Right Wing Nut House

8/22/2009

YOU COULDN’T PAY ME TO BE A DOCTOR

Filed under: Ethics, Government, Politics, health care reform — Rick Moran @ 10:00 am

It takes anywhere from 11 to 13 years of schooling - including 3-5 years residency - to be able to call yourself a doctor. But as many physicians have pointed out, the process of learning is an on-going effort. Classes, seminars, and fellowships are required over the years so that a doctor can keep current with the breathtaking pace of innovation and increased knowledge.

This is one big reason I never even thought of being a doctor. I have an aversion to book learning, and the prospect of having to go to school until I was in my thirties lit my hair on fire. I find the human body eternally fascinating. But there are limits to curiosity and I have satisfied myself over the years with reading about the incredible breakthroughs and mind bending discoveries that makes the human machine so extraordinary.

Another reason I could never be a doctor is tied up with the debate we are having over health care reform; specifically, the discussion of end of life issues involving treatment and care, and most importantly, who should be involved in those decisions.

The doctors, hospitals, medical ethicists, and review boards that struggle with impossibly complex matters involving morality, religion, and the most intimate and personal desires of the patient, coupled with the pace of scientific progress in medicine that hold out the promise to prolong life, combine to present uniquely painful and wrenching decisions for all of us.

That’s really the bottom line, isn’t it? This is the matter we dance around when talking about “death panels” or “end of life consultation.” I think what we fear most about this isn’t so much that government will force euthanasia down our throats but that “efficiencies” that are forced on government by rising costs will result in a “one size fits all” solutions to problems that are best solved on a case by case basis.

To relieve suffering is the goal of palliative care. Should government - or insurance companies for that matter - force people to accept the end by paying for such end of life care rather than paying for a treatment or procedure that could prolong life but not cure the condition? Let’s imagine the procedure costs $100,000. Should government pay for these treatments when insurance companies won’t?

Sticky, yes? Let’s throw a few other ethical bombs on this scenario. Suppose the patient is 10 years old? Suppose the patient’s age increases the chances for survival but not enough to rationally justify the cost of the treatment? Suppose the treatment will only prolong life for a year or two?

While we’re creating moral problems, let’s try another nightmare scenario. An 60 year old cancer patient with a heart condition has a recurrence of the disease. The cancer can be treated with surgery and chemotherapy. But because of the patient’s heart condition, he won’t live more than a year or so anyway. Without treatment, he will die in six months.

Should Obamacare spend the money to cure the cancer?

These are matters faced by patients, their families, doctors, and hospitals every day. Guidelines in such matters drawn up by government or insurance companies are worse than useless. But in the absence of any good choices, shouldn’t someone be able to make the hard decision and deny payment for experimental, or unproven procedures - or life saving treatment when death from another condition is right around the corner?

Each case is different. Each situation has a human being attached to it, not a slide rule. And I believe this is the fear of old and young alike regarding Obamacare; that in the name of acting for the benefit of the many, government will lose sight of the fact that ultimately, the personal cannot be political in this instance, that there are some things that no government should be able to have a hand in deciding.

The same question can be asked of private insurance companies who would also be inclined to deny the kind of care outlined in both scenarios above. Do we really want those kinds of decisions made based on bottom line medicine?

If I’m confusing you, it’s because there are no good answers. And to my mind, this gives the lie to people who claim that health care is a “right.” Health care is a commodity, bought and sold like any commodity, valued like a commodity, and treated like a commodity by government, insurance companies, and patients alike. True, it is vital to life. But so is food. And I doubt even the most rabid proponent of Obamacare would want to see a government takeover of the food industry.

Every single one of us has already faced these choices or will have to do so someday, whether it affects us, or a close family member. Part of the problem is certainly linked to the miraculous state of medicine today. Our knowledge is growing by leaps and bounds, outpacing our capacity to develop a moral framework to make ethical decisions on life, death and “quality of life.”

Our pitiful attempts to quantify quality of life fall short because in the end, we’re talking about someone else’s life being evaluated based on invented criteria. Even Solomon would have a tough time judging something so intimate and personal. But again, is the current state of our health delivery system so bad that we must empower someone - government or insurance companies - to make these decisions for us? This is the philosophy behind Obamacare and it makes most of us uncomfortable.

I don’t have the answers. I think bringing costs down intelligently should be a priority simply because it’s logical, and because fewer dollars expended per patient would mean more potential dollars to spend on others. There are ways to do this without rationing, or simply paying doctors and hospitals less.

As for the rest, the issues are so complex and fraught with ethical and moral landmines, it would be prudent to make a greater effort to examine what is currently being railroaded through Congress without much thought given to the consequences, so that we can avoid engendering the kind of fear I mentioned above.

It’s been said before by others but bears repeating; Obama is trying to do too much, too fast, and without enough thought given to the real world consequences of what he is trying to accomplish. To claim otherwise is silly. And those fascist, astroturfed mobs of 70-something seniors at health care town halls know it - and fear it.

8/19/2009

THE PUBLIC OPTION: NOT A SLIPPERY SLOPE — JUST PLAIN LIES

Filed under: Blogging, Politics, health care reform — Rick Moran @ 9:15 am

So the public option is not a “government takeover” of the health insurance industry? Ok, sure. I’ll buy that.

Except after reading this, you will realize that the eventual goal of the people pushing it is to establish a single payer system and the public option is nothing more than a Trojan Horse designed to make that system a reality:

As progressives mourn the likely death of a public insurance option in health care reform, it’s worthwhile to trace the history of exactly where this idea — a compromise itself — came from. The public option was part of a carefully thought out and deliberately funded effort to put all the pieces in place for health reform before the 2008 election — a brilliant experiment, but one that at this particular moment, looks like it might turn out badly. (Which is not the same as saying it was a mistake.)

One key player was Roger Hickey of the Campaign for America’s Future. Hickey took UC Berkley health care expert Jacob Hacker’s idea for “a new public insurance pool modeled after Medicare” and went around to the community of single-payer advocates, making the case that this limited “public option” was the best they could hope for. Ideally, it would someday magically turn into single-payer. And then Hickey went to all the presidential candidates, acknowledging that politically, they couldn’t support single-payer, but that the “public option” would attract a real progressive constituency.

This little history lesson by Mark Schmitt is instructive. Most liberals know that advocating a single payer system would be political death for reform because, despite everything they are putting out about private health insurers, a huge majority of Americans are satisfied with the insurance they have and don’t want that to change. A whopping 83% of Americans believe the quality of health care they receive is “excellent” or “good” according to this Gallup poll from last December. And 67% believe their health care insurance is also “excellent” or “good.”

Even a Democratic pollster admits that people are “satisfied” with their coverage:

Satisfied’ means they like their doctor and have insurance to go to that doctor,” said Stan Greenberg, a Democratic pollster. “Maybe they think their policy is better than what most people have. But it doesn’t mean they don’t want reform.”

I agree. I want reform too. But establishing a system that is deliberately designed to eventually replace private insurance with a single payer government program would never fly in a million years in this country and the left knows it. Hence, the lies about the public option.

One of the major proponents of a single payer system, Roger Hickey of the Campaign for America’s Future, sold the idea of the public option to Obama and the other Democratic candidates last year:

The good news is that people are ready for big change. But the hard reality, from the point of view of all of us who understand the efficiency and simplicity of a single-payer system, is that our pollsters unanimously tell us that large numbers of Americans are not willing to give up the good private insurance they now have in order to be put into one big health plan run by the government.

Pollster Celinda Lake looked at public backing for a single-payer plan - and then compared it with an approach that offers a choice between highly regulated private insurance and a public plan like Medicare. This alternative, called “guaranteed choice” wins 64 percent support to 22 percent for single-payer. And even the hard core progressive part of the population, which Celinda calls the “health justice” constituency, favors “guaranteed choice” over single-payer. …

So the public option is not a slippery slope at all; it’s simply a lie invented to try and fool the American people into accepting “reform.”

Schmitt calls it “stealth single payer:”

But the downside is that the political process turns out to be as resistant to stealth single-payer as it is to plain-old single-payer. If there is a public plan, it certainly won’t be the kind of deal that could “become the dominant player.” So now this energetic, well-funded group of progressives is fired up to defend something fairly complex and not necessarily essential to health reform. (Or, put another way, there are plenty of bad versions of a public plan.) The symbolic intensity is hard for others to understand. But the intensity is understandable if you recognize that this is what they gave up single-payer for, so they want to win at least that much.

I had given Obama and the left the benefit of the doubt when ascribing a “slippery slope” to the idea that the public option would eventually crowd out private insurance in favor of a single payer government run system. In retrospect, I was too generous in granting them the inability to see the end result of their creation. It turns out, they knew full well where the public option would lead and simply lied about not believing that the public option would perform as they obviously hoped it would.

Professor Bainbridge:

What’s interesting is that so many on the left are willing to make what appears to be an admission against interest, but perhaps they feel it is needed to keep their less insightful troops in line.

It’s also why those of us who worry about slippery slopes want to see Obamacare killed in the womb.

I’ve been trying to think of anything comparable that has ever been attempted by conservatives - where they knew that what they wanted to accomplish was politically impossible and deliberately substituted an intermediate process that would eventually achieve what they wished, all the while denying that the slippery slope outlined by opponents would come to pass. Perhaps there has been abortion legislation designed to eventually outlaw the procedure. I’m sure there have been others. After all, there is nothing new in politics and the chances are very good that both sides have tried something like this before.

But I have never seen what Bainbridge calls this “admission against interest” so blatantly played out in such a public way. I think it shows that many on the left simply don’t care anymore about public opinion, and perhaps they’re right. Why should they when they’ve got such enormous majorities in the legislature, a president who believes most of what they believe, and an incurious media that refuses to call them out for such prevarication?

PREPARE FOR ARMAGEDDON ON HEALTH CARE REFORM

Filed under: Government, Politics, health care reform — Rick Moran @ 6:48 am

The pretense of bi-partisanship is being dropped by the Democrats in the health care reform debate as it now appears they are ready to go it alone to get something passed and rescue Obama’s presidency from irrelevancy.

Carl Hulse and Jeff Zeleny of the New York Times:

Top Democrats said Tuesday that their go-it-alone view was being shaped by what they saw as Republicans’ purposely strident tone against health care legislation during this month’s Congressional recess, as well as remarks by leading Republicans that current proposals were flawed beyond repair.

Rahm Emanuel, the White House chief of staff, said the heated opposition was evidence that Republicans had made a political calculation to draw a line against any health care changes, the latest in a string of major administration proposals that Republicans have opposed.

“The Republican leadership,” Mr. Emanuel said, “has made a strategic decision that defeating President Obama’s health care proposal is more important for their political goals than solving the health insurance problems that Americans face every day.”

The Democratic shift may not make producing a final bill much easier. The party must still reconcile the views of moderate and conservative Democrats worried about the cost and scope of the legislation with those of more liberal lawmakers determined to win a government-run insurance option to compete with private insurers.

On the other hand, such a change could alter the dynamic of talks surrounding health care legislation, and even change the substance of a final bill. With no need to negotiate with Republicans, Democrats might be better able to move more quickly, relying on their large majorities in both houses.

It’s actually sort of amusing. The Democrats have supermajorities in both houses of congress, they control the presidency, the bureaucracy, the press, and other major propaganda organs.

And they’re blaming Republicans for their woes?

The Times dances around the real significance of this decision by the Democrats. Allahpundit at Hot Air explains :

[T]his can only mean that they’re going to go all out for the public option and use “reconciliation” if need be to nuke the filibuster in the Senate, no? Why cut the GOP out of negotiations only to settle for some watered-down alternative like co-ops? If you’re going to kick the minority party out of the room and anger half the country, you might as well make the bill as syrupy sweet to your own side as possible. And if that means having to take a precedent-setting step as draconian as reconciliation to deal with Blue Dogs like Ben Nelson who might not accept a public option, hey. Besides, Grassley and Jon Kyl all but told the Democrats today that they won’t vote for the final bill regardless of what’s in it, in which case it’s pointless for The One to keep making concessions. He might as well get the bill he wants, paint the GOP as “the party of no”, and hope that the inevitable ill effects of his program don’t appear before the midterms. Which they probably won’t.

I call reconciliation the “Armageddon Option” because the aftermath will blow up Washington like no other event in recent memory. The senate is a peculiar institution, steeped in tradition, governed by a kind of amity between members of both parties that, while strained today, nevertheless continues to dominate its proceedings. The minority gets a much better shake via senate rules than in the House and consequently, the potential for minority mischief in sabotaging the majority’s agenda are manifest.

The use - or rather, the clear abuse - of the reconciliation process to get health care reform passed by a simple majority with no chance to filibuster would be unprecedented - dangerous territory for the tradition-bound senate. The GOP has already threatened to slow the business of the senate to a crawl if the tactic is used; something they are more than capable of doing under the rules.

Imagine having the entire Congressional Record of the previous day read out loud. It’s one of the first orders of business and the reading is always dispensed with by unanimous consent. Suppose the Republicans object? The Democrats would be forced to call for a vote - the first of potentially dozens of votes of that day and every single day as the GOP would force the complete reading of all bills and amendments, constantly notice the absence of a quorum, force votes on trivialities, object to all unanimous consent requests and voice votes, and generally wreak havoc to the point where no real business could be done.

The Democrats threatened something similar over the “nuclear option” on judges that the GOP was seriously contemplating at one time. The threat made the Republicans back off and led to the “Gang of 14″ compromise. It is doubtful any such compromise on health care reform could be worked out, which makes the Democrat’s threat to “go it alone” on health care reform that much more likely to lead to a showdown.

With the GOP out of the picture, let’s see how negotiations between liberals and moderates in the Democratic party proceed. One thing seems pretty clear; the public option just got some new life and reports of its demise - including mine from yesterday - appear to have been greatly exaggerated.

8/18/2009

CO-OPS NOT THE ANSWER

In researching my latest AIP article on health care co-ops, I must confess that I wanted to like the idea. I didn’t know much about them but what I had heard was pretty good.

Here’s a reasonable analysis from the Heritage Foundation that finds some things to like but much more to fault with regard to health insurance cooperatives.

For myself, I am a firm believer in the concept of “simple is best.” All things being equal, whether it is in my personal life, or a government program, the less complex the idea, the better chance it has of working. This may sound stupidly simple but if you look at the way many people live their lives, they could benefit greatly by following that advice. Too often, we unnecessarily complicate our lives by overthinking, or overdoing.

With government, it is simply a matter of scale. Trying to serve 300 million people is, by definition, an enormously complex undertaking. So it would be with co-ops.

The plan is so nebulous at the moment that no one is really sure how co-ops would work in practice. Ideally, you would have 50 separate co-ops serving people in the various states. Some smaller states might band together to form regional co-ops to increase their marketing and distribution opportunities. The federal government would provide $3-4 billion in seed money to get the co-ops off the ground (perhaps more) and an administrative infrastructure for each co-op would either be set up by the state or contracted out.

Participants (”shareholders”) would sign up and purchase insurance through these pools. Policies would not be underwritten by private companies but by the co-ops themselves. It is assumed the government would grant generous tax subsidies to businesses and individuals to sign up with the co-ops and make them a going concern. Decisions on what to cover, and reimbursement rates would ideally be made by all the shareholders, but when you are talking about a statewide co-op, that will probably not be possible.

Would it work? Would the co-ops be able to compete with private insurance companies, forcing them to lower premiums while giving shareholders quality care at a reasonable cost?

The answer is almost certainly no. First of all, there is the titanic complexity of setting up so many co-ops in the first place. By definition, they would have different rules, different coverages (although guidelines from the federal government would help there). They would conduct business in 50 different ways.

Coverage would be wildly uneven and quality would also vary. Some - perhaps many - might not make it or be so poorly run that the government would have to take them over (The Washington, D.C. co-op was forced to sell itself to Humana it was so mismanaged.) There were many health care co-ops during the Depression that all ended up failing. And the record of co-ops begun in the last 20 years is very uneven with some succeeding, some failing, and some just limping along.

I think part of the answer is a matter of scale. The successful co-ops in Seattle and Minneapolis are small enough to be well run and large enough to spread the risk out over as many people as possible.

But what happens when you try and graft that model on to a statewide co-op? It won’t take for the simple reason that what is simple at the local level becomes devilishly complicated when you go from insuring 100,000 people to several million. Also, several questions would have to be raised; who elects the directors or would the governor appoint them? How can decisions on what coverages and how much that would be affecting a million or more people be made? Would politics enter into the running of these co-ops?

Co-ops would not adequately address the problem of insuring those with chronic or pre-existing conditions. And forget portability. Nor would they necessarily insure more of the currently uninsured. It’s hard to see how people would see a co-op - which after all, is competing with private insurance carriers - as any more practical or a better deal than anything they are presented with now. Without an individual mandate, there will be millions who simply refuse to buy insurance regardless of how cheap it is or how generous the subsidy.

Heritage’s Edmund F. Haislmaier thinks that there might be a minor role for co-ops in health care reform:

In the case of health insurance markets, there are two areas where the co-op model could conceivably be applied.

The first is with respect to entities that might organize the buying and selling of health insurance, such as employer purchasing groups or state health insurance exchanges. The second is applying the cooperative concept to one or more of the insurers selling coverage in the market.

The idea that businesses could pool themselves and purchase health insurance is an excellent one and is already being tried with liability and other forms of insurance on a micro basis in several industries. This also would be a complex undertaking but much less so than trying to set up statewide co-ops.

In short, the more I read about co-ops the more convinced I became that on a nationwide basis, it would never work to deal with the problems they would be set up to address and may, in many cases, make matters worse. It is possible that eventually, the federal government would be forced to take most of them over anyway.

I don’t necessarily buy the idea that co-ops are a Trojan Horse for a public option but certainly the potential is there for a de facto government takeover. It’s not the only reason to oppose their creation but it should be weighed with the rest of the complex problems that co-ops would create for both government and the consumer.

8/17/2009

THE SLIPPERY SLOPE REVISITED

Filed under: Politics, health care reform — Rick Moran @ 8:07 am

There are two kinds of arguments against Obamacare. The first is philosophical: A clean, virtuous case can be made against much of the kind of health care reform being proposed by Obama and the Democrats based solely on conservative principles. From individual freedom issues, to issues involving the sanctity of every human life, there is a strong and compelling case that can be made against Obamacare.

Too bad more conservatives aren’t making it.

Instead, we seem to be relying mostly on the “slippery slope” arguments that, by nature, are more problematic and as I have shown, can degenerate into logical fallacies that are easily brushed aside by Obamacare supporters.

Admittedly, slippery slope arguments are sexier, and can more easily be employed to scare people with half truths and outright falsehoods. Just ask Sarah Palin whose “death panel” crack was the ultimate in dishonest slippery slope arguments.

But there is another slippery slope argument that can be made about the end of life counseling section that fulfills the requirements of being valid by showing how such “paid for by Medicare” sessions can indeed go far beyond what proponents of the provision - including yours truly - have argued.

Philip Klein writing in the American Spectator voices qualified support for the idea of end of life counseling (employing the Schiavo case as I did), but then, in a logical and reasonable fashion, demonstrates how the government might use that provision to worm their way into end of life decisions:

With that said, the provision has to be viewed within the larger context of the changes that President Obama envisions for the health care system as a whole. Though he denies it now, Obama was once a proud advocate of a single-payer system in which government is the sole purchaser of health care. Throughout the health care debate, he has cited erroneous statistics to promote the idea that government-run systems get better value for their health care spending. And through a web of subsidies, mandates, regulations, and the creation of a government-run plan, Obama hopes to make America function more like the foreign health care systems he prefers. Those systems do not control costs by using magic wands, but by rationing care to the sick.

Britain, for instance, has a panel of experts called National Institute for Health and Clinical Excellence that performs cost-benefit analysis to help determine what sorts of treatment the government will pay for, and for whom. According to a report in the New York Times, NICE “has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750, to save six months of a citizen’s life.”

I wrote about the wildly inappropriately named “NICE” in this AIP column. Suffice it to say, “NICE” is not. (Neither are they a “death panel” by the way.) Klein is being a little disingenuous himself. The figure $22,750 is misleading because very often, there is nothing except highly experimental treatments and drugs that are at issue. Our own insurance industry has similar boards that routinely reject paying for the same kinds of treatments unless they have a gold plated policy that will pay for just about anything.

In short, the real cost of end of life treatment falls in hospital re-admissions for the same chronic illness during those last 6 months. At current rates, that 22 grand would pay for, depending on treatment, perhaps 3, 4, or 5 re-admissions where the patient stays 2-3 days. Hardly a death panel but still troubling if you consider what Klein shows is the potential for mischief:

NICE was one of the inspirations for Tom Daschle’s vision for a Federal Health Board, an idea Obama praised before originally tapping Daschle to lead his health care push. The idea for an expert panel has already manifested itself in the form of Obama’s Federal Coordinating Council for Comparative Clinical Effectiveness Research, created by the economic stimulus bill.

While Obama argues that his council will just be providing expert research to doctors and patients, if you read Tom Daschle’s book Critical: What We Can Do About the Health-Care Crisis, in the context of describing a Federal Health Board, he outlined how government could compel wider adoption of such a body’s recommendations. For instance, Daschle explained, there could be a requirement that all government programs would have to abide by its recommendations and that requirement could extend to any private insurer participating in the government health insurance exchange. And as Daschle wrote, “Congress could opt to go further with the Board’s recommendations. It could, for example, link the tax exclusion for health insurance to insurance that complies with the Board’s recommendations.”

Could something like this morph into government giving seniors little option except to sign on the dotted line for DNR’s, living wills, and hospice care? It would, if nobody noticed. Again, the “boiling frog” fallacy rears its ugly head. To assume the worst, you must believe that opponents wouldn’t notice the problem as it developed and could do nothing about it. You would have to posit the notion that Congress - even if still ruled by Democrats - wouldn’t become incensed at this closing down of options for seniors and order the health board to fix it.

But there is an equally troubling argument that Klein makes and it involves all of us; the idea that we are ignoring delicate problems involving end of life planning. Citing the Oregon assisted suicide program being paid for by government, Klein shows how such thinking can inevitably lead to unintended consequences:

This, of course, is the inevitable result of thinking of health care as a collective good that should be allocated by the state. If health care operates on a global budget, then it becomes a zero-sum game in which providing more care to one patient means depriving another patient of care. And suddenly life and death health decisions evolve from something that is between you, your faith, your family, and your doctor, into highly-politicized issues that are the business of government and your fellow taxpayers.

Instead of being honest about the natural tradeoffs involved in trying to “bend the health care cost curve,” Obama has promised Americans a utopia in which everybody is covered, quality improves, our debt actually decreases over time, only the very rich have to pay a tiny amount of extra taxes, and there will be no rationing of care. As Obama promised this week while in full salesman mode, “You will have not only the care you need, but also the care that right now is being denied to you — only if we get health care reform.”

But Obama’s disingenuousness doesn’t get conservatives completely off the hook, either. The right has been pushing back hard against the specter of government cutting off Medicare beneficiaries in their final days. Even if the House legislation did make that happen, however, is it clearly more ethical for conservatives to argue that we should dedicate an effectively unlimited amount of resources to treat those who are terminally ill or in a comatose state, while depriving others who are not old or sick or poor enough of any form of government benefits?

What any government board’s decision regarding end of life means is that the most intimate and personal decisions someone can make - how to manage their death - allows for a government bureaucrat to be in the room when one discusses such issues with their doctor. It is a humiliating loss of freedom that should be prevented by making such decisions off limits to government entirely. This could still be done in the context of Medicare paying for seniors to talk to their doctor about end of life issues while being aware of the potential for interference.

And Klein believes that this won’t let conservatives off the hook. Advocating unlimited resources being spent on those close to death may not be possible in the future - with our without Obamacare:

It’s an ugly issue that nobody wants to bring up precisely because of the reaction we’re seeing right now. But the dilemma will only become more pronounced with entitlement spending out of control, the development of life-preserving technologies expanding, and Baby Boomers set to retire. The reality is that we do not have a free market for health care in the United States and that government is responsible for 46 percent of health care spending. Nobody wants to be the heartless person who puts a price on human life and argues that we cannot afford to give a patient treatment that will mean the difference between death and survival. And certainly, nobody wants the person making that decision to be a government bureaucrat. But if conservatives believe in providing unlimited end-of-life care, then it necessarily means some combination of higher taxes, greater debt, or substantial cuts in other government services. In the coming years and decades, this reality will create friction between the desire of conservatives to protect human life in all of its forms and to limit the growth of government.

In that sense, the debate we’re having over the implications of end-of-life counseling is just a harbinger of problems to come, which Obamacare would only exacerbate.

In effect, there is a slippery slope argument to be made for both doing nothing, and adopting Obamacare. This is a consequence of the reality that health care reform is necessary but that Obamacare is the wrong way to go.

Is rationing our fate no matter if Obamacare fails? The future is grim and unless we can find someway to expand the health care pie without growing government or giving bureaucrats control over our health care system, these issues that are already on a slippery slope will slide us into choices that are unpalatable and would represent a loss of freedom.

8/16/2009

HEALTH CARE REFORM TEETERING ON THE EDGE OF FAILURE

Filed under: Politics, health care reform — Rick Moran @ 12:58 pm

There is a growing realization that the public option in the Democrat’s reform package is about to be jettisoned, and that the entire reform effort may be in jeopardy.

President Obama said yesterday:

“The public option, whether we have it or we don’t have it, is not the entirety of healthcare reform. This is just one sliver of it, one aspect of it,” Obama said. “And by the way, it’s both the right and the left that have become so fixated on this that they forget everything else.”

Today, it was moderate Senator Kent Conrad giving his opinion that the public option was dead in the Senate. The significance here is that it appears there are a good half dozen Democrats in the Senate who would be willing to filibuster any reform bill with a public option - enough to prevent the Democrats from breaking that logjam by keeping them short of the 60 votes needed to break the filibuster.

There’s always the Armageddon Option for the Democrats: Using the Reconciliation process, which would mean a simple majority of Democrats in the Senate could pass reform. The problem there is that the Republicans would retaliate as no minority has retaliated in memory.

The rules of the senate make it imperative that a congenial, live and let live attitude permeate its deliberations. The minority has many more options for causing mischief in the senate than the House and if the Democrats act dishonestly by using a parliamentary trick to pass such earth shaking legislation, the business of the senate is likely to come to a near total standstill as the GOP plays their own parliamentary gambits to sabotage the Democratic agenda.

So Reconciliation is probably out and the Democrats will keep negotiating, trying to get something their caucus can live with as well as drag a few Republicans over to vote for reform.

Tactically, the GOP smells blood in the water and many are working hard to see that no health care reform at all is passed. In this, I am reluctantly forced to agree. There is so little that is salvageable in this bill that, as most American’s sense at this point, it would be better to scrap the entire measure and start over from scratch. As I’ve said before, you just can’t get to real, reasonable reform from here. And the sooner they scrap what they have and start over the better.

This country desperately needs health care reform - if for no other reason than to get a handle on the out of control rise in costs. But there are other reasons for reform as well. In many cases, the people who need health insurance the most can’t get it because of chronic or pre-existing conditions. This is a group that numbers in the millions and if you include those who would love to have health insurance but can’t afford it, there has got to be a way to see that these people are covered.

Insurance co-ops may be the answer. They require limited government involvement - seed money, basically - and have the advantage of being able to make their own rules and spread the risk so that those with pre-existing conditions can get the coverage they need. And they promise to be a little cheaper than private insurance plan. But the keys are flexibility and portability. Several different plans can be offered and you can take the policy with you if you move or change jobs.

They aren’t perfect, but a far cry better than a public option in my mind.

The real question would be, if the Democrats fail, would the moment in history be lost for genuine health care reform?  I think the desire for Congress to address the problem is still there by the American people. They just don’t want the Democrat’s plan. I am not stupid enough to believe that any further effort at reform will necessarily involve purely market driven solutions. But I can’t believe the Democrats are stupid enough to ignore that aspect of reform.

Simple reforms like allowing insurance companies to sell across state lines, easing rules that insurance companies must include a host of specific mandates in coverages, tort reform, and the aforementioned co-ops would be a good start. It’s not as comprehensive a reform effort as the Democrats are undertaking presently and thank God for that. But it is a reasonable beginning that, along with serious Medicare reform, just might put some downward pressure on costs.

Then, in a few years, we can revisit the issue and gradually, through trial and error, come up with the necessary reforms that would accomplish what we all want; an efficient system that delivers quality care to as many as can reasonably be expected in a nation of 300 million people. What we need is an American solution to this problem, not a Euro-lite bastardization of a system that would probably end up adopting the worst of both worlds.

If the Democrats and Obama fail, there will be much rejoicing by many on our side of the debate. This would be shortsighted and childish. As partisan as the debates can get, it doesn’t obviate the fact that health care reform is a necessity and that both parties have to act like grown ups and be responsible leaders by tackling this issue that perhaps even more than terrorism, threatens us with destruction.

Sadly, it appears that we have a president who just isn’t up to the leadership challenges to get anything done on this issue. By stubbornly insisting on pushing for so much, so soon (and demonizing those who disagreed with him), President Obama has botched it but good. He has stood by and given House and Senate committee chairmen their heads with what even Democrats are saying is minimal guidance. He has failed to energize his own base and get them out to support his reform policies. And perhaps most shockingly, he has failed to exercise leadership in his own party and bring the Democrats together to vote for his ideas on reform.

For his efforts so far, I would give President Obama a D- grade. He is on the precipice of failure at this moment, his fate out of his own hands and in the hands of others.

And that is a position only incompetent presidents find themselves in.

8/14/2009

PALIN WINS — AND LOSES ME

Filed under: Ethics, Palin, Politics, conservative reform, health care reform — Rick Moran @ 10:03 am

So the Senate, giving in to Palin’s fear mongering, has decided to scrap the end of life consultation provision in the health care bill.

“On the Finance Committee, we are working very hard to avoid unintended consequences by methodically working through the complexities of all of these issues and policy options,” Sen. Chuck Grassley (R-Iowa) said in a statement. “We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly.”

The Finance Committee is the only congressional committee not to report out a preliminary healthcare bill before the August congressional recess, but is expected to unveil its proposal shortly after Labor Day.

Grassley said that bill would hold up better compared to proposals crafted in the House, which he asserted were “poorly cobbled together.”

“The bill passed by the House committees is so poorly cobbled together that it will have all kinds of unintended consequences, including making taxpayers fund healthcare subsidies for illegal immigrants,” Grassley said. The veteran Iowa lawmaker said the end-of-life provision in those bills would pay physicians to “advise patients about end-of-life care and rate physician quality of care based on the creation of and adherence to orders for end-of-life care.

Grassley is right about the House bill. There are plenty of slippery slopes that hold the potential for appalling health care policy to emerge once the health bureaucrats got a hold of its broadly drawn and badly written provisions.

But the end of life consultations weren’t one of them. There was no - repeat no mandate to force people to talk to their doctors about DNR’s, living wills, and other crucial, personal, intimate, and private details of what our specific wishes are when we prepare to leave this life behind. Fact check after fact check done by a huge variety of newspapers and websites have thoroughly, completely, and totally debunked Sarah Palin’s cynical fear mongering on the subject.

But it worked anyway. And because of it, it is my belief that Sarah Palin has no business being a national figure in the GOP - nor Guiliani, or any Republican who didn’t have the courage to face the wrath of Palin Zombies and disagree with her. Sarah Palin was wrong. And if she made the “death panel” statement to gin up fear and outrage, then that is the kind of cynical politics I want nothing ever to do with.

If she really believed it, she’s an ignoramus and should stick to being an airhead ex-governor that has conservative little boys drooling over her like they drool over porn actresses and movie stars. If, during the most critical debate on a public policy issue since perhaps the Civil Rights Act of 1964, all she has to offer is an irrational, exaggerated, hyperbolic, and ultimately dishonest critique of the Democrat’s health care plan, responsible Republicans should want to have nothing to do with her.

We needed leadership. She offered fear. We needed a genuine critique of very bad proposals We got fake tears, exploitation of her disabled child in a dishonest cause, and dark hints of the evil our political opponents represent.

Think of the good she could have done if she stuck with the facts. There is - or was - a sizable segment of independent women who admired Palin for her accomplishments. Where are they now? Her lying may have ginned up her base of Zombies who rushed to defend the indefensible but beyond that, she is even losing favor with other Republicans as her positive stands now at 39%, down 7 points since May.

Someone with her visibility could have intervened and called for civil debate based on the facts, denounced people who were shouting down their fellow Americans, and elevated the entire tone of this debate. Instead, she debased herself with her reckless disregard for the facts. And now, an important provision for seniors (one she supported in her own state) that would have had Medicare paying for doctor visits to discuss end of life issues has been sacrificed, largely because she misused her influence to conflate this vital and necessary provision with “death panels.”

Do we realize the irony in all of this? It was 1976 when the country was torn apart by the case of a comatose patient, Karen Ann Quinlan, whose parents sought vainly for months to have her taken off a respirator.

Quinlan was in a persistent vegetative state with no hope of ever coming out of her coma. Despite the parent’s pleas, the doctors and hospital ignored them and kept the young woman on a breathing machine. The legal hullabaloo that resulted was emotionally wrenching, and split the country in two over end of life issues.

At that time, doctors were pretty much Gods who alone could determine what treatments were given to terminally ill or, as in Quinlan’s case, comatose patients with no hope of recovery. In practice, some doctors actually did “pull the plug” but if they were caught, they may have been charged with murder. Clearly, medical technology that could prolong life had advanced beyond our ability to build an ethical and legal framework that would place these decisions in the hands of the patient and the family.

Now that framework is in place and suddenly, we want to prevent seniors and others from exploring these options, one on one with their doctor. This is especially relevant given the fact that too often, doctors are left out of the decision making process altogether and when the time comes, are in the dark about their patient’s wishes.

Many people don’t want to think about these issues but if Terri Schiavo had put it in writing that she didn’t want to live like a vegetable, her family could have been spared a great deal of pain. A living will with that stipulation would have kept the doctors from taking the extraordinary measures they employed to keep her alive. Reason enough for everyone to spend the $45 or so in order to make their own wishes known in a living will so that there is no doubt how medical professionals should treat us if we were to suffer an accident or illness that incapacitated us.

It was a small provision, thought to be uncontroversial - and would have been if we were having an honest debate about health care reform. But we’re not. And thanks to Sarah Palin, who might have changed at least some of that from our side, we’re not going to have one anytime soon.

I’ve said it a thousand times; this bill is so bad that if we spent the same amount of time explaining the truth of it as we do in lying about it, it will be soundly defeated. A good leader, a true conservative lives for the truth. Sarah Palin flunked the test on both counts and deserves to be cast into the outer darkness of politics reserved for those who misuse the public trust she so cynically, and cavalierly abused.

8/12/2009

ALTERNATIVES TO OBAMACARE

Filed under: American Issues Project, Blogging, Media, Politics, health care reform — Rick Moran @ 1:22 pm

No, this isn’t exactly what I promised yesterday about what kinds of health reform I would support. This is a bare bones outline I did for AIP.

A sample:

So yes, we must reform the health care system. But let’s imagine for a moment that President Obama and the Democrats didn’t hate the free market so much and were willing to look at alternatives to what they are proposing that would mean less, not more government control, and allow the free market to do the heavy lifting in helping to bring down health care costs.

It’s not like there aren’t free market ideas out there to reform health care - despite what our president and the Democrats want you to believe. They are attempting to ram this health care reform package through the Congress while saying that their opponents have no new ideas to solve the same problems.

But covering the uninsured by making insurance affordable for all, covering those with pre-existing conditions, bringing down the cost of health care, and assuring that the patient, in consultation with his doctor, has the most control over his own treatment are goals that can be achieved more cheaply, and by using a mostly free market approach to reform.

Unfortunately, a completely market oriented solution is not politically viable or realistic at this time. More than six dollars in every ten we spend on health care in America is spent by government. Medicare, Medicaid, Veterans benefits, Indian health care, active duty military care, and the children’s insurance program S-CHIP are just a few of the programs that have skewed the market in health insurance and health care so that a purely free market solution is not in the cards. And doing away with these government programs - even if it were possible - would not be the answer.

But believe me, we can do better than what the president and the Democrats are proposing.

I then give a rudimentary primer on some of the alternatives.

As I said, it’s not very detailed and there are other reforms I would support. Unfortunately, I lost my internet this morning and it just came on about an hour ago so those who might be interested in what real health care reform might look like - from my humble point of view anyway - are going to have to wait at least another day.

Great discussion with my good friends Ed Morrissey and Rich Baehr last night on my radio show about what’s happening with the politics of health care. Rich, who has been a medical insurance consultant for more than a quarter century, sees a senior citizen backlash coming against the Dems. While Obama and the Democrats concentrate on convincing the middle class about the necessity of health care reform, the seniors are packing town hall meetings and expressing their outrage at the more than $350 billion in Medicare cuts. This will mean longer waits for care, doctors dropping medicare patients altogether, and generally lower levels of service.

Old people, Rich reminded us, vote - big time.

You can access a podcast of the show here.

I think very soon, the Democrats are going to have to decide whether to batten down the hatches and pass their idea of a health care bill, even in the teeth of some serious opposition. Or whether they should scrap what they have and start over with a whole new, much more modest approach. I don’t think they can get to “Plan B” from where they are now. They would have to construct an entirely new framework from which to begin.

It is not likely to happen unless support for their kind of reform hits the low 20’s in the polls. Right now, it’s in the mid-30’s to low 40’s which is bad but not political Armageddon. But support is not rising, it is falling. And the longer they dawdle in Congress, the more the opposition can muster its forces to defeat them.

Right now, I’d put passage of some kind of reform at 60-40 in favor. The only reason it’s that high is that Obama has yet to bring the full force and effect of his office into the debate. A president has enormous power and Obama has several hole cards yet to play. Town halls and speeches won’t get it done. He will have to do what LBJ used to call “the laying on of the hands.” For example, Congress may hold the purse strings but the president has enormous latitude about when those monies can be released. A road project in a member’s district may be held up (or expedited) depending on how that Congressman intends to vote. No matter how bad a member might think the public option to be, that kind of persuasion can work miracles.

If they ditch the public option, that 60-40 number goes up considerably. In the end, that’s what Obama might have to do to get something he can sign.

8/11/2009

THE LOGICAL FALLACY OF SOME SLIPPERY SLOPE REFORM ARGUMENTS

Filed under: Government, Politics, health care reform — Rick Moran @ 9:43 am

I was actually going to write a post today on the kinds of health care reform proposals that I would support, and that I believe a majority of Americans could get behind as well. (Perhaps tomorrow if I have the time.)

But in researching various proposals, it occurred to me that the problem with conservative critiques of Obamacare - at least from pop conservatives like Rush Limbaugh and professional scare mongers like Sarah Palin - is the logical fallacy of their “slippery slope” arguments, and the sheer impossibility of many of their most dire warnings about what will happen if we adopt Obamacare.

Don’t get me wrong (although I know many of you will). There are indeed legitimate slippery slope arguments that can be made about these proposals that meet the stringent test of being logically thought out, and buttressed by facts. Reasonable assumptions can be extrapolated from what the Democrats are proposing that aren’t so slippery that they fall off a cliff into the netherworld of nonsense.

But in truth, many of the worst slippery slope arguments being employed in this debate on the right are full of logical fallacies that assume too much, ignore alternative arguments to explain facts, and stretch logic and reason to the breaking point in order to present half baked notions of the future of American health care under what Democrats are proposing.

What makes a good or bad slippery slope argument? I like the Wikpedia entry that explains a valid slippery slope argument:

Modern usage includes a logically valid form, in which a minor action causes a significant impact through a long chain of logical relationships. Note that establishing this chain of logical implication (or quantifying the relevant probabilities) makes this form logically valid. The slippery slope argument is only a fallacy if such a chain is not established.

A slippery slope argument that evolves into logical fallacy can take many forms; to my mind, failing to rigorously test your own assumptions that define the argument itself is the easiest trap in which to fall. Essentially, trying to impose a false assumption invariably leads to a crumbling of the whole edifice.

Again, Wikpedia has a pretty good definition for those arguments that crumble into logical fallacies:

The heart of the slippery slope fallacy lies in abusing the intuitively appreciable transitivity of implication, claiming that A lead to B, B leads to C, C leads to D and so on, until one finally claims that A leads to Z. While this is formally valid when the premises are taken as a given, each of those contingencies needs to be factually established before the relevant conclusion can be drawn. Slippery slope fallacies occur when this is not done — an argument that supports the relevant premises is not fallacious and thus isn’t a slippery slope fallacy.

Often proponents of a “slippery slope” contention propose a long series of intermediate events as the mechanism of connection leading from A to B. The “camel’s nose” provides one example of this: once a camel has managed to place its nose within a tent, the rest of the camel will inevitably follow. In this sense the slippery slope resembles the genetic fallacy, but in reverse.

Let’s take Sarah Palin’s “Death Panels” statement as a perfect example of a slippery slope argument that degenerates into logical fallacy the moment one looks at it in a rational manner.

Palin doesn’t even bother with any intermediate steps; she goes from A directly to Z without so much as a logical assumption between them. Even those who support her statement admit that there is nothing that the Democrats are proposing that even remotely approaches some kind of board where individuals are sorted out based on how productive they are, or potentially can be. The fallacy of this thinking then, is that any incremental steps that could, in the end, lead to death panels are simply ignored and a kind of intuitive logic is employed to go directly from A to Z.

It is those incremental steps that are the key to the fallacy. In order to accept her statement, one would have to believe that no one would recognize anything untoward in these incremental steps to death panels (the “boiling frog” analogy), or that no one would attempt to change course and prevent the death panels from forming in the first place (a “momentum” argument that is easy to disprove).

Of course, Palin wasn’t making a logical slippery slope argument. That was not her intent. It was to polemecize the debate by throwing rhetorical bombs at Obamacare, hoping to rile up her supporters, and strike fear into seniors and others.

I find it amusing that many of those who seek to explain Palin’s argument go so far afield to justify her logic that they actually prove how patently ridiculous her statement was.

Let’s take the normally reasonable and objective William Jacobsen of Legal Insurrection who makes spaghetti of Palin’s arguments by stretching logic beyond reason:

These critics, however, didn’t take the time to find out to what Palin was referring when she used the term “level of productivity in society” as being the basis for determining access to medical care. If the critics, who hold themselves in the highest of intellectual esteem, had bothered to do something other than react, they would have realized that the approach to health care to which Palin was referring was none other than that espoused by key Obama health care adviser Dr. Ezekial Emanuel (brother of Chief of Staff Rahm Emanuel).

The article in which Dr. Emanuel puts forth his approach is “Principles for Allocation of Scarce Medical Interventions,” published on January 31, 2009. A full copy is embedded below. Read it, particularly the section beginning at page 6 of the embed (page 428 in the original) at which Dr. Emanuel sets forth the principles of “The Complete Lives System.”

No doubt Rhambo II is nutty as a fruitcake. The question we have to ask is where in the alphabet between A and Z does Mr. Potential Death Panel Chief fit?

The next question is, whether Dr. Emanuel’s proposal bears any connection to current Democratic proposals. There is no single Democratic proposal at this point, only a series of proposals and concepts. To that extent, Palin’s comments properly are viewed as a warning shot not to move to Dr. Emanuel’s concept of health care rationing based on societal worth, rather than a critique of a specific bill ready for vote.

Certainly, no Democrat is proposing a “death panel,” or withholding care to the young or infirm. To say such a thing would be political suicide.

But one interesting concept which is central to the concepts being discussed is the creation of a panel of “experts” to make the politically unpopular decisions on allocating health care resources.

As Bill himself admits, the Democrats are not proposing a death panel and Mr. Death Panel doesn’t fit anywhere on the A to Z continuum because frankly, there are no A to Z dots to connect at the moment. There’s only a vague mention of a “panel of experts” who would not have anything to do with the “Complete Lives System” of allocating health care resources. Instead, the proposed Commission would make decisions on treatment options and, according to the letter from Obama to Congress that Bill quotes, “These savings will come not only by adopting new technologies and addressing the vastly different costs of care, but from going after the key drivers of skyrocketing health care costs, including unmanaged chronic diseases, duplicated tests, and unnecessary hospital readmissions.”

Not a hint of a death panel. Not even a hint of a “complete lives” determinant for allocating health care resources. Bill is using one bogus slippery slope argument to support Palin’s equally curious polemic.

Sorry, but just because conservatives combine a genuine distrust of government with the real potential for unintended outcomes by using some valid slippery slope arguments about Obamacare, that doesn’t mean we can go off half cocked and, by sheer intuition rather than facts and logic, imagine the absolute worst nightmares about nationalized health care. All slippery slope arguments against Obamacare are not valid. And Palin’s might be the worst of the lot.

A possibly valid slippery slope argument about this “Medicare Payment Advisory Commission” is that it would result in a “one size fits all” treatment regimen for specific diseases. Instead of coming up with the best course of treatment for what ails you, in consultation with your doctor, a third person will be sitting in the room with you - your friendly, neighborhood government health bureaucrat from MedPac - who will have a specific outline of treatments and drugs that would be approved for payment by the government.

Currently, you can tailor your private insurance plan to cover those “unnecessary tests” that Obama is so concerned about. And, of course, the counterargument is that if you want those tests, you can always pay for them out of your own pocket.

But given what I believe to be a valid slippery slope for what Obamacare could eventually mean - a virtual end to private insurance and all but the richest Americans forced onto the government plan - we should be very concerned with any board or commission set up to make one size fits all decisions on treatment.

In fact, let’s examine the reasonable argument that, by moving steadily from A to Z, Obamacare will for all intents and purposes destroy the general health insurance industry and eventually mandate that almost all Americans join the government plan.

Lindsey Graham, in an interview with Ezra Klien, fills in some of the A to Z gaps:

My belief is that no private-sector entity can survive over a long period of time competing against the government. The public option will be written by politicians. It will be generous. Nobody in my business worries about the bottom line. Eventually, the public option will dominate the marketplace because the political forces in the public sector are different than the economic forces in the private sector. Eventually, the private sector will give way.

You know, we already have Medicaid and Medicare. The private sector covers the middle. If a public option becomes part of that mix, you’ll have the whole deal covered by the government. That’s why I’m against it. And what I’d like to do long-term is enhance the options available to the retirement community and reform Medicare.

Is it logical to assume that because private insurance companies are beholden to market forces and government is not, that eventually - unless government deliberately keeps its premiums high - these companies will simply be forced out of business because they can’t compete?

I believe the answer to that is a great big yes. The government already skews market forces in the health insurance industry because 6 out of every 10 dollars spent on health care in America is spent by government.

Graham’s argument has some holes (the boiling frog, remember?). Is it reasonable to assume that government wouldn’t lift a finger to save private insurance companies from going the way of the dinosaurs?

This is trickier because it would depend on who might be in power. Would Republicans risk the wrath of their base to bail out Prudential, or Allstate? Lots of little guys make a living selling insurance as independent agents. What would happen to them if that part of their business went up in flames?

If Democrats are in power - as I am assuming they will be given the fact that the GOP is prostrate right now and in such a shambles leadership-wise that it is probable the Dems will be in power for the foreseeable future - I think they have made their feelings clear about “greedy” insurance companies. Based on their attitude toward business in general and specifically, the insurance industry,I doubt whether Democrats would lift a finger to help insurance companies remain in the business of selling health care policies.

That is a reasonable assumption drawn from known facts. Attitudes and statements by the Democratic leadership about health insurance companies leads to the logical conclusion that their elimination would not be a catastrophic occurrence. Hence, no private insurance would mean virtually all Americans would be forced on to the government plan.

This is an example of a valid slippery slope argument. Will it really happen? Counterarguments similarly based on facts and logic must, by definition, refute the market forces that would be at work as well as statements made by liberals about evil insurance companies. I don’t think it can be done but anyone willing to try will get a hearing from me.

Unfortunately, too many conservatives use fantastical and illogical slippery slope arguments to posit the absolute worst outcomes for Obamacare. Old folks being forced into signing DNR orders and living wills based on the proposal that Medicare will be paying for doctors visits to discuss these options is a similarly nonsensical idea. To extrapolate people being “forced” to do anything remotely like signing their own “death warrants” just from this simple, common sense idea is beyond the pale of rational discourse. Those who advance the argument are not concerned about anything except ginning up fear among senior citizens over Obamacare.

Slippery slope arguments about rationing are a little different. It has been pointed out that there already is a form of rationing used by private insurance companies who routinely deny some treatments as too experimental or not necessary in their view. The question of how draconian it might get under Obamacare is, I believe, unanswerable at this time. Much depends on whatever ideas they eventually come up with to control costs. If it looks like they won’t do diddly, then a rationing regime will be absolutely necessary. How bad it could get just isn’t logically foreseeable at this time.

If we stick with those slippery slope arguments that are valid and discard the nonsensical ones, we can win this debate. But using logical fallacies and outright imaginary outcomes meant to scare people rather than make them think about the consequences of passing Obamacare only makes conservatives look like hysterics.

And that may be Sarah Palin’s brand of conservatism, but it’s not mine.

8/9/2009

LEARNING NEW THINGS CAN BE FUN

Filed under: Blogging, Government, Palin, Politics, health care reform — Rick Moran @ 6:54 am

Getting a lot of love in the comments from my post yesterday about Palin, the Democrats, and everyone else demagoguing the health care reform issue to death.

To wit:

1. It’s not enough that I think the bill is horrible, bad, a catastrophe, and a threat to individual liberty. I must also get hysterical about it. I must go over the edge of sanity and reason because if I don’t, it’s obvious I am a liberal and an Obama lover. I must extrapolate the most dire, sinister outcomes assumed in the debate with no evidence whatsoever that anything being proposed will lead to “death panels,” or denial of critical care. I agree, and have written previously, there are slippery slopes aplenty in what is being proposed. But the kind of over the top, exaggerated, hysterically fearful claptrap being thrown around by some conservatives is illogical, and in the end, only makes our side look like losers

(Note: Emanuel’s brother is not writing the bill, nor is Holdren going to have anything to do with running any state controlled health care system. For the reasons so many of you outlined, it is extremely doubtful that senate confirmation would be forthcoming for either gentleman if Obama was dumb enough to try and appoint them to any position of influence in his Brave New State Run Health Care Agency.)

2. Saying anything negative about Sarah Palin brings out the creepiest conservatives on the web. The parallels between Obamabots and Palin zombies is disheartening, and makes me wonder what would happen if she did indeed run in 2012. Both are blinded by the notion that their white knight can do no wrong, and say no evil. Both Obamabots and Palin zombies see qualities in their heroes that don’t exist. Both believe their saviors are rescuing them from evil. Both are pathetic manifestations of the times in which we live and reflect the depths to which the American character has sunk. When so many on both sides of the great political divide imbue a politician with almost superhuman qualities, I fear for the future of the republic.

3. People who bring my family into any criticism of me are cretinous louts.

4. I am the last, sane person in America.

Isaac Asimov’s brilliant, and influential short story Nightfall comes to mind as a metaphor for this debate. The sci-fi classic is about a planet that is bathed in continual sunlight due to the fact that it revolves around 6 suns. It is a world that knows no darkness, no sundown, and no stars.

Every 2000 years or so, all six suns go into eclipse and for a brief period, there is night. A cult that predicted this catastrophe, and scientists who studied the remnants of past civilizations on the planet, concluded that when the darkness descends, everyone goes stark raving mad because the night is so frightening, they destroy their own civilization by setting fire to anything that burns in order to bring back the light.

(The final scene is one of the most haunting in all of sci-fi literature. After the darkness has descended, the scientists, who are trying to measure the phenomenon - including getting pictures of the mythical “stars” that they don’t really believe exist - are in for a surprise. The protagonist goes to a window:

Through it shone the Stars!

Not Earth’s feeble thirty-six hundred Stars visible to the eye; Lagash was in the center of a giant cluster. Thirty thousand mighty suns shone down in a soul-searing splendor that was more frighteningly cold in its awful indifference than the bitter wind that shivered across the cold, horribly bleak world.

Theremon staggered to his feet, his throat, constricting him to breathlessness, all the muscles of his body writhing in an intensity of terror and sheer fear beyond bearing. He was going mad and knew it, and somewhere deep inside a bit of sanity was screaming, struggling to fight off the hopeless flood of black terror. It was very horrible to go mad and know that you were going mad — to know that in a little minute you would be here physically and yet all the real essence would be dead and drowned in the black madness. For this was the Dark — the Dark and the Cold and the Doom. The bright walls of the universe were shattered and their awful black fragments were falling down to crush and squeeze and obliterate him.

In America, the darkness is descending and torches are being lit. Fear stalks the land - fear of the unknown, fear of our fellow citizens, fear of our political leaders, fear of the future. This fear is being stoked on both sides by people who are well aware of the consequences of what they are doing, but continue to fan the flames of dread because it gives them power and influence, or furthers their political designs. Reason has left the building. It has been replaced by a raw emotionalism that feeds upon itself, spiraling out of control, threatening violence and disorder while making any rational debate about health care reform impossible.

President Obama may get his statist, ruinously expensive, ridiculously complicated health care reform. But it will be a Pyrrhic victory. For in pulling out all the stops to garner a political triumph, and becoming the number one enabler of demagoguery and fear mongering, he will have so riven the citizenry of this republic as to make any future efforts to solve our problems in a bi-partisan manner an impossibility.

I am one of those who would have supported reasonable reforms in health insurance and realistic means to bring down health care costs. The Democrats are proposing neither, and are ginning up fear and outrage - as are Republicans in opposition - to ram down the throats of the American people, without legitimate debate or discussion reforms that are antithetical to the American character and the American way of doing things. The proposals make a mockery of our First Principles, and threaten not to “remake” America” but to fundamentally alter the compact between citizens and the government.

Without congressional hearings, or any input from opponents; in secrecy, and using complexity as a beard to hide an agenda that they know full well would be rejected by the overwhelming majority of citizens, the Democrats are in full on attack mode. They are not defending what they want to accomplish with reform. They are simply going after those who oppose them, using the most vile and despicable tactics to delegitimize the opposition.

Judging by the polls, it’s not working. And if health care reform fails, it won’t be because of the hysterical fear mongering by Republicans and conservatives, but because they didn’t believe in reform enough to trust the legislative process and the give and take of democratic debate.

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