The Far-Right Conspiracy against the NHS

[Terry Mauro]

Former Surgeon General Koop raises the specter of health care rationing.

DR. KOOP:

I’m 93 and thank God for every year. I’m here with 2 artificial joints, 2 pacemakers to keep my heart in rhythm, as well as a stent to keep my coronaries open. Seniors in this country can get the care I received, but in some places, like the United Kingdom, we would be considered too old and the cost to the state too high. It is vital that America’s seniors understand what Congress is doing. But Democrats are working on a health care bill -- and keeping the discussion and specifics secret. We seniors are concerned about proposals that would reduce Medicare spending. The Administration promised transparent deliberation, which has not been forthcoming. America deserves better than this

http://www.politico.com/livepulse/0110/Koo...rationing_.html

[John Simkin]

I would like to hear from members what they make of the health-care bill passed on Sunday.

[Craig Lamson]

I would like to hear from members what they make of the health-care bill passed on Sunday.

It dies in the courts.....

[Don Jeffries]

Initially, I felt that any proposed change had to be an improvement on the present dreadful system. After reading through some of the details of the legislation passed last night, I believe I was wrong. Somehow, against all odds, our corrupt and incompetent leaders may have managed to actually make this mess even worse.

As I understand it, the only "reforms" those presently insured under the present system will receive is that pre-existing conditions will no longer be an excuse for insurance companies to turn someone down (but inexplicably only beginning in 2014), and parents will now be able to keep their children who are attending college on their policies until age 26 (up from 21). Also, the legislation decrees that almost everyone will be insured now (is it 94%- it's very confusing), and this will obviously help the poor and others who simply can't afford insurance (or their companies don't provide it). Now for the downside....

Nothing, absolutely nothing, is in this legislation which will reign in the monstous profits of the insurance and pharmaceudical companies, not to mention the outrageous salaries of hospital administrators and CEOs. In fact, it is now very likely that the insurance companies will raise the rates on those they insure (with the excuse that the dreaded Obamacare has made their costs go up). Since the law mandates all companies with 50 or more employees must provide insurance, it is a certainty that any company within shouting distance of 50 employees will lay enough people off to get down to 49 or less. Nothing in there about the ridiculous rates the insurance companies already charge, or the prohibitive cost of prescriptions. Nothing about limiting rates or rate increases, or the amount of co-pays. Finally, the most absurd part of the legislation is the stipulation that everyone must get insurance. If one doesn't, one is subject to penalties which increase each year. What kind of "reform" is that?

I should have known that the Democrats would capitulate and offer up a "solution" that touches on none of the biggest problems most people face under the present system. The present system is screwed up beyond repair- the fair and reasonable thing to do is to scrap it entirely and go with a single-payer system, like the rest of the world. But that would mean for once the "American People" wouldn't be the ones sacrificing, the rich and powerful would. None of the Republicrats who "represent" us are about to do that, considering they all belong to the same class. It has been proven again that none of our representatives have the courage to stand up and do the right thing.

It's nice to know that all will be insured (to the point of being fined if they aren't), but unless there is something done about the financial burden our present health care system places on businesses and individuals, eventually health care will be just what some want it to be; a privilege, not a right.

I would urge all Americans to do everything they can to stay healthy.

Edited March 23, 2010 by Don Jeffries

[Craig Lamson]

Initially, I felt that any proposed change had to be an improvement on the present dreadful system. After reading through some of the details of the legislation passed last night, I believe I was wrong. Somehow, against all odds, our corrupt and incompetent leaders may have managed to actually make this mess even worse.

Let me see if I understand your logic here Don.

The pols in Washington are corrupt and incompetent and screwed up the heathcare bill, so your solution is to give the entire system to the same corrupt and incompetent pols?

BTW, what constitutes excessive profit? 10% 20% 30%?

[Terry Mauro]

- The SOB Is A Fascist -

On Sunday, March 21, the disgraced and hated U.S. Congress

committed an act of simultaneous genocide and political suicide,

by voting to pass President Obama's fascist health care

legislation. That bill includes the Nazi T-4-modelled IPAB

(Independent Payment Advisory Board)--exactly as Lyndon LaRouche

had warned for months was the British Empire's central demand.

London and Wall Street immediately expressed their

satisfaction at the vote, with the London {Economist} only

demanding that bigger "fangs" should be added into the IPAB

provision.

LaRouche, who has given leadership to the mass strike

ferment sweeping the country since last August, was blunt in his

assessment:

"We're dealing with {fascism}! The son-of-a-bitch is a

fascist! When people wake up and recognize that, then they are

going to start thinking more clearly. You don't have to be a

World War II veteran to know what a fascist is. This

son-of-a-bitch is a fascist, and the sooner he's called that, the

better for all concerned. Then we have the debate on the right

grounds. And it {will} come on those grounds. There's no way they

are going to avoid that. One way or the other, the fascism

question is going to come out. And the Hitler question is going

to come out. And people are going to start growing moustaches, or

not. You know: `I shine my shoes with a toothbrush moustache.'

"You've got to have a sense of humor about this," LaRouche

noted, "but a {dark} sense of humor."

LaRouche also criticized the approach being taken to stop

the bill by many Republicans, which centers on parliamentary

maneuvers and obstruction. "That's a bad approach," LaRouche

commented. "I think that will not work, because I know what we're

dealing with. And they do not yet want to know what we're dealing

with. We're dealing with {fascism}!"

As for the way the bill was rammed through Congress by Nancy

Pelosi et al., LaRouche said: "The whole thing was a mob scene;

it's like a lynch mob. What you saw in the process here, was the

behavior of a lynch mob. There's nothing rational about it. They

were terrified, and being the gutless wonders that they are--you

get our poor Ohio ex-Trotskyist, Kucinich, who didn't have the

guts to be a Stalinist, and he became a Trotskyist because, since

Trotsky was defeated, he thought that made it all right. He's

politically dead--he's dead meat as a candidate for anything."

The same applies to the pathetic cave-ins by Rep. Luis

Gutierrez (D-IL), Rep. Bart Stupak (D-MI), and others. "I think

Stupak needs to be treated for insanity," LaRouche suggested

sympathetically.

In fact, the only national political figure of stature left

standing, morally, at this point, after the Congressional vote,

is Lyndon LaRouche. Let's make sure we turn that into London's

worst nightmare.

[John Simkin]

Initially, I felt that any proposed change had to be an improvement on the present dreadful system. After reading through some of the details of the legislation passed last night, I believe I was wrong. Somehow, against all odds, our corrupt and incompetent leaders may have managed to actually make this mess even worse.

This is what the Guardian editorial had to say about the legislation:

We live in an age that is quicker to claim that history has been made than it is to try to understand the present. However, a piece of history was made on Sunday night, and yesterday Republicans were scrambling to come to terms with it. It is not just that the United States finally has healthcare legislation that will ensure near-universal coverage (although it will take until 2019 to acquire it). America yesterday also woke up to the comparatively new spectacle of a Democratic president who can get things done. Not a Jimmy Carter, who failed, or a Bill Clinton, who dodged and wove his way through office, but a Barack Obama, who can straightforwardly claim to have delivered the major promise of his manifesto. Not many leaders can claim that after one year in office.

It has been a gruelling year, in which the Obama presidency all but foundered before it had really begun. This has also been a sharp learning curve for the man drawn instinctively to the centre ground, only to realise late in the day that the turf he was standing on was boggy and that he was sinking into it. Over the past week, he and his much-criticised enforcer, Rahm Emanuel, have fought on multiple fronts – even in the House of the Representatives' gym – to keep their party together. Even so, 34 Democrats voted against the motion. The legislation falls far short of the ideal: it has no public option – cheaper insurance plans offered by the federal government – and the executive order assuring that no federal funds would be used to subsidise abortion may have secured the support of a handful of Catholic Democrats, but it would have appalled the rest. But after the compromises he has offered, the carrots he has dangled, the threats he has made, no one can accuse Mr Obama of standing aloof from the ugly fray or being a greenhorn in the dark arts of gaining votes on Capitol Hill. After a fight like this, he has acquired the status of a combat veteran, as hardened as his secretary of state, with whom he was once unfavourably compared.

For Republicans, who took a strategic decision to oppose healthcare reform no matter what it did, this episode has been a disaster and could postpone by at least one presidential term the day when they are deemed fit for office. David Frum, George Bush's speechwriter, to whom the axis of evil phrase is attributed, calls the battle they have just lost their Waterloo. Republican moderates were repeatedly offered a chance to shape the healthcare plan, which would surely not have been as alien to them as they claimed. A plan similar to the Senate bill was passed in Massachusetts when the Republican Mitt Romney was governor. By eschewing all contact with Mr Obama's satanic verses, they have abandoned a large swath of political ground. They don't know it yet but mainstream conservatives, appalled at the chants of a crowd of Tea Party activists on Capitol Hill, surely do.

What happens next comes down to a cold calculation. Will popular opposition to the reforms swell as people discover that their Medicare taxes are going up, or will they claim ownership of a reform that means they can no longer be rejected for insurance because of pre-existing medical conditions and that their children can be kept on their plans longer? Mr Obama has history on his side. No one today is talking about eliminating Medicare, which was denounced in much the same terms when it was passed in 1965, because, far from becoming, in Ronald Reagan's famous words, the end of American freedom, it has instead become part of the American landscape. Mr Obama is banking on a similar fate for his reforms and, if he is right, it means that the Republicans are losing a battle based on the politics of fear. They will take a long time to recover a positive message they can sell to the people. Mr Obama will have to get the message out across the country between now and the midterm elections in November. But he will do so as a changed man and a more assured political fighter.

http://www.guardian.co.uk/commentisfree/20...re-barack-obama

[Craig Lamson]

Initially, I felt that any proposed change had to be an improvement on the present dreadful system. After reading through some of the details of the legislation passed last night, I believe I was wrong. Somehow, against all odds, our corrupt and incompetent leaders may have managed to actually make this mess even worse.

This is what the Guardian editorial had to say about the legislation:

We live in an age that is quicker to claim that history has been made than it is to try to understand the present. However, a piece of history was made on Sunday night, and yesterday Republicans were scrambling to come to terms with it. It is not just that the United States finally has healthcare legislation that will ensure near-universal coverage (although it will take until 2019 to acquire it). America yesterday also woke up to the comparatively new spectacle of a Democratic president who can get things done. Not a Jimmy Carter, who failed, or a Bill Clinton, who dodged and wove his way through office, but a Barack Obama, who can straightforwardly claim to have delivered the major promise of his manifesto. Not many leaders can claim that after one year in office.

It has been a gruelling year, in which the Obama presidency all but foundered before it had really begun. This has also been a sharp learning curve for the man drawn instinctively to the centre ground, only to realise late in the day that the turf he was standing on was boggy and that he was sinking into it. Over the past week, he and his much-criticised enforcer, Rahm Emanuel, have fought on multiple fronts – even in the House of the Representatives' gym – to keep their party together. Even so, 34 Democrats voted against the motion. The legislation falls far short of the ideal: it has no public option – cheaper insurance plans offered by the federal government – and the executive order assuring that no federal funds would be used to subsidise abortion may have secured the support of a handful of Catholic Democrats, but it would have appalled the rest. But after the compromises he has offered, the carrots he has dangled, the threats he has made, no one can accuse Mr Obama of standing aloof from the ugly fray or being a greenhorn in the dark arts of gaining votes on Capitol Hill. After a fight like this, he has acquired the status of a combat veteran, as hardened as his secretary of state, with whom he was once unfavourably compared.

For Republicans, who took a strategic decision to oppose healthcare reform no matter what it did, this episode has been a disaster and could postpone by at least one presidential term the day when they are deemed fit for office. David Frum, George Bush's speechwriter, to whom the axis of evil phrase is attributed, calls the battle they have just lost their Waterloo. Republican moderates were repeatedly offered a chance to shape the healthcare plan, which would surely not have been as alien to them as they claimed. A plan similar to the Senate bill was passed in Massachusetts when the Republican Mitt Romney was governor. By eschewing all contact with Mr Obama's satanic verses, they have abandoned a large swath of political ground. They don't know it yet but mainstream conservatives, appalled at the chants of a crowd of Tea Party activists on Capitol Hill, surely do.

What happens next comes down to a cold calculation. Will popular opposition to the reforms swell as people discover that their Medicare taxes are going up, or will they claim ownership of a reform that means they can no longer be rejected for insurance because of pre-existing medical conditions and that their children can be kept on their plans longer? Mr Obama has history on his side. No one today is talking about eliminating Medicare, which was denounced in much the same terms when it was passed in 1965, because, far from becoming, in Ronald Reagan's famous words, the end of American freedom, it has instead become part of the American landscape. Mr Obama is banking on a similar fate for his reforms and, if he is right, it means that the Republicans are losing a battle based on the politics of fear. They will take a long time to recover a positive message they can sell to the people. Mr Obama will have to get the message out across the country between now and the midterm elections in November. But he will do so as a changed man and a more assured political fighter.

http://www.guardian.co.uk/commentisfree/20...re-barack-obama

The majority of Americans hate this bill and they will exact revenge on the Democrates who voted for it in November by voting them out. And unless he gets VERY lucky, they will vote Obama out as well in 12.

The comparison to Romney care is really telling. That program is a disaster!

Medicare is broken...just this week Walgreens, a large national pharmacy announced they will no longer take new Medicare patients. Dr's are doing the same. My doctor already has decided no more medicare. In fact she is on the forefront of the new reality. A deep discount for cash and no insurance paperwork.

Social Security, that other history making program is this year going to take in less than it spends, forcing it to cash in some of the "notes" extended to the Federal Government to stay afloat. And how will the Feds pay back these notes? Why borrow from China of course.

So they answer this situation by creating MORE taxes on people and business, at a time when LESS taxes is the answer to increasing jobs.

Oh yea people WILL remember Obama, just, I think not in the way painted in the article. He IS the next Carter.

Edited March 25, 2010 by Craig Lamson

[Guest John Gillespie]

Initially, I felt that any proposed change had to be an improvement on the present dreadful system. After reading through some of the details of the legislation passed last night, I believe I was wrong. Somehow, against all odds, our corrupt and incompetent leaders may have managed to actually make this mess even worse.

This is what the Guardian editorial had to say about the legislation:

We live in an age that is quicker to claim that history has been made than it is to try to understand the present. However, a piece of history was made on Sunday night, and yesterday Republicans were scrambling to come to terms with it. It is not just that the United States finally has healthcare legislation that will ensure near-universal coverage (although it will take until 2019 to acquire it). America yesterday also woke up to the comparatively new spectacle of a Democratic president who can get things done. Not a Jimmy Carter, who failed, or a Bill Clinton, who dodged and wove his way through office, but a Barack Obama, who can straightforwardly claim to have delivered the major promise of his manifesto. Not many leaders can claim that after one year in office.

It has been a gruelling year, in which the Obama presidency all but foundered before it had really begun. This has also been a sharp learning curve for the man drawn instinctively to the centre ground, only to realise late in the day that the turf he was standing on was boggy and that he was sinking into it. Over the past week, he and his much-criticised enforcer, Rahm Emanuel, have fought on multiple fronts – even in the House of the Representatives' gym – to keep their party together. Even so, 34 Democrats voted against the motion. The legislation falls far short of the ideal: it has no public option – cheaper insurance plans offered by the federal government – and the executive order assuring that no federal funds would be used to subsidise abortion may have secured the support of a handful of Catholic Democrats, but it would have appalled the rest. But after the compromises he has offered, the carrots he has dangled, the threats he has made, no one can accuse Mr Obama of standing aloof from the ugly fray or being a greenhorn in the dark arts of gaining votes on Capitol Hill. After a fight like this, he has acquired the status of a combat veteran, as hardened as his secretary of state, with whom he was once unfavourably compared.

For Republicans, who took a strategic decision to oppose healthcare reform no matter what it did, this episode has been a disaster and could postpone by at least one presidential term the day when they are deemed fit for office. David Frum, George Bush's speechwriter, to whom the axis of evil phrase is attributed, calls the battle they have just lost their Waterloo. Republican moderates were repeatedly offered a chance to shape the healthcare plan, which would surely not have been as alien to them as they claimed. A plan similar to the Senate bill was passed in Massachusetts when the Republican Mitt Romney was governor. By eschewing all contact with Mr Obama's satanic verses, they have abandoned a large swath of political ground. They don't know it yet but mainstream conservatives, appalled at the chants of a crowd of Tea Party activists on Capitol Hill, surely do.

What happens next comes down to a cold calculation. Will popular opposition to the reforms swell as people discover that their Medicare taxes are going up, or will they claim ownership of a reform that means they can no longer be rejected for insurance because of pre-existing medical conditions and that their children can be kept on their plans longer? Mr Obama has history on his side. No one today is talking about eliminating Medicare, which was denounced in much the same terms when it was passed in 1965, because, far from becoming, in Ronald Reagan's famous words, the end of American freedom, it has instead become part of the American landscape. Mr Obama is banking on a similar fate for his reforms and, if he is right, it means that the Republicans are losing a battle based on the politics of fear. They will take a long time to recover a positive message they can sell to the people. Mr Obama will have to get the message out across the country between now and the midterm elections in November. But he will do so as a changed man and a more assured political fighter.

http://www.guardian.co.uk/commentisfree/20...re-barack-obama

___________________________________________________________________

I thought only Yankee fans were poor winners. This is predictably arrogant, willfully ignorant and overflows with the snide, faux insouciance of editorial sleight-of-hand. Of course, we seldom hear or read of the Far Left, though it exists surely as much as the embittered prose, above, and the violently radical philosophy of (nearly) all the President's men. The American People, nearly collectively, are horrified and demoralized by a group of corrupt, hypocritical oafs whose morals are malleable to a fault - and those are just the Republicans. This is not about ideology but rather all about money and, especially, power. Is the Guardian editorial spot on? Well, yes, if critical political thinking ends with the Left/Right paradigm.

One quickly notices the 'poster boy' aspects of this hype, wherein the pre-existing condition allowances and extended children benefits are extolled, as they should be. But, true to the tenets of all good propaganda (Warren Commission, 9-11 Commission, this), it is the many omissions that expose it. Literally, they are too many to note here. But -suffice to say - like the bloated Warren Commission, one must actually read this 'reform' to fully appreciate the depth and stench of its mire. I have. So go ahead, Guardian, you have time.

JG

Edited March 24, 2010 by John Gillespie

[Guest John Gillespie]

This has been a very interesting thread. I find myself in the unaccustomed position of strongly agreeing with Andy Walker and disagreeing with Terry Mauro.

I don't have any first hand knowledge of the British health system, but it simply couldn't be as bad as ours. I just don't think it would be possible for anyone to devise a poorer one. I worked directly for a huge health care system for decades, and I could tell you countless horror stories about what I personally saw (and I had no real direct contact with patients). The fact is, for more than a decade now, the cost of health insurance has been rising far more rapidly than the average cost of living raise for the majority of American workers. To make matters worse, there has been a simultaneous cutting of benefits- higher co-pays, with fewer procedures covered.

In this country, insurance and pharmaceutical companies, health care administrators and doctors profit enormously from the present system. There is obviously a strong incentive for them to keep the present plan. Our politicians also have one of the best medical programs in the country. They, too, have little reason to push for change. Obama's attempts at reform are tiny and only baby steps in the right direction. We have to have a single payer, government run health care system, like England and Canada. There is no other option, because those who have been getting rich from the present system are not going to willingly give up their profits, and without them doing that costs can never be cut. Without drastic cost cuts, the present system simply cannot endure.

Either we go entirely in the other direction- ala Craig Lamson- and promote the idea that health care is a "privilege" and not a fundemantal right, or we scrap the unworkable present system. Everyone should have access to medical care- I don't know how that can even be up for debate.

------------------------------------------------------

Don,

I agree with Craig Lamson. Besides, as you know, NO ONE gets turned down at hospitals. Please give me evidence to the contrary and I'll cry 'Uncle' even if it's anecdotal. I just posted the following in response to Simkin's gushing promo of an editorial in The Guardian (the usual fare: the 'Far Right' is the primary opposition, which is total bull as we know from multiple polls and news stories):

I thought only Yankee fans were poor winners. This is predictably arrogant, willfully ignorant and overflows with the snide, faux insouciance of editorial sleight-of-hand. Of course, we seldom hear or read of the Far Left, though it exists surely as much as the embittered prose, above, and the violently radical philosophy of (nearly) all the President's men. The American People, nearly collectively, are horrified and demoralized by a group of corrupt, hypocritical oafs whose morals are malleable to a fault - and those are just the Republicans. This is not about ideology but rather all about money and, especially, power. Is the Guardian editorial spot on? Well, yes, if critical political thinking ends with the Left/Right paradigm.

One quickly notices the 'poster boy' aspects of this hype, wherein the pre-existing condition allowances and extended children benefits are extolled, as they should be. But, true to the tenets of all good propaganda (Warren Commission, 9-11 Commission, this), the many omissions expose it. Literally, they are too many to note here. But -suffice to say - like the bloated Warren Commission, one must actually read this 'reform' to fully appreciate the depth and stench of its mire. I have. So go ahead, Guardian, you have time.

JG

Edited March 24, 2010 by John Gillespie

[Don Jeffries]

John and Craig,

I am not suggesting that it's a good option to give more power to the government, especially since it is run by those I feel are corrupt and incompetent. However, the alternative is to let the vaunted marketplace handle things. Unfortunately, the corportate mentality is even worse than the bureaucratic one. That's why I am a populist- I'm against too much concentrated power, whether it's in government or business.

Yes, the poor can get treatment at hospitals now. However, the 75% or so of working-class people (throw out the top 1%, who run things and are above such financial considerations, and the next 20% or so that are paid extremely well to manage the mess, and the poor souls at the very bottom of the economic ladder), the majority of whom have some kind of health insurance coverage, will not be helped in the least by this bill (except for the pre-existing conditions reform and the extension of college students to age 26). That's where the problem lies; the cost is prohibitive now for the vast majority of people, and will only grow because of this bill.

Right now, I have what is considered a pretty good insurance plan through my employer. I pay about $12,000 per yer in paycheck deductions. That's just the start- my co-pays for everything increase pretty much every year, and even though I have the "top" (most expensive) plan, I still would have to pay 10% for any hospital or surgical procedures. Considering what those run now for even the most minor things, you can calculate what such a bill would mean to most people. There are also things added each year to the non-coverage list. Not life threatening, but desired, and more importantly, things that were covered only a few years ago.

This legislation didn't address the primary problem, which is that too many people are making too much money off the present system. Insurance companies are raping the public, and nothing in this bill will change that. Pharmaceudical companies are raping the public, and nothing in this bill will change that. Hospital CEOs and administrators, not to mention surgeons and doctors, have grown extremely wealthy under the present system. They will not lose a thing under this bill (in fact, one of the provisions actually assures that doctors will make even more money, since they will now be compensated at their regular rate for taking on medicare patients).

Unless those who are profiting the most from the present system are asked to sacrifice, no sensible reform can be accomplished. This bill is typical Republicrat nonsense; loud trumpeting and beating of chests, but in reality much ado about nothing. The problem has not been addressed, and the broken system has not been given even a minor repair. We needed at least a public option, and we didn't even get that.

This really assures that before too long health care will become a privilege, and not a right.

Edited March 24, 2010 by Don Jeffries

[Guest John Gillespie]

John and Craig,

I am not suggesting that it's a good option to give more power to the government, especially since it is run by those I feel are corrupt and incompetent. However, the alternative is to let the vaunted marketplace handle things. Unfortunately, the corportate mentality is even worse than the bureaucratic one. That's why I am a populist- I'm against too much concentrated power, whether it's in government or business.

_______________________________________________________

I'm with you on most of that, Don, and there are many, many ways to skin this cat. Instead - and this thing really has to be examined even to believe what is in there - they have concocted a truly Draconian and suppressive edict which, I believe, is all about creating another vehicle for a New World Order. The IRS will be used as an enforcer, by the way.

I dread the gummint's incompetence but I fear the gummint's tentacles even more. It's probably too late now. Like Social Security and many of the Great Society programs, everyone gets locked in. The perpetrators know that, of course, and they certainly have proven that they know how to count votes, too.

Guess the author of this quote (hint - most of the members will hate to hear the name uttered): "One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It's very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can't afford it."

Meanwhile, Richard C. Hoagland is talking about the upcoming Space summit and how "we've got to go to Mars." Is someone stuck there, lost and in need of a ride?

Bon Soir,

JG

Edited March 24, 2010 by John Gillespie

[Terry Mauro]

Is there a real difficulty among EF members recognizing what this so called healthcare bill really respresents?

In Section 3403, the bill creates an Independent Medicare

Advisory Board which is directed to make recommendations the

purpose of which is to "reduce the per capita rate of growth in

Medicare spending." Specifically the bill says that

"implementation of the recommendations ... would not be expected

to result, over the 10-year period starting with the

implementation year, in any increase in the total amount of net

Medicare program spending relative to the total amount of net

Medicare program spending that would have occurred absent such

implementation."

The bill also "empowers the Secretary of Health and Human

Services to impose "efficiency measures." While there are limits

on the use of comparative effectiveness research to justify

denial of treatment based on quality of life criteria, the

quality and efficiency measures are not made subject to these

critically important anti-discrimination protections.

Specifically, the Board's proposals shall include recommendations

that "improve the health care delivery system and health

outcomes, including by promoting ... quality and efficiency

improvement... and protect and improve Medicare beneficiaries'

access to evidence-based items and services."

Starting in 2014, the Board is to make recommendations to

ensure that the growth rate of expenditures does not exceed a

stipulated level.

For 2015, unless Medicare spending is projected to come in

at or below a "target" set at the midway point between medical

inflation and the average inflation rate for all goods and

services (the "Consumer Price Index-Urban"), the Board is to

specify how to cut Medicare payments by either the difference

from the target or half a percent, whichever is less.

For 2016, the Board is to specify how to cut Medicare by the

lesser of the difference from the target for that year or 1

percent, and for 2017 by the lesser of the difference from the

target for that year or 1.25 percent.

For 2018 and subsequent years, the target shifts to the

growth in the nominal Gross Domestic Product (GDP) per capita

plus 1.0 percentage point, and the Board must specify how to cut

Medicare payments by the lesser of the difference from that

target and 1.5 percent.

Each year, the Secretary of Health and Human Services must

implement the Board's directives unless Congress, within a given

deadline, legislates an alternative set of restrictions to

accomplish the same result. However, Congress could not reduce

the net of the targeted cuts unless three-fifths of both chambers

voted to do so. The bill goes so far as to forbid a future

Congress from repealing these provisions, except for a one-time

opportunity to terminate it in 2017! The latter would require a

joint resolution to be introduced no late than Feb. 1 of 2017 and

enacted no later than Aug. 15, 2017. But if the board is

terminated, it does not go into effect until August 16, 2018.

- How is the Board to bring about these Medicare reductions? -

Nominally, the bill instructs the Board not "to ration health

care, raise revenues or Medicare beneficiary premiums ...,

increase Medicare beneficiary cost-sharing ..., or otherwise

restrict benefits or modify eligibility criteria." Predominately,

the reductions will have to come in reimbursement rates for

health care providers. This, according to the Robert Powell

Center for Medical Ethics, is likely to have either/or, more

likely, both of two rationing effects.

First, an increasing number of Medicare providers, being

paid further and further below their costs of providing care,

would stop accepting new Medicare patients.

Second, the Board could change the way reimbursement rates

are structured, away from a fee-for-service model toward a

"capitated" model, for example, under which practitioners are

paid a set annual amount per patient, or toward an "episode"

model somewhat similar to the DRG payment system for hospitals,

under which a set amount is paid per illness or injury. In either

of these cases, the physician or other health care provider would

have a strong financial incentive to limit treatment, especially

if it is costly. So, in compliance with the statute, the Board

itself would not be "rationing" treatment--instead, it would be

compelling health care providers to do so.

Section 10304 empowers the Secretary of Health and Human

Services to impose "efficiency measures," in addition to the

"quality measures" on health care providers. These measures are

to be incorporated "in workforce programs, training curricula,

and any other means of dissemination determined appropriate by

the Secretary." They are to be used in the calculation of

value-based purchasing from hospitals, and renal dialysis

services must abide by them or be penalized. Health care

providers, including hospices, ambulatory surgical centers,

rehabilitation facilities, home health agencies, physicians and

hospitals must provide reports, generally made publicly

available, based on these measures.

Consequently, they exercise considerable influence on how

health care providers practice medicine, and consequently on what

treatment patients do--and do not--receive. In the medical and

bioethical literature, quality and efficiency measures are often

based on "quality of life" standards that discriminate on the

basis of age and disability. Accordingly, during the period when

the group of six Senators were negotiating in an attempt to

achieve a bipartisan health care bill, agreement was reached to

make anti-discrimination language applicable to the results of

comparative effectiveness research.

However, the quality and efficiency measures are NOT made

subject to the same limits on employment of quality of life

criteria that are applied to the use of comparative effectiveness

research. Consequently, the Secretary is free to formulate such

measures in a way that has the effect of rationing treatment on

the basis of disability, age, or other "quality of life"

criteria.

[Michael Hogan]

I would like to hear from members what they make of the health-care bill passed on Sunday.

PREPARED BY THE HOUSE COMMITTEES ON WAYS AND MEANS, ENERGY AND COMMERCE, AND EDUCATION AND LABOR MARCH 23, 2010:

http://waysandmeans.house.gov/Media/pdf/11...010_SUMMARY.pdf

Timeline for implementation: http://waysandmeans.house.gov/Media/pdf/11...re/TIMELINE.pdf

Edited March 25, 2010 by Michael Hogan

[Terry Mauro]

OBAMA'S CMS NOMINEE ADVISED BRITISH NHS, WAS KNIGHTED BY QUEEN

FOR IT

March 29, 2010 (LPAC) -- The physician President Obama is

nominating to head the Centers for Medicare and Medicaid Services

(CMS) was recently named an honorary knight commander of the

British Empire. The service for which the Queen Elizabeth honored

Dr. Donald Berwick, was his role as consultant and advisor to the

British National Health Service (NHS) from 1996 to 2003. During

this period, Prime Minister Tony Blair reorganized NHS treatment

decisions around the creation of the National Institute for

Health and Clinical Excellence (NICE), notorious for denying

treatments to Britain's elderly, very young, and very sick. The

NHS system during the decade of NICE has otherwise been

devastated by cuts in national health spending.

In 2005, {Modern Healthcare} called Berwick the third most

powerful person in American health care. Dr. Elliot Fisher of the

discredited Dartmouth Health Policy Center says Berwick "is an

extraordinary leader when it comes to inspiring people and

creating the will to move forward." Dartmouth's idea of "moving

forward" is to level down healthcare spending in areas where

there is high investment in medical care per patient or per

medical professional -- which Dartmouth defines as "unnecessary"

-- down to those areas where there is much less; and Dr. Berwick

is one of models. For 20 years Berwick's Harvard Institute for

Healthcare Improvement has organized for "bundled" payments

(i.e., capitation payments as HMOs used to call them), for

"paying for outcomes, not for quantity of care," and for large

reductions in U.S. national spending on medical care. But he also

led the 1999 Institute of Medicine Study which spotlighted

medical errors as the cause of 45-100,000 deaths a year.

Steven Findlay of Consumers Union told {New York Times}

"Berwick helped forge many ideas incorporated in the new

health-care law," and Berwick would not accept the nomination

from Obama as head of CMS for months, insisting the Obamacare

legislation had to pass first. CMS has during the past two years

made issued some of the more draconian regulations to cut

payments to doctors, labs, and hospitals for for specific

treatments; many of these regulations have been changed or

overturned by Congress.