fraction of those in the 45 - 54 age group will continue on into the next age group than did in the 2010 case.  Given the effects of ObamaCare, this will surely not be the case.  This number will drop considerably relative to the prediction here.  It will also be insane to believe that a larger fraction of doctors will continue to practice after age 65 than did in 2000 and 2010 after ObamaCare comes into play.

The bad news does not end here.  There is another contribution to decreasing services which we are facing even without ObamaCare, which is going to make ObamaCare much less supportable.  To quote the Health Resources and Services Administration:

Currently, one in four physicians is female, but two factors are contributing to a rise in female representation. First, during the past three decades the proportion of new medical graduates who are female has risen from 10 percent to close to 50 percent. Second, the growth in female representation is a relatively recent phenomenon, and it is predominantly male physicians who are nearing retirement age. Although one in three active male physicians is age 55 or older, only one in eight active female physicians is age 55 or older. Because work and retirement patterns differ systematically for male and female physicians, the increasing proportion of physicians who are female has profound implications for the overall supply of physician services. Female physicians are more likely than their male counterparts to choose non-surgical specialties and to spend fewer hours per year providing patient care. They are also less likely to work in rural areas, and they tend to retire slightly earlier.

So, the increasing shift to more female physicians was going to lead to a smaller supply of medical services in any case.  Now, ObamaCare will chase more doctors out of the profession on top of the smaller numbers of younger physicians already and the larger fraction of female physicians who will work shorter hours and retire earlier.  This smaller pool of available physician manhours will be deluged by much more demand from aging Baby Boomers and from the greater demand brought on by ObamaCare.  The consequence will be that the quality of health care must degrade rapidly.  It will also become much more expensive, or degrade still more rapidly.  The law of supply and demand can never be denied.

We were already staring severe problems in the face.  ObamaCare is clearly going to make those severe problems catastrophic problems.  It will not be long before we really will have to be pulling the plug on granny much earlier than we have in the past.  Obama lied about this again just yesterday.  A lot of Baby Boomers are soon going to be very expendable.  Severe health care rationing is coming.  It probably was coming to some extent anyway due to the Medicare and Medicaid programs and the Baby Boomer demand increase, but ObamaCare will have to make this much more severe.  This will not be because anyone really wants this, except Obama and the Emanuel brothers, but because the Democrats do not think anything through and do not care about the constraints of reality.  They are simply other-worldly people.

A Mayo Clinic in Arizonia Stops Treating Most Medicare Patients

The Mayo Clinic facility in Glendale, Arizona has stopped treating many Medicare patients as part of a two-year trial program.  The Mayo Clinic is known as a high quality, relatively low cost provider of health care and was praised by Obama in June as a model for efficient health care.  Yet, the Mayo Clinic, based in Rochester, Minnesota, with a staff of 3,700 physicians and scientists, treated 526,000 patients in 2008 and lost $840 million on Medicare patients.  The average loss per patient was $1600 and many of their patients were not on Medicare, so the loss per Medicare patient was higher.

According to the March report of the Medicare Payment Advisory Commission (MPAC), doctors made 20% less treating Medicare patients than they did caring for privately insured patients in 2007.  Of course, this is like getting an estimate of future costs for a government medical program from the CBO.  As is well-established historically, the CBO estimates are always many times less than the future costs actually turn out to be.  The underpayment estimates of the MPAC are just as surely underestimates.

Socialists like to claim that Medicare is a huge success.  It would in fact be an obvious total failure, except that many of its costs have been transferred to patients on private insurance and the fact that demographics have allowed it to operate successfully as a giant Ponzi scheme so far.  As the Baby Boomers reach the age of 65, the program will rapidly incur costs which will exceed the current income from the Medicare payroll tax.  This will happen by 2017 or even earlier by 2013 in some estimates.  Some combination of higher taxes, lower medical services payments, and rationed medical care will have to make up the shortfall in the program's ability to pay for medical services.  The day of reckoning is very near and the present socialist Democrat health insurance reform bills are not addressing any of the real problems, except perhaps on the pathway of rationing future health care.  In many ways, the present ObamaCare bills actually add to expenses directly with taxes on medical services and will add further with an incredible overload of bureaucracy and innovation restrictions.

The Glendale Mayo Clinic facility has more than 3,000 patients eligible for Medicare.  They will have to pay cash to continue to see their doctors there.  This facility lost $120 million in 2008 on their treatment.  Only about 50% of the cost of treating elderly primary care patients at this facility was paid by Medicare.  There are a few areas in which Medicare payments will still be accepted there.  Specialist cardiology and neurology services and laboratory services payments will still be accepted.

Medicare covered about 45 million Americans at the end of 2008.  About 92% of family doctors participate in Medicare, but only 73% of them or about 2/3 of all family doctors are accepting new patients under the program.  The increased numbers of patients over 65 in the next few years will result in a further reduction in the percentage of family doctors accepting new Medicare patients.  If payments are cut back, as they likely will have to be due to the coming funding crisis for Medicare, then the percentage of doctors accepting Medicare patients will drop still further.  There is already a severe shortage of family doctors at the present time, so the situation will deteriorate catastrophically.  Congress, just about a week ago, postponed a 21.5% cut in Medicare payments to doctors for two months.

Yes, this is the farce the socialists are telling us is a great and successful program.  In fact, it is as bad as the post office, Amtrak, the ethanol from corn subsidy program, and subsidies for wind and solar power generation.  Well, except that the failure of this program will have fairly immediate deadly consequences for very large numbers of elderly Americans.  At the same time, it will most likely add still more backbreaking taxes upon younger generations, who will also be struggling under the huge increases in health care insurance premiums which ObamaCare will require them to buy for themselves.  Some very nasty intergenerational warfare is going to result.

Obama Government Declares The People Original Polluters

Yesterday, Obama's EPA declared CO2 a pollutant gas.  This allows Obama to regulate CO2 emissions under the draconian Clean Air Act.

But, take note that the People breathe out CO2 as an act of life.  Thus, the sovereign People who instituted government to protect their sovereign rights to life, liberty, and the pursuit of happiness, are now sanctioning a government of elitists who can look down their noses at the People for yet another reason.  No doubt these elitists already consider the People to be Original Sinners, who cling to their religion and guns and ignorance.  But now, they can also be perfectly politically correct in terming the People Original Polluters!

Yes, the elitists are also polluters, but in their minds, they have offsetting social value.  This is why it is perfectly fine for Al Gore to jet around the world giving speeches on man's destroying the world because he uses too much fossil fuel energy.  But Al Gore's use of jet fuel energy is OK.  He is doing mankind a service and has earned his CO2 emissions rights!  But have most of the rest of us?  Well, according to many environmentalists, there are already too many people.  They actually talk about the desirability of getting rid of some of us.  So now they can just make an assessment of our social value and weigh that against the fact that each of us is a polluter by virtue of breathing.  Is that social value great enough to justify the pollution costs of each of us breathing?

There is a very interesting synergy now with the health care reform plan.  The Democrats know very well that their plan is going to require massive rationing of health care.  They know there are not enough doctors to go around, so many of us will be forced to take on nurses and nurse practitioners as primary care givers.  They know there will never be enough tax money to cover all of the expenses.  Indeed, the incoming Medicare tax money will fall below the outgo expenses as early as 2013.  Cutbacks in care are a given.  Some will just have to be allowed to die because their care will be too expensive.  But, the health care legislation pussy foots around the issue of who will be given care and who will not.  They want this legislation passed, so they will have to smuggle in the means to cull the population of the weak and the non-contributors.  They will want to preserve the right-minded, no make that the left-minded, elitists, but let the mere People who cling to their guns and their religion go.  But how can they do this?  Don't most Americans still think every life or nearly every life has considerable value?

But just as the regulation of CO2 was never envisioned when the Clean Air Act was passed, its future use in solving the health care funding and rationing problem is not now envisioned.  Well, at least not until this outcast of the Ivy League educated elite realized that it is as of today politically correct to measure the harm of each person's breathing CO2 emissions against their social value.  If that social value, by the standards of the socialist elitists is not sufficiently high, then the medical care plug can be pulled.  They have a civic duty, a duty even to Mother Earth, to pull the plug on any nasty polluter who cannot pay for the right to emit CO2 with a valid permit granted by a government panel of experts using EPA provided pollution guidelines, Department of Labor guidelines for service value, and medical experts estimates of the cost of medical care.

If medical care is needed, it is denied if the harm of breathing out CO2 exceeds the social value.  Let us suppose the social value exceeds the harm of breathing.  Then guidelines have to establish how the harm of medical costs is added to the harm of breathing and that sum must not be higher than the person's social value as perceived by an "objective" government socialist minion elitist panel.  The government now has a great means to lower medical expenditures, since every penny of cost assigned to those who pollute by breathing is  pennies saved in medical costs.

Let us suppose the government says it cannot afford to spend more than $27,000 a year to extend a life by a year.  Lots of people will be very upset that Granny is only worth $27,000 per year to our government.  But, suppose the government tells us that Granny is worth $50,000 per year, but as a polluter by breathing, she costs us $23,000 a year.  Now, they can allow Granny to die and avoid spending $50,000 a year to keep her alive, while claiming she is worth $50,000 per year to them.  All those who care about Granny will say, "Oh yeah, I can understand why Granny's health care is rationed at $50,000 a year.  If she costs more than that, it is OK to pull the plug on Granny."  So now, the government never actually has to spend more than $27,000 a year to extend Granny's life by a year, but they can tell the stupid People that Granny is so important to them that she is worth $50,000 a year!

This is the ultimate win-win situation.  Look at all the special interests you can make happy and beholden to you, the politician:

• The caring people who think everyone must have medical insurance coverage.
• The labor unions controlling the Dept. of Labor who assess everyone's social value.  People will be crazy to volunteer for labor union sanctioned projects to build up their social value quotient.
  
• Hack doctors who want a government position free from medical malpractice suits.
• Those who want to cull the population of excessive numbers of people in the name of the environment and climate tuning.
• The taxpayers who cannot otherwise afford government-run health care.
• All those who think Granny is worth $50,000 a year, but would be offended to hear that she was really only worth $27,000 a year.

So Obama can now not only impress the socialist leaders of other countries at Copenhagen by telling them that he had the EPA declare CO2 a pollutant, but he can also tell them he feels so strongly about catastrophic anthropogenic global warming and the environment that he is also committing to sacrificing, say, 1,000,000 additional Grannies a year.  Then he can pose solemnly and ask, "How many of your Grannies will each of your countries contribute to the cause of fighting AGW a year?"

Yes, it is now clear that Grannycide is the only way to go if you are environmentally conscious!  Where is your commitment?

Proposed Republican Policy List for RNC Supported Candidates

It has been proposed that any candidate to be supported for election in 2010 by the Republican National Committee must support at least 8 of the following 10 policies:

(1) We support smaller government, smaller national debt, lower deficits and lower taxes by opposing bills like Obama’s “stimulus” bill;
(2) We support market-based health care reform and oppose Obama-style government run health care;
(3) We support market-based energy reforms by opposing cap and trade legislation;
(4) We support workers’ right to secret ballot by opposing card check;
(5) We support legal immigration and assimilation into American society by opposing amnesty for illegal immigrants;
(6) We support victory in Iraq and Afghanistan by supporting military-recommended troop surges;
(7) We support containment of Iran and North Korea, particularly effective action to eliminate their nuclear weapons threat;
(8) We support retention of the Defense of Marriage Act;
(9) We support protecting the lives of vulnerable persons by opposing health care rationing and denial of health care and government funding of abortion; and
(10) We support the right to keep and bear arms by opposing government restrictions on gun ownership.

 I am going to comment on those of these that I disagree with or have some reservations about.  Here goes:

5)  I do support legal immigration and I wish to make it much easier for those who wish to immigrate with larger quotas and lower fees.  I do believe that immigrants should be encouraged to learn English and citizens should be required to know English.  I favor guest worker status which is relatively easy to obtain, so large numbers of those who are now illegal will have future options which are legal.  Those who are now illegal, but have otherwise not been convicted of any crime, who can obtain the recommendations of past employers, who are willing to pay a reasonable fee to alter their status to a legal guest worker status, and who then work 5 years as a guest worker with a continued clean record and further employer recommendations, should be able to obtain legal resident status.  These terms are simply approximations to what I think is a reasonable policy which will benefit the United States and I am open to further discussions on this complex issue.  My views may not be considered consistent with the intent of the resolution enforcers, however.

8)  I flat out reject the Defense of Marriage Act as an infringement of the right of individuals to live in accordance with their own chosen values and their own conscience.  I reject it also because marriage is a spiritual state of union between people and government has no proper role in such a spiritual matter.  Spiritual matters are the realm of individuals, who may chose to make their spiritual values those of a religion or give them a different basis.  What government does have a legitimate role in is domestic partnerships or civil unions by means of enforcing a contract between the parties.  These contracts should no more limit the persons by number or gender than do small business partnerships.  The legal contracts should have multiple standard terms for the care and responsibility for children, for the sharing of property, and for the sharing of medical expenses and decision-making.  The sexual orientation of the partners should be of no concern to the government.  Those of a religious conviction are free to be guided by their convictions in their domestic partnership and are free to have it blessed as a marriage by their religious authorities, but such status will have no legal bearing at all.  Government for its part will refrain from attempting to make any definition of marriage and will leave that to the religions and to the sovereign People.

9)  If the denial of health care is done by government edict, I agree with this statement.  However, I do not agree with it in the context that medical providers are to be forced to provide medical care, if that is the intent of this ambiguously worded statement.  While I support a woman's right to an abortion if she chooses one, it is also clear that taxpayers, many of whom disagree with this, have the right not to play a role in paying for abortions.  They have the right to their convictions and any attempt to make them complicit in an abortion is morally wrong.  Furthermore, partial birth abortions are too marginal to birth to be allowed by law.  They should clearly be illegal.  Once a child is no longer a part of a woman's body, it has the rights of any individual not to be murdered.  I am therefore in agreement with this statement with respect to abortions.

These 10 required positions are simply a proposal at this point.  It will be interesting to watch what happens to this proposal and whether any of my concerns will be addressed.

Medicare and the Public Option

Robert Romano, the Americans for Limited Government Senior Editor, has written a good article on Medicare and the Public Option and on taxes and health care rationing.  It is called Washington's Degenerate Elite.  It tells a story of complete fiscal irresponsibility and of upcoming drastic health care rationing necessitated by biting off more than the government can chew on top of already legislated massive revenue shortfalls.  Even so, Romano does not make a critical part of the problem clear because he allows the government to get away with one of its most irresponsible ruses.  Let's follow his argument and his tale of the numbers and I will point out where the situation gets still more awful and to use his term, still more degenerate.

The Medicare Board of Trustees says Medicare has $2.5 trillion of assets in 2009.  Under a worst case scenario, its assets reach a maximum in 2012 of $2.712 trillion.  The program starts operating at a deficit thereafter.  In 2019, assets will be down to $2.279 trillion after accumulated losses of $433 billion.  Every year after 2012, losses will average about $169 billion per year.  In 2028, Medicare assets will be zero.

Now this is bad, but it is actually much worse than this.  What are these assets?  Well, they are just IOUs written to the program by the government.  To make these IOUs good, the government has to increase taxes or greatly decrease its expenditures elsewhere.  Obama and the Democrat Congress have no intention of generally decreasing spending by enough elsewhere, so taxes will have to go up greatly.  The above paragraph makes it seem as though the increased taxes to continue to fund Medicare must go up when the Medicare assets are gone in 2028.  This is not at all the case.  They will have to go up in 2013 and thereafter in order to cover the average shortfall in Medicare taxes of $169 billion per year!  This is the same year that ObamaCare is supposed to start.  So, the degenerates Obama, Pelosi, and Reid plan to add a new huge spending program the same year that the Medicare program starts operating at a loss.  Brilliant!!!!  These wily, sly socialists are counting on few of the People recognizing this in 2009, which is another of many reasons why they wish to pass this legislation through the Senate this year.

Romano continues with the story.  The Public Option of Obama, Pelosi, and Reid will initially cover about 36 to 45 million people.  The number of covered people is expected to increase with time.  According to the Center for Medicare & Medicaid Services, the cost of the Public Option will be an additional $935 billion by 2019.  How do our degenerate socialists plan to pay for this?  Well, they plan to ration care under Medicare to the extent that they will reduce its costs by $427 billion by 2019.  Note that with no changes of law, we were going to have a deficit of $433 billion by 2019 in Medicare, so these cuts in Medicare, if made, would leave a net deficit of $6 billion in Medicare without the Public Option added expense.  With the Public Option added expense, new taxes are required and Obama and his socialist cadres propose new taxes of $574 billion to be collected by 2019.  This leaves a combined Public Option and Medicare deficit of $367 billion in 2019.  Actually, the deficit will be greater since tax increases do not bring in as much revenue as projected and government plans to cut expenses never reach their goals.

The situation gets worse with time.  The Public Option is initially funded by taxes that go up before the program starts, but which will actually be used to pay the government deficits already in place (Stimulus Bill and other expensive programs).  Consequently, when the Public Option starts spending money, it will also have to convert IOUs into spendable money, which in practice means that either the deficits will be larger at an earlier time than projected or taxes will have to go up still more.  But in the government's ruse, IOUs are gold in the bank and the Public Option debt is only $32 billion in 2017, $59 billion in 2018, and $108 billion in 2019.  By 2030, the deficit from this one program would be more than $1 trillion.  This is based on a number of people covered which many reviewers think is lower than will actually be the case.

The combined costs of Medicare, Medicaid, and the Public Option will soon be greater than $1 trillion per year.  The costs will be increasing every year, which will require severe cuts in health care coupled with severe increases in taxes.  The rich will not be able to bear the cost of these taxes, so Obama's pledge to not raise taxes on the middle class will be meaningless, though that has already become very clear in other contexts.

All of the projections on expenses above were made on older June estimates and on very favorable assumptions.  The Center for Medicare & Medicaid Services now says those June estimates are much too low.  The cost of health care will increase fast enough that the deficit in the Pelosi House Public Option plan will be $289 billion greater than the numbers discussed above by 2019.  How much greater will they be in the outlying years?  Based on past government health care programs, one has to assume they will be many times higher than the costs now projected.

As Romano points out, things get still worse.  PriceWaterhouseCooper says the cost of private insurance will be driven upward sharply by ObamaCare.  An insurance plan that now costs $4,700 will cost $9,917 by 2019 or 2.1 times more than now.  The cost increases for the young will be even larger factors.  Many individuals who are now privately insured will be driven onto the Public Option, raising its costs many times.  When the Public Option is the last resort, it will also be bankrupt!

This Public Option plan simply makes the already intractable problems with Medicare, Medicaid, and Social Security much worse.  It is utter insanity to add to this existing problem with the Public Option.

Of course, as I have said repeatedly, Obama made his insanity very clear when he long ago said that he intended to bankrupt the coal-fired electric power plants which produce half of American electricity.  Apparently, being merely insane is no reason for the American people not to pick a man to be President.  In fact, it almost seems that they thought it was a requirement of the job.  This man is so wrongheaded on so many things that it is not possible to believe that he perceives reality at all.  And he has much company in Pelosi, Reid, Dodd, Waxman, Markey, Baucus (perhaps slightly less insane than the others), Franks, Hoyer, and many others in the Democrat Congress leadership.  All of them are bonkers.  All of them are Looney Tunes.

The Magnificently Efficient U.S. Postal Service

One of the relatively few things the federal government does that is actually constitutional, is the operation of the U.S. Postal Service.  One can question whether this function ever should have been a government function, but it was made so by our Constitution.  Now one would think that the government would take its actual constitutional duties more seriously than its unconstitutional actions.  The reverse often seems to be true, though there is also a problem in that Congress' taking something seriously only means that the politics involved is taken seriously, not the actual delivery of any real service.  The Postal Service has come under renewed evaluation as an indicator of how a government-run health care system will evolve, not that we do not have many more direct indicators of that!

John Potter, the Postmaster General, says the U.S. Postal Service is in acute financial crisis.  He has been the Postmaster General for the last 8 years.  In FY 2009, the Postal Service lost $7 billion.  Its mail volume decreased by 28 billion pieces compared to the year before.  The recession economy has reduced its business, as well as the Internet and e-mail.  Its Christmas mail has been way down.  In response, Potter cut $6 billion of expenses and 40,000 employees.  Despite this, Potter expects the Postal Service to lose $5 billion every year for many years.

Potter bragged that the fleet of 219,000 vehicles included 44,000 alternative-fuel-capable vehicles.  I'll bet they cost a pretty penny to buy.  Most people do not buy these vehicles because it is difficult to rationalize on an economic basis.  But if you are a government-run business, where politics is everything, you have to back the government story, however fictional, that man-made CO2 emissions are a catastrophic threat to the planet.

This U.S. Postal Service always had plenty of positions considered to be ripe political plums.  Local postmasters were often chosen by politicians.  Nowadays, that still happens, but also political correctness, rather than on-the-job skills, dictates who gets many of these positions.  White males need not apply in many cases.  Having a relative in the Postal Service, I have heard many a story that would make any real businessman's blood boil.

U.S. Postal Service facilities were also long considered great pork.  No doubt, many a facility is badly located and sized as a result.  Politics still limits the closing of many of these facilities.

It is interesting to observe that the U.S. Postal Service tried competing with Federal Express and UPS on next-day deliveries and found that it could not.  It contracted its next-day service to Fed Ex in the end.  Of course, it charges more than Fed Ex does.

Shades of government rationing of health care services, the U.S. Postal Service is now thinking it will have to cut services.  It wants to cut Saturday deliveries, which it says will save it $3 billion a year.  It also wants to offer new products, as the postal services of Japan and France do.  In other words, it wants to compete more with the private sector, which should be considered unconstitutional.  Evidence would suggest it cannot compete successfully.  But, those long lines waiting for counter service are a tempting market.  They could offer them sodas, coffee, candy and other survival goods to enable their captive customers a chance to survive the long waits.

Will our government-run health service do the same?  Imagine severely ill old folks lined up around the block waiting to see the few tired and bored doctors taking a break for sanity from their mountains of paperwork.  Think of all the unskilled new jobs for union members peddling water, sodas, hot dogs, aspirin, renting wheelchairs, and stealing their money!  Think of all the additional money their SEIU union will be able to give the Democrats to further transform America into a socialist peoples state, which is a misnomer for a socialist leaders state.

Changes for Doctors and Patients Under ObamaCare

The House bill 3200HR is one of the bills being folded together in some mysterious way in Congress.  The Senate has some Democrat Senators and Rahm Emanuel huddled behind closed and locked doors meshing together the Health Committee bill and the Finance Committee bill, which seems to have become 1500 pages long suddenly after the Finance Committee voted on a conceptual plan a bit under 300 pages long.  We do not know precisely what the ill-chosen provisions of the final passed bill will be, but the way everything is being rushed and so much is being hidden, we have to evaluate as much as we can from the available information, or we will be caught flat-footed when the final version is rushed blindly through Congress.

Here are a few provisions of HR 3200 we had best take note of:

• Doctors are in the public option unless they opt out.  There is no mechanism for opting out.  The Secretary of Health and Human Services will set up a mechanism someday and it may include penalties, fines, taxes, and who knows what other disincentives.  In effect, the plan is to make doctors slaves who may then have some onerous option to buy their freedom, their manumission.
• The paperwork required of doctors has been increasing rapidly over the last 15 years.  This bill will increase it much more, cutting down on patient time, attendance at seminars and on post-graduate education.  They will have to document all interactions with the many new federal bureaucracies to be set up, as well as the greatly expanded ones.  They will have to document all referrals, determine if there are fraud risks, and continually update quality assessments.  They will be bored to death!
  
• The expanded patient records will include copious financial records, medical data, mental health evaluations, and such things as any sexually transmitted infectious diseases.  This data will be available to huge numbers of medical people and to many bureaucrats.  Imagine what the Democrats will do with this information on a Republican running for public office?  Apparently, they will use such information on that Republican's entire family, if we can extrapolate from Sarah Palin's case.
• If patient's must be readmitted to a hospital after being released, there are fines.  Those with chronic diseases, the disabled, and the elderly are most likely to be readmitted.  Doctors and hospitals will become reluctant to treat such people because they inherently bring with them an increased likelihood of fines due to readmission.  There will be attempts to transfer such patients to other facilities.
• End-of-life counseling will be required as part of the regular medical practice.  The government will train and approve the counselors.  It will provide the films, brochures, and the data to be given to the patients.  It is expected that this advice will be for them to forgo more than ordinary medical treatments and play upon their guilt in being a burden.  The health czar, Ezekiel Emanuel, believes doctors are obsessed with the Hippocratic Oath.  He serves on an advisory panel for the Hastings Center which states that patients should reject ordinary and extraordinary care and accept death.
  

Let's Find a Reason Not to Repair this Man's Broken Arm!

The NHS of Britain has four times canceled operations to repair a plumber's fractured arm which occurred 10 months ago.  Look at this horribly disfigured and useless arm in the picture accompanying the British newspaper account.  I shuddered.

This man has 3 children, cannot work, has been denied unemployment insurance, is about to lose his home, and he cannot get the NHS to operate on his arm.  They say they will not operate because he is a smoker and has high blood pressure.  Well, it sounds as though he is willing to take the chance of complications due to his high blood pressure.  Apparently being homeless on the streets and alive is less acceptable to him as a way of life than the risk of an operation.  But the NHS has to look for reasons to ration care to save money, so the fact that he is a smoker makes him of less value to society.  The fact that he has high blood pressure means there is some chance the cost of the operation will not bear the fruit of a happy outcome.  So, this plumber has no choice in how he will live out his life in Britain.  It is all up to the whims of the state.

We can follow a path which will lead to the same outcome by passing ObamaCare.  After a few years, we will also be powerless to make our own choices with respect to the quality of our lives too.  When we cede our responsibility for our own health care, we also cede our right to life.

Should We Allow Granny to Die?

Stories are now widespread in the newspapers in Great Britain about people, usually elderly, being put on the Liverpool Care Pathway.  The plan is intended for people very close to death, or at least it was originally claimed that that was its purpose.  More and more stories are emerging about people who are not so close to death being put on this euthanasia plan.  Here is another such story.

At around 4am on Monday, a friend of mine was woken by a call from the private care home in south-west London where her 98-year-old grandmother is resident.
"Mrs ------- has breathing difficulties," the night manager told her. "She needs oxygen. Shall we call an ambulance?"
"What do you mean?" my friend responded. "What's the matter with her?"
"She needs to go to hospital. Do you want that? Or would you prefer that we make her comfortable?"
Then, the chilling implication of the phone call filtered through – she was being asked whether her grandmother should be allowed to die.
"Call an ambulance now," my friend demanded.
The person at the other end persisted. "Are you sure that's what you want? For her to go to hospital."
"Yes, absolutely. Get her to hospital."
Three hours later, her grandmother was sitting up in A&E, smiling. She had a mild chest infection, was extremely dehydrated, but was responding to oxygen treatment.

Her granddaughter was wondering how her grandmother, whose major health problem is a badly calcified knee, had been allowed to become dehydrated in the first place.  Dehydration is one of the steps in the Liverpool Care Pathway when the NHS decides that an elderly patient will be allowed to die.  Now the granddaughter is worried about the care her grandmother is getting in the private care home.

As costs rise in a nationalized health care system, the average taxpayer inevitably does not have the same incentive the loving family members have for the preservation of grandma's and grandpa's lives.  Naturally, they are going to refuse the higher taxes to support the health care system and that system will have to respond with bureaucrats creating rules that will ration health care.  Generally, the value of your grandmother to society is weighed against her value, not to you, but to society.  When that happens, your rather expensive grandmother is going to receive less care than a younger person and less care than you want for her.  There is every incentive to put your grandmother on the Liverpool Care Pathway, or in America on the Chicago Care Pathway a few years down the pike after we adopt ObamaCare.  Some death panel of bureaucrats will promulgate the rules that save the system money.

Darwall - Government Medicine vs. the Elderly

Rupert Darwall, a London-based strategist currently writing a book on the history of global warming, wrote an interesting Opinion in the Wall Street Journal on 14 September 2009. He noted that the Patients Association, an independent charity, had examined many end-of-life care cases of the British National Health Service (NHS) and had found "a consistent pattern of shocking standards of care." It gave examples across the NHS of "appalling treatment."

Darwall notes that the usual justification for socialized medicine is to provide access to care for the poor and disadvantaged. But this is best done by a benefits system and refundable tax credits. In reality, it is assumed that health care resources are fixed and it is necessary to prioritize their use for those who can benefit the most from them. So, Britain's NHS is the "national triage service." He notes:

It should come as no surprise that the NHS is institutionally ageist. The elderly have fewer years left to them; why then should they get health-care resources that would benefit a younger person more? An analysis by a senior U.K.-based health-care expert earlier this decade found that in the U.S. health-care spending per capita goes up steeply for the elderly, while the U.K. didn't show the same pattern. The U.K.'s pattern of health-care spending by age had more in common with the former Soviet bloc.

He notes that this assumption of limited resources lies behind Obama's claim that "We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it." Obama claims this threatens our economic competitiveness.

In my opinion, we would not be so tempted to view it from that angle at all except that we only offer tax breaks to companies for the purchase of employee health insurance. If we separated this cost from companies, then it would not affect their competitiveness and it would solve the problem of people losing their insurance when they lose a job or switch jobs. If the tax break for the purchase of health insurance went only to individuals, as it should, then their spending on health insurance would be viewed just like that on any other consumer spending, except that they would get a tax deduction for it. If Americans wanted to spend 1.5 times what other nations do and if they want to spend more specifically to keep granny alive another year or two or five, that would be viewed as entirely their prerogative.

Darwall questions what makes it bad to spend so much on health care? He does say that distortions such as malpractice suits and the absence of consumer price consciousness should be addressed. Putting insurance in the hands of the individual, rather than his company, and allowing high deductible plans with Health Savings Accounts is an effective answer to the issue of consumer price consciousness. Darwall observes that our greater spending on health care "incentivizes new drugs, new therapies and better ways of delivering health care. Government-administered systems are so slow and clumsy that they turn the lump of health-care fallacy into reality."

A 2002 Wanless report, which Blair's government used to justify a large tax increase to fund more NHS spending, found the NHS to be late to adopt and slow to diffuse new technology. The NHS more than doubled its spending from 1999-2000 to 2009-2010, an increase of more than 7% a year [according to Darwall, but I calculate that to be more than 10% a year], and still remains medically backward. This Wanless report examined five country's health care systems and found that only the U.S. was both an early adopter and rapid diffuser of new medical techniques. The U.S. is the world's "principal engine driving medical advance."

Indeed, which nation's scientists and doctors win almost all of the Nobel Prizes in Medicine? Those working in the U.S., of course. And it does not end with the fundamental scientific advances either, as the Wanless report confirms. Yet, Obama wants us to have the backward equivalent of the British NHS simply because he objects to the way we spend so much on granny to give her a year or two or five more years of life!

No wonder he is so sensitive on the death panel issue. It is because this really is one of the main issues, as recognized earlier by the professional publications of Dr. Ezekiel Emanuel, an adviser to Obama on health care issues and brother of Obama's Chief of Staff, Rahm Emanuel. The recent cover story in Newsweek also trod this path. As I have noted before, this path is inevitable once health care becomes a government service, rather than a personal consumer choice. This is so no many how many lies are told by socialist politicians to deceive the People, even if some of those politicians believe the lies.

Decreasing Number of Doctors with Increasing Health Care Demand

From 2003 to 2006, the number of doctors in the U.S. grew at a rate of 0.8% per year. That is an increase of 25,700 doctors per year. Meanwhile, the U.S. population grew at a rate of 1% per year. Patients are increasing at rates faster than doctors.

The Obama/Democrat Congress health care reform effort intends to increase the demand still further for doctors by inducing people without health insurance now to acquire it and use it. They also envision a major increase in such services as preventive care, which they claim will reduce overall medical expenses and therefore the use of doctor time. Medical studies show that preventive care actually costs more and uses more doctor time, however. In addition, the mandated insurance plans will require expanded coverage for many medical services, increasing still further the need for doctors and other medical service providers' services. Despite the inevitable increase in doctor and medical service provider services generally, Obama and henchmen claim that medical costs will come down. Hogwash. Obama and his anti-reality gang of socialist thugs cannot control the effects of supply and demand. They can take actions to increase demand and to decrease the supply with respect to doctors, however.

The U.S. already has only 2.4 doctors per 1,000 population. The median in the OECD nations is 3.1 doctors per 1,000. The Association of American Medical Colleges found that enrollment in medical schools has decreased steadily since 1980. With current health care demand, they found that there would be a 159,000 doctor shortage by 2025. This shortage is already the result of the very unpleasant environment in which doctors have to work with skyrocketing malpractice insurance costs, less than adequate Medicare and Medicaid reimbursement rates, and arbitrary second-guessing of physician decisions by government bureaucrats for Medicare, Medicaid, and other government health programs.

The Medicare Payment Advisory Commission says that the number of elderly Medicare patients who had trouble getting a primary care doctor to take them increased from 11% to 17% from 2004 to 2007. ObamaCare will greatly increase the present aggravations of having to deal with government as it gradually takes over the half of the industry it does not yet control.

Investor's Business Daily (IBD) polled 1,376 doctors to see what they thought of ObamaCare. 65% said they opposed it, while 33% supported it. Asked if seniors would get lower quality care under ObamaCare, 65% of the doctors polled agreed and 28% disagreed. Asked if ObamaCare was passed, would they consider leaving their practices or taking early retirement, 45% said they would and 5% gave no answer. This means 360,000 doctors will consider quitting or Going Galt!

Who can blame them? They will be saddled with more paperwork, which is almost no one's favorite pastime. In order to try to fulfill its promises of more affordable health care, the government will put more pressure on doctors to reduce their fees and to spend less time with patients, thereby reducing doctor rewards both in remuneration and in personal satisfaction with a job well-done. With more patients per hour, more mistakes will be made and the number of litigious patients will increase, both leading to still higher malpractice insurance rates. Doctors will be underpaid and more weary even than now. What a life!

Massachusetts began the ObamaCare experiment in 2006. So have Hawaii, Tennessee, and Maine done similar experiments. In all of these cases, expenses increased faster than the national norm and doctor shortages became worse. Services had to be cut back. That is, rationing always resulted.

The Massachusetts Medical Society just released a study that found that insurance premiums are rising at a rate 22% faster than the U.S. as a whole. The doctor shortage is worsening due to the poor practice environment in the state. Primary care specialties (family and internal medicine) are in short supply for the 4th year in a row. The fraction of primary care practices closed to new patients is the highest ever recorded. Doctors in the dermatology, neurology, urology, vascular surgery, obstetrics-gynecology, family and internal medicine are in short supply. Recruitment and retention of doctors is very difficult, especially in primary care and in community hospitals.

Overall health spending, rather than complying with Obama's wishes, is higher than in the U.S. on average and growing faster, according to the Urban Institute. Apparently, Obama's wishes and claims carry less weight than does the law of supply and demand. The IBD survey found that this reality was well-understood by many doctors. 71% of them said they did not believe that "the government can cover 47 million more people and that it will cost less money and the quality of care will be better." It just is not understood by Obama and the Democrat Congress who are determined to use the force of government to force us all into their medical care hell.

Some may say that the American Medical Association (AMA) is backing ObamaCare, so the doctors must be backing it. The AMA only represents 18% of doctors and it is losing those who are members in large numbers because of its backing.

Great Britain's National Health Service (NHS) has a severe shortage of doctors. One-third of primary care trusts are flying in general practitioners from other countries to help them with their overloads. They actually fly in doctors from Hungary, Italy, Lithuania, Poland, Germany, and Switzerland, according to the British Daily Mail. Many of their resident doctors are already immigrants trained in other countries, in even much larger numbers than is the case in the U.S. or Canada, whose nationalized health care system is not as old as is Britain's. The overworked British doctors refuse to see patients at night or on weekends.

Canadian doctors can fairly readily emigrate to the U.S. and have done so in large numbers. What else is to be expected as a response to rigid work rules and income limits in Canada? The law of supply and demand always works, no matter what some people may wish and choose to impose through the use of government force.

Above all else, above the shortages, the increased costs, and the rationing of medical care that results with government controls, I worry most about the quality of the people who will choose to become doctors under this new regime. The most dedicated to their profession, the most independent-minded, the most creative, the most moral young people will Go Galt on the profession of medicine by refusing ever to become doctors in the first place. Only those who are easily brainwashed with the Obama duty to serve mantra will enter the field of medicine. The advancement and the quality of medical care will suffer horribly as a result during the lifetime of our children and grandchildren.

Many good doctors today will Go Galt and many a prospective good doctor will Go Galt by choosing a profession less enslaved by government. All good professionals are looking to enjoy their profession. They have the ability to excel in many professions, so why not choose one they will enjoy? My own daughter, Kate, worked in hospitals while earning her dual undergraduate degrees in Biotechnology and Biomedical Science with a 4.0 GPA while taking one-third more credits than she needed to graduate in four years. She decided she did not like the way medical care was already practiced and decided not to go to medical school. If medical practice were free of the harm already done by heavy-handed governmental regulations, I believe the profession would have had great appeal for her. As it is, she made the right decision to Go Galt on the medical practice profession and she made it without my input.

An Obama Lie: No Interference with Doctor-Patient

Obama tells so many lies that a rational observer almost has to assume that if he says something, then the opposite is true. Or, at the least, what he has said can never be given the credence of truth.

In his recent speech before a Joint Session of Congress, when Representative Joe Wilson rather indecorously declared Obama a liar to his face on one statement about illegal aliens not getting health care benefits, Obama lied about that and many, many other things as well. One of these was that once he establishes:

a publicly-sponsored insurance option, administered by government just like Medicaid or Medicare ..... I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need."

Michael F. Cannon points out that the Medicare program already gets between you and the care you need. It already has a review of care process in place to put pressure on doctors not to provide some of the care doctors are providing. He quotes a letter from a government bureaucrat involved in this review process. The bureaucrat points out that the doctors are between a rock and a hard place. If they do not lean toward giving more care given a severe medical condition with potential to become life threatening, then they are subject to lawsuits, which will cost them and their hospitals a fortune, even if the court decides in their favor. So, they are under great pressure to consider the worst case outcomes of denying care, rather than simply the straight odds. The review contractors and the reviewing bureaucrats have no such concerns at all. They do not consider the litigation consequences of denying health care.

And of course, the reviewers have the benefit of hindsight and they were not present to actually judge the health situation of the patient either. The records are all they have to go on. This is not always adequate.

A logical person would also consider Obama's claim that he would never let the government get between you and the health care you need if you pass his legislation to mean that Obama is President for Life and Eternity. If the logic of a program requires rationing, the program might deny that logic for awhile, but in the eternal life of government programs, it will eventually generally fall prey to its internal logic. Government-controlled health care must eventually ration health care as doctors become scarce and as expenses rise. You can count on it happening. Obama will not always be there to stop the program from rationing health care. Even if he were, he will no more stop the rationing then, then he has stopped the rationing already in the Medicare program, which is just now enlarging the review programs to ration care under his watch!

Update on the Uninsured

Michael D. Tanner, a senior fellow at the Cato Institute, has updated us on the uninsured Americans, who according to the Census Bureau number 45.6 million. I have dealt with this issue of the uninsured in previous posts on 25 November 2007, 23 July 2008, 27 August 2008, and 29 August 2008.

The story now is similar. The uninsured are:

• 12 million eligible for Medicaid and the State Children's Health Insurance Program, including 64% of uninsured children and 29% of parents with children. If these people go to a hospital for treatment, they are automatically enrolled in the relevant program, so they are not really uninsured!
• 10 million who are not citizens of the United States, where 5.6 million are illegal immigrants and 4.4 million are legal immigrants.
• 43% of the uninsured have incomes greater than 250% of the poverty level or greater than $55,125 for a family of four. More than one-third have incomes over $66,000.
• Nearly three-quarters of the uninsured can afford health insurance coverage.
• 60% of the uninsured are under age 35 and 86% say they are in good or excellent health.
• About half are uninsured for less than 6 months, 30% for less than one year, 16% for less than 2 years, and less than 2.5% for 3 years or longer.

Tanner then says that with this information in hand, we should be able to produce a more focused plan to address the issue of the uninsured. The young and healthy who choose not to have health insurance, would be more willing to buy it if their premiums were not jacked up by community rating [plans have to accept the already ill, those with unhealthy lifestyles, and the old] requirements often required by the states, by eliminating the many mandated benefits that many people do not need or want, and by allowing people to buy insurance across state lines [in the spirit of the interstate commerce clause of the Constitution].

The generally short durations in which people do not have health insurance suggest that many lose it when they lose or change jobs. Some lose it because they have started a small business and current tax policies exclude many small business owners from tax deductions for health insurance. The best way to deal with this is to give everyone a large Health Savings Account (HSA) to purchase health insurance, but the Democrats hate this for no reason but that it removes health care decisions from politics and deprives them of political power. A great advantage of the HSAs is that they give health care users a reason to care about the cost and effectiveness of the health care they seek from providers. In the government-run system, no one has such reasons for personal interest so costs balloon.

Democrats claim that the massive health care overhaul is needed to address two issues:

• The many uninsured.
• The ever-increasing cost of health insurance.

Their answer is to create a new, government-run system which will force everyone to buy much more expensive health insurance than that bought by most people today. This will hit the young and the healthy the hardest. Then they will force the wealthier to pay for the insurance that the less wealthy are already buying or could buy at present prices. Of course, the unfunded Medicaid and Medicare programs will remain inadequately funded and will require either a huge future rationing of health care or huge additional taxes. This makes no sense at all, but never let it be said that Democrats are ever constrained by rationality. Demagoguery is so much more emotional fun. It is so easy to make people imagine that 47 million Americans are so poor that they cannot afford health insurance and they live for decades in terror of becoming ill without any way to pay for care.

Cannon: Massachusetts' Obama-like reforms increase health costs, wait times

Michael F. Cannon, of the Cato Institute, wrote an interesting article on the effects on health care of the Massachusetts reform of health care in 2006. He notes that:

• 29% of Massachusetts' voters believe the reform lowered the quality of care, while 10% believe it improved care.
• 27% believe reform made health care less affordable, while 21% believe it made it more affordable.
• 37% believe the reforms are a failure, while 26% believe they were a success.

But what on Earth do Massachusetts voters know anyway? They voted overwhelmingly for Dukakis, Gore, Kerry, and Obama. They also sent Teddy Kennedy to the Senate for 8 terms or 46 years, though he did not finish his last term in office. But, this health care reform was initially very popular in Massachusetts and it does have all the essential features of the Obama - Pelosi - Reid health care reform plans. The Massachusetts plan is already unpopular even in a state much committed to socialism and despite the fact that many of its faults are hidden as yet from many of the people.

Massachusetts did reduce the number of uninsured by two-thirds, or 432,000 people. The cost is at least $2.1 billion in 2009, or an average cost per 4-person family of about $20,000, which is well above the average cost of $13,000 of an employer-sponsored family policy. But, the average Massachusetts voter does not know how bad costs are because many of the costs are well-hidden from him.

As with the Obama - Democrat plans:

• Every person is required to pay for health insurance.
• Approved health insurance plans must accept already ill individuals.
• Approved plans must also cover prescription drugs, preventive care, diabetes self-management, drug-abuse treatment, early intervention for autism, hospice care, hormone replacement therapy, non-in-vitro fertility services, orthotics, prosthetics, telemedicine, testicular cancer, lay midwives, nurses, nurse practitioners, and pediatric specialists. The national plan will evolve in this direction due to lobbyist power also.
  
• 70 addition requirements for plans are under consideration in the legislature.
• Price controls to prevent insurers from basing premiums on the health of the individual.

So, what are the observed effects?

• Premiums are growing 21 to 46% faster than the national average, whose rapid growth rate is supposed to be a great part of the reason for a Massachusetts or Obama health plan.
• The young and healthy have to pay much more to cover the costs of those already sick and joining their plan.
• Low cost plans are no longer available.
• Plans with more extensive benefits than those required by Massachusetts are disappearing because the sick want to be in such very comprehensive plans. The costs for such plans are going up particularly quickly, so insurers will not offer them.
• In 2004, Boston already had the nation's longest waiting times for medical care of all metropolitan areas. The waits in Boston have since increased to 7 weeks, while the average wait in other metropolitan areas has shortened to 3 weeks.
• Taxes have been raised on hospitals, tobacco, insurers, employers, and coverage of legal immigrants has been reduced to eliminate the 20% of that cost charged to the state.
• The high costs caused a legislative commission to recommend a single-payer system such as Canada's and evidence-based purchasing strategies to ration care not only for Medicare patients, but now for everyone.
  

Many of the costs are not borne by the state. The individual mandate to own insurance has put about 60% of the increased costs on the individual's back. The federal government, or the federal taxpayer, pays about 20% of the costs, and the taxpayers of Massachusetts pay about 20% of the costs. In other words, the struggle that Massachusetts is having to pay the costs is due to only about 20% of the costs. Non-Massachusetts taxpayers are paying about 20% of the costs minus that amount paid by Massachusetts taxpayers as federal taxes. So, one way or another, Massachusetts taxpayers are paying more than 80% of the costs.

The Boston Globe badly misrepresented the cost to Massachusetts taxpayers as only about $88 million per year or about 19 times less than the real cost, despite taxpayers outside Massachusetts paying a very large tip on the tab. The New York Times did a more accurate job of estimating the costs: it was only a factor of 3 too low!

In Massachusetts, it is very clear that if you liked your health insurance plan, you were not allowed to keep it. Obama's promise does not apply in Obama-mad Massachusetts and for the same reasons, it will not apply in the entire U.S. soon after the Obama plan becomes law. We had better see to it that it does not become law.