Thursday, August 13, 2009

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.

Wednesday, August 12, 2009

Words Words Words

Brainy Quote is a website which displays notable quotes from notable people. Here are some interesting quotes made by candidate, then President, Barack Obama:

“Change will not come if we wait for some other person or some other time. We are the ones we've been waiting for. We are the change that we seek. “

“I can make a firm pledge, under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes. “

“I don't take a dime of their [lobbyist] money, and when I am president, they won't find a job in my White House.“

“I found this national debt, doubled, wrapped in a big bow waiting for me as I stepped into the Oval Office.”

“I will cut taxes - cut taxes - for 95 percent of all working families, because, in an economy like this, the last thing we should do is raise taxes on the middle class.”

“It's not surprising, then, they get bitter, they cling to guns or religion or antipathy to people who aren't like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations.”

“My administration is the only thing between you [CEO's] and the pitchforks.”

“Over the last 15 months, we've traveled to every corner of the United States. I've now been in 57 states? I think one left to go.”

“We need earmark reform, and when I'm President, I will go line by line to make sure that we are not spending money unwisely.”

That he made those statements is undeniable. Barack Obama fashioned his image and reputation on the basis of these and similar statements. Whether he has kept the promises made in some of those statements, and whether he is in truth the man he presented himself to be, is now the proper focus for debate.

Tuesday, August 11, 2009

Thoughts on Bible Prophecy

I was watching TV earlier this week and caught one of those old programs about Nostradamus. You know, the French guy from Sixteenth Century France who – if you believe the spin – accurately predicted every important event between then and the end of the world. Our boy Michel – I’m gonna call him Mike – grew up in a Jew-converted-to-Catholic family with no money or influence, which meant he got into a lot of scrapes with the Inquisition (yeah, those guys who figured the best way to express the Love of God and Christ for Humanity was to torture confessions outta people and burn heretics to death). Mikey picked up a few patrons along the way; reportedly the Queen thought he was all that and a basket of croissants, which helped him build both his reputation and a defense against his enemies.

Mike had a problem. On the one hand he had all these great prophecies spinning in his noggin, just screaming to be put down on paper. On the other hand, Mikey had a lot of enemies, who could be counted on to use anything he wrote against him, and misuse the prophecies for potentially horrific results. So, Mike wrote his prophecies down in a strange sort of verse called Virgilianized Syntax, mixing in words from other languages and playing word games. While this produced a book of odd verse which many have taken for profound prophecy, it’s a bit difficult to credit it completely, precisely because our boy Mike was a big vague on details. I’ve read Mikey’s prophecies and while some of them seem to have hit the mark, others are hard to consider proven, and some are just too darn weird to take any specific meaning from them.

And that brings me to the Bible. The Bible is also a book with many prophecies, and some of the wording makes it hard to understand. My problem here, is that while I can pretty much ignore Mike’s prophecies with no worries because I really do not see anything to indicate that I need to be up to speed on what a dead Frenchman’s saying on the issues of the day, I do happen to believe in the Bible, and that includes the prophecies. So I believe that I need to pay attention to what God’s saying in the Bible. And that is sometimes harder than I would like.

Part of that is the number of people who want to sell their own interpretation of Scripture. Nothing wrong with someone saying what they think, except that some of these folks are not calling it their own opinion, but selling it as God’s truth. That gets a person into real trouble, right quick. So before I post again on this subject, let me be very clear that whatever think on the matter of prophecy, it’s nothing but my guess and take it as that and no more than that.

to be continued

Monday, August 10, 2009

What I See So Far About HR 3200

There are a lot of words in the 1,017 pages of HR 3200, even by my standards. The bill is poorly written from what I can tell, since it constantly directs the reader to consult other laws and regulations to see the way a particular section is to be applied. If the Democrats were listening to me, the first piece of advice I would offer is to rewrite this thing in plain English, with a simple Table of Contents and page listing, along with a synopsis of each section to explain its intent and function. People tend to resent a piece of legislation which involves a lot of tax money, will be permanent, and which seems to be rushed, when it is difficult to understand and discuss. It may be that the Democrats have put together a really effective piece of legislation, but if so they should be happy to discuss it in detail, not act defensively and as if they have something to hide.

Anyway, to the bill. HR 3200 is a huge piece of work, but to start its examination, we see that it has three “Divisions”, seventeen “Titles”, and fifty “Subtitles”. Division A is titled “Affordable Health Care Choices” and Title I therein addresses the description of heath care plans, access, benefits, and consumer protections. Title II is important, as it creates the government entity known as the “Heath Insurance Exchange”. Section 201 lays out how it works, as follows:

The government will set up a new bureaucracy called the Health Choices Administration, with a Commissioner who reports directly to the President. The HCA will create and supervise an entity known as the Health Insurance Exchange, wherein all nominal insurance coverage will be administered at the federal level. The HCA would have complete authority to determine whether individuals, employers, or insurance companies met the requisite criteria to participate, and the tone of the Title implies that the final decision will be made only with government approval. The function of the HCA invites legal challenge on at least two constitutional grounds – first, the traditional separation of powers does not allow the Executive Branch authority to control domestic commerce in this way; on a practical level imagine the fallout if this bill becomes law and if/when a Congressman or Senator wishes to look more closely at the HCA’s activities he/she is told that Congress is excluded from such authority? The second conflict is that creation of the HCA would effectively eliminate the state insurance boards, as all insurance would be controlled and directed from the federal level, in what appears to be a direct violation of state’s rights under the U.S. Constitution.

There’s a lot more to consider, but for now it might be interesting to consider the almost certain legal challenges which this bill would face were it actually to become law.