Right Wing Nut House

Yes, it was great the our president reached out his holy hand and tried to bring his adversaries to the promised land of health insurance reform. Just more proof that our president really, really, really wants to govern in a bi-partisan manner. Liberals and little children believe that fairy tale - and if you can point to a difference in emotional and intellectual maturity between the two, I would welcome it.

Only partisans believe the bi-partisan shtick, of course. Just as only partisans on the other side believe that the GOP was anxious to cut a deal. It’s part of the reason that this whole summit idea was stupid to begin with. When the president has been plotting with Harry Reid for weeks to ram health insurance reform through using reconciliation, the idea that there was any attempt to do anything save make the GOP look bad at the summit is absurd. “Bi-partisanship” was the farthest thing from Obama’s mind, and the cynicism it took to stand in front of a television audience and piously proclaim otherwise was breathtaking.

And what of the “start over” Republicans? Yeah, right. Since many conservatives think our health care system is the finest in the world and we shouldn’t mess with it at all, the idea that any of the GOP ideas on health insurance reform - some of them good ones - would be advanced by the Republicans is equally absurd. The GOP was no more interested in bi-partisanship than Obama and the Democrats but at least they didn’t pretend that they could find enough common ground to pass something both parties could support.

Meanwhile, health care costs and the price of insuring Americans continues to go through the roof while millions go uninsured because they can’t afford it or can’t get coverage at any price due to a pre-existing condition.

Earth to Republicans: This is a problem. This is a problem that needs to be addressed by responsible legislators. I agree with you that the ultimate goal of the Democrat’s plan is a single payer insurance system and a near total takeover of the health care segment of the economy. Plenty of Democrats haven’t even bothered to hide their feelings about that and have openly said as much. But this is why God gave you a brain; figure out a way to pass health care reform that will prevent that from happening. Slippery slopes are not inevitable if you recognize them and work to avoid them.

Moon to Democrats: Read any good polls lately? That sucking sound you hear is your ironclad majorities going down the drain because, as the economy slips even further into recession, your constituents are wondering what in the name of all that is good and holy you are doing fiddling with health care reform while they can’t even get a job flipping burgers. Have you noticed those cooking pots of tar and people tearing into feather pillows when you’re speaking to the home folks? Lots of pitchforks in evidence too. The contorted faces of rage that shocked you last summer are nothing compared to the lynch mobs that await many of your colleagues on election day if you continue to pursue this Ahab-like obsession of our presidents’s.

Did one side “win” the day yesterday?” I’d say from what I saw of the summit (the first 4 hrs - then I watched woman’s hockey which was far more interesting), the Republicans had a clear advantage. It’s always better to be on offense and the GOP speakers scored several hard blows to the Democrats while offering some modest reforms of their own. For their part, the Democrats weirdly tried to get everyone watching to break down weeping as they related story after story of Americans losing insurance, having inadequate insurance, or some insurance executive beating them up, eating their children, or sucking their blood vampire like from their necks. I’m sure the wonks who were watching the fiasco had to excuse themselves to dry their eyes and blow their noses. Or not. Such emotionalism plays well on campaign commercials but only made Democrats look unserious and mostly silly for their going for the heart tactics.

For their part, the Republicans scored some good points when pointing out reality about many parts of the bill. There was an interesting dust up over a useless argument on CBO’s estimate of premium costs for the average family. Lamar Alexander said the CBO calculated that premiums would rise, Obama differed. The president was right; the CBO said premiums will go down - except that families may choose to purchase more insurance at a higher cost.

The whole question is moot anyway. The CBO numbers calculate that Obamacare will find $500 billion in Medicare savings. Everyone knows that’s off the table so, while the actual CBO report claims lower premiums for families, the reality is going to be different if Obamacare is passed because the CBO estimates on premiums are based on the idea that the Medicare reduction in hospital and doctor payments will actually come about and lower health care costs. No lowering of health care costs means no lowering of health insurance premiums. So, score one for the president on accuracy, but deduct a half for disingenuousness.

Other than that, Dr. Tom Coburn had some devastating points about malpractice and defensive medicine and really landed some body blows when talking about waste and fraud in Medicare. Since there is no tort reform in the bill, Democrats had no coherent answer. And in one of the few truly bi-partisan moments, the entire room agreed about waste in the system.

Such esoterica was nothing compared to the tour de force presentation by Paul Ryan (video here). Ryan took the Democrats to school with his treatise on the budget and deficits, and how simply dishonest the Democrat’s bill is in presenting itself as a budget cutting measure. Ryan proved once again why he is a young turk in the Republican party. That 5,000 watt brain of his cannot be ignored.

I was wracking my brains thinking of something good to say about another Democrat on the panel but frankly, only the president impressed me. The rest of his colleagues only revealed a “stature gap” as Mike Gerson pegged it. There was the president. And then there were the seven dwarfs.

But no clear Obama advantage this time, as there was in Baltimore at the GOP retreat a couple of weeks ago. There, Republicans sputtered while Obama - completely at ease and in full professorial mode - lectured his opponents and made them look small.

But the GOP came loaded for bear yesterday and it showed. They were sharp, penetrating, and for the most part, reasonable. If the White House strategy was to repeat the president’s performance from Baltimore, they were clearly disappointed. Even David Gergen, who spends a lot of his face time on TV bashing Republicans, said it was the GOP’s “best day in years.”

Considering what has transpired in recent years, that ain’t saying much.

A growing scandal in Great Britain may give us a glimpse of America’s future under a health care system run by the government.

Note, I said “may.” The fact is, government run health care systems in other countries have varying mixes of public and private care available to consumers, which gives many citizens options regarding their care. Canada is a good example. Most Canadians are satisfied with their health care system despite its long waiting periods for routine procedures for many. That’s because private insurance is still available for those who wish coverage for prescriptions, dental and vision, as well as little extras like private hospital rooms. Up to 2/3 of Canadians have some form of private, supplemental insurance, mostly paid by their employers.

And unlike Great Britain, almost all services are provided by private companies. Doctors are paid a fee for services rendered rather than receiving a salary. The industries are heavily regulated and competition is stifled to a large degree. But there is no rationing per se and no lifetime limit on using the system.

But the National Health Service in Great Britain is a different story. Here, only about 10% of citizens purchase supplemental private insurance, although the government will pay for some procedures performed by private concerns if the waiting period in the public sector is too long. We’ve heard of the NICE Commission - the National Institute for Health and Clinical Excellence - which functions as a de facto rationing body by approving or denying treatments. They say they base most of their decisions on quality of care and only deny treatments that “don’t work” or have limited value in improving the condition of patients. The Medicare Cost Control board that the health care reform bill would set up here would perform similar duties.

Since private insurance companies routinely make those kinds of decisions here already, the difference will be in treating the patient as a number or a customer. While the motivation underlying both private insurer and government may be similar, it is not the same and most critics of Obamacare make the point that the pressure on government to deny services will be greater than on a private insurance company due to efforts by government to not only put downwards pressure on the cost curve of medical care generally, but also meet budgetary targets. It’s a political argument and I’m not sure about it’s real life implications. But looking at the workings of NICE, one has to wonder about some of their decisions.

But the big difference between Great Britain and Canada is that almost all health care facilities are run by the NHS. The result?

Up to 1,200 people lost their lives needlessly because Mid-Staffordshire NHS Trust put government targets and cost-cutting ahead of patient care.

But none of the doctors, nurses and managers who failed them has suffered any formal sanction.

Indeed, some have either retired on lucrative pensions or have swiftly found new jobs.

[...]

The devastating-report into the Stafford Hospital-shambles’ laid waste to Labour’s decade-long obsession with box-ticking and league tables.

The independent inquiry headed by Robert Francis QC found the safety of sick and dying patients was ‘routinely neglected’. Others were subjected to ‘ inhumane treatment’, ‘bullying’, ‘abuse’ and ‘rudeness’.

The shocking estimated death toll, three times the previous figure of 400, has prompted calls for a full public inquiry.

Bosses at the Trust - officially an ‘elite’ NHS institution - were condemned for their fixation with cutting waiting times to hit Labour targets and leaving neglected patients to die.

But after a probe that was controversially held in secret, not a single individual has been publicly blamed.

The inquiry found that:

• Patients were left unwashed in their own filth for up to a month as nurses ignored their requests to use the toilet or change their sheets;

• Four members of one family. including a new-born baby girl. died within 18 months after of blunders at the hospital;

• Medics discharged patients hastily out of fear they risked being sacked for delaying;

• Wards were left filthy with blood, discarded needles and used dressings while bullying managers made whistleblowers too frightened to come forward.

If the hospital were run by a private concern, would those kinds of problems exist? There are many private nursing homes and hospices that are a disgrace in this country but a big municipal hospital like the one described above would be under intense examination by state boards and other bodies. And you would think insurance companies would also be concerned if they were paying out for treatment in such a death trap. There’s no way to prove it, but common sense would dictate that conditions like the kind described above would not exist for very long in many privately run American hospitals.

Some Draconian proposals coming out of the NHS in recent years - denying care to the very sick, patients being diagnosed as “close to death who aren’t - only happens when government run health care pays too much attention to budgets and rules and not enough to individual patients and their needs.

To hear health care reform advocates on the left in this country, it is apparent that they wish to do away with private insurance entirely in favor of a single payer system. In fact, the very idea of for-profit health care seems to annoy them. I would guess that if given a choice, liberal health care reform advocates would prefer the British model as opposed to the Canadian model.

In that sense, if they eventually get their way - and they have made absolutely no secret about their view that Obamacare is a gateway to that kind of system - such horror stories could indeed alight here. But we can only hope that a more rational approach, mixing public sector funding and the efficiency of private companies to deliver services, will eventually emerge from the current process.

It won’t happen today at the health care summit. And I’m not sure that President Obama and the congressional Democrats are open to that kind of real compromise anyway. They have used the insurance industry, the drug companies, for-profit hospitals, and doctors as political whipping boys so often in this debate that they are almost forced to forgo any hint of market reforms in their package.

I don’t like much of anything that the Democrats have proposed so far. But if we’re going to have some kind of national health insurance program, we should think about what works in the real world rather than what we would prefer to see as a result of an ideological bent on the part of the legislature.

Indiana Governor Mitch Daniels would be on my short list for presidential candidates if he decided to run in 2012.

Unfortunately, outside of us RINO’s, I would be pretty much alone in that hope. Why this is so says a lot about conservatives and Republicans today.

Daniels represents one of the most conservative states in the union. He was just re-elected in 2008 with the largest vote total in state history despite Obama carrying Hoosierland that same year - the first Democrat to do so since LBJ in 1964. Clearly, he is conservative enough for almost anyone in Indiana.

But outside of his home state? Daniels runs into problems because he is actually interested in governing, rather than posing. He wants to get things done rather than hope for failure on the part of the majority as a path back to power. To that end, he has committed the unpardonable sin of working with Democrats in the legislature to pass health care reform, as well as fight the deficit by strategically cutting spending and - another horror - raising taxes.

Somehow, this makes Daniels less conservative than, let’s say, Rush Limbaugh who doesn’t have the responsibility of governing and can afford to posture about evil Democrats because he doesn’t need them to perform his job.

For most movement conservatives, obstructionism and doing nothing about the enormous problems facing us is definitional. Dismissing the opposition as out to harm America is a litmus test.

But Daniels - a great admirer of Reagan - comes at the task of governing a little more pragmatically.

The results speak for themselves:

On this day, Daniels is describing how, in his first term, he won bipartisan support for a program known as Healthy Indiana, which provides health insurance for Hoosiers who aren’t poor enough to qualify for Medicaid but earn too little to afford buying coverage for themselves. So far, 50,000 residents have signed up for the program, under which the state contributes up to $1,100 each year to each enrollee’s individual health savings account. Participants also contribute according to their income, and when the account is depleted, a catastrophic insurance plan kicks in to cover any additional expenses. It’s all paid for with a portion of the state’s Medicaid funds, along with an increase in the cigarette tax that Daniels pushed through a reluctant legislature.

In fact, Daniels is such a believer in health savings accounts and consumer-directed health plans that he made sure one was offered to state employees. So far, he reports, 70 percent of state workers have signed up — including himself — saving millions of dollars each year for themselves and taxpayers.

[...]

The good Mitch, by contrast, is a principled but practical conservative who respects the intelligence of voters and would rather get something done than score political points. Daniels is a genuine fiscal conservative who took a $600 million state budget deficit and turned it into a $1 billion surplus but managed to do so without cutting spending for education and even increased funding for child welfare services. He pushed hard to lower property taxes but didn’t hesitate to propose temporary hikes in income and sales taxes to keep the state in the black. He privatized the state’s toll road and then used the $4 billion proceeds to launch a major public works investment program.

He served as Bush’s OMB director and is scary smart. And he doesn’t sound like a tea party patriot in this interview with National Journal:

NJ: What do you think is the biggest lesson that the Republicans haven’t quite learned yet from the last election?

Daniels: Always have a better idea. Let me tell you how this looks from out here — and we’re anomalous. In Indiana, Republicans are the party of change and reform; ask anybody — our opponents, the press, everybody. In the rhythm of life here, four years ago we replaced a 16-year regime that had gone stale.

And so we are the party that restored fiscal integrity. We are the party that addressed health care for the uninsured. We are the party that rebuilt an attractive business environment. We are the party that cleaned up the ethics issues in government — that and much more. We attacked our infrastructure problem in a novel and taxpayer-friendly way.

NJ: That you took a little heat over…

Daniels: Yes, yes, but you know, the results are in — and incidentally, we just won with the largest vote total in the history of elections in our state for any office any year.

NJ: A tough year, too…

Daniels: In a tough year. Obama won the state — you know that. I guess what I’m saying is that when Indiana Republicans meet, I always tell them we cannot control what the party looks like in other places or nationally, but here in Indiana if we don’t remain the party always defining the agenda, bringing the new ideas and standing for constructive change, then people will excuse us from duty. And they should. …

People want to know first of all that you hear them and understand what’s going on in their lives. I work at this incessantly.

Politics is about the winning of power. Governance is about using that power to serve the people. In order to serve the people, you must listen to their concerns, and work with the other branch of government to address them.

Sometimes, like Daniels, you get it mostly right. Other times, like Obama, you get it mostly wrong. Both executives listened to the people but drew radically different conclusions about how to go about addressing their problems.

This week, the president is trying one last time to pass health insurance reform. He is trying one last time to get some cooperation from Republicans. Frankly, I don’t blame the GOP for their opposition after what Harry Reid pulled with the jobs bill, taking a carefully crafted compromise and junking it in favor of a nonsensical measure that barely scratches the surface of our jobs crisis. And I am in agreement that there is so much in the Democrat’s proposal that is overreach that opposing the entire process is probably the only alternative open to principled Republicans.

But I have to admit to having admiration for the president. He is doing what good presidents do; not giving up a cornerstone of his agenda despite the odds because he obviously believes he is right. I want a president to be a stubborn mule when he thinks himself correct. Obama is damning the politics of health care reform and proceeding full speed ahead. I agree that he is perhaps taking his party over a cliff. But he will go down with his flag waving high.

Not very practical of me but a president who digs in their heels when they feel they’re right is someone who “gets it” about the job. History has tapped him on the shoulder. That’s a powerful incentive to make your mark and do so your own way.

Daniels hasn’t had the national responsibility but he didn’t hesitate to raise taxes and cut popular programs to balance the budget. While his health care reforms have been market friendly, the state subsidy to the uninsured would probably be viewed with a jaundiced eye by most movement conservatives. He privatized the state’s tollroads but took the money and funded infrastructure projects.

In short, Daniels has allowed necessity to guide his actions rather than ideology. That, and his decidedly dour take on CPAC does nothing to enamor him to “true” conservatives:

Daniels said he wasn’t at CPAC because it was “a lot of rowdyism and barbs cast at the other side. I think that’s appropriate at a certain time. But that’s not my lane right now.”

Daniels was arguing for the GOP to embrace “a friendly and unifying tone” and that his primary political focus was the upcoming elections for the Indiana legislature.

He argued that the problems facing the country — deficits and economic stagnation in particular — were so dire that they demanded serious policy work, not red meat politics.

“For the first time, I’m concerned about the future of the American experiment,” Daniels said.

When red meat politics is all you understand, and when you view cooperation with the enemy and any straying from a narrow, ideological worldview as apostasy, you are not going to fathom a character like Mitch Daniels nor ever consider him for national office.

I love rowdyism myself. This blog likes to mix it up and I pride myself on my ability to trash liberals with the best of them - when they deserve it. But Daniels is repelled by the kind of hysterically exaggerated critiques of the left that flowed so easily from so many at CPAC, depicting Obama with a horns and tail while ginning up fear and outrage over what might be done in his name. That alone disqualifies him in this current climate of “savagery.”

And that is the republic’s - and the Republican party’s - loss.

It would be easy to dismiss the deficit reduction plan offered by Representative Paul Ryan (R-WI) a couple of weeks ago as a non-starter politically. Indeed, ordinarily I would castigate either a Republican or Democrat for offering such a pie in the sky, politically unfeasible plan with regard to anything.

But what makes Ryan’s deficit reduction plan worthy of serious discussion is what it portends for the future; that the longer we go without addressing the underlying causes of the deficit, the harder it is going to be to save the US from bankruptcy.

Even liberals were impressed. Ezra Klein totally disagreed with it but called the plan “daring.” Ygelsias said of the plan that Ryan “has gone where I thought no Republican would dare to tread.” But the establishment Republicans tiptoed around Ryan and virtually disavowed his efforts at finding a way forward. Ryan himself said he wasn’t speaking for his fellow Republicans, thus letting them off the hook.

Ryan’s plan can be considered very stiff medicine indeed. He calls for the elimination of Medicare and Medicaid as we know it by substituting vouchers that seniors can purchase to buy their own insurance plans. The value of these vouchers will go up in succeeding years but - and here’s the kicker - they will not rise as fast as the cost of medical care. Basically, it is rationing health care through individual choices.

Bruce Bartlett writing in Forbes, gives us the barebones outline of Ryan’s bitter pill deficit reduction plan:

[I]t is really heroic that Rep. Ryan did not shrink away from confronting head-on the necessity of slashing entitlements for the elderly in order to achieve his goal of abolishing the federal debt without an increase in the tax-to-GDP ratio.

On Social Security Ryan would reduce initial benefits for retirees by changing the benefit formula. Private accounts would be established immediately for those under age 55 that would be partially funded by payroll taxes.

Ryan would also raise the age to qualify for Medicare from 65 to 69 years and 6 months for people born in the year 2022. After the year 2021, the Medicare program as we know it would cease to exist. Instead of receiving health benefits through Medicare, those over age 65 would instead receive government vouchers worth $5,900. These vouchers would be adjusted for age and health status, which would put the average voucher at $11,000. Medicare beneficiaries would buy private health insurance with the vouchers.

These amounts are considerably less than estimated Medicare spending per enrollee in 2022, so there is a sharp cut in spending right off the bat. Furthermore, these amounts would only be indexed to half the historical rate of price inflation for medical care. This means that the real, inflation-adjusted voucher amount would fall continuously. To cover the shortfall, Medicare beneficiaries would either have to pay out of their own pockets for medical care or buy private insurance over and above what could be purchased with the Medicare vouchers.

Ryan also calls for the elimination of the tax exclusion for employer health care plans. This would mean a huge tax increase for workers who would have to pay income tax on the cost to the employer of their insurance.

The plan is political poison - but illustrative of the kinds of draconian measures that will be necessary to get us out of this deficit mess. In this way, Ryan has done a huge service to the American people by having the political courage to present this plan with all its pain, and the political opening you can drive a Mack truck through if you were a Democrat seeking to make hay out of it.

The GOP showed in the health care debate how easy it is to demagogue Medicare cuts; just pretend that you never supported the idea of cutting Medicare and lambaste the Democrats for wanting to cut $500 billion over 10 years. You instantly become a hero to seniors who go nuts if you even whisper about cutting Medicare. They don’t know that as recently as 2007, Republicans were calling for similar cuts in Medicare. And thus will be the fate of any politician or party who seeks to fiddle with Medicare reimbursements or costs.

This is a recipe for total disaster, as the former GAO chief David Walker has been trying to tell us for the last 4 years:

“History has shown that when America faces difficult challenges and when it rises to the occasion, anything is possible,” he said in an interview. Yet “a fiscal cancer,” he said, “is growing within us, that if we don’t treat, can have catastrophic consequences.”

For more than a year that’s been Walker’s message to Americans. It is part of what he calls a Fiscal Wakeup Tour, an itinerant, bi-partisan lecture panel known as the Concord Coalition, which is traveling to college campuses in advance of the 2008 presidential elections. Accompanying Walker are economists from the left-leaning Brookings Institution and the conservative Heritage Foundation (usually Isabel Sawhill from the former and Stuart Butler from the latter). They may disagree about the potential solution, but they are in accord that a problem exists.

The crux of the campaign: to spread the word that Americans and their government are living beyond their means and that fiscal fecklessness is imperiling the country’s living standards.

Here we are, 3 years after that column was written and the prescience of Walker and others who have been shouting in the wilderness for so long about how absolutely imperative it is to address our long term deficit problem becomes obvious. We are only at the beginning of our “unsustainable” deficits. With the debt ceiling primed to rise above our GDP for the first time, we will get a very close look at what Walker, Ryan, and others have been grousing about; less and less government spending devoted to items like defense, education, the environment, and aid to the poor with more and more of the budget being forced to fund social security and Medicare.

When I profiled Rep. Ryan here, I highlighted the kind of muscular conservatism he stands for; meaty, intellectually coherent, and now add politically courageous to that thumbnail.

Bartlett challenges the tea party movement to embrace Ryan:

I think it is irresponsible to say, as almost all tea party goers do, that they are unalterably opposed to tax increases without specifying spending cuts–large cuts in popular programs that go far beyond foreign aid, earmarks and even a budget freeze. And if they are serious they must admit that coming anywhere close to budget balance cannot be done without slashing Social Security and Medicare benefits. There’s no way around that and anyone who says so is either ignorant or a fool.

When I see people like Paul Ryan addressing large tea party conventions and receiving standing ovations for his budget plan, maybe I will begin to think it is possible to avoid a massive tax increase. But right now, I don’t see even the tiniest glimmer of understanding among the tea party crowd about the true nature of our budget problem and what it would take to avoid a major tax increase.

The next time I see pictures of a tea party crowd I will be looking carefully for signs that say “Abolish Medicare,” “Raise the Retirement Age” and “Support the Ryan Plan!” I won’t hold my breath waiting.

Indeed, those familiar with this site know that I have, on several occasions, called out conservatives for their lack of specificity in defining what they mean by “limited government.” Where would you cut? Whose ox would you gore? How would you be able to do it when the political winds blow so strongly against you? In response, I’ve gotten vague intimations of some kind of “Super-Federalism” that would transfer most of what the federal government does now to the states, or a “let them eat cake” attitude where many on the right wish to roll back not only LBJ’s Great Society, but also FDR’s New Deal. Some wish to go even further and set up what would amount to a pre-constitutional government where the states would be supreme - “an Articles of Confederation on steroids” I’ve called it.

Ryan’s plan shows it won’t be easy, that it won’t come by only cutting spending, and that not only our lawmakers, but voters as well must become responsible citizens of the republic in order to bite down - hard - and do what is necessary to save us from our own profligacy. A nation that defeated fascism, communism, and can rise above its own sordid past and elect a black man president can do anything it sets its mind to.

Just give us a couple of hundred more Paul Ryans, please.

My post yesterday drew the usual praise and congratulations from some of my friends on the right. I am always heartened when such open mindedness, thoughtfulness, and attention to nuance pours forth from such a perspicacious crew. They always reinforce my core beliefs about many conservatives who have set themselves up as gatekeepers and arbiters of acceptable thought.

And I am heartily glad that I make a conscious effort to eschew their anti-intellectual, anti-reason, pro-conformist worldview.

Disagreeing with someone because you believe they are wrong is fine. Posing counter-arguments based on logic and rationalism is the goal of enlightened discussion. But trying to suppress, or otherwise condemn reasonable points of view by making unsupportable attacks on my intellectual integrity and character bespeaks a mind incapable of prudent, reflective discourse.

Every now and then, the bilious rants, unthinking diatribes, and ignorant bombast directed at me by legions of right wing conformists becomes too much to ignore and I feel that some kind of response is necessary. The trap, of course, is that complaining about it automatically brands one as a “whiner.” This tactic, employed by those without the chops to argue on the merits of the proposition thus shielding themselves from their own stuporous inanity, is similar to the left’s stratagem of calling anyone who disagrees with Obama a “racist,” - an ironic juxtaposition for the ages.

I reject the idea that talking about the ugliness, the stupidity, the outright fallaciousness of one’s detractors is indicative of “whining.” I consider it a large part of my continuing critique of modern conservatism. After all, the whole point of their philippics are that I am not a conservative - by their shallow and benighted definition of the term.

I suppose I shouldn’t let it bother me after all these years but celebrating one’s own ignorance by glorying in ad hominem attacks is more than an internet phenomenon. It is the same kind of crap pushed by Hannity, Limbaugh, and other cotton candy conservatives whose influence on the base is so profound. Parroting such louts does not make one sound intelligent. It makes you sound like, well, a parrot who’s been taught to screech obscenities.

Yeah I’m guilty of the same thing at times in response. I’ve tried being reasonable in the past and it’s like talking to a brick wall. I’m supposed to be “reasonable” in responding to this?

It was the Tea Party Movement that just won Mass…and…and…I was going to put something in that was nasty. But victories by the Real Roots of Conservatism, that part which doesn’t require big names and big money to be successful, make me giggle about some of the sanctimonious posts you have made, Rick.

LOL! :giggle:

Do you really think you have a part in the future of conservatism? And if you do…why?

Can an adult reason with a two year old? I would think a spanking would be more to the point.

The ugly truth is, many who call themselves “conservative” today haven’t a clue what that means - not because they disagree with me but because their conformist mentality - the palpable fear of being caught thinking differently than the cool conservatives on the radio and TV - drives them to view any deviation from what they know as “conservatism” as enemy propaganda. Nuance is suspect because conservatism is something you should feel in your gut, not reason out with your mind. And for many, intellectualism equals elitism - the “ism” most in bad odor these days.

Allow me to say that I am pleased as punch at Scott Brown’s stunning win yesterday. I am buoyed by the fact that in 6 months, I will still feel that way while the overwhelming majority of my detractors will be spitting blood at Brown for being a traitorous wretch, a RINO, an apostate, and an ungrateful lout.

Tom Blumer:

The worries about Brown’s vulnerability to selling out only grow when one learns, as Politico reported on Monday, that Brown’s campaign was “filled with staffers who once worked” for Romney. Expect Romney, who I believe is the only potential GOP presidential candidate guaranteed to lose in 2012 if nominated, to take major credit within party circles for Brown’s win in an attempt to revive his flagging viability and to quietly attempt to minimize the importance of tea partiers and others on the ground and throughout the country who did the dirty work. Sadly, top-echelon Republican leaders are still enamored of Romney based on his money and supposed charm. They don’t call it the Stupid Party without reason.

“Selling out?” To whom? For what? I think it significant that Brown did not utter the words “tea party” last night in his acceptance speech. The base may have rallied to his candidacy but to believe that Brown would commit political suicide in Massachusetts by redefining himself in the image of a Rush Limbaugh conservative is idiocy. For about 80% of the country, Scott Brown is plenty conservative enough; a fiscal hawk, supporting tax cuts, against Obamacare, and interested in a robust but reasonable kind of federalism.

But in a couple of months, the Blumers of the movement will realize that Brown also believes in - gasp! - spending tax money on stuff like education, alternative energy, infrastructure, and unholy of unholies, health care reform. This will be enough for apoplexy to set in among some conservatives who either didn’t bother to read where this guy is coming from, or who believed that because “true conservatives” supported him, he’d change his stripes and start thinking as they do.

A telling poll done by Rasmussen on how Bay State voters viewed Brown:

In the end, Brown pulled off the upset in large part because he won unaffiliated voters by a 73% to 25% margin. The senator-elect also picked up 23% of the vote from Democrats. [Our polling shows that 53% of voters in Massachusetts are Democrats, 21% Republican and 26% not affiliated with either party.]

[...]

Twenty-eight percent (28%) say Brown is Very Conservative politically; 44% say he’s Somewhat Conservative, and 22% view him as a political moderate.

Two-thirds of Brown’s fellow Massachusettians see him as a moderate conservative or a political moderate. And how much further left are political independents in Massachusetts than anywhere else in the country? When Brown ends up disappointing those who believe he is the future of the Republican party due to his strong conservative beliefs, they will have only themselves to blame. Blinding oneself to reality is what many conservatives are all about these days.

And Scott Brown will pay the price for their myopia.

The panicked Democrats are thrashing about trying to come up with a way to save health care reform if Republican Scott Brown wins the special election in Massachusetts on Tuesday to fill Ted Kennedy’s seat.

The first scenario involves challenging the results of the election, no matter how much Brown wins by. The Democrats have already deployed their crack team of election law lawyers who will attempt to muck up the process of counting the ballots, challenging machine counts, trying to force a recount if the result is close enough, and generally throwing a monkey wrench into the proceedings.

The Massachusetts Secretary of State must certify the results within 10 days of the election. That means it’s likely that the earliest Brown could be seated would be January 29 - barring challenges to the vote. It would only be earlier if the Democrats in the senate agreed to swearing Brown in before certification - good luck with that one.

If a Brown victory is within the 3-5% margin, it will be days, perhaps weeks before he is sworn in. The watchword will be “Delay” and if it’s close enough, they will probably succeed in keeping the caretaker senator Paul Kirk in his seat until health care reform is safely passed which, according to ABC’s Rick Klein, won’t be until February 2 at the earliest.

But suppose Brown wins by a large margin or the Democrats run out of challenges before reform is passed? Then things can get a little sticky.

Jonathan Chait at TNR:

As the likelihood grows that Republicans could win the special election in Massachusetts, it’s worth thinking again about alternatives for health care reform in case that happens. I see three, in descending order of preference:1. Finish up the House-Senate negotiations quickly and hold a vote before Scott Brown is seated. Republicans will scream, but how could they scream any louder? It’s a process argument of murky merits that will be long forgotten by November.

2. Get the House to pass the Senate bill, and maybe use a reconciliation bill (which only needs a Senate majority to pass) to implement as many House-Senate compromises as possible.

Option #3 is to flip Olympia Snowe. The Maine senator may very well end up voting for the revised package since, according to Chait, all of her concerns about the bill have been met. Her calculation now is purely political; how badly does she want to remain in the Republican party?

Mainer Andrew Ian Dodge insists that Snowe is never likely to bolt the GOP in Maine, even if the national Republicans would strip her of her seniority or punish her in other ways. But former Vermont Senator Jim Jeffords bolted for a lot less than the Dems would offer Snowe to switch parties. It is a distinct possibility given the alternatives.

Obviously, #3 would be the preferred route. The fact that #1 is almost certainly off the table giving the time period I mentioned above, the only other option is to blow up the senate by using reconciliation to pass reform.

If the Democrats were to employ reconciliation in getting health care reform passed, the Republicans would have no choice but to bring the senate to a standstill. If they didn’t, the Democrats would be able to ride roughshod over them for the rest of the year, not to mention destroying the principle of minority rights. It is a scorched earth option that the Democrats use at their own peril.

The only other option the Democrats have is to vote to get rid of the filibuster entirely. This, I don’t see happening. Saner heads in the party realize that they will not always be in the majority and that the filibuster is a useful tool to block legislation. Besides, they would need a supermajority to change the rules of the senate which means several Republicans would have to go along with the scheme - not very likely.

The most likely scenario? If Scott Brown pulls off the upset and is seated before health care reform is passed, I think reform will die. It may not even be able to pass the House as a couple of dozen members take note of what happened in the most Democratic state in the union and resist voting for this unpopular monstrosity of a health care reform measure.

Welcome news, indeed. But first, Brown has to win.

This blog post originally appears in The American Thinker

I must confess that the more I read of the health care reform bill that just passed the senate this morning, the more it grows on me.

Unfortunately, that growth is a cancerous tumor, one that will be impossible to excise once this God-awful monstrosity becomes law.

If the Democrats had stuck to their original intent - covering more people, covering those who are chronically ill and denied insurance, and trying to bend the cost curve on Medicare - I would probably have supported it. These things are necessary goals for America and legislation was desperately needed to address these problems.

But the overreach in this bill is incredible. Non-partisan outfits like CMS are saying that premiums will go up drastically, that the bill won’t do anything to reduce the cost of health care, that the quality of care will go down, and that even cuts in Medicare payments to doctors and hospitals (if they could be sustained which they haven’t been over the last 9 years) won’t have any effect on the cost curve.

As far as coverage, that same CMS report figures a net increase of 3 million Americans who will be insured - 12 million will lose their insurance through their employer while 15 million will gain insurance coverage that way. This doesn’t include the estimated 15 million who will now be eligible for Medicaid - an unfunded mandate (except for Nelson’s Nebraska and Landrieu’s Louisiana) that will top $60 billion according to some estimates. Increased state taxes to pay for new Medicaid coverage is not included in the cost of the bill.

The bill is profligate with the taxpayer’s money when it should have been niggardly. It places the heaviest hand imaginable upon health care consumers instead of the lightest touch possible. It’s strictures, rules, and regulations on insurers guarantee higher premiums. And it will take unfairly from the young and give to the old by forcing the “young invincibles” to purchase coverage they will probably not need in order to service seniors.

Seniors have their own problems with this bill - some of it ginned up outrage over nothing - but many of their concerns are well heeded. The destruction of supplemental insurance programs by cutting back on what they can cover, as well as increasing their costs will mean more out of pocket cash spent on health care by Medicare patients. This is the goal, of course; to discourage people from using the health care system. And the Medicare cost containment panel frightens many seniors with its mandate to discover the efficacy of specific treatments for specific diseases and conditions. Hardly a “death panel” - more like Obama’s “take an aspirin for the pain” panel.

If some of this would have accomplished some of the goals the Democrats set out to fulfill, there’s a chance that reasonable conservatives could have supported it. After all, no bill is going to be perfect, and the opposition, working with the material you have at hand in order to improve it, might have achieved at least the appearance of bi-partisanship.

It’s not the the Democrats were necessarily not interested in bi-partisanship as it was they were not interested in the gradualist approach favored by those few lawmakers in the GOP who would have supported health care reform. When even Olympia Snowe and Susan Collins wouldn’t get on board, this should have been a sign that what the Democrats were proposing was a bridge too far even for moderate Republicans.

Married to process rather than sticking to substance, Harry Reid then took a bad bill and made it infinitely worse by trying to please all segments of his caucus. The buy offs, the favors - all the little ornaments Reid added to this Christmas tree of a bill made it less fair, more complex, and more expensive.

Previously occupying the “Worst Piece of Legislation” niche in my mind was the 1981 tax cut bill - a bill that guaranteed huge deficits as far down the road as anyone could see by allowing every Congressman, every special interest group - even individual companies - to get a tax cut goodie written into law. If the coalition of Republicans and conservative Democrats had stuck to the original intent of across the board tax cuts and a few business goodies like cutting the capital gains tax, the bill would have cost a third of what it eventually cost. Of course, the bill did jump start the economy, but at the cost of massive deficits that weren’t reined in until Clinton’s presidency a decade later. It should go without saying that the Republicans under Bush abandoned any pretense of fiscal responsibility and ran up record deficits - at least they were a record until this crew got into office.

And now, we’re looking at another “crapshoot” as one Democratic congressman referred to the tax cut bill nearly 30 years ago. (The GOP sage Howard Baker called it a “riverboat gamble.) Nobody can possibly know what the outcomes will be from playing with such a large chunk of the American economy. How much more will the bill cost than advertised? The CBO thinks $1.5 trillion while others see that figure doubled. What will be the effect of people being forced to buy insurance? Will enough of them buy into the system to help slow the rise in premiums (forget the idea they would come down - that’s baloney)?

How will all these changes in Medicare play out in the real world? How many people will take advantage of the increased eligibility (133% of the poverty level) for Medicaid? How will states pay for that increase? How will the exchanges work? What will happen to private insurance carriers who now must cover those with pre-existing conditions? How many companies will opt-out and pay the fine rather than cover their employees? What will happen to small businesses who will see their cost of doing business skyrocket, despite “tax credits” to assist them? What will be the effect of the cost control panel on the quality of care?

I could fill a page or two with questions about the future of health care in America. But the only question that matters is, with so many unknowns, what possessed supposedly sober, prudent lawmakers to pass this bill in the first place?

I suppose it is too much to expect that either party could deal effectively with the health care crisis. In fact, I would argue that our system was not set up to make such massive changes in American life so quickly, that the very nature of the legislative process prevents prudent lawmakers from overreaching and trying to do too much, too soon.

Part of that is the dance that occurs between the majority and minority. True, the atmosphere in Washington has been testy the last couple of decades. But beyond that, there are systemic checks on the majority - most of them built in to the very fabric of the House and Senate rules while others can be found in the Constitution. The Founders saw the People’s House as a place where men were governed by raw passion, and that the supposed elitists in the senate (chosen by state legislators), would put a brake on any imprudent measures passed in the lower chamber.

No, the filibuster is not in the Constitution. But I have no doubt the majority of the Founders would have approved of how it has been used in the past as well as how it is being employed now. When the GOP wanted to ram through some judges who were seen as being either poor jurists, or too extreme, the Democrats balked. The New York Times favored the tactic back in November of 2004:

The Republicans see the filibuster as an annoying obstacle. But it is actually one of the checks and balances that the founders, who worried greatly about concentration of power, built into our system of government. It is also, right now, the main means by which the 48 percent of Americans who voted for John Kerry can influence federal policy. People who call themselves conservatives should find a way of achieving their goals without declaring war on one of the oldest traditions in American democracy.

And they were right. Of course, now that the shoe is on the other foot, the filibuster is evil incarnate if you listen to many on the left. But the principle is sound; legislation that either doesn’t have the support of the people, or is flawed thinking, or whose consequences cannot be easily seen, deserves the “check” that the senate can place on it.

Does this mean that there shouldn’t be health care reform at all? Some on the right would argue this but I think I’ve made my own position clear over the last few months; when millions who want insurance, or need insurance, who are either too poor to afford it or can’t get it because of a chronic condition, something is wrong with the system. The other big reason for reform is the cost of health care - and thus, the cost to government who spends about 40 cents of every health care dollar - are out of control and desperately need to be reined in.

We can’t simply say to those who can’t get insurance, “Too bad if you get sick or hurt. Try bankruptcy, OK?” I don’t see health insurance as a “right” but neither is it fair for families to be burdened for the rest of their lives with a health care bill from a car accident or a serious childhood illness. It is the same reasoning we use for assistance to the poor. If through no fault of their own, someone finds themselves unable to pay for food or shelter, the government must step in. Again, do we say “Too bad you can’t eat. Try a church pantry, OK?”

I am of the school that sees government as an agent to fill in gaps where doing so is prudent and makes sense. Clearly, there is a role for government to play in addressing the health care problem. A purely free market solution does not prevent itself, although certainly applying market forces to the cost curve would seem to make a good deal more sense than the arbitrary manner in which the House and Senate bills address this aspect of the problem.

But government alone cannot address these problems - a position utterly rejected by the far left in the Democratic party who are driving this reform bill over a cliff. If the bill simply addressed the problem of insuring the uninsured and trying to “bend the cost curve” in health care spending, I have no doubt that many Republicans would have enthusiastically thrown themselves into the process. But the overreach written into the bill guaranteed from the beginning that the GOP would be on the sidelines.

You don’t need comity between warring parties to get something done on health care. What is needed is the application of common sense and a little prudence. Indeed, prudence has been sacrificed on the altar of process - the abandonment of the principle of “good government” in order to achieve a purely political triumph for the majority.

As a civic virtue, prudence is underrated.

Russell Kirk:

Burke agrees with Plato that in the statesman, prudence is chief among virtues. Any public measure ought to be judged by its probable long-run consequences, not merely by temporary advantage or popularity. Liberals and radicals, the conservative says, are imprudent: for they dash at their objectives without giving much heed to the risk of new abuses worse than the evils they hope to sweep away. As John Randolph of Roanoke put it, Providence moves slowly, but the devil always hurries. Human society being complex, remedies cannot be simple if they are to be efficacious. The conservative declares that he acts only after sufficient reflection, having weighed the consequences. Sudden and slashing reforms are as perilous as sudden and slashing surgery.

I don’t see how anyone can apply the principle of “prudence” to this legislation. And please note that Professor Kirk is inferring the existence of a body like the United States Senate to place a check on the passions of the imprudent.

In truth, the senate has traditionally been a “conservative” body in that its rules and traditions allow for a more thoughtful and measured approach to legislation. After all, it used to be that these cloture votes would occur after hundreds of hours of talking, as an even smaller minority than the 40 GOP senators (the rules used to call for 66 votes in favor of cloture) could tie up the “World’s Greatest Deliberative Body” for weeks by reading cookbooks, the Congressional Record, and other time consuming tomes.

Cloture itself is a relatively recent invention. It was created prior to our entry into World War I when just a couple of senators could hold up the business of the senate simply by not yielding the floor (See Jimmy Stewart’s one man filibuster in Mr. Smith Goes to Washington).

The practical effect of all this talking was that bills were considerably watered down in the senate before going to conference. In order to achieve passage in the senate, the minorities concerns were addressed. And it prevented the kind of wholesale changes in American society that we are seeing with health care reform.

President Obama is not a prudent man. He is a reckless, arrogant ideologue who is so concerned with his legacy and his place in the history books, that he is willing to foist this very bad bill on the American people and damn the consequences. It is so big, so broadly drawn, encompasses so much, that it would be impossible for any group of bureaucrats to write rules and regulations that wouldn’t horribly infringe upon the liberties of the people.

There is no blueprint, no roadmap that would reveal what the long term consequences of passing this bill might be. Guessing at its cost is akin to looking into a crystal ball. And Harry Reid ain’t no gypsy. In fact, the Democrats have tried to hide the costs of the bill:

For starters, as CBO notes, the bill presumes that Medicare fees for physician services will get cut by more than 20 percent in 2011, and then stay at the reduced level indefinitely. There is strong bipartisan opposition to such cuts. Fixing that problem alone will cost more than $200 billion over a decade, pushing the Reid plan from the black and into a deep red.

Then there are the numerous budget gimmicks and implausible spending reductions. The plan’s taxes and spending cuts kick in right away, while the entitlement expansion doesn’t start in earnest until 2014, and even then the real spending doesn’t begin until 2015. According to CBO, from 2010 to 2014, the bill would cut the federal budget deficit by $124 billion. From that point on, it’s essentially deficit neutral — but that’s only because of unrealistic assumptions about tax and Medicare savings provisions. By 2019, the entitlement expansions to cover more people with insurance will cost nearly $200 billion per year, and grow every year thereafter at a rate of 8 percent. CBO says that, on paper, the tax increases and Medicare cuts will more than keep up, but, in reality, they won’t. The so-called tax on high cost insurance plans applies to policies with premiums exceeding certain thresholds (for instance, $23,000 for family coverage). But those thresholds would be indexed at rates that are less than health-care inflation — forever. And so, over time, more and more plans, and their enrollees, would bump up against it until virtually the entire U.S. population is enrolled in insurance that is considered “high cost.”

Chicanery in budgeting is not limited to the Democratic party. But it’s a question of scale, isn’t it? We’re not talking about fudging some numbers on a new jet fighter that might show a couple of tens of billions of dollars less over 5 years. We are discussing trillions of dollars in federal spending that are being covered up because if the true cost of this bill were known, it would be even more unpopular than it is now.

Prudence is a lost virtue in Washington. Neither party adheres to its meaning or even its spirit. Profligate, wastrel, wasteful, uncaring of the future - there is more broken in Washington than what passes for political discourse between the parties.

I watched this 60 Minutes segment last night on “The Cost of Dying” with extraordinarily mixed emotions. From anger to fear to horror, I have rarely had such an emotional reaction to an issue.

But once past the knee jerk outrage, I began to assess the moral and ethical dimensions of the problem and am extremely unsettled in where these questions lead me.

Some background on the segment:

Last year, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients’ lives - that’s more than the budget of the Department of Homeland Security or the Department of Education.

And it has been estimated that 20 to 30 percent of these medical expenditures may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked.

You might think this would be an obvious thing for Congress and the president to address as they try to reform health care. But what used to be a bipartisan issue has become a politically explosive one - a perfect example of the costs that threaten to bankrupt the country and how hard it’s going to be to rein them in. Dr. Byock leads a team that treats and counsels patients with advanced illnesses.

He says modern medicine has become so good at keeping the terminally ill alive by treating the complications of underlying disease that the inevitable process of dying has become much harder and is often prolonged unnecessarily.

“Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse. Most generally, it’s having someone you love die badly,” Byock said.

Asked what he means by “die badly,” Byock told Kroft, “Dying suffering. Dying connected to machines. I mean, denial of death at some point becomes a delusion, and we start acting in ways that make no sense whatsoever. And I think that’s collectively what we’re doing.”

Now for the moral questions raised by the piece; How much do we, as a society, value individual life? At what point does what’s good for the many outweigh what’s good for the one? Should anyone - insurance companies, government, or a “death panel” - have the right to tell a patient and their family when it is time to let go of life and allow the natural progression of their disease to kill them?

All of these questions and more like it are asked with the costs associated with end of life treatment always in the background. And it isn’t just the costs. It is the tremendous amount of health care resources devoted to people who have no hope of recovery but make choices like this patient:

Charlie Haggart is 68 years old and suffering from liver and kidney failure. He wants a double transplant, which would cost about $450,000. But doctors have told him he’s currently too weak to be a candidate for the procedure.

At a meeting with Haggart’s family and his doctors, Dr. Byock raised the awkward question of what should be done if he got worse and his heart or lungs were to give out.

He said that all of the available data showed that CPR very rarely works on someone in Haggart’s condition, and that it could lead to a drawn out death in the ICU.

“Either way you decide, we will honor your choice, and that’s the truth,” Byock reassured Haggart. “Should we do CPR if your heart were to suddenly stop?”

“Yes,” he replied.

“You’d be okay with being in the ICU again?” Byock asked.

“Yes,” Haggart said.

“I know it’s an awkward conversation,” Byock said.

“It beats second place,” Haggart joked, laughing.

Should someone make the decision to resuscitate this gentleman for him? Who?

This is what end of life caregivers are asking these days. And the solution, in an echo of Sarah Palin’s “death panels,” may be hard and fast rules on what kind of care the terminally ill can demand of the system:

By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.

“I think you cannot make these decisions on a case-by-case basis,” Byock said. “It would be much easier for us to say ‘We simply do not put defibrillators into people in this condition.’ Meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now that’s going to outrage a lot of people.”

“But you think that should happen?” Kroft asked.

“I think at some point it has to happen,” Byock said.

Is Byock a ghoul? Or is he talking sense? This is a compassionate conflicted man if you watch the segment. The chasm he has opened beneath our feet is both a moral and practical one and the tightrope he is asking us to walk is very thin indeed. If we decide to take these circumstances and apply universal guidelines for the treatment of the dying, won’t individuals “slip through the cracks” and be condemned to die who might otherwise outlive a doctor’s expectations with treatment? How many people who are given 2 months, three months, six months to live end up amazing their physician by surviving for years?

And then there’s the question of resources devoted to the dying. Here’s a Dartmouth researcher who did a detailed study on patients in the last two years of their lives:

The institute did a detailed analysis of Medicare records for patients in the last two years of their lives. Fisher says it is more efficient for doctors to manage patients who are seriously ill in a hospital situation, and there are other incentives that affect the cost and the care patients receive. Among them: the fact that most doctors get paid based on the number of patients that they see, and most hospitals get paid for the patients they admit.

“The way we set up the system right now, primary care physicians don’t have time to spend an hour with you, see how you respond, if they wanted to adjust your medication,” Fisher said. “So, the easiest thing for everybody up the stream is to admit you to the hospital. I think 30 percent of hospital stays in the United States are probably unnecessary given what our research looks like.”

[...]

“In medicine we have turned the laws of supply and demand upside down,” Elliot Fisher said. “Supply drives its own demand. If you’re running a hospital, you have to keep that hospital full of paying patients. In order to, you know, to meet your payroll. In order to pay off your bonds.”

And, of course, the fact that these costs are rising at a frightening pace is also driving the debate over end of life care:

“The perverse incentives that exist in our system are magnified at end of life,” David Walker, the government’s former top accountant told Kroft.

Walker used to be the head of the Government Accountability Office. He now heads the Peter G. Peterson Foundation, which is a strong advocate for reducing government debt. He says that 85 percent of the health care bills are paid by the government or private insurers, not by patients themselves. In fact most patients don’t even look at the bills.

“Does that make any sense to have, I mean, most things you buy, the customer has some impact,” Kroft remarked.

“We have a system where everybody wants as much as they can get, and they don’t understand the true cost of what they’re getting. The one thing that could bankrupt America is out of control health care costs. And if we don’t get them under control, that’s where we’re headed,” Walker said.

What all of this adds up to is that America is headed for the most difficult ethical and moral dilemmas in its history - questions that go to the very heart of what our country stands for, how we see ourselves; questions that deal with our deeply held religious beliefs, and perhaps most uncomfortable of all, cultural questions about the nature of life and death.

In all of this, the individual, and choices they have been able to make in the past about how they wish to exit this world, may very well be taken from them for the “good of the many.”

(Note: I hasten to add that there is nothing in either the Senate or House bill that directly deals with these questions, although the Medicare Cost Control panel certainly has that potential.)

When a society is faced with a crisis that may lead to its dissolution, is it a higher moral choice to abandon individual ethics and morality to save it? Are we really facing this kind of moral conundrum or am I setting up a “false choice” where another solution is available but I am refusing to acknowledge it?

I would like to think I have fairly presented the questions asked in the 60 Minutes segment. My personal belief is that the issues raised are impossible to discuss at this point because of the debate over reform and the political ramifications of discussing end of life treatment that would necessarily play into the fear mongering that arises whenever “unplugging grandma” is mixed in.

Here’s Doctor Byock on that subject:

“Well, this is a version then of pulling Grandma off the machine?” Kroft asked.

“You know, I have to say, I think that’s offensive. I spend my life in the service of affirming life. I really do. To say we’re gonna pull Grandma off the machine by not offering her liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And it’s certainly scurrilous when we have 46 million Americans who are uninsured,” Byock said.

One thing that can be done was removed from the House bill because of Palin’s fearmongering; family doctors being paid to sit down with their Medicare patients to discuss living wills, end of life options, and educating their patients on the death process. The number of people who are unaware of these simple, common sense options are staggering. The idea that this is somehow cruel or would lead to doctors recommending that patients simply allow themselves to die was idiotic when the argument was made and, if you watch this segment closely, even more idiotic now.

A word about “rationing” which is the 800 lb gorilla in the room that I have avoided because of the idea that many opponents of health care reform can’t face the fact that we are already rationing resources. What’s interesting - and gives a depth of understanding to the moral dilemma we face - is that according to the Dartmouth study, rationing would be unnecessary if we dealt with end of life issues:

After analyzing Medicare records for end-of-life treatment, Fisher is convinced that there is so much waste in the present system that if it were eliminated there would be no need to ration beneficial care to anyone.

Multiple studies have concluded that most patients and their families are not even familiar with end-of-life options and things like living wills, home hospice and pain management.

“The real problem is that many of the patients that are being treated aggressively, if you ask them, they would prefer less aggressive care. They would prefer to be cared for at home. They’d prefer to go to hospice. If they were given a choice. But we don’t adequately give them a choice,” Fisher said.

“At some point, most doctors know that a patient’s not likely to get better,” Kroft remarked.

“Absolutely,” Fisher agreed. “Sometimes there’s a good conversation. Often there’s not. You know, patients are left alone to sort of figure it out themselves.”

I can’t stand people who approach these issues as if there is no real moral or ethical dilemma; that people should either be forced to die or that they should get any care they wish in order to hang on to life even after hope for recovery has expired. We are fast approaching a time when we will forced to make this choice and there is nothing easy or pat about it.

Those so certain of the moral ground beneath their feet are oblivious to the fact that they are really standing in quicksand. And their arrogant certainty about right and wrong is exposed as the sophistry it truly is.

No matter how the vote in the House on health care reform turns out, the amateur historian in me is tickled to be living in such “interesting times.”

I think that 200 years from now, this interlude in American history will be seen in the same way that we look upon the Missouri Compromise, or the nullification debates. More modern examples would include the Civil Rights Act and Voting Rights Act. The impact that all those debates had on the future of America cannot be overstated.

Even debates over New Deal or Great Society social legislation were muted and, in retrospect, not as controversial as the health care reform bill that is being brought to the floor today.

Never has such a large part of the American economy been designated for federal control. Never has the government reached so far into the personal lives of its citizens, compelling them through force of law to surrender some of their liberty. Every American will be affected by this bill in ways that not even the bill’s most ardent supporters can say with any certainty.

It is, as was said of the 1981 tax cuts, “a crap shoot.”

There is the potential for great mischief - a veritable smorgasbord of slippery slopes - some more realistic than others. There is the danger that the bill will not do what its supporters say it will do; lower costs and cover more people. There is the certainty that with the government now paying more for health care, they will feel it necessary to, if not dictate, then strongly encourage people through punitive tax laws to change what they consider “unhealthy” behavior.

I have written often over the last months that some reform is vitally necessary. The system is broken. Too many who want and need insurance are priced out of the market. Costs are rising at a ruinous rate and are sucking the life out of our economy. And some provision must be made for those with chronic or pre-existing conditions who are rejected by insurance companies.

Then there are the real biggies; We need to begin now to reform Medicare and Medicaid. There simply is no choice if we don’t want our economy to be destroyed.

But the bill that has been brought to the floor of the House today is far too ambitious in some areas, much too timid in others, way too expensive, and at bottom, an invitation for government to inject itself into the economic and personal lives of its citizens. The president and the Democrats have not made their case that this bill is the answer. Instead, they have made the primary goal of the process not the reform of health care, but a political yardstick by which to measure the president’s success. A failure is to be avoided because it would wound his presidency and damage the Democratic party’s chances for electoral success in 2010. Using that thinking, a bad bill is better than no bill at all - a recipe for unmitigated disaster.

This is not surprising because the monumental complexity of this bill makes it impossible to boil down into coherent policy. It is a slap-dash, confused, utterly incomprehensible mish mash of clashing interests, favors for industry, mandates for business, and the worst that nanny statism has to offer. It is too much for America to digest at once, and the best we can hope for is that the votes to pass it never materialize, forcing its withdrawal.

Despite the Democrat’s huge majority, chances for passage are still up in the air. That’s due to something that the president, in his health care reform speech, said was not in the bill but to no one’s surprise, ended up being included anyway; federal funding of abortions.

An agreement on language that would have set up an “independent monitor” to make sure that federal funds were not spent on abortion fell through last night - largely because the Catholic bishops, who are involved in the negotiations for this issue - wouldn’t support it.

Instead, Pelosi reluctantly agreed to a deal where Bart Stupak would be able to offer a floor amendment banning most federal funding for the procedure. It appears that this will satisfy a couple of dozen Democrats who will vote for the final package once the abortion amendment goes down to defeat.

According to Politico, that’s not nearly enough to assure passage:

“It’s a question of how you can keep everybody together and that’s the challenge before us,” Waxman said of the proposal earlier in the day. “What’s being called the Ellsworth language is also the bishop’s language which is the Stupak proposal. It’s basically to stop any services for abortion coverage in both the public plan and all private insurance. Not just for those who get subsidies but for everybody who goes to private insurance policies.”

“I would like the bishops, who I understand want to see passage of the legislation, to help us work out a way so we don’t have winners and losers,” Waxman said. “Because the losers will make us lose the bill and the winners then wont have won anything.”

Democratic officials said their count of hard “nos” was in the range of about 25. While House Speaker Nancy Pelosi can afford to lose up to 40 votes and still win passage, there are dozens of other lawmakers who remain on the fence publicly.

The last whip count had Pelosi at least 14 votes short, with no doubt a lot of fence sitters added to the “Yes” column. And that was for a bill with a “robust” public option. The abortion and illegal immigrant access issues weren’t even considered.

President Obama will come to the Hill today to twist some arms, and perhaps do a little horse trading with the fence sitters. Indications over the last month is that there may be as many as 60 Democrats who are very nervous about the bill, either because of abortion, or it’s ever climbing cost. No doubt many of them are open to blandishments from the White House. But in the end, it may be that there are just too many who won’t go along with the majority to realize passage - at least now.

It is possible that Pelosi will yank the bill from consideration today and delay the vote for a few days or a week in order to really turn the screws on recalcitrant members. But regardless of what happens, the thrust and parry in this debate has been one of the most fascinating exercises of democracy in our republic I can remember.

How it ends will determine what kind of country we will be forever after.