Death Panels in/out of Medicare, Obamacare still Betting on Death to Cut Costs

Posted by PITHOCRATES - January 5th, 2011

Death is more Cost Efficient than Life

First they denied it.  Then they backtracked when everyone could see they were included.  Then they pulled them.  Then they tried to sneak them back (see Administration reverses on end-of-life counseling by Ricardo Alonso-Zaldivar, The Associated Press, posted 1/5/2011 on The Washington Post).

Medicare coverage for voluntary end-of-life planning was part of the original House version of the overhaul legislation in 2009, but it was dropped after Sarah Palin and other Republicans raised the specter of “death panels” deciding the fate of vulnerable seniors. Those charges were later debunked by several non-partisan fact-checking groups.

I keep hearing this.  That they’re not death panels.  They’re actually good things that people want.  But I have to ask this.  Why are they constantly trying to sneak this legislation in?  I mean, Obamacare itself is controversial and unpopular.  The people already hate it.  So why are they hiding these so called death panels that aren’t death panels?

I can think of only one reason.  Cost control.  With Social Security, Medicare and Medicaid all projected to go bankrupt in the not so distant future, there’s no way that Obamacare can escape that same fate.  Unless sick people die quicker.  Before the government spends a fortune trying to extend their lives. 

Yes, it’s a grim prospect.  But that’s the only way you can save cash-strapped programs that incur costs from sick and dying people.  You stop spending money on sick and dying people.  That way you can take in more money than you pay out.  Do that and these programs (Obamacare, Social Security, Medicare and Medicaid) can stay solvent.  And there is only one way to do this.  You have to ‘let’ people die.  You get them to choose death.  By persuading them that it’s for the best.  For them.  Their family.  And for the country.  In other words, death panels.  Because death is more cost efficient than life.

Obamacare Welfare:  Wealth Transfer from the Responsible to the Irresponsible

This is what they want to hide from the people.  Because it’s just too ghoulish.  It’s something the Nazis did.  Getting rid of undesirables.  Or the stuff of science fiction like Soylent Green.  Only without the cannibalism.  So far, that is. 

I joke, of course.  Then again, no one knows what’s in the Obamacare legislation.  No one read it.  At least, no one that voted for it.  After all, it was the now deposed Speaker of the House, Nancy Pelosi, who said we’d have to pass Obamacare to learn what was in it.  So anything can be in it.  We just don’t know.  But we’re learning.

The new regulations have already exploded private health care costs.  Even though they said it wouldn’t.  In fact, everything was supposed to get cheaper.  But when you force private insurers to cover preexisting conditions, they have to act accordingly. 

With preexisting coverage, no one will buy insurance.  They’ll save their money for car payments.  New entertainment centers.  Jet skis.  You know, fun stuff.  Then, if a kid gets leukemia or some other catastrophic diagnosis, then they’ll buy insurance.  Get the picture?  The only people buying insurance will be those with catastrophic medical expenses.  People who will be consuming millions in benefits but only pay a pittance in premiums.  And that ain’t insurance.  That’s pure welfare wealth transfer.  From the responsible.  To the irresponsible.

The House Rules Enabled Corruption and Backroom Deals

And this is just asinine.  So how did they pass something this stupid into law?  Well, have you seen the House rules (see New rules in the House of Representatives by Felicia Sonmez posted 1/5/2011 on The Washington Post)?  Here’re some of the rules back then.  When Congress slipped Obamacare into law.

  1. 1.  No “Constitutional Authority Statement” was required.  A similar statement was required only for bills reported out of committee and was included in the committee report.
  2. 2.  Only bills reported out of committee were required to be “made available” three days before a vote, and they were not required to be posted online.
  3. 3.  Spending increases could be paid for by spending cuts or tax increases.
  4. 4.  Committee chairmen did not have term limits.
  5. 5.  Legislation was not required to be posted online before it was marked up.
  6. 6.  The “Gephardt Rule” allowed the House to automatically raise the debt limit when a joint budget resolution was adopted.
  7. 7.  The Constitution has never been read in full on the House floor.

This is not what the framers of the Constitution had in mind.  Not even Alexander Hamilton (the biggest of the ‘big government’ Founding Fathers).  In fact, he would be as shocked as his arch nemesis, Thomas Jefferson (who thought any central government was too much central government).  (Just to prevent any confusion, Jefferson was in France during the Constitutional Convention and did not participate.  His assault against the Constitution escalated after ratification.)

The Constitution means something.  It’s the Rule of Law for the central government.  The Constitution has to authorize everything the central government does.  Why?  Because that’s the law.  And we’re a nation of laws.  At least, we used to be.

The fact that Congress has never read the Constitution in full on the House floor is worrisome.  Why haven’t they?  Are they trying to bury the restrictions it places on Congress?  It would appear so.  And that lawmakers look at it as more of a nuisance than as the foundation of our nation.  Something that checks their power and spending sprees.  Which tax and spend Big Government types just don’t like.

The other rules just invite corruption and backroom deals.  The very thing Jefferson warned about.  And he was right.  Because that’s what it took to pass Obamacare.  They bribed Congress people to vote for it.  The Cornhusker Kickback bribed Nebraska Senator Ben Nelson.  The Louisiana Purchase bribed Louisiana Senator Mary Landrieu.  And a laundry list of bribes to other people and organizations.  Hidden in the bowels of the health care reform bill.  Which was fast-tracked into law before anyone read it.  Thanks to the rules of the House.

The New 112th Congress to Revise House Rules to Stop the Corruption and Backroom Deals

But all is not lost.  The new 112th Congress is proposing to change the rules.  They even plan to read the Constitution in full on the House floor.  It may be the first time some will learn what’s in it.  And that’s good.  Here are some of the other changes (these numbers correlate to the numbers above):

  1. 1.  All proposed bills must be accompanied by a “Constitutional Authority Statement” that notes the specific section of the Constitution that empowers Congress to enact the legislation.
  2. 2.  All bills must be posted online for three days before they are put up for a vote.
  3. 3.  Spending increases have to be offset by cuts of an equal or greater amount elsewhere and cannot be paid for by tax increases.
  4. 4.  Committee chairmen have a six-year term limit.
  5. 5.  The text of legislation must be posted online 24 hours before it is due to be marked up in committee; the House Rules Committee is exempt from this rule.
  6. 6.  A new rule eliminates automatic debt-limit increase upon passage of joint budget resolutions.
  7. 7.  A full reading of the Constitution will take place on Thursday, the second day of the 112th Congress.

It’s a start.  It might stop some of the Founding Fathers from spinning in their graves.  Probably not Jefferson, though.  It’s going to take a whole lot more to soothe his distraught spirit.

Revised House Rules a Good First Step.  Repealing Obamacare a Good Second Step.

So maybe with the new Congress and the new House rules (if adopted) will prevent another corrupt bill like Obamacare from sneaking through backrooms and into law.  Good.  But that’s just a start.  Now we have to address Obamacare itself.  We need to repeal it.  For a plethora of reasons (see New Congress Begins Fight to Repeal Obamacare and Get Health Care Reform Right by Kathryn Nix posted 1/4/2011 on Heritage’s The Foundry).  Many already know some of these reasons.  But it’s good to keep talking about them.

The negative effects of Obamacare will be felt by all Americans. The new law includes several new taxes and penalties for businesses that threaten to kill job growth and further damage the economy. Budget gimmicks and double counting of savings mean Obamacare will increase federal deficit spending significantly.

Obamacare does nothing to reform the systemic problems and unfunded liabilities represented by Medicare and Medicaid. Instead, the new law uses savings in Medicare to fund a new entitlement that experts expect to greatly exceed its projected cost. Obamacare does not fix Medicaid, which already performs poorly, but adds more to its ranks as a means to reduce the uninsured.

Obamacare increases premiums and overall health spending in the U.S. Instead of allowing insured Americans to keep their current coverage, the new law will cause millions to change or lose their health plans. Last but not least, Obamacare will increase federal control of every aspect of the health sector, increasing the role of bureaucracy in the practice of medicine and interfering in the doctor–patient relationship.

If you want more detail, you can find them in Impact of ObamaCare at The Heritage Foundation.   

If we repeal Obamacare, the death panels become a moot point.  And our deficit and debt crises become that much easier to manage.  As will the Social Security, Medicare and Medicaid crises.  So let’s do it.  Repeal Obamacare.

Give Grandma a Chance

Obamacare is bad.  We should repeal it.  Death panels and all.  Instead of putting all our eggs into the ‘death’ basket, we should give living a chance.  But we need to get away from welfare.  And move into insurance.  Pay our own way for expected, routine costs.  And buy insurance to protect our finances from unexpected, extraordinary costs.  And allow insurers to compete across state lines, tort reform, etc.  You know, the usual, sensible stuff.

Come on.  Give Grandma a chance.  Repeal Obamacare.

www.PITHOCRATES.com

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Partnering with the Grim Reaper: Saving Medicare, Medicaid and Obamacare

Posted by PITHOCRATES - December 29th, 2010

Taxing the Young to Save Medicare for the Old

Medicare and Social Security make up the lion’s share of the federal budget.  The government is setting records for both deficits and debt.  And everyone is projecting both of these programs to go bankrupt.  A dim picture for anyone hoping to rely on either for their retirement.  And they’re worried (see AP-GfK Poll: Baby boomers fear outliving Medicare by Jennifer Agiesta and Ricardo Alonso-Zaldivar posted 12/29/2010 on the Associated Press).

A new Associated Press-GfK poll finds that baby boomers believe by a ratio of 2-to-1 they won’t be able to rely on the giant health insurance plan throughout their retirement.

The boomers took a running dive into adolescence and went on to redefine work and family, but getting old is making them nervous.

Now, forty-three percent say they don’t expect to be able to depend on Medicare forever, while only 20 percent think their Medicare is secure. The rest have mixed feelings.

The problem with both Medicare and Social Security is that they are both Ponzi schemes.  Scams by the government to make generations dependent on government.  And to funnel a lot of cash to Washington.  But the Baby Boomers mucked up the works.  Their free love in the 60s and use of birth control and abortion left their family tree a barren one.  The boomer generation of families with maybe 2-3 kids will support in retirement their parent’s generation of families with 10+kids.  There’ll be more people entering retirement than entering the workforce to pay for those retirees.

Here’s the math: when the last of the boomers reaches age 65 in about two decades, Medicare will be covering more than 80 million people. At the same time, the ratio of workers paying taxes to support the program will have plunged from 3.5 for each person receiving benefits currently, to 2.3.

And the numbers are worse.  Because Social Security will be covering those same people.  We’re approaching one working person supporting one person in retirement (Medicare and Social Security benefits combined).  Even Bernie Madoff’s great Ponzi scheme had a better ratio when his pyramid imploded.  It just isn’t sustainable anymore.  Something’s gotta give.  And by something I mean benefits paid out to people.

The government can’t balance its books without dealing with health care costs, and Medicare is in the middle. Some leading Republicans and a few Democrats have called for phasing out the program and instead giving each retiree a fixed payment — or voucher —to help them buy private medical insurance of their choice. The poll found doubts about the idea, and a generational debate.

Overall, a narrow majority (51 percent) of Americans opposed the voucher plan. But those born after 1980 favored it by 47 percent to 41 percent, while seniors opposed it 4-to-1. A majority of boomers were also opposed, with 43 percent strongly objecting.

And here’s the problem.  Those who don’t pay payroll taxes anymore (retirees) are all for raising taxes to pay for their current level of benefits.  No matter how much it bankrupts future generations.  And these people vote.  More than anyone else.  So for good reason they call Social Security the third rail of politics.  You touch it at your own peril.  Those with a lifetime of paying taxes ahead of them, on the other hand, would rather raise a family than support an individual in retirement.  Not only do they want to touch the third rail, they want to short it out.  But they don’t have the numbers.  Yet.

States to Make Steep Cuts in Medicaid to Stave off Bankruptcy

And we even haven’t talked about Medicaid yet.  This program is bankrupting the states.  It’s their biggest budget item.  And they can’t sustain it any longer (see Medicaid Pushes U.S. States Off ‘Cliff’ as Governors Seek Cuts by Christopher Palmeri and Pat Wechsler posted 12/22/2010 on Bloomberg).

Governors nationwide are taking a scalpel to Medicaid, the jointly run state and federal health-care program for 48 million poor Americans, half of whom are children. The single biggest expense for states, Medicaid consumes about 22 percent of their total $1.6 trillion in expenditures, more than what is allocated to elementary and secondary education, according to a National Governors Association report.

Talk about being stuck between a rock and a hard place.  You know that states aren’t going to cut education.  The unions won’t let them.  So they have to address the 800 pound gorilla in the room.  And cut Medicaid.

Governors are slashing Medicaid to close as much as $140 billion in budget deficits for the 12 months starting in July 2012, after eliminating $130 billion in gaps this year, according to the Center on Budget and Policy Priorities, a Washington-based research group. Spending is being cut even though state revenues rose for the three quarters ended Sept. 30, as the U.S. recovered from the longest recession since the Great Depression, the Nelson A. Rockefeller Institute of Government in Albany, New York, said in a Nov. 30 report.

“I don’t think most states want to sentence people to death,” said Judy Solomon, co-director of health policy at the Center on Budget and Policy. “But what we see is a pretty bleak picture of tough cuts made this year, and next year’s numbers look worse.”

The sad truth is that sick people are costly.  Dead people aren’t.  So you can see where this is going.  Rationing.

Spending on Medicaid nationwide rose 8.8 percent last year, the most since 2002, according to Kaiser. Nearly every state issued at least one new policy to cut program costs in the past two years, including benefit reductions, increased copays and lower reimbursements to health-care providers.

Cost cutting and reductions in benefits.  Rationing.  And you know where that will lead to.  More dead people.  Which is the only thing that will save Medicaid.  That, or federal contributions.

Every state has a unique formula for calculating the federal contribution for Medicaid. The 12 with the highest personal income, including California, New York, New Jersey, Connecticut and Colorado, typically depend on the U.S. government for about half their expenditures.

Lucky for the states that the federal government has money to spare.  Wait a tic, they don’t.  They’re setting record deficits and debt.  They don’t have the money.  Especially now that they’ve thrown Obamacare into the mix.  And the cost for this behemoth will dwarf Medicare and Medicaid.

States face the prospect of enrolling 16 million more people in Medicaid beginning in 2014 under the Patient Protection and Affordable Care Act, the health-care law Obama signed in March. It expands coverage to include certain childless adults under 65, according to Foley & Lardner LLP, a law firm in Milwaukee. The federal government will pay 100 percent of the increased expense for the first three years.

Well, perhaps not.  They’ll be sticking the states with some of those costs.  Poor states.  These unfunded federal mandates are killing them.  But they won’t be the only ones dying.  In three years time, when those federal subsidies expire, some of the current Medicaid patients may lose their heath care benefits.  And die.

Death Panels to Decide Life and Death

The problem with healthcare is that the raison d’être of healthcare is the very thing bankrupting it.  Providing healthcare to sick and dying people.  If the sick and dying would just hurry up and die these healthcare programs (Medicare, Medicaid and Obamacare) would be just fine.  If only there was some mechanism to encourage people to take a pill to manage pain instead of consuming expensive healthcare services.  I mean, they are only delaying the inevitable.  They should just suck it up.  And do the right thing.  After receiving something like, oh, I don’t know, let’s call it end of life counseling (see WSJ Opinion Death Panels Revisited posted 12/29/2010 on The Wall Street Journal).

On Sunday, Robert Pear reported in the New York Times that Medicare will now pay for voluntary end-of-life counseling as part of seniors’ annual physicals. A similar provision was originally included in ObamaCare, but Democrats stripped it out amid the death panel furor. Now Medicare will enact the same policy through regulation.

We hadn’t heard about this development until Mr. Pear’s story, but evidently Medicare tried to prevent the change from becoming public knowledge. The provision is buried in thousands of Federal Register pages setting Medicare’s hospital and physician price controls for 2011 and concludes that such consultations count as a form of preventative care.

No wonder they hid it.  Encouraging people to hurry up and die.  That’s something that doesn’t win you points at the PTA.  The law as written isn’t all that bad, though.  The panels are voluntary.  So far.  But everything Big Government has done started small.  They are, after all, the master of incrementalism.  And with out of control healthcare spending bankrupting Medicare and Medicaid, what do you think these panels will evolve into?

The regulatory process isn’t supposed to be a black-ops exercise, but expect many more such nontransparent improvisations under the vast powers ObamaCare handed the executive branch. In July, the White House bypassed the Senate to recess appoint Dr. Berwick, who has since testified before Congress for all of two hours, and now he promulgates by fiat a reimbursement policy that Congress explicitly rejected, all while scheming with his political patrons to duck any public scrutiny.

If there was nothing to hide they wouldn’t have hidden this provision so deep in the federal register.  But when you hide things, there are reasons you hide them.  So much for transparency.  And the most ethical Congress ever (of course an ethical Congress is a moot point when the executive rules by fiat).

Under highly centralized national health care, the government inevitably makes cost-minded judgments about what types of care are “best” for society at large, and the standardized treatments it prescribes inevitably steal life-saving options from individual patients. This is precisely why many liberals like former White House budget director Peter Orszag support government-run health care to control costs: Technocrats in government can then decide who gets Avastin for cancer, say, and who doesn’t.

When a government bureaucrat decides who gets life-saving medication and who doesn’t, that sounds like a death panel to me.  Because that decision has the power of life and death.  They can be as nontransparent as they want but the truth is pretty clear.  To control the out of control spending of Medicare and Medicaid (and, in time, Obamacare), they will be partnering with the Grim Reaper.  Because dead people don’t consume health care benefits.  And that is their biggest problem.  Consumers of benefits.

The Swedish National Health Care System Rations Care

So what about the social utopias of European Socialism?  Those advanced nations that have national healthcare?  Are they having these problems?  Of course they are.  In fact, their future is ours.  Here’s a small sampling of what to expect (see Man’s penis amputated following misdiagnosis posted 12/29/2010 in Science and Technology on The Local).

A Swedish man was forced to have his penis amputated after waiting more than a year to learn he had cancer.

The man, who is in his sixties, first visited a local clinic in Blekinge in southern Sweden in September 2009 for treatment of a urinary tract infection, the local Blekinge Läns Tidning (BLT) reported.

When he returned in March 2010 complaining of foreskin irritation, the doctor on duty at the time diagnosed the problem as a simple case of inflammation.

After three weeks passed without the prescribed treatment alleviating the man’s condition, he was instructed to seek further treatment at Blekinge Hospital.

But it took five months before he was able to schedule an appointment at the hospital.

When he finally met with doctors at the hospital, the man was informed he had cancer and his penis would have to be removed.

It remains unclear if the man would have been able to keep his penis had the cancer been detected sooner.

The matter has now been reported to the National Board of Health and Welfare (Socialstyrelsen) under Sweden’s Lex Maria laws, the informal name used to refer to regulations governing the reporting of injuries or incidents in the Swedish health care system.

Misdiagnosis.  And long waits.  National healthcare.  Where government bureaucrats cut costs and make doctors work long hours.  Not a very attractive offer for all those years of medical school.  So there’s a doctor shortage.  And, consequently, long waits.  In this case, 6 months to be advised he needed to go someplace else.  Then another 5 to get an appointment someplace else.  In the mean time the cancer spread.  This is what happens when you ration health care.

Is this the future you want?  It’s not the future I want.

The Third Rail of Politics is a Generational Thing

It’s a generational battle.  The young want to cut taxes (and benefits).  Because they’re paying those taxes.  And not consuming the benefits.  The old want to raise taxes and maintain benefits.  Because they’re not paying those taxes.  But are consuming the benefits.  Right now there are more old than young.  So you can guess who will win this struggle.  Bankrupting the future will help the politicians stay in office today.  So the old will win.

But there is a little irony in all of this.  To save these programs (Medicare, Medicaid and Obamacare), they need old people to die.  But once they do, the politicians will lose their political support.  The younger generation (whose future the politicians mortgaged) will then broom them out of office.  And they will be all too glad to short out that third rail once and for all.

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