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

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.

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.

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

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.

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!

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.

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.

@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.

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.

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….

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

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.

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:

Captcha: Beltway Begin

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.

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.