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Health Care Bill info from the Liberty Counsel

(HT: Davy Buck on Southern Appeal)

You can find it in either PDF or html form. It is a summary (including very brief commentaries) of parts of HR 3200. It was, according to the document, "reviewed, revised and adapted on July 29, 2009, by Liberty Counsel from the original authored by Peter Fleckenstein and posted on FreeRepublic.com and his blog, http://blog.flecksoflife.com." I reproduce it in its entirety below.

  • Sec. 113, Pg. 21-22 of the Health Care (HC) Bill MANDATES a government audit of the books of ALL EMPLOYERS that self-insure in order to “ensure that the law does not provide incentives for small and mid-size employers to self-insure”!
  • Sec. 122, Pg. 29, Lines 4-16 - YOUR HEALTH CARE WILL BE RATIONED!
  • Sec. 123, Pg. 30 - THERE WILL BE A GOVERNMENT COMMITTEE deciding what treatments and benefits you get.
  • Sec. 142, Pg. 42 - The Health Choices Commissioner will choose your benefits for you. You have no choice!
  • Sec. 152, Pg. 50-51 - HC will be provided to ALL NON-US citizens.
  • Sec. 163, Pg. 58-59 beginning at line 5 - Government will have real-time access to individual’s finances & a National ID health care card will be issued!
  • Sec. 163, Pg. 59, Lines 21-24 - Government will have direct access to your bank accounts for electronic funds transfer.
  • Sec. 164, Pg. 65 is a payoff subsidized plan for retirees and their families in unions & community organizations (ACORN).
  • Sec. 201, Pg. 72, Lines 8-14 - Government is creating an HC Exchange to bring private plans under government control.
  • Sec. 203, Pg. 84 - Government mandates ALL benefit packages for private Health Care plans in the exchange.
  • Sec. 203, Pg. 85, Line 7 - Specifications of benefit levels for plans means that the government will define your HC plan and has the ability to ration your health care!
  • Sec. 205, Pg. 95, Lines 8-18 - The government will use groups (i.e., ACORN & AmeriCorps) to “inform and educate” (sign up) individuals for government plan.
  • Sec. 205, Pg. 102, Lines 12-18 - Medicaid-eligible individuals will be automatically enrolled in Medicaid. No freedom to choose.
  • Sec. 223, Pg. 124, Lines 24-25 - No company can sue the government for price-fixing. No “administrative of judicial review” against a government monopoly.
  • Sec. 225, Pg. 127, Lines 1-16 - Doctors – the government will tell YOU what you can make. “The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year.”
  • Sec. 312, Pg. 145, Lines 15-17 - Employers MUST auto-enroll employees into public option plan.
  • Sec. 313, Pg. 149, Lines 16-23 - ANY employer with payroll $400,000 and above who does not provide public option pays 8% tax on all payroll.
  • Sec. 313, Pg. 150, Lines 9-13 - Businesses with payroll between $251,000 and $400,000 who do not provide public option pay 2-6% tax on all payroll.
  • Sec. 401.59B, Pg. 167, Lines 18-23 - ANY individual who does not have acceptable care, according to government, will be taxed 2.5% of income.
  • Sec. 59B, Pg. 170, Line 1 - Any NONRESIDENT alien is exempt from individual taxes. (Americans will pay for their health care.)
  • Sec. 431, Pg. 195, Lines 1-3 - Officers and employees of HC Administration (government) will have access to ALL Americans’ financial and personal records.
  • Sec. 441, Pg. 203, Lines 14-15 - “The tax imposed under this section shall not be treated as tax.” Yes, it says that.
  • Sec. 1121, Pg. 239, Lines 14-24 - The government will limit and reduce physician services for Medicaid. Seniors, low income and poor are the ones affected.
  • Sec. 1121, Pg. 241, Lines 6-8 - Doctors, it does not matter what specialty you have; you’ll all be paid the same. “Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.”
  • Sec. 1122, Pg. 253, Lines 10-23 - The government “validates work relative value units” (sets value of doctor’s time), professional judgment, methods etc. (defining the value of humans).
  • Sec. 1131, Pg. 265 - Government mandates and controls productivity for private HC industries. “Incorporating Productivity Improvements into Market Basket Updates that Do Not Already Incorporate Such Improvements.”
  • Sec. 1141, Pg. 268 - The government regulates rental and purchase of power-driven wheelchairs.
  • Sec. 1145, Pg. 272 - Treatment of certain cancer hospitals: Cancer patients and their treatment are open to rationing!
  • Sec. 1151, Pg. 280 - The government will penalize hospitals for what government deems preventable readmissions (incentives for hospital to not treat and release).
  • Sec. 1151, Pg. 298, Lines 9-11 - Doctors, treat a patient during initial admission that results in a readmission and the government will penalize you for that action.
  • Sec. 1156, Pg. 317, Lines 13-20 - “PROHIBITION on physician ownership or Investment.” Government tells doctors what/how much they can own.
  • Sec. 1156, Pg. 317-318, Lines 21-25, 1-3 - “PROHIBITION on Expansion of Facility Capacity.” The government will mandate that hospitals cannot expand (“number of operating rooms or beds”).
  • Sec. 1156, Pg. 321, Lines 2-13 - Hospitals have opportunity to apply for exception BUT community input required.
  • Sec. 1162, Pg. 335-339, Lines 16-25 - The government mandates establishment of outcome-based measures. Rationing.
  • Sec. 1162, Pg. 341, Lines 3-9 - The government has authority to disqualify Medicare Advantage Plans (Part B), HMOs, etc. This will force people into a government plan. “The Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part.”
  • Sec. 1177, Pg. 354 - Government will RESTRICT enrollment of special needs people! “Extension of Authority of Special Needs Plans to Restrict Enrollment.”
  • Sec. 1191, Pg. 379 - Government creates more bureaucracy – “Telehealth Advisory Committee.” HC by phone or the Internet – dial 1 for your health care advice?
  • Sec. 1233, Pg. 425, Lines 4-12 - Government mandates Advance (Death) Care Planning consultation. Think Senior Citizens and end of life. END-OF-LIFE COUNSELING. SOME IN THE ADMINISTRATION HAVE ALREADY DISCUSSED RATIONING HEALTH CARE FOR THE ELDERLY.
  • Sec. 1233, Pg. 425, Lines 17-19 - Government WILL instruct and consult regarding living wills and durable powers of attorney. Mandatory end-of-life planning!
  • Sec. 1233, Pg. 425-426, Lines 22-25, 1-3 - Government provides approved list of end-of-life resources, guiding you in death.
  • Sec. 1233, Pg. 427, Lines 15-24 - Government mandates program for orders for life-sustaining treatment (i.e. end of life). The government has a say in how your life ends.
  • Sec. 1233, Pg. 429, Lines 1-9 - An “advanced care planning consult” will be used as patient’s health deteriorates.
  • Sec. 1233, Pg. 429, Lines 10-12 - “Advanced Care Consultation” may include an ORDER for end-of-life plans - from the government.
  • Sec. 1233, Pg. 429, Lines 13-25 - The government will specify which Doctors (professional authority under state law includes Nurse Practitioners or Physician’s Assistants) can write an end-of-life order.
  • Sec. 1233, Pg. 430, Lines 11-15 - The government will decide what level of treatment you will have at end of life, according to preset methods (not individually decided).
  • Sec. 1302, Pg. 468, Lines 16-21 - “Community-Based Home Medical Services means a nonprofit community-based or state-based organization.”
  • Sec. 1302, Pg. 472, Lines 14-17 - PAYMENT TO COMMUNITY-BASED ORGANIZATION: One monthly payment to a community-based organization. Like ACORN?
  • Sec. 1308, Pg. 489 - The government will cover Marriage and Family therapy. This will involve government control of your marriage.
  • Sec. 1308, Pg. 494-498 - The government will cover Mental Health Services including defining, creating and rationing those services.
  • Sec. 1401, Pg. 502 - Center for Comparative Effectiveness Research Established. Big Brother is watching how your treatment works.
  • Sec. 1401, Pg. 503, Lines 13-19 - The government will build registries and data networks from YOUR electronic medical records. “The Center may secure directly from any department or agency of the United States information necessary to enable it to carry out this section.”
  • Sec. 1401, Pg. 503, Lines 21-25 - The government may secure data directly from any department or agency of the US, including your data.
  • Sec. 1401, Pg. 503, Lines 21-25 - The “Center” will collect data both “published and unpublished” (that means public & your private information).
  • Sec. 1401, Pg. 506, Lines 19-21 - An “Appointed Clinical Perspective Advisory Panel” will advise The Center and recommend policies that would allow for public access of data.
  • Sec. 1401, Pg. 518, Lines 21-25 - The Commission will have input from HC consumer representatives.
  • Sec. 1411, Pg. 524, Lines 18-22 - Establishes the “Comparative Effectiveness Research Trust Fund.” More taxes for ALL.
  • Sec. 1441, Pg. 621, Lines 20-25 - The government will define “NEW Quality” measures in HC. Since when does government know about quality?
  • Sec. 1442, Pg. 622, Lines 2-9 - To pay for the Quality Standards, government will transfer money from “qualified entities” (government Trust Funds) to other government Trust Funds. More Taxes.
  • Sec. 1442, Pg. 624, Lines 19-23 - Qualified Entities: “The Secretary shall ensure that the entity is a public, nonprofit or academic institution with technical expertise in the area of health quality measurement.”
  • Sec. 1442, Pg. 623, Lines 5-10 - “Quality” measures shall be designed to assess outcomes and functional status of patients.
  • Sec. 1442, Pg. 623, Lines 15-17 - “Quality” measures shall be designed to profile you, including race, age, gender, place of residence, etc.
  • Sec. 1443, Pg. 628 - The government will give “Multi-Stake Holders” pre-rulemaking input into selection of “quality” measures.
  • Sec. 1443, Pg. 630-31, Lines 9-24, 1-9 - Those Multi-Stake Holder groups include unions and groups like ACORN deciding what constitutes quality.
  • Sec. 1444, Pg. 632, Lines 14-25 - The government may implement any “Quality measure” of HC services that bureaucrats see fit.
  • Sec. 1444, Pg. 632-333, Lines 14-25, 1-9 - The Secretary may issue nonendorsed “Quality Measures” for physician and dialysis services.
  • Sec. 1251 (beginning), Pg. 634 to 652 - “Physician Payments Sunshine Provision” – government wants to shine sunlight on Doctors but not government. “Reports on financial relationships between manufacturers and distributors . . . and between physicians and other health care entities.”
  • Sec. 1501 (beginning), Pg. 659-670 - Doctors in Residency – government will tell you where your residency will be, thus where you’ll live.
  • Sec. 1503 (beginning), Pg. 675-685 - Government will regulate hospitals in EVERY aspect of residency programs, including teaching hospitals.
  • Sec. 1601 (beginning), Pg. 685-699 - Increased funding to fight waste, fraud, and abuse. (Like the government with an $18 million website?)
  • Sec. 1619, Pg. 700-703 - If your part of HC plan isn’t in the government’s HC Exchange but you qualify for federal aid, you don’t have to pay.
  • Sec. 1128G, Pg. 704-708 - If the Secretary determines there is a “significant risk of fraudulent activity,” on HC provider or supplier, the government can do a background check.
  • Sec. 1632, Pg. 710, Lines 8-14 - The Secretary has broad powers to deny HC providers and suppliers admittance into HC Exchange. Your doctor could be thrown out of business.
  • Sec. 1637, Pg. 718-719 - ANY Doctor who orders durable medical equipment or home medical services is REQUIRED to be enrolled in, or eligible for, Medicare.
  • Sec. 1639, Pg. 721 - Government MANDATES that Doctors must have face-to-face with patient to certify patient for home health services.
  • Sec. 1639, Pg. 723-24, Lines 23-25, 1-5 - The same government certifications will apply to Medicaid and CHIP (Children’s health plan: Your kids).
  • Sec. 1640, Pg. 723, Lines 16-22 - The government reserves right to apply face-to-face certification for patient to ANY other HC service.
  • Sec. 1651, Pg. 734, Lines 16-25 - Proposes, for law enforcement sake, that the Secretary of HHS will give Attorney General access to ALL medical data.
  • Sec. 1701 (beginning), Pg. 739-756 - The government sets guidelines for subsidizing the uninsured (and you have to pay for them).
  • Sec. 1704, Pg. 756-761 - The government will shift burden of payments to Disproportionate Share Hospitals (DSH) to states (your taxes).
  • Sec. 1711, Pg. 764 - The government will require preventative services - including vaccinations (no choice).
  • Sec. 1713, Pg. 768 - Government-determined Nurse Home Visitation Services (Hello union paybacks).
  • Sec. 1713, Pg. 768, Lines 3-5 - Nurse Home Visit Services – Service #1: “Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.” Compulsory ABORTIONS?
  • Sec. 1713, Pg. 768, Lines 11-14 - Nurse Home Visit Services include determinations of economic self-sufficiency, employment advancement and school-readiness.
  • Sec. 1714, Pg. 769 - Federal government mandates eligibility for State Family Planning Services. Abortion and government control intertwined.
  • Sec. 1733, Pg. 788-798 - Government will set and mandate drug prices, therefore controlling which drugs are brought to market. (Goodbye innovation and private research.)
  • Sec. 1744, Pg. 796-799 - Establishes PAYMENTS for graduate medical education. The government will now control your doctor’s education.
  • Sec.1751, Pg. 800 - The government will decide which Health Care conditions will be paid. Say “RATION!”
  • Sec. 1759, Pg. 809 - Billing Agents, clearinghouses, or other alternate payees are required to register. The government takes over private payment systems too.
  • Sec. 1801, Pg. 819-823 - The Government will identify individuals “likely to be ineligible” for subsidies. Will access all personal financial information.
  • Sec. 1802, Pg. 823-828 - Government sets up Comparative Effectiveness Research Trust Fund. Another bottomless tax pit.
  • Sec. 4375, Pg. 828-832, Lines 12-16 - Government will impose a fee on ALL private health insurance plans, including self-insured, to pay for Trust Fund!
  • Sec. 4377, Pg. 835, Lines 11-13 - Fees imposed by government for Trust Fund shall be treated as if they were taxes.
  • Sec. 440, Pg. 837-839 - The government will design and implement Home Visitation Program for families with young kids and families that are expecting children.
  • Sec. 1904, Pg. 843-844 - This Home Visitation Program includes the government coming into your house and teaching/telling you how to parent!
  • Sec. 2002, Pg. 858 - The government will establish a Public Health Fund at a cost of $88,800,000,000 (That’s Billions).
  • Sec. 2201, Pg. 864 - The government will MANDATE the establishment of a National Health Service Corps.
  • Sec. 2201 - “Fulfillment of Obligated Service Requirement”
  • Sec. 2201, Pg. 864-875 - The NHS Corps is a program where Doctors perform mandatory HC for 2 years for partial loan repayment.
  • Sec. 2212, Pg. 875-891 - The government takes over the education of Medical students and Doctors through education and loans.
  • Sec. 340L, Pg. 897 - The government will establish a Public Health Workforce Corps to ensure an adequate supply of public health professionals.
  • Sec. 340L, Pg. 897 - The Public Health Workforce Corps shall consist of civilian employees of the United States as Secretary deems necessary.
  • Sec. 340L, Pg. 897 - The Public Health Workforce Corps shall consist of officers of Regular and Reserve Corps of Service.
  • Sec. 340M, Pg. 899 - The Public Health Workforce Corps includes veterinarians. Will animals have heath care too?
  • Sec. 2233, Pg. 909 - The government will develop, build and run Public Health Training Centers.
  • Sec. 2241, Pg. 912-913 - Government starts a HC affirmative action program under the guise of diversity scholarships.
  • Sec. 2251, Pg. 915 - Government MANDATES cultural and linguistic competency training for HC professionals.
  • Sec. 3111, Pg. 931 - The government will establish a Preventative and Wellness Trust fund, with initial cost of $30,800,000,000 (Billions more).
  • Sec. 3121, Pg. 934, Lines 21-22 - Government will identify specific goals and objectives for prevention and wellness activities. More control of your life.
  • Sec. 3121, Pg. 935, Lines 1-2 - The government will develop “Healthy People & National Public Health Performance Standards.” They will tell us what to eat?
  • Sec. 3131, Pg. 942, Lines 22-25 - “Task Force on Community Preventive Services.” More government? Under the Offices of Surgeon General, Public Health Services, Minority Health and Women’s Health.
  • Sec. 3141, Pg. 949-979 - BIG GOVERNMENT core public health infrastructure includes workforce capacity, lab systems, health information systems, etc.
  • Sec. 2511, Pg. 992 - Government will establish school-based “health” clinics. Your children will be indoctrinated and your grandchildren may be aborted!
  • Sec. 399Z-1, Pg. 993 - School-Based Health Clinics will be integrated into the school environment. More government brainwashing in school.
  • Sec. 2521, Pg. 1000 - The government will establish a National Medical Device Registry. Will you be tracked?
(Originally posted on First Thoughts)

Comments (105)

If this is accurate, I'm soooo so pissed for being charitable with these guys. This plan is asinine!

Half this list is honest-no-bones-about-it scary. The other half is scary only because I think some assumptions that aren't in the language of the bill are being injected into the summary without much justification. I would recommend reading the original bill itself in relation to each of these points. The legal language is not as dense as most that I have the displeasure of reading, honestly.

Todd, it's the "without much justification" thing I can't help wondering about. I really doubt that much benefit of the doubt should be given to Obama and the architects of Obamacare. If anything, he has downplayed the truly radical nature of the views of his advisers in various areas, including healthcare, and the amount of power given to government means that those views are pertinent to predicting how the law will be applied.

If there is one point that has resonated with the public in this debate it is that whatever comes out of Congress, our representatives should be required to participate. Then if they, our duly elected members of Congress, knew they would have no choice, their decisions and their ideas would evolve over a much longer period of time with more patience, research, discussion, and consensus. How do we as concerned citizens work toward this outcome? Any ideas?

Todd, it's the "without much justification" thing I can't help wondering about.

The list provides no means, in some cases, to get from the bill as written to the conclusions or BOLD FACE questions raised. They're good for sound bites and quotable snippets and they're obviously intended to incite outrage and in most cases they appear correct. But I would like to know how the authors got to their conclusions, I can't simply accept them in all cases as the summaries are frequently a level of abstraction above the wording of a bill.

I really doubt that much benefit of the doubt should be given to Obama and the architects of Obamacare.

Most assuredly; we should give them not an inch nor quarter. But upon reading the list as an independent document, and reading the wording of the bill referenced in the above list, I can't make the connection in some cases and wish that it were made more explicit.

If anything, he has downplayed the truly radical nature of the views of his advisers in various areas, including healthcare, and the amount of power given to government means that those views are pertinent to predicting how the law will be applied.

that's what I would like to see... advisor X holds Y, therefore section Z items 1, 3 and 4 would give the government power to enact Y. Maybe the reader of the scare list is assumed to know this, I just think it would best to spell those not-as-clear-as-others connections.

Such as the first responder's post: If this is accurate.... He and I would benefit from seeing, explicitly, how accurate some of those claims are.

We, the contributors and (most) readers of this blog can probably be trusted to go through the necessary motions to verify these statements (I have not, yet). Out in the wild, it's going to look and feel like a scare list, end up on snopes with a 'mixed true and false' declaration and discarded as an irrational, inflamatory argument and simple scare tactic against the Obamacare plan. I just think we owe it to the cause to remain better philosophers.

Of course it could just have been the repeated use of ALL CAPS. I don't like being yelled at, even when it's from my own team. It's like intellectual friendly fire.

Why should we take seriously something that was written by a person who doesn't even know how to reference items in legislation or was written by someone who was trying to confuse (the format makes it near impossible to keep all the subsections and sub paragraphs in line)?

For example, "Sec. 1233, Pg. 429, Lines 13-25 - The government will specify which Doctors (professional authority under state law includes Nurse Practitioners or Physician’s Assistants) can write an end-of-life order."

I assume this is the item referenced, "(2) A practitioner described in this paragraph is--

`(A) a physician (as defined in subsection (r)(1)); and

`(B) a nurse practitioner or physician's assistant who has the authority under State law to sign orders for life sustaining treatments."

Why not Sec. 1233(a(2)? Then we are all on the same page, what he was referencing was clear, and one isn't dependent on one source. Besides, why is it unreasonable to specify the professional level of a person acting as a medical consultrant?

Anyway, here is another assertion, "# Sec. 1233, Pg. 429, Lines 10-12 - “Advanced Care Consultation” may include an ORDER for end-of-life plans - from the government."

Here is the section, "10 ‘‘(4) A consultation under this subsection may in11
clude the formulation of an order regarding life sustaining
12 treatment or a similar order."

I don't see the government mentioned and if we read the next paragraph and put things in context,

" (5)(A) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--

`(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional's authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;

`(ii) effectively communicates the individual's preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

`(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items--

`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

`(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;

`(iii) the use of antibiotics; and

`(iv) the use of artificially administered nutrition and hydration.'."

This is SEC. 1233(a)(1)(B). It adds a new subsection to the Social Security Act (42 U.S.C.) It is dishonest to ignore (5) and read (4) as a stand-alone item (which is itself unproblematic if read honestly).

Todd, please give us a few scary items that will stand up to analysis, I have yet to find any.

Lydia, you wrote, "If anything, he has downplayed the truly radical nature of the views of his advisers in various areas, including healthcare, and the amount of power given to government means that those views are pertinent to predicting how the law will be applied," but no references and exactly how much power? How about enlightening us as to your sources, Dr. Beckwith's don't seem to serious.

As one example: David Blumenthal, appointed to be "national coordinator of health information technology," believes in government cost control. These two items make sense, because apparently the position to which he has been appointed will involve giving doctors electronic guidelines for care. (Relevant to bullet point #3, for example.) Ezekiel Emmanuel, who has been appointed as "health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research," is explicit that doctors should not simply be thinking about what is best for the patient in Hippocratic care fashion but rather should consider costs as well. Emmanuel also is explicitly on record as saying that health care "should not be guaranteed" to patients with dementia. (I have linked in my other post the full article in which Emmanuel makes the statement about dementia.)

http://www.nypost.com/seven/07242009/postopinion/opedcolumnists/deadly_doctors_180941.htm?page=0

This is relevant to all of the above pertaining to determinations regarding conditions and payment, incentives to doctors or hospitals against readmission, etc.

Al, both I and Wesley Smith and Lane (in the Post article Frank lists in a different post) have discussed in some detail the issues related to the new doctor-initiated counseling to try to induce elderly patients to sign an advance directive.

But I'm beginning to remember why I prefer to blog about this subject at my personal blog.

Over and out.

I just read sections 123 and 201-203. Yes, this committee will have enormous power over what health care is available in America. Yes, this should disturb any sensible person.

By the way, I have not had time even to read the Liberty Council's entire list and, a fortiori, haven't had time to check myself on all its items. But in line with the responsible citizenship Todd urges, and to show that I am not simply reckless to possible concerns about exaggeration, I will mention that I happen to know that the home visits the list mentions are expressly said in the law to be voluntary. For my part, I'm not happy about home visits of this kind and with these goals once the health care system of our country is increasingly a government entity. So I do not fault the Liberty Council for raising some concerns. However, as Wesley Smith has pointed out, the express language stating that the visits are voluntary could with profit be added as well to the section on end-of-life counseling sessions, and it is cause for concern that it has not been added. So _at least_ the bill says that in theory you get to say "no" to a health care professional, ultimately and significantly answerable to the government, who wants to come into your home to counsel you on your most intimate family matters. Yippee.

Correct me if I'm wrong, but many of us have health plans that ration and some of us have no health coverage, so I'm sort of at a loss as to know what's wrong with the government rationing care. Surely it must be the way that they are rationing care, but if I can't get the government to pay for that which no one else is going to pay for I just don't see how this is a threat or a harm. It's the absence of a benefit that some of you are happy for us to not have under the present system.

Does anyone care to find the page on which there's warrant for Palin's claim:
"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil."

As for the notorious pp. 425, "Government provides approved list of end-of-life resources, guiding you in death." Is that a wrong-making feature? They are offering to pay for counseling services that you don't need to take advantage of. Bad? Bad how?

"Nurse Home Visit Services – Service #1: “Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.” Compulsory ABORTIONS?"

I'll wager that there won't be compulsory abortions. Who cares to take me up on this? C'mon, this is your chance to pump some money out of a liberal.

Clayton, I can see you haven't been reading. I already said, in the comment _immediately above_ yours, that it appears even the nurse visits will be voluntary. Moreover, in other posts, which I mentioned above, the counseling on end-of-life has been discussed. Finally, the ambiguity on "rationing" is rather frustrating. The assumption liberals make, and expect all the rest of us to be too tongue-tied to question, is that when the government, amoeba-like, takes over most of the health care industry, government rationing of services means nothing more than "government's not paying, but no problem for you to get it some other way." Balderdash. Getting non-covered services is always extremely difficult where health care has been nationalized. This is why Canadians come to the U.S., with money in hand, willing to pay. Because in Canada it isn't just a matter of, "Oh, the government won't pay for that, but you're welcome to give us money and then you can have that." Rather, the service is not available in Canada, or not before a waiting period the patient finds understandably unacceptable. They have to come here to be *able to pay money* for it. For example: The commission decides what benefits are covered, and then "private" plans are gradually chivvied into becoming part of the "health care exchange." Which means they won't cover what the Committee doesn't want covered either.

Why should we take seriously something that was written by a person who doesn't even know how to reference items in legislation

Good point. There should be actual passages quoted from the bill and auditability for all of us who want to understand this better.

Besides, why is it unreasonable to specify the professional level of a person acting as a medical consultrant?

In what capacity are they consulting? Will they have a vested interest or personal agenda in ensuring greater cost containment? Can one be truly "neutral" about matters of life or death? Will subtle soft pressure be applied to either the dying who already feel like a burden, or to medical professionals reporting upstream to a government agency/review board as a result of this legislation?

Transparency as been lacking on all sides of this debate, so before we go any further, what is your position on assisted suicide? Would it bother you if this bill led to greater acceptance of the practice?

I'll wager that there won't be compulsory abortions.

If abortions are subsidized there will be more abortions. Do you dispute that, or does that fact not bother you?

That would never bother Clayton, Kevin. I have been acquainted with him blogospherically from of old. As long as it's the woman's choice, y'know.

There will be no compulsory abortions, just as there is no compulsory elementary and secondary education.

It all depends what one means by "compulsory."

But one thing is for sure: those universities and colleges that do not provide abortion coverage to their employees will eventually be prohibited from advertising in Jobs for Philosophers. :-)

The government rationing care means that the government decides – by way of rationing it out to me – what medical care I am allowed to receive, and how much of it I am allowed to receive.

Health plans are a voluntary arrangement: you are not compelled to participate; hence you are not obliged to submit to the limits they set.

But I will not have such liberty with the proposed plan. Furthermore, I'm not really allowed to opt out of any plan altogether, because the bill requires me to do so (on pain of even higher taxes than the bill will require for those who do participate).

We will be compelled to accept the government's rationing plan. That is the antithesis of the present system.

Medical care is a scarce resource: there are not enough doctors for everyone to have all the medical care that they want at zero price. The way that the proposed law will "work" (I use the term loosely) is to promise some medical care at strictly controlled prices, and we are compelled to purchase them. The problem is that price controls (and make no mistakes about it: this is nothing but a price control scam) always result in shortages and lousy quality for legal goods. History amply demonstrates this. Canada and the UK amply demonstrate this, as Lydia just said.

Fred

The more I look at it the more I think that Todd has a point that the list _as presented_ is a mixed bag, though so far the only actually questionable items I have found are the implication of coerced home visits and the implication of coerced vaccinations. As far as I could see, the vaccination coverage section did not address the question of parental opt-out. Currently this is covered variously by state laws. It is a perfectly legitimate question whether those state laws on opting out would be modified or superseded by some sort of federal regulation once the federal government is covering vaccination, but as far as I can tell the section of the law referenced simply doesn't address that issue.

It would have been better for the think tank to take a few more days and to present a list in chunks with quotes from the law and/or discussion of legal background, legislative history, or opinions of those likely to be commissars to document all implications or alarms raised. Publishing in chunks would make it easier to read, and better documentation would have helped avoid accusations of alarmism and weed out errors.

There is plenty to be alarmed about, however. My comment above is exceedingly important for those who think this is just some sort of minimal floor and that care un-restricted by the government will be available for anyone who wants to pay for a "private plan." The chivvying of all plans gradually into the health care exchange is particularly concerning here. See also other discussions here at W4 about end-of-life counseling. And of course, as we know, a recent "compromise" has included abortion coverage in the bill.

It would be a mistake for anyone to think that the need to sift the LC's list here means that alarm is just a matter of conservative hype. Far from it.

I've not the slightest interest in affirmatively defending Obama's reform proposals, largely because I am skeptical of everything issuing from either of the wings of the duopoly, that singular bird of prey. Nonetheless, I am also skeptical of analyses such as the one proffered by the Liberty Counsel, notwithstanding the fact that, in some conservative circles, the absence of the correct sort of opposition is somehow transmuted into support. As an illustration of the basis for my skepticism, consider the construction placed upon Sec. 122, Pg. 29, Lines 4-16 - YOUR HEALTH CARE WILL BE RATIONED!

Actually, your health care, assuming that you are one of the Americans who has an existing health insurance plan, will not be rationed. You will be free to maintain that plan, provided either that your employer continues to offer the coverage, or that you can afford to purchase it in the individual market. One of the avowed purposes of the legislation being to extend coverage to the burgeoning numbers of Americans who lack adequate coverage, for whatever reason, the purpose of this section is to define the parameters for the minimum health insurance package that the insurance companies will be required to offer to that segment of the population pursuant to this legislation. Within that context, the limitations are intended to cap costs resulting from this aspect of the reform; those who wish to purchase coverage above and beyond these minimums will retain the ability to do so. The remaining question will then be one of financing, as many of those currently uninsured will require subsidies or credits of one sort or another in order to avail themselves of this basic package.

Notice that this issue is distinct from the question of whether a public option, if included - it won't be; if this passes, it will be a massive giveaway to the interested industries, much as Medicare schedule D was - will gradually subvert the private industry, leaving only the public option as a viable option for the majority of Americans, where the public option will be defined with such limitations as provided for in the private basic coverage.

Moreover, the fretting about insurance exchanges is somewhat amusing. I purchase auto insurance through an exchange, and there are no real limitations upon the coverages that one can purchase, if one so desires. Conservatives would do well to focus on mandatory abortion coverage and other obvious red flags, as opposed to red herrings.

"If abortions are subsidized there will be more abortions. Do you dispute that, or does that fact not bother you?"

That wasn't the complaint. The complaint wasn't the relatively sensible one (i.e., should someone who objects to abortion be forced to subsidize abortion), it was a "concern" about the batsh** crazy one (i.e., they're going to make us have abortions).

"Clayton, I can see you haven't been reading. I already said, in the comment _immediately above_ yours, that it appears even the nurse visits will be voluntary. Moreover, in other posts, which I mentioned above, the counseling on end-of-life has been discussed."

That's true, I read Frank's stuff and not yours. That's because I was evaluating Frank's claims rather than yours. I've been busy and haven't had a chance to keep up with your comments. At any rate, it looks like I repeated something that you said that Frank hadn't addressed. So we sort of agree that the point was misleading. I could see why that's frustrating, you must take that as strong inductive evidence that you've said something wrong.

Actually, your health care, assuming that you are one of the Americans who has an existing health insurance plan, will not be rationed. You will be free to maintain that plan, provided either that your employer continues to offer the coverage, or that you can afford to purchase it in the individual market....Moreover, the fretting about insurance exchanges is somewhat amusing. I purchase auto insurance through an exchange, and there are no real limitations upon the coverages that one can purchase

It might be behovely for you to go and read section 203 yourself, which certainly sounds on the face of it like the benefits offered by the exchange plans will be _set_ by the commission, including benefit levels for ostensibly better-level plans ("premium," etc.) It specifies, if this is relevant, that the entities offering these exchange plans must offer only one such plan on each desirability level for the area in question. I take it that this would mean that you couldn't get some plan that offered something not offered in one of the government-regulated plans. And here is an interesting sentence regarding the "premium-plus" plans: "A premium-plus plan is a premium plan that also provides additional benefits, such as adult oral health and vision care, approved by the Commissioner." (Emphasis added) How interesting. So these extra-super-duper good packages, this is under the _private_ exchange now, offer such benefits as are "approved by the Commissioner." This might just mean, Maximos, that the level of regulation and decision-making regarding what is covered under this sweeping health care bill is somewhat different from the situation w.r.t. your auto insurance, policy!

I shd. add that some earlier coverage made it clear that after a short transition period, insurance companies will only be able to enroll new participants in these highly regulated exchange plans.

Take note, Kevin. Your complaint about subsidizing abortion was only "relatively sensible."

Yes, William, I think the logic behind this is becoming clear; in order to insure more Americans we have to make sure there are fewer people.

The biggest savings for the system can be realized by reducing the number of those found at both the beginning and the end of life's mortal continuum, since it is they who are most dependent and demand the greatest care and resources.

The spirit of Thanatos married to Nurse Ratched Ceasarism underwrites this legislation.

Just a question from someone who hasn't had time to read any of the legislation: if the proposed healthcare plan will eventually squeeze out private agencies, why aren't the insurance lobbyists up in arms?

The Chicken

Because they anticipate rich subsidies for the coverage of the 47-million Americans who are presently uninsured.

"Approved by the Commissioner" brought to mind this famous scene:

http://www.youtube.com/watch?v=3q9WaW0_grw&feature=related

why aren't the insurance lobbyists up in arms?

The industry has already accomplished its main goal of at least curbing, and maybe blocking altogether, any new publicly administered insurance program that could grab market share from the corporations that dominate the business. UnitedHealth has distinguished itself by more deftly and aggressively feeding sophisticated pricing and actuarial data to information-starved congressional staff members. With its rivals, the carrier has also achieved a secondary aim of constraining the new benefits that will become available to tens of millions of people who are currently uninsured. That will make the new customers more lucrative to the industry. http://www.businessweek.com/magazine/content/09_33/b4143034820260.htm

The government will print money and funnel it to the insurance industry. For a while at least, as long as the economy sustains it, this will look like a bonanza to them. It's the doctors and nurses and their patients whose lives will be profoundly changed.

"The government will print money" means "the government will engage in legal counterfeiting." It is called "theft." Whether its the government, or Xavier the Xeroxer, flooding the market with phony bills diminishes the value of everyone's real cash. In other words, the government takes the value of your cash and gives it to those for whom it printed the money. It is, at the end of the day, a regressive tax.

Why doesn't the government just pass legislation and declare everyone "healthy" so that it can claim that it has solved the health care crisis?

As Bob Dylan once sang:

"Steal a little and they put you in jail
Steal a lot, and they make you king."

By the way, how much of the Troubled Assets Relief Program's $700 billion has been used to buy troubled assets so far? Thought so. How is the Treasury Dept and Federal Reserve being held accountable for their new powers? How's that audit coming? Is the federal health council or "independent" medical board going to be held accountable just like the Federal Reserve?

There is a special place in hell reserved for useful idiots who should have known better.

Thanks for providing this list. You've now given my wife and I something to read and kvetch about all night :)

As I write this there is an ad on the telly that is basically blue-sky speculation and outright lies. It is designed to scare us old folks into opposing any serious change in health care delivery. If this works; if all one has to do to stop something is scare a increasing demographic, we are doomed.

"Transparency as been lacking on all sides of this debate, so before we go any further, what is your position on assisted suicide? Would it bother you if this bill led to greater acceptance of the practice?"

No, it hasn't. One side is mostly making stuff up (David Frum has had some interesting comments though) and the other is trying to solve a problem. In an ideal world both sides would engage in constructive debate. We don't live in that world. One consequence of this is that concerned people have come to ask questions like yours, which I don't doubt are serious, but are irrelevant. (Just to avoid evasion charges - I see AS as a complex issue, not a binary decision for a society. Should any body be able to provide anybody else with the means to end their life? No. Should a person facing a painful terminal illness be able to acquire the means to properly end their life? Yes. Should this be dealt with on a federal level? No, it is properly a state matter and an individual decision. Will anything in this bill lead to more AS? Not in any section I've read and it would be extremely bad policy that I would oppose.)

"The government will print money and funnel it to the insurance industry. For a while at least, as long as the economy sustains it, this will look like a bonanza to them. It's the doctors and nurses and their patients whose lives will be profoundly changed."

""The government will print money" means "the government will engage in legal counterfeiting." It is called "theft." Whether its the government, or Xavier the Xeroxer, flooding the market with phony bills diminishes the value of everyone's real cash. In other words, the government takes the value of your cash and gives it to those for whom it printed the money. It is, at the end of the day, a regressive tax."

This is one of the canned, fall-back items that the right trots out on a regular basis. It can apply to almost any initiative. The echo chamber then picks it up, takes it as fact and embellishes it.

Look what happened here. A laundry list of one-liners is posted (it was obvious that it was nonsense but what ever). It is pointed out that we have a mix of unremarkable observations mixed with outright lies. We then segue to hobby horses like abortion and assisted suicide, wend our way through the rationing and Canada canards and wind up at Weimar.

This is from an IBD editorial (07/31/09):

"Can't happen here, you say? "One troubling provision of the House bill," writes Betsy McCaughey in the New York Post, "compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, Pages 425-430)."

From the same editorial:

"People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

The first isn't true and the second is just embarassing. Are conservatives capable of serious policy discussion?

This was over at Sullivan's blog in a letter from a reader about their child:

"At our first visit, she recommended a vaccination for a common virus. This is a virus that everybody gets, and is generally mild. With preemies, however, it can be quite severe and commonly results in hospitalization and even death. It should have been done in the NICU, but it had been missed. She scheduled us for the following week. She had to order the vax since it was quite expensive (a total of about $16K.) Two days beforehand, she notified us that our insurance company had denied the coverage as too expensive."

A friend of mine in her late twenties has her PhD and is well regarded in her field and has published, She would like to strike out on her own and has an excellent chance of being successful. She is also uninsurable and can't take the risk. Stories like hers and the preemie's are all too common in our disfunctional system. The human and economic costs are real.

There are real consequences for folks here and canned conservamania punctuated with off the wall quips is the best you can come up with?

"Thanks for providing this list. You've now given my wife and I something to read and kvetch about all night :)"

To make sense of some of the stuff you and your wife will also need to read the bill in parallel with the U.S. Code. Here is a link to Chapter 7,

http://www.law.cornell.edu/uscode/html/uscode42/usc_sup_01_42_10_7.html

Should a person facing a painful terminal illness be able to acquire the means to properly end their life? Yes
So you favor assisted suicide.
Will anything in this bill lead to more AS? Not in any section I've read and it would be extremely bad policy that I would oppose.
Why the turnabout, because it involves a federal agency? Is "mercy killing" now a states rights issue like slavery once was?
We then segue to hobby horses like abortion and assisted suicide
Hobby horses? Seems a strange way to refer to legitimate concerns about matters involving life and death. Such glibness only reinforces fears that the trade-off for your friend to strike out on her own requires that others be struck down.

Let's have a look and see if the summary matches the actual proposed bill. We'll start at the top.


Sec. 113, Pg. 21-22 of the Health Care (HC) Bill MANDATES a government audit of the books of ALL EMPLOYERS

Section 113 does not mandate a government audit of the books of all employers that self-insure. It mandates a government study of the large group insured and self-insured employer health care markets.

Sec. 122, Pg. 29, Lines 4-16 - YOUR HEALTH CARE WILL BE RATIONED!

Section 122 talks about a minimum level of coverage that "does not impose any annual or lifetime limit on the coverage of covered health care items and services" and the only limitations it talks about are limitations on the amount of cost sharing (e.g. co-payments) a patient is responsible for.

That doesn't sound like rationing to me.

*snip the rest of this*

What's the point of carrying on?
Clearly the author is happy to to outright lie about these things. Clearly people who should know better are happy to pass it along.

What's the point of trying to have an adult discussion on healthcare reform if people are just going to make things up?


unremarkable observations

Lest anything I said above be misconstrued, I certainly do not agree to regard the observations regarding the problems with this bill to be "unremarkable." Moreover, I think the rationing concerns very well-founded, and I suspect that plenty of other things in the LC list are correct as well, such as those about setting levels of physician payment. The latter is, after all, already a hallmark of Medicare/Medicaid. Expanding government control over the health care industry as a whole will only expand this attempt at artificially keeping down prices while vastly expanding entitlement--a common form of economic idiocy peculiar to the Left.

Frank: Just to be clear: In posting this, are you in any way endorsing this "information"?

If abortions are subsidized there will be more abortions. Do you dispute that, or does that fact not bother you?

To the extent there is any correlation, countries with national health insurance (which presumably covers legal abortions) generally have lower abortion rates, although there are multiple exceptions to the rule. If I were to venture a guess as to cause, it would be because those countries actively promote contraception education.

http://www.nationmaster.com/graph/hea_abo-health-abortions

If I were to venture a guess as to cause, it would be because those countries actively promote contraception education.

To my understanding, the statistics that are available actually indicate the reverse. In places where abortion is legal and readily available, contraception education correlates very well with increased rates of abortion. I will see if I can locate some of those statistics.

If I were to venture a guess as to cause, it would be because those countries actively promote contraception education.

What in God's name is contraception education? Do you mean the Pill is largely unknown, hard to procure, difficult to self-administer or somehow scarce here in the US?

Sounds like conscience balm for those growing a little uneasy about forcing the rest of us into subsidizing abortions.

Why is it necessary that Medicare pay for voluntary "end of life" counseling?

Do clergy typically charge for their insights? Or, is this a solution for a problem that doesn't exist and the creation for a new, morbid kind of "profession"; licensed advisors trained to soothingly inform us of our expiration dates?

I rarely say this, but Go, Kevin.

One side is mostly making stuff up (David Frum has had some interesting comments though) and the other is trying to solve a problem.

Al, is the White House being transparent? No mention of abortion at their reality check website?

http://www.whitehouse.gov/realitycheck/?e=10&ref=text

Is this any way to engage in constructive debate?

KevinDo clergy typically charge for their insights? Or, is this a solution for a problem that doesn't exist and the creation for a new, morbid kind of "profession"; licensed advisors trained to soothingly inform us of our expiration dates?

Oddly enough, end of life counseling already happens all the time.

Here's some free end of life counseling for you: if you don't already have one, you need to get yourself a healthcare power of attorney. Seriously.

On the other hand, if you want me to draw one up and go through it with you - explaining what it means, what options you have, and so forth - then I'm going to need to get paid.

Kevin,

The differences between Europe and the US on marriage and long-term relationships offer better insight. In Europe, it is still common for women to have long-term, stable relationships with a partner. In some form, family life is arguably actually healthier in much of Europe than it is in the US. Both sides are equally statist on most issues, but in the US, the state exists now to enable people to pursue their own happiness on someone else's dime.

Oddly enough, end of life counseling already happens all the time

James,
I know and it is done for free by thousands of clergy across the country. Are you saying this part of the bill is an attempt to subsidize Elder Law attorneys?

In some form, family life is arguably actually healthier in much of Europe than it is in the US
Mike T, You may be right, but Europe’s contraceptive ethos and antipathy towards children is not the spiritual or demographic model we want to adopt.

Mike T:

In some form, family life is arguably actually healthier in much of Europe than it is in the US

How acquainted are you with European life?

If anything, I've found their rather callous attitude towards life more appalling than Americans!

For example, they treat abortion as common as a daily cup of coffee.

As repugnantly awful as Americans are as regarding Pro-Life issues, they have yet to reach the nadir of monstrosity as these so-called sophisticated Europeans!

No turnabout, Assisted suicide involves criminal statutes that are properly dealt with by the states in our federal system. It is irrelevant to a health care reform bill. I call these things hobby horses because they are irrelevant to the matter at hand which is reforming insurance practices and general health care issues. Places, seasons, things like that.

"Al, is the White House being transparent? No mention of abortion at their reality check website?"

Kevin, there's a comment section, why not communicate your concerns. Also he will be at a town hall today at 1:00 PM EDT. CSPAN and the cables will carry it.

"Why is it necessary that Medicare pay for voluntary "end of life" counseling?

Do clergy typically charge for their insights? Or, is this a solution for a problem that doesn't exist and the creation for a new, morbid kind of "profession"; licensed advisors trained to soothingly inform us of our expiration dates?"

Here is a discussion you might be interested in:

http://voices.washingtonpost.com/ezra-klein/2009/08/is_the_government_going_to_eut.html

Turns out it was a Republican idea - and a good one. I don't know where your confusion over AS and advance directives comes from but they are two separate things. They have nothing to do with each other.

Nothing prevents a person from taking the forms and taling things over with a clergyman. Taxpayers subsidize the clergy by giving churches a tax break. Since we are dealing with medical issues, consulting with a medical professional is probably wise. This takes time and it is fair to compensate the doctor.

Lydia,I didn't call the problems enumerated "unremarkable", I called some of the observations "unremarkable". There are usually problems with every important bill - that is the nature of the legislative process. So far we have yet to see any "problem" from the list Dr. Beckwith posted that stands up to serious analysis. That is what would be expected from a series of one-liners by someone (the author, not the good Dr.) who clearly has problems with reading comprhension and the truth.

I put rationing in the canard category because it has been pointed out repeatedly, by folks, on the right and left, that any time you have scarce resources, rationing will result by one mechanism or another. Unless one is very wealthy ones health care is going to be rationed in some manner. What you need to explain, hopefully with a greater level of sophistication then "me conservative, government bad - always", is why I am better off with a system that rations my health care so the CEO of my insurance company can have a nine figure salery as opposed to a mere eight figure one (competition? Maybe with that insurance company that doesn't have a CEO, Oh. Competition doesn't work because payment is up front while claims, if made, come after one is locked in) then I am with a system that is run by folks who depend on my vote. Invoking hypothetical runaway costs is hardy persuasive when we already have real runaway costs with the present system.

You are better off with so-called "rationing" that simply limits your number of, say, chiropractor visits to 15 per year than with invidious rationing that limits your receipt of life-saving antibiotics on the grounds that you have dementia from Alzheimer's and hence that you cannot contribute well to civic society. Given the people involved in Obama's administration and their avowed opinions on these subjects, and given the fact that limiting chiropractor visits for everybody a la HMO's probably wouldn't save _enough_ money (because this bill is going to break the bank anyway), it is highly likely that we will have the latter kind of real rationing, which is the kind of thing I mean when I talk about "rationing."

Are you saying this part of the bill is an attempt to subsidize Elder Law attorneys?

If you also think that offering preventative healthcare is an attempt to subsidize doctors, then sure.

You are better off with so-called "rationing"....

But as between the latter sort of rationing and the sort of private sector rationing which deems necessary treatments for, say, cancer to be medically unnecessary for curable patients, there's not much to choose. Death by quality of life metric and death by medical loss ratio aren't really different, unless "letting die for reasons of utility" and "letting die for reasons of a profit and loss statement" are substantively different, which, come to think of it, they aren't, given that the latter is merely a quantification of utility in the form of money.

Taxpayers subsidize the clergy by giving churches a tax break.
Actually, churches are tax-exempt because of the 1st Amendment concerns about the separation of church and state, not so taxpayers can subsidize them since actually subsidizing clergy establishes religion in our legal system (which is a no-no). To view the tax exemption of churches as taxpayer subsidies is a historically ignorant step along the road of incoherence where all of a sudden we're subsidizing churches. Guess Jefferson missed that one!

"You are better off with so-called "rationing" that simply limits your number of, say, chiropractor visits to 15 per year than with invidious rationing that limits your receipt of life-saving antibiotics on the grounds that you have dementia from Alzheimer's and hence that you cannot contribute well to civic society."

I would agree if your example reflected reality but it doesn't and your point conflates different issues. It also has nothing to do with the health care bills,

Assuming the treatments are justified, chiropractor visits are limited solely to increase insurance company profits.

Not using antibiotics is a more complex issue. Ideally a person has indicated their wishes about these matters while they were still legally competent. That underlies the concerns of Sen. Isakson in advocating the counseling. Otherwise we can only rely on the decisions of next of kin. Lydia's preferred option is cruel and akin to torture in my opinion. This is one of these things about which folks will disagree.

If I indicate that I don't want antibiotics after my life has come to a certain turn, that is my right and my business. If Lydia prefers to prolong a mindless drool into eternity that is her right and her business. Both of our preferences should be respected.

Again, this is a fun discussion to have but we should be aware that it has nothing to do with the proposed health care legislation.

"Given the people involved in Obama's administration and their avowed opinions on these subjects,"

One is going to believe these things if one doesn't check ones sources. Accepting an editorial or op-ed that uses quoted passages without checking the original sources is simply irresponsible. Today I found this -

http://www.theatlantic.com/doc/199703/euthanasia

on Ezra Klein's blog. Turns out that Dr. Emanuel opposes legalizing assisted suicide and euthanasia.

Please, Maximos, you've already ignored one fact-check I gave you above. You know, the one where you parroted Obama's "you like your insurance, you can keep your insurance" line. Why should I try to do more? But for the record, no, bumping off Grandma by denying her antibiotics or ANH because she has dementia and Ezekiel Emmanuel doesn't think she contributes enough to civic society isn't the same thing as disagreeing with you about the purely medical value of some particular cancer treatment and hence denying payment for it to everybody. Or limiting chiropractor visits to everybody.

Invoking hypothetical runaway costs is hardy persuasive when we already have real runaway costs with the present system.

Runaway costs are the impetus for reform. If Obamacare fails to deal with them, then it is useless and should be rejected. Does Obamacare address the problem at all?

Al, excuse me? I posted a link from my previous post to the *entire text* of Emmanuel's article, as well as providing a lengthy quotation within the post. I encourage you to go look it up. Go ahead. Have fun. Oh, how wonderful. Emmanuel ostensibly opposes legalizing assisted suicide. I'm so impressed. Wonder how long that will last. But denying care to civic non-participants? No problem. It's "communitarian," you know. A point of agreement between communitarians and liberals. So says the article. Oh, excuse me: Not _guaranteeing_ care to them. So if the government amoeba takes over the whole healthcare industry, you can wave goodbye to Grandma with dementia, because "guaranteed" care will be the only kind there is. Or if Grandma is poor and the only kind she has is "guaranteed" care, forget about it. She can't participate in civic society.

As my brilliant teenage daughter says, "People with Alzheimer's don't participate in civic society? You mean _after_ being President?"

I'd be happy to go ahead but you have numerous posts, please help me out.

Oh, and I just went and read the Emmanuel article you linked. He actually advocates making "exceptions" to laws against PAS, so he actually wants it to be legally permitted in some cases. Overall, the article is pretty strong against PAS, but already in 1997 it was not actually complete opposition, only partial opposition. He indicates that PAS should remain formally illegal but implies that doctors should not be punished in "exceptional" cases where it was in fact, in his view, moral to bump off the patient because "everything had been tried."

Here is the link to my post. At the bottom of it I link the Hastings Center article, which actually pre-dates Emmanuel's 1997 piece on PAS.

http://www.whatswrongwiththeworld.net/2009/07/note_to_the_elderly_just_say_n.html

Assisted suicide involves criminal statutes that are properly dealt with by the states in our federal system. It is irrelevant to a health care reform bill. I call these things hobby horses because they are irrelevant to the matter at hand which is reforming insurance practices and general health care issues. Places, seasons, things like that.

Gee, and I thought emerging unwounded from the womb, or dying a natural death fell under the general rubric of “health care issues”.

We are being told that this legislation will simultaneously expand coverage and contain costs. We know what stages of life generate the most costs and we understand the subtle power of economic coercion. Living wills are widely available without being charged through religious entities, and of course can be obtained, less ideally while hospitalized. The formalization of end of life counseling should raise amber lights for anyone alarmed by the prospect of the elderly receiving “assistance” from persons handicapped by a non-transcendent vision and a possible financial stake in swaying the decisions of the emotionally vulnerable. Since you are pro-euthanasia, I understand your unreserved enthusiasm for this proposal. You will admit, you have a novel definition for “health care”. As for Obama’s desire to subsidize abortion by dishonest stealth, I understand that too, since it comports with his overall approach. Winding down in Iraq meant expanding operations in Afghanistan, banning torture means simply the continued outsourcing of it and greater transparency means shrouding key elements of his reform in secrecy and denial.

If you also think that offering preventative healthcare is an attempt to subsidize doctors, then sure.

I said lawyers, but what kind of healthcare will end of life counseling prevent? I think we’re getting to the heart of the issue here.

I said lawyers
I know. I was analogizing.

If offering end of life counselling is a subsidy to lawyers, then offering preventative care is a subsidy to doctors.

but what kind of healthcare will end of life counseling prevent? I think we’re getting to the heart of the issue here.

It will prevent the kind of healthcare the patient wants prevented.

Al,
Obama might as well say; Here's some more Change We Can Believe In, Suckers ;

Last week, after being reported in the Los Angeles Times, the White House confirmed it has promised Big Pharma that any healthcare legislation will bar the government from using its huge purchasing power to negotiate lower drug prices...Any bonanza for the drug industry means higher health-care costs for the rest of us, which is one reason why critics of the emerging healthcare plans, including the Congressional Budget Office, are so worried about their failure to adequately stem future healthcare costs. To be sure, as part of its deal with the White House, Big Pharma apparently has promised to cut future drug costs by $80 billion. But neither the industry nor the White House nor any congressional committee has announced exactly where the $80 billion in savings will show up nor how this portion of the deal will be enforced. In any event, you can bet that the bonanza Big Pharma will reap far exceeds $80 billion. Otherwise, why would it have agreed?

In return, Big Pharma isn't just supporting universal health care. It's also spending a lots of money on TV and radio advertising in support. Sunday's New York Times reports that Big Pharma has budgeted $150 million for TV ads promoting universal health insurance, starting this August (that's more money than John McCain spent on TV advertising in last year's presidential campaign), after having already spent a bundle through advocacy groups like Healthy Economies Now and Families USA.
Robert Reich
http://tpmcafe.talkingpointsmemo.com/talk/blogs/robert_reich/2009/08/how-the-white-houses-deal-with.php?ref=fpblg

If offering end of life counselling is a subsidy to lawyers, then offering preventative care is a subsidy to doctors

End of life counseling is, as you said earlier, already available for free. Why the provision for lawyers now?

It will prevent the kind of healthcare the patient wants prevented.

That's it? So, the permanently despairing as the Economist called them, can refuse what exactly? Whatever they want? Frankly I wish you were the public face of Obama's propoasal because the debate would be more honest and open than it is now.

So, the permanently despairing as the Economist called them, can refuse what exactly? Whatever they want?

This is why I made the charge of hypocrisy in the last thread. Patients can ground all sorts of refusal of treatment in religious motives, but if someone dares decide not to undergo the trials of fighting for every breath against a terminal illness or extending their twilight wait for death in a permanent coma, suddenly it is imperative that their personal beliefs be trampled on.

Related to what Al said, in a townhall meeting another member of Congress mentioned that this language in the bill was requested by senior groups. They were the ones who wanted to have more control over end of life decisions, and by having it with their current doctor it would be easier for everyone to be on the same page.

Do you mean the Pill is largely unknown, hard to procure, difficult to self-administer or somehow scarce here in the US?

It isn't unknown or scarce here, but it is self-administered in an inaccurate way, since over half of women getting abortions believed they were protected by contraception.

You may have noticed the very high rate of abortion in Russia. Part of that is because there is a social taboo against discussion of sexuality in that culture, so contraception is not discussed at home or through the education system. The Pill also has a limited availability, in rural areas it is difficult to find at all, in urban areas it is estimated about a quarter of women of reproductive age use any kind of contraception.

no, bumping off Grandma by denying her antibiotics or ANH because she has dementia and Ezekiel Emmanuel doesn't think she contributes enough to civic society isn't the same thing as disagreeing with you about the purely medical value of some particular cancer treatment and hence denying payment for it to everybody.

Actually, yes it is, because they're not "disagreeing about the medical value of the treatment", but determining that providing the treatment would cut into their medical loss ratios, which is to say, determining that the provision of the necessary treatment would be unprofitable; this utilitarian judgment is then veiled by a mystagogical invocation of medical criteria. Please. It doesn't take much effort to ferret out examples of patients denied treatments, treatments that would have been effective, that would have prolonged life, and cases, moreover, of patients so denied who then basically went through bankruptcy to pay for the treatments the insurers should have paid for, and did indeed survive (physically).

As regards the other question I've raised about the Liberty Counsel's analysis, the definition of minimum benefits is undertaken by regulators on the state level at present, and so I'm a bit unclear on the particular innovation here, except that this impresses me as a heavy-handed approach to an insurance exchange. Moreover, I'm not aware of any provision mandating the conversion of existing policies to those offered under the exchange, nor of any sunset provision setting a date beyond which policies not conforming to the strictures of the exchange may not be issued, speculation in some conservative circles notwithstanding. I'll be accepting of contrary evidence, provided that it is actual evidence, and not a worst-case scenario parsing of legal jargon; but as for the matter of private insurance exclusions and limitations, no, these are not solely, or even primarily, the results of differing medical judgments, not by a longshot.

Patients can ground all sorts of refusal of treatment in religious motives, but if someone dares decide not to undergo the trials of fighting

Are you saying agnostics and non-believers are being forced into prolonged and painful deaths that Christians routinely avoid?

Is that the "problem" you have uncovered and now seek to remedy through this bill?

over half of women getting abortions believed they were protected by contraception

That is an argument against contraception. The Pill unnaturally separates couples from sexual union, creating such profound personal and social disorder that the taking of innocent lives becomes an acceptable back-stop for a mechanical, denatured people who robotically rely on chemicals to alter their natural biology.

Maximos, I grow impatient. I already quoted to you evidence *from the law* that these are not merely "minimum benefits" but rather appear to be creating clone policies. But what do you care? Anything that doesn't advance the "pox on both their houses" meme is uninteresting to you.

As to this:

Moreover, I'm not aware of any provision mandating the conversion of existing policies to those offered under the exchange, nor of any sunset provision setting a date beyond which policies not conforming to the strictures of the exchange may not be issued, speculation in some conservative circles notwithstanding.

Maybe you should get aware. It's not as though it has not been documented. Speculation, my foot. Here is the relevant quotation, which I have *just now copied* from section 110 of the law at the government's site:

IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.

Don't give me any !@#$ about "worst-case scenario parsings." All coverage offered to patients on or after the beginning of the effective date of the law must be offered only as "exchange-participating."

And, yes, deciding that people with dementia should not be treated *because they have dementia* or *because their quality of life is too low* is a great deal worse than denying everybody X expensive drug, even if the evil, evil profit motive enters the latter calculation. Obviously, you do not have this ethical intuition. But then again, maybe that ethical intuition would just interfere once more with your desire to shake anathemas out to left and right with a sort of blogospheric aspergillium. And since such even-handed anathematizing is your entire blogospheric raison d'etre, indeed, since sending such a "both are equally bad" message to us all, repetitiously, regarding this important matter of Obamacare is the only thing that can get you out of blog hibernation, facts--moral or material--cannot be allowed to get in the way. Harrumph.

And, yes, deciding that people with dementia should not be treated *because they have dementia* or *because their quality of life is too low* is a great deal worse than denying everybody X expensive drug, even if the evil, evil profit motive enters the latter calculation.

In the first instance, this is not a case of denying everyone X expensive drug, but a case of denying particular patients particular treatments, even where those treatments are not exotic, on what amounts to a for-profit cost-benefit analysis. the question of exotic and experimental treatments, so-called, is merely a subset of this problematic. In the second instance, I'm quite at a loss to perceive how denying treatment to the demented because their quality of life is deemed to be too low to warrant consideration is in any respect worse than denying necessary, life saving/prolonging treatment to, say, a 30-year old mother diagnosed with an aggressive form of breast cancer, purely because it would cost too much to successfully conclude the treatment, or because the probabilities do not conform to some statistical threshold. It's morally obligatory to preserve the one life, and not the other? Or is it merely that some mechanisms of culling are subtler in their iniquity?

As for the rest of it, I'll peruse the legislation as I have leisure.

or because the probabilities do not conform to some statistical threshold

The idea is that paying for the drug would accomplish the end of saving the life. If it were guaranteed that the drug would not accomplish that end, then of course everyone would agree that buying it would be like burning the money. Probabilities of less than 1 that it will not accomplish that end can still approximate the same situation. If the life isn't going to be saved, then no one is judging that the life isn't worth saving. The judgment rather is that this isn't going to work to that good end. Myself, I'd prefer a lifetime limit on total payments, with the doctor deciding what is medically appropriate (including, yes, statistical probabilities) independently of the insurance agency. Then, if the family wants to spend up to their lifetime liability on the drug in question, that would be their choice. And something similar is true of the "too expensive." If the family has X amount of insurance coverage in dollars and can apportion it flexibly to medical care as they please, up to a limit, after which they get no more, this seems to me better than the insurer's deciding that something is too expensive on some more case-by-case basis. I have never expressed any fondness for HMO micro-managing. Decidedly to the contrary. I think it softened people up--mind and heart--for government micro-managing of both the same and of a much more invidious sort. But yes, the scenario you give is decidedly less evil than the scenario I described because it does not involve determining that particular *lives are unworthy*. Why you can't see that...

Is that the "problem" you have uncovered and now seek to remedy through this bill?

I am trying to look for some glimmer of a consistent position regarding patient choice. A hopeless task to be sure.

That is an argument against contraception.

Well, no. It is only an argument against using contraception incorrectly.

Btw, I await anxiously to see what reform proposals you would support rather than criticize. I recall you saying something about how broken the current system is.

I am trying to look for some glimmer of a consistent position regarding patient choice.

No patient of any religion, creed or background should be pressured, cajoled or coerced into taking their own life. I'd love to see some protections like that built into this bill.

It is only an argument against using contraception incorrectly.

Since any use reduces the person to a mere instrument, there is no correct usage.

I await anxiously to see what reform proposals you would support rather than criticize.

Any reform must be judged on how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those in the shadows of life--the sick, the needy, and the handicapped.

This bill fails on all counts. Time to start all over and get it right. All should have some coverage and no one should be deemed a burden or expendable.

Just on a break but I noticed this:

"I'll be accepting of contrary evidence, provided that it is actual evidence, and not a worst-case scenario parsing of legal jargon;"

I would add that laws need to be read in context and nested clauses should not be read alone. When we see something like (a) we need to go to (a) to figure things out.

I see no Section 110. I do see the selected paragraph in the Section above 111, It is from Sec. 102(c)(1). We need to read the whole section. Here it is:

"SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.

(a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term `grandfathered health insurance coverage' means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:

(1) LIMITATION ON NEW ENROLLMENT-

(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

(B) DEPENDENT COVERAGE PERMITTED- Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS- Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.

(3) RESTRICTIONS ON PREMIUM INCREASES- The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.

(b) Grace Period for Current Employment-based Health Plans-

(1) GRACE PERIOD-

(A) IN GENERAL- The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.

(B) EXCEPTION FOR LIMITED BENEFITS PLANS- Subparagraph (A) shall not apply to an employment-based health plan in which the coverage consists only of one or more of the following:

(i) Any coverage described in section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).

(ii) Excepted benefits (as defined in section 733(c) of the Employee Retirement Income Security Act of 1974), including coverage under a specified disease or illness policy described in paragraph (3)(A) of such section.

(iii) Such other limited benefits as the Commissioner may specify.

In no case shall an employment-based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses (i) through (iii) be treated as acceptable coverage under this division

(2) TRANSITIONAL TREATMENT AS ACCEPTABLE COVERAGE- During the grace period specified in paragraph (1)(A), an employment-based health plan that is described in such paragraph shall be treated as acceptable coverage under this division.

(c) Limitation on Individual Health Insurance Coverage-

(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.

(2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.

Subtitle B--Standards Guaranteeing Access to Affordable Coverage

SEC. 111. PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS."

I see nothing sinister here. Individual plans that are not grandfathered have to participate in the exchange. Just what is the problem? Where is the sunset and conversion requirements in this language?

Be not afraid.

As long as they have a good product and the government plan has to sustain itself through premiums and other non-tax revenue, private insurers should be able to compete with the government plan, Obama said.

"They do it all the time," he said. "UPS and FedEx are doing just fine. ... It's the Post Office that's always having problems." http://news.yahoo.com/s/ap/20090811/ap_on_go_pr_wh/us_obama_health_care_overhaul

The idea is that paying for the drug would accomplish the end of saving the life.

You're attempting to compare the proverbial apples to the proverbial oranges. I am stipulating, for the sake of argument, parallel cases in which an elderly dementia patient contracts an infection, the treatment for which is obvious enough (one utilizes an antibiotic indicated for the type of infection, and not just any old antibiotic lying at hand), but which cannot, given the age of the patient guarantee success, and a young mother develops an aggressive variant of breast cancer, where the medically-recommended course of therapy is more or less obvious (one prescribes the treatment best suited to treating that type of cancer, the one that affords the best odds, and not any old course of chemo), but which cannot, given the nature of the cancer, guarantee survival beyond a certain date. In any comparison between cases stipulated so as to be as closely analogous as possible - in other words, so as to have any relevance to the sort of controversies the nation is actually undergoing - there's simply no appreciable difference between determining that a particular life is unworthy of uncertain means, and determining that a particular life is not worth the expense of uncertain means. In point of fact, the posited ethical difference between the respective utilitarian metrics is about as recondite as can be imagined, when the quality of life metric would hold that a given patient has reached the limit of his marginal utility to either, or both, his autonomy and society, and the cost-benefit metric would yield the result that the utility value of preserving a given patient is negative. The respective judgments contained in the metrics, "Too unproductive/dependent" and "Too expensive" are functionally equivalent, as any economist could tell us.

I have never expressed any fondness for HMO micro-managing. Decidedly to the contrary. I think it softened people up--mind and heart--for government micro-managing of both the same and of a much more invidious sort.

I agree wholeheartedly. But it bears observing that the emergence of HMOs corresponds to the period of time in which health insurers were deregulated and permitted to convert from non-profit to for-profit status.

Myself, I'd prefer a lifetime limit on total payments...

I not prefer this, for reasons aready either adumbrated or implied. What I would prefer is an explicit determination on the part of the American people, acting through their representatives, that we will no longer have health insurance issued on the basis of individual actuarial judgments and predictions, but have social insurance, administered generally through private, non-profit institutions, but supplemented through public interventions where necessary, under which - again generally - the young and healthy will effectively subsidize the old and infirm.

the treatment for which is obvious enough (one utilizes an antibiotic indicated for the type of infection, and not just any old antibiotic lying at hand), but which cannot, given the age of the patient guarantee success,

Ah, but I am stipulating that that is not the reason the antibiotic is denied. Rather, the antibiotic is denied because it probably would succeed in treating the illness, and elderly patients with dementia simply aren't sufficiently worth keeping alive by means of that care. The denial of the care renders death more likely, which is the desired outcome, as giving the benefits does not benefit the "community," since the person with the dementia cannot (allegedly) meaningfully contribute to the community. The quotation from Ezekiel Emmanuel is pretty damning. I refer you to the quotation in my earlier post, to which I referred Al.

Al, what is your problem? Plans which participate in the exchange have their benefits set (and a lot more extra and new regulations besides) by the Commissioner. I already referenced that relevant section of the law in an earlier comment; I believe it's section 123 but don't have time or inclination to look it up again. I already did the due diligence.

No patient of any religion, creed or background should be pressured, cajoled or coerced into taking their own life. I'd love to see some protections like that built into this bill.

Since there is nothing in the bill as written that can be construed to “pressure, cajole, or coerce patients into taking their own life” I don’t see why it is necessary to add protective language, but if it will get conservatives to stop their nonsense about death panels, sure.

Since any use reduces the person to a mere instrument, there is no correct usage.

Any use of family planning, natural or otherwise, accomplishes the same instrumentality. Either a sex act is intended for reproductive consequence or not, drawing an absolute distinction between natural methods and artificial birth control is a distraction from the motive.

Any reform must be judged on how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those in the shadows of life--the sick, the needy, and the handicapped.

Okay, unless you think this bill reduces the assistance already given to children, elderly and the handicapped you should have no objection. Since this bill improves by a significant factor the insurance coverage of the sick and needy, your objection to it for those specific reasons is misguided.

End of life counseling is, as you said earlier, already available for free. Why the provision for lawyers now?

Actually, my earlier point was that some people are already paying for end of life counseling. Clearly then, free options either are unavailable or do not meet people's needs.

That's it? So, the permanently despairing as the Economist called them, can refuse what exactly? Whatever they want?

Whatever they can refuse right now.

Counseling alone can't going to change the options one have, only help them decide what they want to do, and memorialize their choices.

Frankly I wish you were the public face of Obama's propoasal because the debate would be more honest and open than it is now.

A remarkably ironic statement given the totally made-up piece of lying trash that sits atop this thread.

I don’t see why it is necessary to add protective language, but if it will get conservatives to stop their nonsense about death panels, sure.

Pretend we're dealing with a rare species and let us err, if we must on the side of caution and apply legal safeguards against exploitation.

Any use of family planning, natural or otherwise, accomplishes the same instrumentality.

The Pill is an artificial barrier that closes one off to life. NFP requires self-denial, inner-discipline, honors the sacrament of marriage, and protects the physical and spiritual integrity of the body. Do you think a couple that practices NFP aborts their unplanned new born?

Since this bill improves by a significant factor the insurance coverage of the sick and needy, your objection to it for those specific reasons is misguided
.

I count the unborn as needy and they are worse off under this bill. We can only forge an acceptable system by creating a consciousness that genuinely upholds the dignity of the human person. Stripping out abortion coverage is an essential step to take in moving past the narrow self-interest and cramped ideologies that are choking us to death.

Actually, my earlier point was that some people are already paying for end of life counseling.

Let's spell out what the acceptable options in this bill and make the forms downloadable for free from church, hospital, insurer and gov't websites.

"Let's spell out what the acceptable options in this bill and make the forms downloadable for free from church, hospital, insurer and gov't websites."

If one googles "durable power of attorney" one will get 27,500,000 hits with all sorts of forms to download. Kevin, it seems the whole concept is new and scary to you, In reality it's quite routine and has been for decades.

The reality is that most people actually want that which you and Lydia fear. Most people don't want to die in an ICU hooked up to all sorts tubes and machines. Most people don't want a prolonged drool into eternity.

What has been missed here is are the process issues. There is no mechanism in this bill (or any other) for accomplishing that which you fear, which, by the way, happens every day under our present system which seems to be ok because it increases insurance company profits but would be wrong for any other reason.

My problem Lydia is that you haven't shown how a provision in a section designed to protect those who wish to keep their current coverage is problematic in any real world sense. It's clear from your post that you didn't read the whole section and it is impossible to understand nested sections without reference to the parts within which they are nested.

As for sec. 123, the states have been doing this for awhile. They are doing this because we have found out the hard way that, left to their own devices, insurance companies will do all sorts of very bad things. There are gaps that still need to be filled in - pre-existing conditions, caps, rescissions, coverage, co-pays, etc.

I understand that your conservatism puts you in opposition to all sorts of things and that is fine but that opposition, no matter how much it is based on principle, doesn't justify the sort of crude economic determinism you seem to be falling back on to sustain the snuff grandma meme.

One thing that Sec. 123 makes clear is that the process isn't going to be determined by one person, so there goes the Dr. Emanuel problem, if there was one, which there isn't. Due process and all that.

Please consider this thought experiment; life insurance doesn't exist and then it is proposed that such a thing might be a good idea. Some might think that such schemes sound like a good idea and a good way to protect ones family. Others (and you know who you are) would immediately go to the dark side and start spinning fantasies of the wholesale slaughter, by their beneficiaries, of those foolish enough to purchase such a product . That doesn't seem to have happened in the real world.


It's clear from your post that you didn't read the whole section and it is impossible to understand nested sections without reference to the parts within which they are nested.

I can't help wondering which whole section you think I didn't read or what misunderstanding you think I am committing. I realize that you believe that the provisions I am referring to (in section 203 as well) set minimum rather than maximum benefits. That this is not true for public option is obvious from the very need to constrain costs in the public option, admitted by advocates of the bill. The only question, then, is why the section on exchange participating plans sounds so much like they are being made into clones of the public option and why, in that case, we should not also take them to be setting maximum as well as minimum benefits. I also note the sentence I pointed out above to Maximos regarding even the so-called "premium plus" plans among the so-called private plans--that the additional benefits are covered as approved by the Commissioner. That certainly sounds like a maximum rather than a minimum.

If one googles "durable power of attorney" one will get 27,500,000 hits with all sorts of forms to download. Kevin, it seems the whole concept is new and scary to you, In reality it's quite routine and has been for decades.
So why the push for a formalized Medicare-covered mechanism? Or, are we supposed to just place our trust in the cavalcade of clowns, witch-doctors and medicine men crafting this bill?
There is no mechanism in this bill (or any other) for accomplishing that which you fear, which, by the way, happens every day under our present system which seems to be ok because it increases insurance company profits but would be wrong for any other reason.
Nor is there any mechanism to prevent abuse. Instead a vague protocol is being recommended. Again, you're pro-euthanasia, so you won't be wary. And, Al, drop the party hack schtick and brush up on your reading comprehension skills. Opposition to "mercy killing" is all encompassing and implacably arrayed against the State, for-profit sectors, and the kill 'em with kindness hustlers.

Kevin
So why the push for a formalized Medicare-covered mechanism?

Imagine, if you will, that while at a routine checkup, Terri Schaivo's doctor said to her, "by the way, your health insurance also covers free end-of-life counseling. If you have a few minutes I can help you decide what treatment you would want in the event you become incapacitated. We can then ensure your wishes are memorialized so there will be no dispute in future."

Good thing?
Or bad thing?

Nor is there any mechanism to prevent abuse.

Apart from the mechanisms that currently prevent end-of-life counseling abuse. Again, end-of-life counseling already happens. Not enough, but it does.

Apart from the mechanisms that currently prevent end-of-life counseling abuse

James,
Elaborate on those, if you can.

Since you didn't know the number of the section (102 not 110), I saw a case for you not having read from the top.

As Sec. 203(b)(4) uses the plural ("plans") I would assume some difference between them. As for the rest, let's back up and would you tell me what the objection to a maximun on the basic plan is. I copied part of subtitle C of title I below the excerpted part of SEC. 203.

"SEC. 203. BENEFITS PACKAGE LEVELS.

(a) In General- The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans during each plan year, consistent with subtitle C of title I and this section.

(b) Limitation on Health Benefits Plans Offered by Offering Entities- The Commissioner may not enter into a contract with a QHBP offering entity under section 204(c) for the offering of an Exchange-participating health benefits plan in a service area unless the following requirements are met:

(1) REQUIRED OFFERING OF BASIC PLAN- The entity offers only one basic plan for such service area.

(2) OPTIONAL OFFERING OF ENHANCED PLAN- If and only if the entity offers a basic plan for such service area, the entity may offer one enhanced plan for such area.

(3) OPTIONAL OFFERING OF PREMIUM PLAN- If and only if the entity offers an enhanced plan for such service area, the entity may offer one premium plan for such area.

(4) OPTIONAL OFFERING OF PREMIUM-PLUS PLANS- If and only if the entity offers a premium plan for such service area, the entity may offer one or more premium-plus plans for such area."

Subtitle C...

"SEC. 122. ESSENTIAL BENEFITS PACKAGE DEFINED.

(a) In General- In this division, the term `essential benefits package' means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security, that--

(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;

(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);

(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;

(4) complies with section 115(a) (relating to network adequacy); and

(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.

(b) Minimum Services To Be Covered- The items and services described in this subsection are the following:

(1) Hospitalization.

(2) Outpatient hospital and outpatient clinic services, including emergency department services.

(3) Professional services of physicians and other health professionals.

(4) Such services, equipment, and supplies incident to the services of a physician's or a health professional's delivery of care in institutional settings, physician offices, patients' homes or place of residence, or other settings, as appropriate.

(5) Prescription drugs.

(6) Rehabilitative and habilitative services.

(7) Mental health and substance use disorder services.

(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.

(9) Maternity care.

(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

(c) Requirements Relating to Cost-sharing and Minimum Actuarial Value-

(1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.

(2) ANNUAL LIMITATION-

(A) ANNUAL LIMITATION- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).

(B) APPLICABLE LEVEL- The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

(C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance."

Obama said “you just get into some very difficult moral issues” when considering whether “to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill.

“That’s where I think you just get into some very difficult moral issues,” he said in the April 14 interview. “The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health- care bill out here.”


http://www.bloomberg.com/apps/news?pid=20601070&sid=aGrKbfWkzTqc

The quote above suggests we develop a moral consensus that isn't subordinate to economics.

So why the push for a formalized Medicare-covered mechanism?

Because the doctor is needs to be aware of the existence and details of advance directives. This way is transparent for everyone affected by such directives.

NFP requires self-denial, inner-discipline, honors the sacrament of marriage, and protects the physical and spiritual integrity of the body.

Self-denial is the only virtue I would apply to those using NFP. All the others may be applied to women using artificial contraception. Under Kevin's peculiar view, a married woman could literally have a dozen children, but if she ever took the Pill because her husband lost his job or other reason, she would have betrayed the sacrament of marriage and be hostile to life. It is such an absurd accusation I don't know how anyone could take it seriously. I also find the rhetoric about physical and spiritual integrity creepy. How is her integrity supposedly destroyed by being temporarily infertile?

Do you think a couple that practices NFP aborts their unplanned new born?

Probably not, but I do know that as a group Catholic women in the US get more abortions than Protestant women. It might behoove you to figure out why that is the case.

I count the unborn as needy and they are worse off under this bill.

That only applies if you assume there will be more abortions under this plan. I already provided some evidence to suggest that your assumption is mistaken.

"So why the push for a formalized Medicare-covered mechanism? Or, are we supposed to just place our trust in the cavalcade of clowns, witch-doctors and medicine men crafting this bill?"

"And, Al, drop the party hack schtick.."


Of course, what would I ever read on this blog to bring the notion "party hack' to mind?

"...and brush up on your reading comprehension skills. Opposition to "mercy killing" is all encompassing and implacably arrayed against the State, for-profit sectors, and the kill 'em with kindness hustlers."

I guess you haven't been reading the exchange between Lydia and Maximos on this very thread.

"So why the push for a formalized Medicare-covered mechanism?"

There's no push. This has been a project of Sen. Isakson (R) of Georgia for a while. It was an amendment attached to an appropriate bill. That is how legislation is done.

"Nor is there any mechanism to prevent abuse." Keven, have you stopped beating your wife? This is a great way to write legislation. Select out the extremists; let them churn over the darkest conceivable scenarios in their fevered minds and then amend the legislation to make them happy. That will work real well, I bet.

Have you ever heard of the Constitution? If a public commission can impose regulations that violate laws on discrimination as well as the Fifth and Fourteenth Amendments to the Constitution we have bigger problems then even you can imagine.

I also find the rhetoric about physical and spiritual integrity creepy. How is her integrity supposedly destroyed by being temporarily infertile? How is her integrity supposedly destroyed by being temporarily infertile?

A woman is altering her natural biological and body processes when she takes a chemical that renders her infertile. No problem for you, I guess.

Self-denial is the only virtue I would apply to those using NFP. All the others (inner-discipline, honors the sacrament of marriage) may be applied to women using artificial contraception.

The whole point of the Pill is to obliterate the need to sacrifice or postpone any sexual pleasure. It is about convenience as you well know and has nothing to do about marriage as your own fact-free discourse proves; in urban areas it is estimated about a quarter of women of reproductive age use any kind of contraception.

The Pill liberates one from the "oppressive" chains of the marital bond and chastity, and lays the foundation for the anti-sacraments of divorce and abortion. Two institutions that grew in acceptance and application with the advent and increased usage of the Pill. Besides, it is your premise that the Pill prevents the consequences of promiscuity. Are you now recommending it as a means for strengthening marriages?

That only applies if you assume there will be more abortions under this plan. I already provided some evidence to suggest that your assumption is mistaken.

You offered your opinion, no evidence. But, based on your strained arguments, I guess you're telling us that the subsidizing of abortions is morally acceptable for you.

Have you ever heard of the Constitution? If a public commission can impose regulations that violate laws on discrimination as well as the Fifth and Fourteenth Amendments to the Constitution we have bigger problems then even you can imagine.

Well if the vulnerable are truly protected by laws already in place, then a little redundancy in the name of clarity shouldn't be too much to ask. Should it?

"Well if the vulnerable are truly protected by laws already in place, then a little redundancy in the name of clarity shouldn't be too much to ask. Should it?"

Ok, help me out. What exactly do you want to your proposed law to do.?

Ok, help me out. What exactly do you want to your proposed law to do.?

To protect the "chronically ill and those toward the end of their lives" who "are accounting for potentially 80 percent of the total health- care bill out here” from being counseled/coerced into the unloving arms of the right to die regime. And if that sounds like a call for deliberation and reflection you are right. A moral consensus should always precede legislation, especially when it involves matters of life and death.

You have announced your enthusiasm for euthanasia and coincidentally this bill. Let us have a fully transparent, no-holds debate about the kind of reforms we truly want to make to our health-care system.

Al, Wesley J. Smith has repeatedly suggested that the law contain explicit provision that the offering of end-of-life counseling and its receipt are voluntary both for health care providers and for patients. Health care providers cannot be punished for refusing to get into that sort of counseling, and patients cannot in any way be punished or threatened with loss of care for refusing to accept that counseling. Smith has also suggested that language in the law suggest that the counseling should not be outcome-directed (towards consenting to refuse care, for example).

http://www.firstthings.com/blogs/secondhandsmoke/2009/08/12/obamacare-kathleen-parker-urges-explicit-language-ensuring-voluntariness-of-end-of-life-counseling/

These suggestions have been made for some time now but was not included even when other revisions were made to the law.

I hasten to add that there are overwhelming problems with Obamacare and that this would deal with only one. But as far as the end-of-life counseling aspect of the law, this would help clarify matters and make the good faith of the authors on this one score self-evident. It's worth noting that family nurse visits are labeled in this very law as "voluntary," so there is precedent for bothering to state that accepting a possibly controversial benefit is voluntary rather than taking it as read, and in an area as contentious as end-of-life counseling this seems particularly indicated, yet it has not been done. Food for thought.

"Have you ever heard of the Constitution? "

Yes, I have.

But why should anyone follow the Constitution? Now, you can't point to anything in the Constitution to establish that principle, for that would be begging the question. So, why should anyone follow the Constitution?

Under Kevin's peculiar view, a married woman could literally have a dozen children, butif she ever took the Pill because her husband lost his job or other reason, she would have betrayed the sacrament of marriage and be hostile to life.

Ah, Step2's in favor of contraception only in the hard cases.

Wesley J. Smith has repeatedly suggested that the law contain explicit provision that the offering of end-of-life counseling and its receipt are voluntary both for health care providers and for patients.

That seems a very limp proposal. I'd need language making it clear taxpayers won't be financing the funnel to Hemlock Society certified waiting rooms.

Kevin
*crickets*

I'll take that as a "good thing."

Elaborate on those, if you can.

Off the top of my head: Lack of capacity, undue influence, fraud. I'm sure I'm missing something obvious.

In any event, the safeguards must be working. Either that or they're simply not needed.


Francis Beckwith
Ah, I'm glad you're still looking in here. Given that your opening post turns out to be complete hogwash, do you not think that perhaps a little 'mea culpa' is in order here? Maybe even a not-so-little one right at the top of the page?

James, sorry but; Off the top of my head: Lack of capacity, undue influence, fraud hardly seems exhaustive, but I assume you are willing to state these conditions in the legislation. We're making progress.

James, sorry but; Off the top of my head: Lack of capacity, undue influence, fraud hardly seems exhaustive

Was it the "I'm sure I'm missing something" that gave it away?

but I assume you are willing to state these conditions in the legislation

That would be rather redundant, seeing as those safegards are already in place, but whatever floats your boat.

It wouldn't be the first time we had redundancy in governance, but this time it is well worth it.

"But why should anyone follow the Constitution?"

An intersting attempt to derail things, but irrelevant except for that which it confirms about your (and the conservative/Republican) approach to government. While I have a certain emotional attachment to our system that stems from having kin who participated in setting the project up and who defended it from Southern treason, I also believe in the rule of law and in our system (unlike the UK) we have a written Constitution so that is where we start. I abhor (and am puzzled by) those who seek power for its own sake, and see adhering to the limits imposed by a constitution that seeks to check power, promote the general welfare and guarantee individual rights as a good thing.

Lydia and Kevin, If getting the reform necessary to keep our healthcare system from crashing means adding "voluntary", well ok. As this thread is dropping off greater detail will probably come above. I would make two further comments.

We have three things going on here; folks who want a more rational system of health care, folks who see problems, real or imagined, and a political party that is willing to lie, cheat, and steal in order to regain power even if their actions render the nation ungovernable.

Thanks to that third group, we now have a goodly number of folks who deeply believe that a goodly number of their fellow citizens want to kill them and, as the latter group knows that they don't harbor such desires and having had their protestations of innocence rebuffed, have no alternative but to think the former somewhat mad

Kevin, if you have actually read what I have written, you know I oppose euthanasia outside of the defacto euthanasia that results from double effect.

And I've seen the discussion with step2 and read some George and Finnis. You have no idea how weird and creepy you natural law folk sound when you get to sex.

I love some of them, it reads like a parody;

"THERE WILL BE A GOVERNMENT COMMITTEE deciding what treatments and benefits you get."
because of course private insurance companies don't put any restrictions on what they cover.

" The government will cover Marriage and Family therapy. This will involve government control of your marriage."
And...um...yeah. Seriously? so if your current insurance covers couples therapy, does that mean there's corporate control of your marriage?

Are you now recommending it as a means for strengthening marriages?

Depending on the circumstance I might. Maybe I was too vague in what I wrote. I wrote that the other qualities may be applied to women using contraception. Contraception may also be used for reasons of vice. Just because it can be used that way doesn't mean it must be. Further, I never claimed that contraception prevents promiscuity, only that contraception used correctly helps prevent unwanted pregnancies. This happens to be a little bit relevant to reducing the number of abortions.

Contraception may also be used for reasons of vice. Just because it can be used that way doesn't mean it must be.

The Pill is the pharmacological accelerant of the revolution that ushered in a 50% divorce rate, record number of STDs, the barbarism of abortion, personal alienation and a social anomie so great that the other wonder pill of our age - the anti-depressant - is the most popular over the counter drug with 27 million regular subscribers.

Self-induced artificial sterility is by definition, unnatural, and a more civilized people will, as they tour the ruins and peruse the cultural artifacts of this age; porn, condom-wrappers, "sexual performance enhancing pills", gangbanger memoribilia, videos games of school massacres and yellowing documents detailing child-custody disputes, wonder why it took so loveless and despairing a tribe as we, so long to fully embrace the right to die.


THIS E-MAIL ARTICLE IS FULL OF LIES. Read This Point-By-Point Analysis From PolitiFact.com -
http://www.politifact.com/truth-o-meter/article/2009/jul/30/e-mail-analysis-health-bill-needs-check-/

One quote from the analysis

"It's awful," she said. "It's flat-out, blatant lies. It's unbelievable to me how they can claim to reference the legislation and then make claims that are blatantly false."

Frank: Just to be clear: In posting this, were you in any way endorsing this "info"?

I may be off topic, but just one addition to Kevin's wonderful defense of NFP. As a former devotee of the lies of a contraceptive culture, now ragged and wiser, I want to explain one crucial difference between NFP and contraception. NFP takes advantage of a natural, God-given, worked-into-the-body period of infertility for couples to take advantage of--if they need to postpone pregnancy. NFP is simply taking advantage of nature at its fullest, whereas contraception obviously, deliberately separates procreation from the unitive marital act--which is unnatural and the source of its evil. NFP is 98% effective if used well, better than all the other contraceptive methods without all the gruesome side-effects, blood clots, breast cancer, depression, etc.NFP is immediately reversible and as Kevin has stated, it enhances the union of the partners as they both participate in the process--the burden is not left to the woman. With NFP, a woman is no longer just a vestibule for someone else's pleasure but becomes what she was meant to be-a giver and receiver of full, life-giving love. With NFP, a woman is no longer simply used in the sexual act, but is participating in an act of love with a spouse that accepts all of her even to the point of creating new life with her. Each sex act then becomes more than simply a release or a pleasure, it becomes a possible act of creation, a direct link to the divine. It’s the fullest and most natural way to live. It is also very useful for achieving pregnancy in this chemically-induced infertility-ridden society, without all the horrors that technology can do to a woman’s body. God is wiser than all of us after all. Just had to add my 2cents from the trenches.

Nice artikle! I learn every day ;)

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