No Runny Eggs

Tonight, President Obama will once again fill the living rooms of America.  Again he will be telling us that we have a crisis at hand and that “doing nothing is not an option.”  It’s being reported that he will make a clear and compelling argument that a government option is the “best way to introduce competition into they system.”  In essence, Obama’s argument this evening will ask us to trust the government to insert themself into a large, complex industry and that there will be no adverse affects to the overall system or end users.

This morning it is being reported that much, my guess nearly all, of the money lent to GM and Chrysler will be complete write offs for the American taxpayer.  Big surprise that!  Any high school accounting student could have told you that any money put into either of these companies had no expectation of being repaid.  Automotive is a large, complex industry that government has inserted itself into with unsuccessful results.  In fact, if you are one of the dealers who were closed even though you a major employer in a small community, had successful sales and high customer satisfaction, you’d say the results of government intervention were disastrous!

Yesterday, Senator Max Baucus released a framework for a health reform plan that has been worked on by a “Gang of Six” from the Senate.  Within the grand plan of Senator Baucus are still mandates for health care purchases, penalties on those who don’t and a government option, now called a coop. 

What is not in Senator Baucus’ plan is anything puts free market leverage on the health care system.  In fact, in one of the few attempts to put free market window dressing in his plan, where Baucus addresses removing the interstate sales restrictions on health insurance, there is no mandate for the removal.  Rather, Baucus’ plan allows states to from “compacts” amongst themselves that would allow insurance companies to sell across state lines of those within the compact.

The Baucus plan ends up being just the most recent attempt at “reform” who’s only real reform is using new words to describe an eventual government take over of the health care system.

Regardless of what is or isn’t included in the various attempts at health care to date, they all need to be scrapped.  Making anything of quality, be it a manufactured item, art or even food, usually requires following a specific process.  Even if you have the correct ingredients, it doesn’t work to just mix them or put them together in just any order you want.  While the current attempts may have some pieces that are worth discussing, none of them have been put together in the correct way.  Until we get a plan whose first ten precepts are based on increasing the leverage of the free market on health care, we should refuse to debate, opine or offer advice on them.  We should take the advice of Nancy Reagan and “Just say no!”

From the classic that is the original Star Wars movie (now Star Wars IV) during the attack on the death star:

As one of the rebellion pilots is heading to make the impossible shot that would destroy the death star Empire fighters are attacking from all directions.  The pilot loses his concentration as his head is spinning trying to keep track of the frenetic activity around him.  The leader of the attack then states his infamous line, “Stay on target!  Stay on target!”  In the end, he never gets his shot fired and is ultimately destroyed by one of the pursuing Empire fighters.

The month long Congressional recess has been an usually heady time for Conservatives.

First, after explaining to school administrators and the blogging world that we and our children “pledge allegiance to the flag” and not the president, the Obama acolytes resorted to using “in artfully worded” before redoing the “lesson plan” for Obama’s indoctrination speech to school children. 

Second, led by Worldnetdaily and Glenn Beck, Conservatives used the method that John McCain was too squeamish for and held Van Jones accountable for his extremist views, statements, actions and associates.  The result is that Van Jones has left the Obama administration “to seek other opportunities.”  Perhaps the most interesting aspect of both of these events is that neither of them had any of the D.C. Republican leadership leading them.  In fact, now now that I think about it, what was the last issue of substance that any of the D.C. Republican leadership?

Finally, Conservatives have successfully led an effort to expose the truth about the Democrat’s attempts to nationalize health care.  In town hall meetings, blogs, rallies and one on one discussions, Conservatives came armed with facts that left their opponents either lying or stumbling through things they made up.  Regardless of how many times President Obama or Democrat leadership claimed “it wasn’t in there,” the majority of Americans believe it is “in there” and they don’t like it.  The situation has degraded so far that President Obama will be addressing a joint session of Congress on Wednesday evening in an attempt put the plan on some new track that could lead to success.

While the first two items clearly sent a message to the Obama administration that he was not elected to a monarchy, the final outcome of the last issue is still to be decided.

Innumerable articles have been written in the past 10 days opining on whether Obama can save the health care reform bill.  Amongst other topics, the articles discuss the pros and cons of a 60 vote Senate approval versus a reconciliation process, dropping a public option or moving to a coop and which group of Democrats are more likely to support or jump ship from President Obama.  With so many different experts and theories it’s hard to guess what scenario may play out in the coming weeks.  In fact, depending upon your own personal preference, if there isn’t an article supporting your theory, just wait another day and there likely will be one written.

Over the next few weeks the fight over health care reform will take many new turns.  Some events will likely be complete surprises.  We can certainly expect that as President Obama reengages in the fight we’ll see him hang “shiny bright objects”that are meant to distract conservatives from their focus on health care.  Whatever transpires, one thing is certain, the fight is far from over.  We can’t allow the victories of small skirmishes to lull us into any sense of accomplishment.  We must keep pressure on every Congressional representative until health reform that has any increase, or might allow any possible future increase of government intervention is dead, dead, dead.

For the next six weeks or so we need to stay focused, stay aggressive and keep the White House on the defense.  Every morning for the next six weeks you should wake up to the admonishment of Gold Five:

(H/T – Ed Morrissey)

It is almost as if our friends across the Atlantic are warning us of what is in store if we follow them into socialized medicine. The Daily Telegraph ran a story of how (Not-So-)Great Britain’s health-care “scrutiny” body, the inappropriately-named National Institute for Health and Clinical Excellence, has adopted a particularily cruel end-of-life program called the Liverpool Care Pathway. I’ll let The Telegraph explain what this “last hours treatment”, now in place in nearly 1,000 British health-care facilities at the insistence of NICE, is:

Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor.

They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication….

When a decision has been made to place a patient on the pathway doctors are then recommended to consider removing medication or invasive procedures, such as intravenous drips, which are no longer of benefit.

If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention.

Unlike the Terri Schiavo situation, where there were conflicting interpretations of the level of care she wanted, what is missing is any decision by either the patient or a patient’s family. Considering the average person spends roughly a third of his or her life asleep, I guess one should not fall asleep in a British hospital with a sore throat.

Seriously, the story goes on to report on a letter signed by several leading British palliative-care experts calling the LCP a “national crisis”. Quoting The Telegraph’s reporting on the letter:

“Forecasting death is an inexact science,” they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong.

“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients.”

Dr. Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer center in Guildford, told The Telegraph that he personally took patients off that pathway who went on to live for “significant” amounts of time because he did what many doctors don’t – keep monitoring the patient for signs of improvement. Those signs of improvement are harder to spot when a patient is under constant sedatement according to Professor Peter Millard, Emeritus Professor of Geriatrics, University of London.

Another problem with sedation while dehydrating is that a patient can enter a state of semi-consciousness and confusion. I wonder how many of the 16.5% of those who died in Britain in 2007 and 2008 during a state of continuous deep sedation, twice the rate in the Netherlands, which has a policy of physician-assisted suicide, suffered that state.

Of course, not all of those in Not-So-Great Britain are doomed to such a fate. Just ask Abdel Baset ali Megrahi, who got a get-out-of-Britain-free card after serving less than 12 days per person he and his Libyan associates murdered in the bombing of Pan Am Flight 103. Of course, he wasn’t a loyal subject of the British crown; he was a mass-murdering thug.

Every time attempt at a government run or mandated health plan has resulted in some form of rationing.  There is no exception to this rule.  The reason for this is quite simple.  Once people get something that appears to have no cost to it they will demand more and more of it.  As folks demand more and more it costs more and more to provide the service.  At some point, even the most arrogant printers of money will realize that there has to be some cap on the total costs.

Canada, England, Cuba and Massachusetts all have rationing occurring in their plans.  Rationing can take all kinds of forms; from the most blatant and obvious forms of outright denying the particular service to the less obvious like someone not answering a phone to accept an appointment. 

Since the rationing issue has been raised, those who support Obamacare have been besides themselves telling us that there will be no rationing in this plan.  As evidence, they often point to Medicare and Medicaid as shining utopian examples of everyone gettng all the health care they need without a hint of rationing.

An article from Tuesday’s USAtodayshows just how Medicaid is implementing rationing.  As a result of budget constraints the State of Louisiana has cut payments made to service providers of Medicaid by 10%.  The result?  68% of surveyed physicians will begin rationing of services to Medicaid patients.  Oh, they won’t refuse to perform a procedure that a patient needs, they’ll just quit accepting new patients, stop accepting referrals or for nearly 16%, quit seeing medicaid patients altogether. 

In a separate but related article, Bloomberg reportsthat the Obama administration’s plan to take $1.4 billion in payments from physicians who provide Medicare patients heart or cancer treatment and shift it to family practice physicians will likely result in fewer cardio and cancer physicians.

Folks, you can call it anything you want; cost shifting, benefit reduction or some other euphemism.  The fact remains that no matter what you call it, you will have to recognize it as rationing.

Earlier this year the Obama administration eliminated several words and phrases from the English language.  “War on terror,” “enemy combatants” and finally the word “terrorism” itself was eliminated from the Obama lexicon.  According to Janet Napolitano this is the officially approved, new language:

“I did not use the word ‘terrorism,’ I referred to ‘man-caused’ disasters. That is perhaps only a nuance, but it demonstrates that we want to move away from the politics of fear toward a policy of being prepared for all risks that can occur.”

Well, I guess we can all understand how emotionally charged the word “terrorism” is.  We can understand that using it does nothing but inflame a situation that might otherwise be solved by clear thinking adults. 

From BarackObama.com as part of an organizing call to flood Congressional offices with calls supporting health care reform on 9/11:

All 50 States are coordinating in this – as we fight back against our own Right-Wing Domestic Terrorists who are subverting the American Democratic Process, whipped to a frenzy by their Fox Propaganda Network ceaselessly re-seizing power for their treacherous leaders.

So now, according to President Obama’s own website, those of us (the majority of Americans) who oppose the government’s further involvement with our heath care are terrorists. 

You’re not a terrorist if you rape, brutalize and kill innocent children, but if you disagree with the President….watch out!

As I’ve been listening to various talk radio programs I’ve heard the following new meme proffered by Obamacare supporters, at least four times in the past 48 hours:

We have to pass a government option!  2/3rds of the bankruptcies in the US are caused by medical bills!

The basis for this argument is found in this recent study in the American Journal of Medicine.  A snippet of the conclusion of the study is as follows:

Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income.

At first look you’d have to say “Wow!”  Can nearly 2/3rds of bankruptcies be caused by the results of medical costs?  The answer, after you look at the study and some other information is “No.”

Brett J. Skinner did a great job of deconstructing the noted study.  His article, here, noted several items that left the study’s conclusions suspect.

First, Skinner makes the logical comparison with Canada.  With the bankruptcy law very similar in the two countries, and Canada having a government provided health care system, if the studies conclusions are correct, we should expect to see significantly lower bankruptcy rates in Canada.  We don’t.  In both 2006 and 2007 Canada had a higher bankruptcy rate per population than we had in the US.

Secondly, Skinner looked at other studies done on the topic.  One of those analysis was done by the Department of Justice:

finding that medical debts accounted for only 12 percent to 13 percent of the total debts among American bankruptcy filers who cited medical debt as one of their reasons for bankruptcy.

So now your question ought to be, “Is it possible to reconcile the study with the data Skinner found or is the study a fraud?”  Thanks for asking, I think I can reconcile the two.

Going back to the original study we find Table 1 shows that the mean negative net worth (the excess of debt over assets) is not materially different between those who claimed to file bankruptcy due to medical reasons (-$44,622) and those who filed for other reasons (-$37,650).  On page 4 we see that the average, total, not just the unpaid portion of out of pocket medical costs for those that filed bankruptcy for medically bankrupted families was $17,943.  If we assume that the entire amount of out of pocket costs were left unpaid and counted in the negative net worth (it wouldn’t be but let’s use it for a moment), that would still leave a negative net worth of approximately $27,000. 

A negative net worth of $27,000 would typically not be from a home mortgage as most of those would not be allowed to borrow more than the equity.  Also, remember that the study was done in 2007 before the current melt down and reduction in home values.  A negative net worth could be partially incurred from a vehicle as most new vehicles are upside down in equity for the first year or two of ownership.  However, with the average mean income reported as only $30,000, one wouldn’t expect a whole lot of really expensive new vehicles included in the negative net worth of this sample.  A negative net worth of $27,000 likely comes from one place, credit cards or uncollateralized loans.

While the study didn’t break it out this way, it appears to me that the average person who claims they filed for bankruptcy because of medical reasons also had significant credit card debt.  I suspect, but can’t prove it with what is in the study, that the individuals who filed for medical bankruptcy didn’t file only because of the medical costs.  Likely, the medical costs were the “straw that broke the camel’s back.”  And, while medical was the straw for these people  in this instance, the straw could have been any of a number of other things i.e. a major car repair, a major home repair or any number of other unexpected items. 

It appears to me that rather than any one specific issue, like most other bankruptcies, the folks that this study looks at had a series of issues with the last one in line, for them, medical expenses, being more than they could recover from.  In their case, medical costs were just one of the issues that led them to bankruptcy.  To say medical expenses were the reason that these folks filed for bankruptcy is about as accurate as saying that the Titanic sank because it was holding too much water.