It’s Reasonable To Be Angry

One thing I have not liked to see in this health care issue, is the arrogance of Congressmen who yell at their constituents, who try to evade a difficult question by talking on their cell phone so they can ignore the citizen, or who actually protest that it’s unreasonable for them to have read the bill before voting on it.

That’s just the behavior of elected officials, not even touching the many allegations of union thuggery and exclusion of constituents who might not cheer the plan.

A better course, from where I sit, is to discuss specific proposals in HR 3200, the original House bill from which all three pending versions are derived, and SB II (BAI09A84), the Senate bill. Pay particular attention to the choice of wording, in order to recognize the intent and likely bias of the bill. Or at least you can come to understand a resistance to the bill, when the people who will be voting on it either cannot explain the bill in specific or refuse to address the draconian provisions set out in it. The distinction is that the politicians have no just cause to be angry, while the people who learn what’s in these bills will have every reason to become upset.

The Senate bill can be read here.

HR 3200 can be read here.

I strongly suggest you make time to read them both.

First, I notice some unusual wording in the Senate Bill. Looking at Section 399HH, “National Strategy for Quality Improvement in Health Care”.

In Part A of that section, under ‘Requirements’, the Senate Bill directs the Secretary of the Health Choices Administration (HCA), to “address the health care provided to patients with high-cost chronic diseases” [ (Sec. 399HH, (2)(B)(i) ]

One may wonder why the emphasis on high-cost chronic diseases, and certainly one may excuse the patients suffering from, say, AIDs, Cancer, Diabetes, Alzheimer’s, or any other of a number of similar maladies for asking why their conditions appear to be targeted.

That same section directs the HCS Secretary to “address gaps in quality and health outcomes measures, comparative effectiveness information, and data aggregation techniques, including the use of data registries” [ (Sec. 399HH, (2)(B)(ii) ].

Wording like that is certainly evocative of ‘Big Brother’, and just why should Americans expect uniform levels of “health outcomes” in every region and city? Effectiveness in health issues often depends not only on resources but the skill of the professionals and on the patient.

And there’s nothing like an open-ended excuse, like this one:

“address other areas as determined appropriate by the Secretary.” [ (Sec. 399HH, (2)(B)(ix) ].

We can safely say that the Senate bill is problematic in its language.

Looking now to Section 1233 of HR 3200, we see the following fascinating passage regarding mandatory “advance care planning”.

“Such consultation shall include the following:
‘‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.” [ Sec. 1233 (hhh)(1) ]

Yes, you read that right. By law, anyone over 65 would have to be advised at least once every five years about the ‘benefits’ of ending their life.

So just who makes that all-important life-or-death decision? Well, the patient is allowed the decision, but only when “guided by a coalition of stake holders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.” [Sec. 1233 (iii)(IV) ].

The bill also says the patient may be advised about the end-of-life option “more frequently” (and it seems, more aggressively) “if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program." [ Sec. 1233 (iii)(3)(B) ]

By the way, according to that definition, my doctors – by law – would be required to ‘consult’ with me about killing myself, since my cancer is incurable. It would suggest that Michael J. Fox kill himself, since Parkinson's is progressive, that Dr. Hawking should die, being in a 'life-limiting' condition, and so on.

It is also worthwhile to go back a bill already signed into law, the “American Recovery and Reinvestment Act of 2009” (give that a read as well, please).

In Subtitle A, “Promotion of Health Information Technology”, the Act cites the intention, among other things, to ‘reduce health disparities’ [Section 3001, (b)(2)] and “reduce health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information” [ Sec. 3001, (b)(3) ] and “provides appropriate information to help guide medical decisions at the time and place of care” [ Sec. 3001, (b)(4) ]

That same bill also specifies the intention of establishing “the utilization of an electronic health record for each person in the United States by 2014” [ Sec. 3001, (3)(A)(ii) ]

The Act also requires a National Database for health care information in every single American: “Facilitate the adoption of a nationwide system for the electronic use and exchange of health information” [Sec. 13113, (a)(1) ]

That same Act requires medical care providers receiving federal funds must “consult and consider the recommendations” of any health care provider, agency, school, or other “entity” specificied by the Secretary of HHS as a "qualified State-designated entity” when providing diagnosis or care for any patient. [ Sec. 3013,(5),(g) ]

Now comes the question of what these separate and associated devices mean. Are they, As Governor Palin claims, a ‘death panel’? Nowhere in any of these bills does it state that the government wants to kill anyone, but at the same time, all three of the bills clearly create a vast increase in government snooping into our private information (yes, they say they will abide by HIPAA, but does anyone really believe that a vast government database identifying everyone by their most intimate medical details will never be hacked or the data misused?) All three bills take a lot of our choice away, by requiring compliance with onerous federal rules and paperwork, and direct government ‘advice’ to your doctor about what can and should be performed. And the House bill quite specifically encourages the premature death of the elderly and the infirm.

Whatever you want to call it, this proposed law is inhuman and repulsive. The only appropriate response, as I see it, would be anger and resistance.