Tuesday, August 11, 2009

Beware Directive 1233

This just in from Frank Beckwith, over at First Things, concerning Section 1233 of President Obama's health care plan: a quote from Charles Lane's article in Saturday's Washington Post about charges that Obamacare would result in pushing those troublesome and obsolete seniors to realize they are a burden on our society and should therefore not bother the rest of us with their continued costly presence:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.

. . . Ideally, the delicate decisions about how to manage life’s end would be made in a setting that is neutral in both appearance and fact. Yes, it’s good to have a doctor’s perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party — the government — recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don’t have to be a right-wing wacko to question that approach.

Provisions like this just make Obama look indecisive. First, he makes us think he is turning us into Russia (I'm thinking of the partial nationalization of the auto industry), then Sweden (what with nationalized health care). Now he's making it look like the Netherlands (euthenasia).

I say we just take an up or down vote now on which socialist European country we're going to become.

27 comments:

Susan Weston said...

Martin,

I've read Section 1233. The incentive is to have a discussion. There's no incentive there to get patients to sign a document specifying that they want or don't want any particular level of intervention.

Did Mr. Beckwith read the provision, or did he just guess how it worked?

His description of that section of the bill serves fear better than it serves truth, and I hate to see that coming from First Things. I hate to see it here, too.

Kycobb said...

Susan,

You shouldn't be surprised. Anyone who thinks realizes that the status quo is untenable and health care has to be reformed. Thus the GOP has to resort to trying to instill irrational fear to block reform on behalf of the corporate interests it serves.

I read the section, and the point of it is to inform seniors of their rights and options. If seniors want their doctors to keep them alive as long as possible, this will enable them to express that preference in writing before they are incapacitated, which can then serve to counterbalance any pressure from the family to allow the senior to "die in peace."

Lee said...

> Thus the GOP has to resort to trying to instill irrational fear to block reform on behalf of the corporate interests it serves.

Looking at how beautifully socialism works wherever it's tried, it's hard to imagine how scary a rational fear must look.

Kycobb said...

Lee,

Its not socialism. It use to be that almost everybody got their health insurance from non-profits. Then regulatory lapdogs for the insurance industry allowed the Blue Cross/Blue Shields to be privatized. Their main objective became to generate profits rather than provide affordable health care to their members. Noone is talking about nationalizing hospitals or doctors. Though I can understand your fear if you believe all the lies being told, like Palin's claim that people will have to justify their existence to a "death panel."

Francis J. Beckwith said...

Susan:

I did indeed read it. Like you, I was initially skeptical of some of the claims made by conservatives about provision 1233 until I read Lane's piece. I then went back to the bill and read it.

"Life-sustaining treatment," according to the 1233,
"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.'"

Antibioetics require a special end of life consultation?

And we are not told what "end of life" means? Does it mean suffering from a fatal illness? But one can have a fatal illness that takes 25 years to kill you? Magic Johnson has a fatal illness; and yet he is living a vibrant life.

Or does it mean a non-fatal illness had by an old person that statistically is at the "end of life" (e.g., 92 year old)

Of course, incentives affect treatment. No doubt about it. But at least private insurance, businesses and individuals can shop around, and thus competition forces insurance companies to please their customers. But a government monopoly--which will surely occur if businesses have to choose between the cheap government option and private companies--will diminish that competition.

I have spoken out against the HMO referral policy as unethical. So, I don't need any lectures on how incentives work. This is why I think the problem is with the current insurance model that supplements virtually every procedure and visit rather than just the more expensive ones. It seems to me that we would have lower premiums and more efficiency if only catastrophic illness and major surgeries were covered with patients paying into Medical Savings Accounts that are allowed to roll over and collect interest.

Here's my piece on HMOs and their gatekeeper policy: http://homepage.mac.com/francis.beckwith/JSP.pdf

Francis J. Beckwith said...

I meant to include that MSA's would be the means for patients to pay for routine visits, small procedures, etc. The MSA's would be pre-taxed.

Lee said...

> Their main objective became to generate profits rather than provide affordable health care to their members.

Profits are the overhead that we pay for economic efficiency and effectiveness. Moving 15% of the economy into the government sector is not going to make anything more efficient, except for the hold the government will have over us once that transfer of control takes place.

I think most liberals despise profits simply out of envy.

> Noone is talking about nationalizing hospitals or doctors.

Sure they are. There is a video on YouTube showing the One himself talking about the single-payer system he wants to establish. Special effects, were they?

> Though I can understand your fear if you believe all the lies being told, like Palin's claim that people will have to justify their existence to a "death panel."

What I feel is disgust, not fear. There will be time for fear later, when the only people with options are the ones who voted to take ours away.

Kycobb said...

Lee,

"Profits are the overhead that we pay for economic efficiency and effectiveness."

Then you don't have anything to worry about. Noone will voluntarily move from efficient private insurance companies to a public option. Its strange, though, that veterans and seniors are both more satisfied with the VA and medicare than people are with private health insurance. I guess those vets and seniors are just addled.

Lee said...

I used at least to try to give liberals the benefit of the doubt on these issues. I may disagree, but they have good intentions, blah blah blah.

But when was the last time liberals gave the benefit of the doubt to conservatives? Pelosi says we're un-American. kycobb says we're liars. Obama says opposition must be paid corporate interests. So forget that.

Liberals have a basic problem with freedom. They don't like it. Well, to be more precisely, they don't like it when it's other people's freedom. Congress was careful to exempt themselves from whatever plan they decide on. It fits the pattern. Obama preaches public education but sends his girls to a posh private school. Geitner is fine with raising taxes while not paying his own. Congress is against corporate jets for CEOs of bankrupt firms, but is favor of corporate jets for Congressmen. Al Gore travels the world in private jets and Lincoln Town Car limousines to lecture the rest of us about our unsustainable carbon footprints.

Socialism for thee, but not for me.

Liberals are wonderful at indicting the status quo. Since nothing is perfect, everything is vulnerable at some level to their indictments. But then some huge federal program is created, and two things never happen: 1. The program is never held accountable for the benefits that were supposed to materialize or for the unintended harms that did; and 2. Once we have the program, we can never give it back. It's here. For good. Your only hope at that point is to keep it from growing, which is like trying to catch all the rain in Seattle in a bucket.

The taxpayers pay, the bureaucrats are happy in their new bureaucracy, and liberals run off to find something else in desperate need of all their indispensable help. The only people who aren't happy are the taxpayers, but if we demonize them enough, they'll keep their mouths shut.

The goal here is not to provide everyone a better health care system. The goal is for the federal government to acquire more power and money, and control over our lives. Better health care is the pretext. People aren't buying it. Must be because they're stupid. Who wouldn't want more involvement in his life from Nancy Pelosi or Barney Frank?

> Noone will voluntarily move from efficient private insurance companies to a public option.

Utter nonsense. It's the foot in the door to a single payer system. I know this. You know this. Obama certainly knows this, as witness that video I spoke of earlier. As if a private corporation can compete against an enormous competitor who not only gets to write the rules, but also gets to ignore them when it wants to.

> Its strange, though, that veterans and seniors are both more satisfied with the VA and medicare than people are with private health insurance. I guess those vets and seniors are just addled.

You haven't spoken to the same vets and seniors I have spoken with, obviously.

Susan Weston said...

Francis,

I don't understand why you think doctors will tilt the discussion toward less intervention.

If you're saying there's an economic incentive, may I remind you that doctors make their money by providing added services. If they are driven by making money, they'll encourage patients to direct maximum treatment.

If you're arguing that doctors are inclined to recommend less care for some other reason, I can't figure out what it is.

I assume some doctors will encourage more intervention, some encourage less, and some just help patients articulate their own desires--and I don't see why a law encouraging the discussion pushes that either way.

Kycobb said...

Lee,

If Palin didn't lie, show me where the legislation authorizes "death panels".

Thomas said...

Given Catholic tradition, I'm a bit surprised that Mr. Beckwith would have a problem with advising patients that they don't have to use any means whatsoever to prolong life.

It seems common that hospitals push treatments that artificially extend life beyond where it ought to be extended. Extraordinary means of putting off death for a short while are not morally compulsory and in some cases are fiscally irresponsible.

Lee said...

> If Palin didn't lie, show me where the legislation authorizes "death panels".

I don't feel like my opposition to this initiative is dependent on what Sarah Palin says. I have been a conservative since she was in kindergarten.

Having said that... obviously, she didn't design her remarks to acquire coos of approval from the American left. But, aside from the fact that liberals for the first time since Reagan have to face a conservative who is as good as they are at using inflammatory rhetoric, I don't think she is all that far off the mark.

Last I heard, medical care is what economists classify as a "scarce good" -- meaning not that it is rare, but that we can't all have as much of it as we want or need without dealing with limits and constraints. That means, at some point, someone makes decisions as to who gets care and who doesn't.

It is the particular conceit of the leftist that political decisions are more fair than decisions made by individuals throughout the remaining sectors of the still somewhat free economy. But the decisions will have to be made by someone: everyone can't have as much medical care as they want. Someone picks who gets it and who doesn't. In socialized medicine, that someone is the government.

We have all heard horror stories from liberals about how this or that HMO denied care to someone. Well, to the consumer, the advantage of HMOs is that everybody is not forced to use the same one, and the HMOs are bound by contractual law in such a way that there is only so much they can deny to a paying customer.

In other words, the customer has options. Maybe not quite as many as he might like, but they're there.

When the same life-or-death decisions are made by the government, however, the avenues of redress are not obvious nor are the options as plentiful. Since government is a political entity, such decisions will be made politically -- favored constituencies, favored states, etc. But all the wishful thinking in the world will not make medical care a free good, like oxygen. That means someone will make the life-or-death decisions.

If Sarah Palin wants to call those decision-makers a "death panel", she is doing liberals a greater disservice than she is doing to the truth. I say, close enough.

In other countries with socialized medicine, end-of-life things are treated in the manner you can expect to see here when our time comes. In Britain, for example, they just quit feeding old people at the hospital, so family members smuggle in food. In the Netherlands, where there is euthanasia, the doctors can just flat-out kill you; only an idiot lets himself get checked into a Dutch hospital if he's older than, say, 55. My age.

There are clues that the Obama administration may value human life somewhat differently than most Americans. Here's what John P. Holdren, director of the White House Office of Science and Technology Policy, wrote:

> "The fetus, given the opportunity to develop properly before birth, and given the essential early socializing experiences and sufficient nourishing food during the crucial early years after birth, will ultimately develop into a human being."

I don't think Herr Goebbels could have said it better.

Sorry, I don't want these people in charge of deciding my health-care options.

Kycobb said...

Lee,

"Well, to the consumer, the advantage of HMOs is that everybody is not forced to use the same one"

In the real world, most people don't have a choice-they have to use the HMO offered by their employer, if they are lucky enough to be offered health insurance at all. So whether they get a treatment or not will be decided by an HMO bureaucrat who has only one motivation-to save the HMO money.

"When the same life-or-death decisions are made by the government, however, the avenues of redress are not obvious nor are the options as plentiful."

I don't think you have thought out the political implications here. If the democratic health care plan instituted "death panels" to euthanize the baby boomers, who are about to start qualifying for medicare, the GOP is going to enjoy the greatest landslide electoral victory in the history of American politics. The democrats would have to be insane to do that.

Lee said...

So, if having few options regarding HMOs is bad, how is having even fewer options better?

Lee said...

> The democrats would have to be insane to do that.

And your point is...?

Thomas said...

Context is important to understanding the bill as well. Patients are often incapacitated and unable to make decisions regarding their treatment during the last few months of their lives. It is a very good idea to plan ahead to specify the kind of treatment one wants and the kind one doesn't want. Counseling to notify people that they can decide their treatment ahead of time and that would demonstrate how is a good idea, and it clearly ought to be more common.

Kycobb said...

Lee,

"So, if having few options regarding HMOs is bad, how is having even fewer options better?"

Most people aren't going to have fewer options. The ones currently getting health insurance through their employer will continue to have the same amount of options: the one HMO or public option their employer offers them. Many people will have increased options: from zero to one. Many people are going to lose employer provided health insurance if reform isn't passed because private health insurance is just getting too expensive.

"And your point is...?"

You should be rooting for health care reform to pass, because if it does the things the Right is claiming it does, it guarantees GOP control of the federal government no later than January, 2013. Just give the democrats enough rope to hang themselves.

Lee said...

> Most people aren't going to have fewer options. The ones currently getting health insurance through their employer will continue to have the same amount of options: the one HMO or public option their employer offers them.

The following quote is Obama himself, from a "fact-check" posted on his presidential campaign web site in Jan 2008:

> "“Here’s the bottom line. If I were designing a system from scratch I would probably set up a single-payer system... But we’re not designing a system from scratch... And when we had a healthcare forum before I set up my healthcare plan here in Iowa there was a lot of resistance to a single-payer system. So what I believe is we should set up a series of choices... Over time it may be that we end up transitioning to such a system. For now, I just want to make sure every American is covered... I don’t want to wait for that perfect system..."

So we know what constitutes a perfect system from Obama's perspective: a single-payer system. If Congress delivers him one, he will sign it.

How to accomplish that? Meet Congresswoman Jan Schakowsky:

> She cites an insurance company spokesman as saying, “A public option will put the private insurance industry out of business and lead to single-payer.... My single-payer friends, he was right.... This is not a principled fight. This is a fight about strategy for getting there, and I believe we will.”

So whatever health-care bill is signed now is just a foot in the door for more control later on. It's a Trojan horse. Liberals never rest.

I know this. You know this. Let's move on. Save it for the rubes.

> Many people will have increased options: from zero to one.

Yep. People such as illegal aliens.

> Many people are going to lose employer provided health insurance if reform isn't passed because private health insurance is just getting too expensive.

Can you explain the difference between prices and costs? Prices are what we are presented with from a vendor; costs are what it took to get to that point. The government can put insurance providers out of business by lowering prices -- effectively, to $0. But they can't eliminate costs. Under a government system, costs are going to go up. There's no way around it. Who will be on the hook to pay them? Three guesses. Warren Buffett? No. The tooth fairy? No.

The taxpayers? Here's your gift certificate for a Daily Kos T-shirt.

Lee said...

> You should be rooting for health care reform to pass, because if it does the things the Right is claiming it does, it guarantees GOP control of the federal government no later than January, 2013.

You obviously overestimate my degree of partisanship. I'm after conservative public policy. I don't find liberalism served to me by Republicans to be any less foul than the same cowpie served by a Democrat, though the Republicans do seem to measure their doses.

To a conservative, Republicans are like the famous line from a British junior military officer evaluation: "He performs well when watched constantly and finds himself cornered like a rat."

A more craven bunch of cowards is hard to find. But they compensate by being inarticulate and uninterested in defending what their constituents hold dear.

On this issue, as on so many others, a few have popped their heads out of their air-raid shelters and are busily leading from the rear. Right now, the polls say Obama is running about 43 in favor, 53 against. That would be all a Democrat would need to see. But a Republican needs to wait until it goes down to 35/61 before he will timorously chime in with a half-hearted attack on the Democratic initiatives.

So please don't dangle that unappetizing little carrot anymore. Once socialized medicine is in, it's in, and it's never going away. Republicans, however, can and do get voted out of office.

> Just give the democrats enough rope to hang themselves.

If I give Democrats a rope, they'll hang the taxpayers.

KyCobb said...

Lee,

The U.S. spends more per capita on health than any other country in the world, and a lot of that money is wasted. There are huge amounts of money to be saved by reducing unnecessary tests and procedures and using the bargaining strength of medicare to reduce costs. Plus taxes on the rich have been reduced so much that there is a lot of revenue to be garnered from returning them to the levels that existed during the Clinton Administration, or perhaps even to the higher levels during the Reagan Administration. I know that for conservatives, keeping tax rates for the rich low is priority #1, but the people voted for a different set of priorities last November.

Lee said...

> The U.S. spends more per capita on health than any other country in the world...

A choice.

> ...and a lot of that money is wasted.

An opinion.

> There are huge amounts of money to be saved by reducing unnecessary tests and procedures...

And we have perfect knowledge at all times which tests and procedures were unnecessary. Sure.

> and using the bargaining strength of medicare to reduce costs.

Baloney.

> Plus taxes on the rich have been reduced so much that there is a lot of revenue to be garnered from returning them...

Most of the tax revenues are provided by the rich already. They are called "rich" because they have options. They can move their money offshore, or move altogether, or simply channel their money into tax shelters. There isn't much more money left in those golden teats. But you wouldn't be a liberal if you weren't immune to common sense, so believe what you want.

> I know that for conservatives, keeping tax rates for the rich low is priority #1...

If you want to help the poor man, you cannot avoid helping the rich man. But the point is that the rich man is going to be okay regardless. What you wind up doing with confiscatory taxation is making it hard for the poor man to become the rich man.

> ...but the people voted for a different set of priorities last November.

They didn't think they were voting for the most left-wing administration since Lenin-Stalin. Obama ran as a moderate, a "post-partisan" president. Maybe you're in denial about the direction Obama is heading in the polls. Buyers' remorse is setting in. And you know it. Obama's only chance for a second term is to destroy the Constitution. I know he's willing to do that, I just don't know if he's able. I guess we'll find out.

KyCobb said...

Lee,

"They didn't think they were voting for the most left-wing administration since Lenin-Stalin. Obama ran as a moderate, a "post-partisan" president. Maybe you're in denial about the direction Obama is heading in the polls. Buyers' remorse is setting in. And you know it. Obama's only chance for a second term is to destroy the Constitution. I know he's willing to do that, I just don't know if he's able. I guess we'll find out."

Talk about balony. Obama's approval rating is down from the sky high level of February, but its still well over 50%. Obama has an excellent chance at reelection-since its his good fortune that he entered office in the trough of an economic cycle, the economy will be on the upswing, with falling unemployment in 2012. However since employment is one of the last things that recover from a recession, because employers wait to start rehiring until they have to, the GOP should make big gains in the midterm elections next year. You'll have to put up with the Obama Administration until 2017, which is only fair, since I have to suffer through eight years of Bush!

Lee said...

> Obama's approval rating is down from the sky high level of February, but its still well over 50%.

Somebody isn't keeping up with the times...

http://www.rasmussenreports.com/public_content/politics/obama_administration/daily_presidential_tracking_poll

A majority are now registering disapproval of Obama at some level. Read and weep.

And pay attention to the trend lines.

> Talk about balony.

You were saying...?

> Obama has an excellent chance at reelection-since its his good fortune that he entered office in the trough of an economic cycle, the economy will be on the upswing, with falling unemployment in 2012.

He stands a fighting chance, but two things have to happen first. The Republicans will need to win back Congress, so they can put the brakes on his lunatic left-wing agenda; and Obama himself will need to reinvent himself as a moderate Democrat. The first is likely; the second, unlikely. But I'm not an Old Testament prophet; it's just an educated guess.

Your analysis presumes the economy will recover enough by 2012. Obama and Congress have to allow that to happen. Before that happens, they have to understand the role the federal government played in this economic downturn. That is highly unlikely, in my opinion.

> However since employment is one of the last things that recover from a recession, because employers wait to start rehiring until they have to, the GOP should make big gains in the midterm elections next year.

During the Bush years, the news media complained about 5.5% unemployment, calling it 'the jobless recovery'. Any bets as to how they'll characterize 9% plus unemployment while the One is still president?

> You'll have to put up with the Obama Administration until 2017, which is only fair, since I have to suffer through eight years of Bush!

There you go again: using that word "fair", which means nothing at all in your world view. It's just preferences. Naturally, I prefer my own.

KyCobb said...

Lee,

Rasmussen is way out of line from every other poll. I already know that Obama's popularity has been trending down-that happens to every new president. The question is how popular he'll be three years from now. I think you're wrong about his policies, but only time will tell.

"Before that happens, they have to understand the role the federal government played in this economic downturn."

A couple of things: one, Greenspan kept money cheap, enabling the real estate bubble to continue expanding, and two, regulators did nothing while Wall Street created and marketed bizarre financial instruments as solid investments which were in fact backed by very little value.

And of course "fair" means something to me-natural selection favored organisms with a strong desire to be treated fairly! I do, of course, recognize that life ain't fair.

Lee said...

Don't forget the star of the show: the housing bubble caused by lending mortgage money to people who couldn't afford it, done in the name of civil rights.

In short, the regulators were the ones who made it happen.

But since the fix for bad government is more government, we can look forward to more of the same.

Lee said...

This is not your typical recession. Check this out:

http://article.nationalreview.com/?q=N2Y0ZGUyYWVmZWU0ZWJlMGNjYTA0MTNlMWQ1NjA0ODg=

Essentially: small business and new business start-ups have led us out of every modern recession. But Obama's class-warfare rhetoric, his lawless strong-arming of the bond holders in the government takeover in the auto industry, the talk of raising taxes, increasing entitlements, and the fiscal incontinence -- all of this is creating a business climate not of quiet confidence in the economic future of America, but of uncertainty, fear, and no confidence.

Not the sorts of emotions that are conducive to new business and new hiring.