ObamaCare Then = ObamaCare Now

By Justin Gardner | Related entries in Barack, Democrats, Health Care, health care reform, Legislation, Obama

Ezra Klein did some digging and finds that the health care plans Obama proposed during the campaign season (pdf) closely mirrors what is currently on the table.

First, what he said then…

The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.

So how does that compare to the current HRC bill on the table?

We don’t know what the employer mandate will look like once the House and the Senate merge their bills, and the exchanges look likelier to be run by states or regions than by the government (though there will also be a national exchange overseen by the Office of Personnel Management), but those are really the only differences. And it’s not even clear they’re differences.

Nor were there aggressive cost controls outlined in Obama’s white paper but abandoned amid the legislative process. The Senate bill is quite a bit stronger on controlling costs than the campaign paper, which makes no mention of prudential purchasing or the excise tax on high-cost health insurance or the Medicare Commission or specific delivery-system reforms. The paper promises investments in comparative effectiveness research and health information technology, and the Obama administration delivered on both in the stimulus.

Also, Rick Ungar rounds up the major changes to the new bill. Too much to post here, but there are a lot of similarities.

That’s why I have no idea why so many progressives are crying foul. But this is what we often hear from Obama’s detractors on the left. They don’t actually pay attention to what he said during the campaign. So this notion of “selling out” is usually misinformed and juvenile in its intellectually simplicity.

Folks, this legislation is a BIG step in the right direction and just because the Daily Kos crowd didn’t get a public option doesn’t mean this isn’t going to help people. Also, did progressives ignore the part where the moderate Dem Senators said they wouldn’t vote for a public option under any circumstances? But I suppose this is why Dems are so often snatching defeat from the jaws of victory.

Rick Ungar reminds…

Do you like Social Security? Did you know that, as initially passed, millions of people were left out of the program, particularly African-American citizens? As time has progressed we’ve fixed it, constantly improving the entitlement to treat everyone more fairly. Do you like Medicare? Did you know that, as initially passed, the coverage did not extend nearly as far nor as deep as it does today?

And to that broader point…these reforms will actually help a lot of people…

A handy chart from Erik Kain (via Jonathan Cohn)

It’s not perfect. No legislation is. So to my Democratic friends I say this…manage your expectations appropriately and stop whining.


This entry was posted on Monday, December 21st, 2009 and is filed under Barack, Democrats, Health Care, health care reform, Legislation, Obama. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

26 Responses to “ObamaCare Then = ObamaCare Now”

  1. michael reynolds Says:

    So after months of screaming right-wing loons, and screaming left-wing loons, and approximately three billion column inches written on Obama’s collapse, failure, disaster, destruction . . . Obama will get almost exactly what he set out to get.

    It’s a pattern. I wonder how long it will take for people to notice that he gets what he wants and does what he said he’d do?

  2. Justin Gardner Says:

    Another three years at least. Why? Because too often in this country we mistake hubris and arrogance for leadership, and it’ll take at least that much time to show folks what a real leader looks like.

  3. mike mcEachran Says:

    Did you see Olberman’s “special comment” to Obama, where he chastized him for not being tougher with the Repubs on Healthcare reform? (With all the “sir”‘s and over-earnestness – these comments are becoming a joke, but I digress…) Thank god Obama doesn’t employ Olberman as a politcal strategist. It is becoming a pattern, where Obama stays cool and polite, and plays by the rules, while all the nut jobs on the left scream for him to go for the jugular, and all the crazies on the right scream all their typical nonsense, and in the end, Obama stays steady and gets what he wants. Observing it is the single most refreshing experience I’ve had as a politcal watcher.

    PS: It reminds me of everything I’ve ever read about Lincoln. He really is the legacy, I swear. It’s amazing.

  4. Jacob Says:

    no offense Justin, but do we have to call it ObamaCare?

  5. Doomed Says:

    There ’s one provision that I found particularly troubling and it’s under section C, titled “Limitations on changes to this subsection.”

    And I quote — “It shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report that would repeal or otherwise change this subsection.”

    This is not legislation. It’s not law. This is a rule change. It’s a pretty big deal. We will be passing a new law and at the same time creating a Senate rule that makes it out of order to amend or even repeal the law.

    1. Acorn gets funding thru health care now.
    2. Nebraska doesnt have to pay medicaide costs.
    3. Wyoming, Utah, ND, SD, Montana get vastly reduced medicaide liability.
    4. Longshoremen dont have to pay a tax on their health plan but everyone else with nice plans DO.
    5. 6.7 billion dollar tax grab exempts insurance agencies based in California, Michigan and ILLINOIS.
    6. Their is a provision in the bill for long term health care paid to the US government but only paid for 7 years and then the US is committed to pay for your long term care forever despite having spent the money 30,40, 50 years ago.
    7. And the Coup de Gra….the Secretary of HHS shall determine which 17 states pay the greatest share of health care costs and they shall be exempt from taxation. Of course for now their is little doubt whom the HHS secretary will determine to be eligible for this and I rather suspect that they will be solidly blue states.

    This is what tyranny brings to America. So how are you guys going to feel when the Republicans get a 60 vote majority and make it illegal to have gay marriage and they put a rule in there that says…it takes 67 votes to repeal this law?

    How about tax cuts for the 32 red states and a tax increase for the 18 blue states?

    This is why tyranny has always been carefully guarded against in our congress. Not anymore….So if the democrats can do it this year…what about the next time the GOP has a 60 senators and can override any veto??

    This is not a GOP problem folks. This is an American problem and if you cant see that well then just remember your anger when the GOP is passing tyranical laws….and if this is allowed to move forward with this rewritten rule in place then trust me THEY WILL.

  6. gerryf Says:

    And so the spin begins…I guess I am a screaming left loon then. By all indications once the senate bill and house bill come out of committee we will have terrible legislation — if this is all Obama wanted he should have stayed home.

    The ultimate test of any legislation is the outcome.

    Despite all the hope and promise engendered by his election, what we have ended up with is legislation that fails to guarantee high quality, cost effective care for all Americans, and instead locks into place a system that entrenches the insurance giants on our health.

    If this bill passes, the industry will become more powerful and we may never get this done right.

    All you need to do is look at how Wall Street responded–the healthcare stocks doubled in value.

    The individual mandate has insufficient cost controls which can only result in ever increasing premiums and insane profits for the industry. And now the government gets to help foot the bill. What does this mean? It means either more taxes (ha!) or more debt.

    Great outcome.

    Those who tout competition as the solution are out of luck–the insurance companies that enjoy near monopolies in most areas will continue to enjoy those monopolies.

    Great outcome.

    The “tax” on expensive insurance plans will encourage employers who do give healthcare benefits to reduce those benefits. So, kiss the revenue needed to support this plan good-bye and kiss the good private healthcare plans good-bye

    Great outcome.

    We are being promised reform that will ensure pre-existing conditions will not be grounds for rejecting people from obtaining insurance and that people who are sick will not be cancelled, but there are major loopholes that were inserted by insurance industry lobbyists. Anyone here think the inurance industry won’t use those loopholes?

    For instance, if you have diabetes, high blood pressure, high cholesterol readings, or other medical conditions the legislation as proposed allows for doubling of premiums. If a family of four making $55,000 annually is expected to pay $9,000 for healthcare, doubling that means your paying 32percent of your annual income for healthcare.

    Good outcome.

    Despite complete lack of GOP support for the legislation, they did get their Holy Grail of allowing insurers to sell policies “across state lines”–they there is the competition thign so that is good right? Well, yeah, but it also exempts these insurers from state patient protections laws (interstate commerce). Insurers will set up in the least regulated states resulting in a race to the bottom when it comes to consumer protection.

    Good outcome

    There is almost nothing built into these bills when it comes to oversight of insurance denials of care. I know a lot of doctors and insurance companies typically reject between 15 and 20 percent of claims. What good is insurance if it doesn’t?

    Good outcome.

    The legislation has laughable limits on drug prices–of course we knew that was coming when Obama brought Big Pharmaceutical in early.

    Good outcome.

    I could go on for hours.

    I have been an Obama supporter, but his refusal to push for real reform has left me disappointed.

    If Obama really set out to be a transformational president, he succeeded only in that he has given even more control to the corporations (I can hardly wait for his Wall Street reform) than even George Bush did.

    Since we are talking healthcare, this legislation utterly fails the Hippocratic Oath (First, do no harm). Ironically, the GOP plan which was to do nothing would have been a better approximation.

    This legislation is a big steaming pile of crap.

  7. Nick Benjamin Says:

    @Doomed
    You appear to be referring to instructions to the Conference Committee. Those are included with most controversial proposals because guys like Nelson like to know their ideas won’t be destroyed by Nancy Pelosi.

    Even if you’re not it doesn’t really make it harder for the Congress to change any of the rules you mention. They just have to amend two sections of the bill rather than one.

    @gerry:
    I stopped reading when you started talking about pre-existing conditions. Your claims are simply false. Insurers can’t increase premiums due to pre-existing conditions. That’s called community rating. They can’t deny them either. That’s called guaranteed issue.

    Moreover poverty level for a family of four is $22k, a family with an income of $55k is 250% of poverty. Under the house bill they have a full subsidy. Under the Senate bill they have a partial subsidy.

    Even if by some bizarre twist of fate a family gets no subsidy and the only policies available on the Exchange cost them more than 8% of income they don’t have to buy insurance. They lose nothing in this bill, and gain the right to buy on the Exchange, which (for a variety of reasons) should be much cheaper then on the individual market we have today.

    I freely admit this bill isn’t enough. We’ll probably need to add a public option or Medicare buy-in, but we have until 2013 to do that. And once the dang bill passes it’ can be amended via reconciliation. IMO it would be very smart for Obama to propose seriously screwing with the drug companies in June. That would be very good politics, and it would help bend the cost curve.

  8. michael reynolds Says:

    What Nick said.

    This isn’t the end of the game, it’s the beginning. And a very good beginning that Mr. Clinton was not able to achieve.

  9. PG Says:

    I’m normally opposed to calling it ObamaCare because Obama has been so ostentatiously NOT repeating the errors of “HillaryCare” (i.e. he did not write the Perfect Bill and tell Congress to pass it; he left it to them, and as one expects in Congress the resulting bill can’t be assigned to any individual except perhaps ModerateDemocratCare). But I think this post makes a decent case for calling it ObamaCare if it really hews as closely to what Obama said as the post claims. I am more skeptical, but I’m detail-oriented and just setting out a half-dozen broad goals that are mostly getting met in one way or another doesn’t seem quite the same as active participation in the process of determining HOW those goals will be met.

    Captcha: Beltway Begin

  10. PG Says:

    Nick,

    Nah, you’re giving Doomed too much credit. He’s just parroting back what he’s been told by RedState, except with greater dishonesty. The “subsection C” to which he refers is not about the overall bill at all; it’s in one specific section (Sec. 3403) that deals with the Independent Medicare Advisory Board, which is going to be MedPAC (the body that was created in the 1997 Budget act and not recommended a death panel yet!) except with teeth. For a decade MedPAC has been recommending that Medicare’s costs be reduced through overall measures such as reducing certain payments to specialists.

    (I’ll announce my dog in the fight: my dad is a specialist in a geriatric field, meaning that most of his patients are on Medicare. He’s in a small town, less than 30k people. On the money from his practice, he’s sent three kids through private school — nursery through grad school. If you can’t make your practice work on Medicare rates, you don’t know how to run a business. Neither does my dad really, but that’s what Mom is for.)

    MedPAC’s recommendations go to Congress and Congress ignores them. Charlie Rangel isn’t going to reduce Medicare reimbursement rates for doing CAT scans and nuclear medicine, not when he has a large, for-profit hospital as a major donor. Rangel would be OK with reducing Medicare reimbursements for urologists in rural areas, but some other Representative has those interests close to heart. Everyone is in favor of reducing Medicare costs; no one cares enough to get any one of these changes past the Congressman who’s opposed.

    We’ve been in a place like this before, in the 1980s when we needed to close excess military bases. Everyone fought to keep the military base in her district while mouthing the standard wisdom that of course we needed to close some bases – just not this one. It makes me sad to realize that I’m looking back on Phil Gramm with affection, but he and some others came up with a good plan to deal with the impasse: have an independent, expert commission study the matter and recommend which bases to close. Their recommendation could not be amended or altered in any way. Congress had to vote up or down on the whole package. The chair of the Armed Forces or Ways & Means could not logroll his district’s base off the list to get chopped.

    The same idea applies to the Independent Medicare Advisory Board (aka MedPAC-with-teeth). IMAB submits its proposal for a package deal to the Secretary of HHS, who submits it to the President, who submits it to Congress. And then it goes like this:

  11. PG Says:

    ‘‘(d) CONGRESSIONAL CONSIDERATION.—
    ‘‘(1) INTRODUCTION.—
    ‘‘(A) IN GENERAL.—On the day on which a proposal is submitted by the President to the House of Representatives and the Senate under subsection (c)(4), the legislative proposal (described in subsection (c)(3)(B)(iv)) contained in the proposal shall be introduced (by request) in the Senate by the majority leader of the Senate or by Members of the Senate designated by the majority leader of the Senate and shall be introduced (by request) in the House by the majority leader of the House or by Members of the House designated by the majority leader of the House.
    ‘‘(2) COMMITTEE CONSIDERATION OF PROPOSAL.—
    ‘‘(A) REPORTING BILL.—Not later than April 1 of any proposal year in which a proposal is submitted by the President to Congress under this section, the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate may report the bill referred to the Committee under paragraph (1)(D) with committee amendments related to the Medicare program.
    ‘‘(B) CALCULATIONS.—In determining whether a committee amendment meets the requirement of subparagraph (A), the reductions in Medicare program spending during the 3-month period immediately preceding the implementation year shall be counted to the extent that such reductions are a result of the implementation provisions in the committee amendment for a change in the payment rate for an item or service that was effective during such period pursuant to such amendment.
    ‘‘(3) LIMITATION ON CHANGES TO THE BOARD RECOMMENDATIONS.—
    ‘‘(A) IN GENERAL.—It shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, or amendment, pursuant to this subsection or conference report thereon, that fails to satisfy the requirements of subparagraphs (A)(i) and (C) of subsection (c)(2).
    ‘‘(B) LIMITATION ON CHANGES TO THE BOARD RECOMMENDATIONS IN OTHER LEGISLATION.—It shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report (other than pursuant to this section) that would repeal or otherwise change the recommendations of the Board if that change would fail to satisfy the requirements of subparagraphs (A)(i) and (C) of subsection (c)(2).
    ‘‘(C) LIMITATION ON CHANGES TO THIS SUBSECTION.—It shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report that would repeal or otherwise change this subsection.
    ‘‘(D) WAIVER.—This paragraph may be waived or suspended in the Senate only by the affirmative vote of three-fifths of the Members, duly chosen and sworn.

    Subsection c(2)’s subparagraphs (A)(i) and (C) are referred to repeatedly above, so you’re getting those too!
    ‘‘(c) BOARD PROPOSALS.—
    ‘‘(2) PROPOSALS.—
    ‘‘(A) REQUIREMENTS.—Each proposal submitted under this section in a proposal year shall meet each of the following requirements:
    ‘‘(i) If the Chief Actuary of the Centers for Medicare & Medicaid Services has made a determination under paragraph (7)(A) in the determination year, the proposal shall include recommendations so that the proposal as a whole (after taking into account recommendations under clause (v)) will result in a net reduction in total Medicare program spending in the implementation year that is at least equal to the applicable savings target established under paragraph (7)(B) for such implementation year. In determining whether a proposal meets the requirement of the preceding sentence, reductions in Medicare program spending during the 3-month period immediately preceding the implementation year shall be counted to the extent that such reductions are a result of the implementation of recommendations contained in the proposal for a change in the payment rate for an item or service that was effective during such period pursuant 2 to subsection (e)(2)(A).

    ‘‘(C) NO INCREASE IN TOTAL MEDICARE PROGRAM SPENDING.—Each proposal submitted under this section shall be designed in such a manner that implementation of the recommendations contained in the proposal would not be expected to result, over the 10-year period starting with the implementation year, in any increase in the total amount of net Medicare program spending relative to the total amount of net Medicare program spending that would have occurred absent such implementation.

  12. PG Says:

    If you encounter more folks like “Doomed” (and you will, they’re everwhere!), just ask them to do what they keep yelling at Congress to do: read the bill. Not even the WHOLE bill, just the part they’re claiming to be upset about. Then ask them why this upsets them, with reference to the particular subsection they’re concerned about and what they think that subsection does.

    Alas, even Gramm-grade Republicans are scarce on the scene these days. Conservatives have already labeled a MedPAC capable of getting something done as a “death panel,” and the notion of Congress not being able to amend IMAB’s recommendation unless it will be cost-reducing or cost-neutral has conservatives convinced that ZOMG WE’RE ALL GOING TO DIE!

    They also have a charming, much-repeated typo of referring to IMAB as the Independent Medi**cal** Advisory Board — funny how “mistakes” like that always seem to go toward making the provision seem much more far-reaching than it actually is. “Medicare,” that’s just for the elderly and severely disabled. Once you call it the Independent Medic**cal** Advisory Board, it sounds like it controls all medical decisions, not just the rates for a particular government program.

    I stopped believing it was an innocent typo after I googled “Independent Medical Advisory Board” and noticed that when in reference to the health care bill, it only showed up on sites opposed to that bill. It even showed up on a Weekly Standard blog post that got the phrase right the first time, and then used the “error”: http://www.weeklystandard.com/weblogs/TWSFP/2009/12/reid_bill_declares_future_cong_1.asp

  13. gerryf Says:

    Nick,

    Everywhere I read or everyone I speak to in support of this bill is making a huge assumption that this is just some beginning and that Obama is playing chess not checkers.

    What has transpired that makes people believe that?

    The time for action is now; history favors the bold.

    Maybe I am just too cynical, but I have seen nothing that makes me believe that the end result of all these machinations (intended or unintended) is going to be a boon to the insurance industry.

    Ron Williams is doing cartwheels down the halls of Aetna as we speak….

  14. Aaron Says:

    Nick,

    Just for some clarification. Are you saying that once this passes there will be no coverage denial or that there’s no coverage denial currently?

    I’m hoping for the former, and the latter is simply untrue. A good friend of mine is uninsurable due to a mix of chromosome oddities and a hereditary chance of cancer. My fiance and I are finding it very difficult to get her covered due to chronic migraines.

    I’ll be honest, that right there is my personal interest in this bill passing. I’m right now okay with a private system that’s properly regulated and protected, so long as the folks I care about (and everyone else) can get coverage, at any price. Lowering that price is of course a huge welcome bonus, but it does no good if everyone can’t get it on it.

  15. Nick Benjamin Says:

    @Aaron:
    That currently some folks can;t get insurance, when this bill is passed that will change.

    @Gerry
    We don’t really trust Obama to do the right thing on his own. We trust Progressives to propose the right thing in 2011, and we trust Obama and many other Dems to go along with it (or most of it) after we bully them some.

  16. bubbaquimby Says:

    Nick what have progressives won on since Obama took office? How can you realistically think you will propose “the right thing” in 2011 when it looks like the Democrats will lose seats not gain. The time was now when you had the upper hand and momentum.

  17. Nick Benjamin Says:

    Where have we won?

    Dude, have you been paying attention?

    We got exactly what Obama said he’d deliver on Iraq. We’ve got a deadline on Afghanistan. We’ve got a flawed health bill, that will nonetheless cover 30 million Americans.

    We’ll probably get C+T, and if we don’t we’re gonna get major carbon-emission regulations from the EPA. We’ve probably get ok finance regulations. And if Obama et al. are politically savvy they’ll propose major initiatives to screw with drug companies this June.

    Granted if we had a Parliamentary system we’d have all that already, and probably more. But we don’t. We have a US Senate, and the US Senate contains people who debate things for 11 months, agree with everything in the entire bill, and then vote against it because they think 11 months of debate isn’t enough. I’m looking at you Olympia Snowe.

    Moreover when Health Care is finally signed we’ll have the ability to get the rest of it through reconciliation.

  18. Justin Gardner Says:

    Nick,

    It’s almost impossible to talk to hard core liberals these days. They’re so jaded from the last eight years that they think Obama should do to Republicans what Bush did to Dems. Obviously they don’t have their eyes on the long term, and we can both be glad that cooler heads are prevailing.

  19. Peggy Says:

    The proposed Obama Health care plan is integrating the QALY system of, forerunner of the Culture of Death, activist Peter Singer. QALY or Quality Adjusted Life Years is an equation used to equate the value of each human life to the government. The plan is to use QALY to ration health care.

    Key Words:
    Quality-Adjusted Life Years, Disability-Adjusted Life Years,
    outcome assessment, cost-effectiveness.

    QALYs and DALYs is important to researchers and policy makers, for a sound interpretation of the evidence on the outcomes of health interventions.

    To not loose any of the moraless ideas of Singer, the following is how he explained the QALY equation in the New York Times

    Singer: “As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities.”

    Consider a decision maker (government) who can fund treatment with rationed dollars
    for:
    - a 65 year old man who has entered the end stage of an illness
    or
    - a 45 year old man who has entered the end stage of an illness

    There is also a DALY – Disability-Adjusted Life Years which would technically make null & void all the progress of Americans with Disabilities Act (ADA) which prohibits discrimination against people with disabilities in employment, transportation, public accommodation, etc.

    QALY – Quality Adjusted Life Years —
    • “COMPARATIVE EFFECTIVENESS RESEARCH”
    which is funded by the recent Stimulus bill.
    Do you understand that this means the the government will
    take the cost and ÷ the number of years of life expectancy to justify the procedure?

    In depth: The Oxford Journals
    http://heapol.oxfordjournals.org/cgi/content/full/21/5/402

    Yes, this administration touts that all Americans will be covered by insurance.
    Pre-existing conditions will be covered – BUT, under QALY & DALY not treated!!!!
    What good is being covered when a government will decided if you get care.
    COVERAGE WITHOUT CARE …. That, my friends, is OBAMA-CARE!

  20. Nick Benjamin Says:

    Peggy,

    Comparative Effectiveness Research encompasses a wide variety of techniques. For example one major area of Medicare waste is Doctor’s who order unnecesary tests in exchange for kickbacks from researrch labs:
    http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

    Any attempt to figure out which Doctors are doing this is Comparative Effectiveness Research, because you Comparing when a test is Effective.

    Or maybe there’s $1 Billion to give to pay hospitals to improve quality. To spend that money non-stupidly you have to Compare the Effectiveness of various treatments using Research.

    Regardless of that reality your scenario is simply false. No decision-maker is allowed to deny a patient treatment simply because of his calender age. Period. It’s theoretically possible that a decision maker could do so, but if he did so he’d be fired at the minimum. He’d probably lose his license too. It’s also theoretically possible Congress could amend the law. And if they ever try I’ll be on your side. Until then please stop reading tea party propaganda. It’s just not good for your mind.

  21. Peggy Says:

    Nick: Thank you so much for your concern. I guess you could easily tell that I am a senior citizen. However, I get my information from many sources, one of which is the New York Post. Another is the Journal of the American Medical Association and also the New England Journal of Medicine.

    The health bills coming out of Congress would put the decisions about health care in the hands of presidential appointees.

    Americans need to know what the president’s health advisers have in mind for them.

    Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.

    Savings, he writes, will require changing how doctors think about their patients:
    Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association)
    Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.
    Emanuel believes that “communitarianism” should guide decisions on who gets care and in withholding care from the elderly for greater good.

    Many doctors are horrified by this notion.

    Obama also appointed Dr. David Blumenthal as national coordinator of health-information technology. He recommends slowing medical innovation to control health spending.

    Blumenthal has long advocated government health-spending controls, though he concedes they’re “associated with longer waits” and “reduced availability of new and expensive treatments and devices” (New England Journal of Medicine).
    But he calls it “debatable” whether the timely care Americans get is worth the cost. (Ask a cancer patient, and you’ll get a different answer. Delay lowers your chances of survival.)

    Blumenthal’s job involves making sure doctors obey electronically delivered guidelines about what care the government deems appropriate and cost effective.

    No one has leveled with the public about these dangerous views. Nor have most people heard about the arm-twisting, Chicago-style tactics being used to force support.
    They want to push the bill through before the public understands it. Even if it is
    delayed, the rationed care issue may still be in effect.

    Read entire article at the link below:
    http://www.nypost.com/seven/07242009/postopinion/opedcolumnists/deadly_doctors_180941.htm?page=0

  22. Nick Benjamin Says:

    @Peggy
    I don’t care that you’re a senior. I care that your information is fantasy.

    You’re quoting an op-ed written by Betsy McCaughey. I have never heard anyone who is intellectually honest say a nice thing about her. She makes things up.

    The theoretical desires of Obama’s appointees are irrelevant. Neither bill, nor any version of either bill that has been proposed, will allow them to do the things you are worried about. Period. End of story. Do not pass go, do not collect $200.

    Take Blumenthal’s job. He is tasked with encouraging Doctors and Hospitals to use electronic medical records, because the archaic paper systems they currently insist on using cost a buttload of money and hurts people.

    He has no ability to prevent hospitals from buying the latest CT Scan machine, robotic surgeons, or anything else that might strike their fancy. He has no ability to tell a hospital that they can’t scan a patient. What he can do is encourage them (not force them) to put it on an electronic record so that the patient’s future Doctors know what happened.

  23. Peggy Says:

    Nick:
    Gee, you must be one of the few who have actually read the entire bill. I’m impressed. You must have missed this regarding Comparative Effectiveness Research.
    The bill still establishes the Patient Centered Outcomes Research Institute (PCORI), a nonprofit corporation, to conduct comparative effectiveness research (CER). PCORI will replace the Federal Coordinating Council created in the American Recovery and Reinvestment Act of 2009. Despite repeated attempts by Republicans to prohibit the government from using CER to make coverage decisions, such amendments failed along party lines. There is concern that this unelected, bureaucrat-appointed board will lead to rationing and make one-size-fits-all judgments prohibiting treatment options on the basis of cost.
    Rationing is a REALITY with this administration!
    To quote Obama “Maybe you’re better off not having the surgery but taking a pain killer.” see YouTube
    http://www.620wtmj.com/shows/charliesykes/65008422.html
    As for electronic records, our doctors and hospitals have had them for years.

  24. Nick Benjamin Says:

    @Peggy

    Gee, you must be one of the few who have actually read the entire bill. I’m impressed. You must have missed this regarding Comparative Effectiveness Research.

    Apparently I read more than you on the PCORI. Page 1680:

    ‘(j) RULESOFCONSTRUCTION.— ‘‘(1) COVERAGE.—Nothing in this section shall 8
    be construed— 9
    ‘‘(A) to permit the Institute to mandate 10
    coverage, reimbursement, or other policies for 11
    any public or private payer; or 12

    Back to you:

    To quote Obama “Maybe you’re better off not having the surgery but taking a pain killer.” see YouTube
    http://www.620wtmj.com/shows/charliesykes/65008422.html

    Depending on the situation that could be very smart advice.

    There’s always a risk to surgery. Always. Sometimes a lifetime of taking one pill in the morning is less risky then a single surgery.

    The problem is our current system punishes the Doctor who doesn’t recommend surgery because he only gets paid if he operates. There are pilot programs to fix this flaw, but nothing mandated.

    As for electronic records, our doctors and hospitals have had them for years.

    Where are you?

    In Detroit some of the hospitals have them, but not all. The systems don’t talk to each-other. As for private practices I have never been inside a medical office that didn’t have an entire room devoted to paper records, usually right behind the receptionist.

    One of my friends actually had to physically prevent a doctor from giving his wife a shot she was allergic to. The physical confrontation didn’t get very far, because they were interrupted by the head of the department, who was personally adding her allergy to the file.

  25. Peggy Says:

    I’m in CA. Electronic records everywhere.
    Nick … keep eating the pablum.
    I’m done!!

  26. Nick Benjamin Says:

    So Blumenthal doesn’t have any work to do in CA.

    But he has work to do in lots of states, that’s why they created the job.

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