First Obama pushed for end-of-life counseling in ObamaCare, then it was pulled after Sarah Palin rightly pointed out the spooky nature of the death panels (you put this in as a cost saving feature of a bill and you’re damn right its a death panel). Then Dr. Donald “I love Socialism” Berwick, head of Medicare, put it back in…this time during the yearly Medicare checkups, and he tried to do it all sly like and back door the thing. He got caught and now Obama is pulling it once again:
Reversing a potentially controversial decision, the Obama administration will drop references to end-of-life counseling from the ground rules for Medicare’s new annual checkup, a White House official said Wednesday.
~~~The White House official said the administration is now pulling back the language because there wasn’t enough chance for all sides to comment on the change. The official spoke on condition of anonymity to discuss what has turned into an embarrassing episode for the administration.
Who is this Donald Berwick you ask?:
No one was surprised that a man of this character tried to quietly sneak this requirement into Medicare but still, wasn’t the whole hopey changey Obama thing supposed to include increased transparency? Yeaaaaah. So why the backtrack on this?
The general unpopularity of Obamacare has united conservatives and independents into a potential new political coalition that threatens to be the iceberg to the Obama administration’s Titanic. With repeal to be the first order of business for the House of Representatives, and a war of attrition likely to result against it when the Senate refuses to go along, it seems that the administration is trying to make Obamacare and its ancillary parts as small a target as possible. This is a sign of political weakness that should encourage repealers to keep pushing.
To put it plainly, Obama recognizes there is some real rumblings of discontent with ObamaCare and any issue which threatens to tip the scales in our favor is going to go down the drain.
Good.
openid,aol.com/runnswim hi, with all respect for your difficult position to deal with
very sick patients, why take away the last hope for a still alive person,
who carry behind him a lifetime of hope for anything concerning living and having a future,
most of those people have fed the GOVERNMENT all their life,some of long life,
they tought that they would have the needed care and rightly earned until the end made as loving as they deserve, without breaking their spirit before they the endof the last breath
further more, donrt you get paid enough that you would debase yourself to accept a fee for couseling any counsel about life and death? as you know the death follow in the mind of everyone from birth to the end so why bring something which is already in the mind of a person sick at the hospital or at home in a VULNERABLE SITUATION,
BEST TO YOU FOR 2011
Gee, Larry… this is already mandated by the PSDA (Patient Self Determination Act). Patients are to be advised about their rights to continue, or refuse treatments. This isn’t extra, and has been done for decades as a part of a physician’s service. Now they want an annual review?
Hey, why not spend cash printing a pamphlet explaining the basics in options for end of life directives? The doc doesn’t have to spend time talking about something that has a direct conflict of interest. If there is something about a patient’s condition that has changed, that’s all part of their usual diagnosis/prognosis. It simply does not take all the doctor input you purport. And in fact, how long does it take to say, “do you have them”, and hand them a pamphlet filed with resources?
I’m not sure what you want from me. Do we agree that end of life planning is important? Of course. Do we agree that the principal figure in that planning is a physician, who should be paid for his time? No. Am I impressed by your own grasp of the documentation INRE end of life planning? Nope. Do I respect you and your expertise, other than in this arena? Certainly. That’s about it in a nutshell.
INRE the tax debate… what the figures showed was that the Clinton policy of raising taxes, combined with the choice of tax cuts he decided to implement, “lost revenue” (in the way you think of lost revenue by not increasing the amount the goverment will take from earners…) and was in a decline for his terms. The Reagan policies that also included both tax cuts and tax increases also resulted in “lost revenue” (see above for disclaimer), but show an incline throughout his terms. Reagan was in a dire straits economy, inherited from that idiot, Carter. Clinton enjoyed boom times from two bubbles, and still managed to show a decline in tax revenues.
I’d ask what’s your point, but it’s off topic, and I have no desires to return there with you. We fundamentally differ on whether the nation’s earnings are up for grabs by the government, in order to support their irresponsible spending habits.
@bees: You ask:
That’s the precise reason why end of life counseling must be included in comprehensive health care reform.
It is SO easy to simply keep treating the patient with a never ending armamentarium of drugs and radiation and surgery and clinical trials — literally right to the bitter (and too often painful) end. All the incentives are to do this. The patient wants “hope.” The family wants “hope.” The doctor wants money. The doctor gets much more money when he treats patients than he’ll ever get out of a 30 or 45 or 60 minute doctor visit to discuss the pros and cons of continuing with active treatment versus supportive care and what, precisely, supportive care means in his particular situation.
Humans are remarkably resilient and even courageous. They can and do handle the truth. It’s always their choice, whether or not to proceed with further, active treatment, and no government death panel is ever going to take that choice away from patients. But an informed choice requires knowledge, and the only way patients can get that knowledge is to have their doctor sit down with them and explain their situations and go over the details of the alternatives.
There is vastly more in the way of transparency and public accountability regarding health care decisions in the context of Medicare than there is in health care decisions involving private insurance. That’s what people don’t understand. Patients and doctors have to deal with gatekeepers in private insurance, but not in Medicare. There is virtually unlimited choice among providers and hospitals with Medicare, but this is much more restricted in the case of private insurance. And there is much more payment-related “rationing” with private insurance than in the case of Medicare.
The best health care system for America would, in fact, be Medicare for all. Eventually, we’ll figure this out, and, someday, that’s what we’ll have.
On another thread (started by Curt), Dick Morris tells Republicans what they must do to defeat Obama in 2012. One strong warning he gives Republicans is this: “Don’t mess with Medicare.” That’s because Medicare has the highest consumer satisfaction rating of any insurance plan.
- Larry Weisenthal/Huntington Beach CA
openid.aol.com/runnswim, further more why diminish the medecine or care before the end,
it bring to my mind a way for OBAMA to take from the old or sick and redistribute it to where he get his votes, illegals the youngs who are teach to adore him like a god which he ‘s not by far,
IT’S so telling that we cannot escape to see it
bye
So again, it comes to exactly what I said it was. You want the doctors to be paid to explain the diagnosis and treatment options. Like I said, bring your car to my mechanic shop. I’ll run the diagnostics and come up with some solutions for you, but I’ll only tell you if you pay me extra.
Your father’s Medicare from a medical service provider standpoint? Possibly… and perhaps debatable. I have a primary care giver for her parents who’d argue that with you until the cows jumped over the moon. But then, your father’s Medicare is not to be our Medicare.
From a fiscally successful standpoint? Not even remotely the “best health care system” since it’s unsustainable. Ponzi schemes always are.
Like they have a choice? Mandated enrollment, or opt out and give up your Social Security checks. Yeah… some choice. There’s only hamburger available at the restaurant, and not steak. Am I happy with the hamburger? Well hang, yeah. Better than starving, don’t you think? And since those on Medicare today have had their earning absconded for a health care insurance they can’t use until they are 65, it’s also the only way to get some of their cash back.
Now, since I know you’ll come back with how much more money in benefits they get than they put in, let’s give you a reality check. If I have my house insured for $200K, paying a $500 premium annually, and my house burns down after 10 years, have I paid in more than I get back? Nope. If my house never burns down, and I keep it until my dying days, do I get any benefit from my premium payments? Nope. But at least, when I pay my premium, I have some coverage.
Insurance has always been about risk spread. A gamble the company takes that they will be collecting more premiums from many that outweight the payouts of a few with claims. With Medicare, it’s entirely different. They are collecting premiums from those who get no benefits for decades… and with no promise the system will be solvent when they reach the age of eligibility. In short, they pay, get nothing, and have no guarantees they will ever get anything. Many die long before they ever get to the age of eligibility.
Instead, the money is collected from those who are not covered, to pay for those who are.
Medicare needs to be phased out and transitioned for the young. The same with Social Security, also suffering from insolvency, and merely just a piggy bank for an irresponsible Congress to spend, replacing it with worthless IOUs.
@mata:
Of course they have the RIGHT to continue or refuse treatment, but they can’t make an intelligent decision unless they understand the facts of their situation. And, no, they don’t want an annual review. The proposed statute simply said that they would pay for an “end of life” or “advanced care planning” session A MAXIMUM OF once per year per patient. That’s just common sense.
What the study you cited showed was that every single tax cut was associated with a tax revenue decline, while every single tax increase was associated with a tax revenue increase. In that same long thread, you castigated me for changing the subject. The subject was whether or not tax cuts pay for themselves. Answer: No, they don’t. The subject was NOT was Reagan or Clinton the better President, with regard to management of the economy.
All you had to do was to simply acknowledge the fact (supported unanimously by the 10 conservative economists cited on the thread, and supported also by the very data you cited but incorrectly interpreted) that tax cuts don’t pay for themselves, and then you could have raised an issue for a new thread: “Resolved, Reagan was a better President than Clinton,” or whatever. But you couldn’t just do that. After castigating me, repeatedly, for (1) failing to address your alleged “smoking gun” of a citation (of which your interpretation was totally wrong) and (2) for changing the subject, rather than addressing the issue at hand. Well, when it turned out that you were wrong, you simply changed the subject.
- Larry Weisenthal/Huntington Beach, CA
openid.aol.com/runnswim , yes on your point of view as your vast knowledge lead you,
and yes to the reality of the patient courage and ability to receive the truth,
what is your assurance of how many days left to live, some truth can fall beteen the cracks
and survive longer, AND I MAINTAIN THAT the vulnerability of the person is top
consideration and not to be made worse, as he is being handle by many diffrent aids,
given shots in his weaken body which hurt for he is to frail and not equip to have that kind of discussion from the doctor he has trusted with his life not his death which belong to him alone to keep in his mind,and discuss only when he want to not before
Well Larry, of course a “tax cut” results in the government collecting less revenue. If I rent you your lab building, and reduce your rent by $500, I’m getting $500 less. When you put something in that simple of a context, it’s a no brainer. “Mata, is the sky blue? Why yes, Larry… it is. Unless you want to include those clouds over there, and the colors of the setting sun… in which case, it ain’t all blue”.
Were that tax policies so simple.
The point is, is any particular tax policy more effective in increasing overall revenues by allow earners to increase their individual earnings? That answer is yes… and demonstrated by Reagan’s combination of tax policies, and proves how Clinton’s tax policies resulted in declining revenue.
Which is why Obama’s economic council is suggesting a similar tax reform that was used by Reagan… the balance of tax cuts to the earners, and tax increases or removal of write offs to businesses.
Now, last from me on this. Not interested in going this far off topic.
@ Mata. Medicare is not a “ponzi scheme.” It’s health insurance, with the broadest possible risk pool (the entire population), which makes it the most sound and efficient. Medicare has the lowest health care costs and delivers the best outcomes. And provides the best consumer satisfaction rating, your “primary care giver’s” opinion notwithstanding. The only reason Medicare has funding problems is that it can’t raise it premiums by 30% in a single year, the way that private insurance can. You take away Medicare, and what are you going to replace it with? Anything you choose will cost more and deliver less.
- Larry Weisenthal/Huntington Beach, CA
I posted this on the Open Thread, but it fits better here:
More here:
http://spectator.org/blog/2011/01/07/breaking-cbo-says-repealing-ob
Halleluyah! I am saving this quotation forever, and the next time I’m arguing this issue with Aye or Hard Right or Missy or any of my other friends on this particular blog, I am going to toss that right into their laps.
Free at last. Free at last. Lord, Lord. Free at last.
I have climbed the mountain and seen the promised land.
Thank you, Ms. Harley. Thank you. Thank you. Thank you.
- Larry Weisenthal/Huntington Beach, CA
First of all, there is no “proposed statute”. It was a Medicare regulation. I have not seen the specifics of that regulation, or it’s exact language, reproduced anywhere. Have you? Were there any other stipulations about payment if that annual counseling did not take place? I don’t know. None of us do since they didn’t pass the regulation language on to the public.
What you describe is what was originally proposed in the O’healthcare prior to passage, but change the visits to once every five years. Again, even that didn’t have the specifics of regulations attached since they hadn’t been passed on to the Medicare agency for those details. We have no idea what would be attached, based on the bill’s original language. As I always say, devil in the details…. just like you probably didn’t know if you opt out of hospice, you lose your coverage for that period and can’t return.
You’re welcome, Larry. Doesn’t mean anything in reality, but if it makes you happy. Facts still remain… Reagan’s tax policies result in a steady incline in revenue during a recession, and Clinton’s tax increases on the individual resulted in a declining revenue trend.
But you cling to your “sky is blue” simplicity. Not to put a damper on your spirits, I didn’t say “tax cuts don’t pay for themselves”. I said the obvious… the government collects less revenue.
@Nan. Besides getting rid of ObamaCare, you could also get rid of Medicare and then you’d “save” 77 gadzillion dollars in taxes. But, guess what, all those people would still need health care and someone would have to pay for it and it would cost MORE THAN 77 gadzillion dollars.
You could also get rid of the police department and “save” a bunch of tax dollars. But then everyone would have to go out and buy Glocks and dobermans and hire bodyguards.
The question is this: does the private sector do a better job or a worse job, in a given area? Market economics doesn’t work in health care because the “sellers” (doctors) make virtually all of the big ticket purchase decisions for the “buyers” (patients).
- Larry Weisenthal/Huntington Beach, CA
Been here, done that with you, Larry. If it were a “health insurance” policy, I’d be able to have something for my cash payout.
As it is, I’m paying out for a “health insurance” policy today that I can’t have until I’m 65. Therefore, it’s not “health insurance” because I get nothing for my contribution and, in fact, when I do become eligible, will have to pay even more. The best picture you can paint on this clown face notion is that I’m paying for a reservation to get a health insurance plan in the future that may, or may not, be solvent… and that I may, or may not, live to enjoy any benefits.
In the meantime, the government is taking my “reservation” money, giving me nothing, and paying for others health insurance bills. The first enrollee into Medicare didn’t pay in but 2-3 years maximum… certainly not vested with any reasonable amount of time. But the government didn’t care… they were busy collecting my “reservation” money to pay for the early “investors”.
Ponzi scheme… per the SEC’s definition:
Let’s try that again, with a bit of editing:
@mata: Your “inclining revenue trend” and declining revenue trends were simply your own armchair way of looking at it. It has no basis in real economic reality, anymore than your initial (fallacious) armchair way of looking at it had any basis in economic reality. The point is this: every single tax cut in the very study you yourself cited resulted in decreased tax revenues and every single tax hike resulted in greater revenues and Reagan hugely inflated the debt to GDP ration (after 35 years of continuous declines, and through much larger recessions than the one which took place during Reagan’s term), while Clinton again reversed this, and I produced 10 conservative economists to back up the completely obvious point of view that tax cuts don’t pay for themselves while you didn’t provide a single contemporary economist who supported the view that tax cuts do pay for themselves.
What really miffed me, however, was the way you kept castigating me for changing the subject away from the study which you claimed proved your point and then, when I showed you how your own study didn’t show what you claimed it showed, you simply changed the subject.
Your “incline in revenue” and “declining revenue trend” have NOTHING WHATSOEVER TO DO with the point of whether or not tax cuts pay for themselves! It’s an utterly naive argument, with no merit whatsoever. The principle driver of government revenue is the overall performance of the economy. When the economy recovers from a recession, tax revenues of course increase at a very steep rate. That’s what’s going to happen this year and next year. I’m sure that the rate of revenue increase will handily exceed that of Reagan — because the recession Obama inherited was much deeper than the one Reagan inherited, meaning that the rate of revenue increase during recovery is going to be greater — only then you’ll never credit Obama the way you credited Reagan. The economy always grows (except during recessions) and, therefore, tax revenues always grow. What is most important, though, is whether or not revenues increase sufficiently to keep up with the inevitable, built in growth of government spending. In Reagan’s term, it didn’t. In Clinton’s term — it did. Obama is an early work in progress. We’ll have to see.
But this discussion about economic stewardship of different Presidents is a change the subject diversion. No, the issue was this: Do tax cuts increase government revenues enough to pay for the money lost, owing to the tax cuts? The answer — as proven by the very study you cited was NO, THEY DO NOT!
This is why all tax cuts MUST be “paid for” (in near dollar for dollar spending cuts), if you really care about debt and the deficit.
- Larry Weisenthal/Huntington Beach CA
MATA, hey you hit right on the nail, a fraudulent sheme just like some who are currently in prison for having done the same and are responsible for ruining many people who put their faith in it, and the GOVERNMENT IS DOING THE SAME ON AMERICANS,
RIGHT ON YOU GOT IT
BYE
@mata: I’ve asked you this before. Every year I get a statement from the government, telling me how much I’ve paid into Medicare. It’s a drop in the bucket, compared to the health care benefits which my parents got out of Medicare. How about you? Because of Medicare (and Social Security), I didn’t have to worry about their medical expenses, after they retired and aged. Basically, I was paying my parents’ health insurance premiums, because they couldn’t pay for it themselves, because they didn’t have an income beyond their retirement resources. Because of this, I was free to concentrate on growing my business. When I retire, my children will pay my premiums and both of us will get the same benefit. And it’s not a ponzi scheme because, once we’ve reached a steady state (people are dying at roughly the rate new customers are going in, which will be taking place over the next several decades), it’ll simply be one big insurance pool. Or it will get there much faster, if Medicare is expanded to the entire population.
- Larry Weisenthal/Huntington Beach, CA
Larry, don’t disagree that when the govt collects less revenue, they need to make cuts. Hang, even if they leave revenue where it is now, they still need to make cuts. I refuse to agree to higher taxes for a Congress with a history of increased spending. Period. Starve the beast, IMHO.
Secondly, I’ve already addressed your “how much you paid into Medicare” vs what benefits you may, or may not, receive when you are on the program yourself. You’ve said this over and over in past comments, so I simply answered your question before you repeated it one more time. It is in the comment above, with the homeowners insurance analogy. Paying more into any insurance policy is not a prerequisite or demand for any policy.
Yes, it is a Ponzi scheme. You and I will never agree on that. You paint it purdy, I see it as it is. Not my problem. It’s a ponzi scheme “insurance pool” that I pay for, but get nothing. What they take from me, they give to those who are enrolled before me. Ponzi scheme. Period.
If or when Medicare expands… i.e. you and your hero, Obama’s beloved single payer… the nation will be fiscally destroyed in short order, and any semblence to this nation as founded will have disappeared. Hopefully my “end of life” provisions will have kicked in before I witness that sad day.
I’m tellin’ ya, Bees…. that avatar just makes me grin every time!
MATA ,you know it’s a bee, there some which are hard to define without a magnifier
that’s why I like this bee,
I ‘m glad it make you smile
You are turning drama queen. The government already pays for more than 50% of all health care (the largely functional part). Once the dysfunctional part is folded into the system, the whole thing will work vastly better and, as shown by the experience in numerous other first world democracies, cost vastly less.
And even then, it won’t be a “takeover” and it certainly won’t be socialized medicine. And, as in countries like Sweden and the UK (where there is true socialized medicine), they’ll always be a parallel system of fee for service medicine, for those who want it.
Employer paid health insurance premiums distort the capitalist economic system severely — but that’s yet another aspect of all of this.
– Larry Weisenthal/Huntington Beach, CA
Drama queen? No, Larry. I do not want to live in the America you and Obama want. Instead of remaking my country, why don’t you both trot off and further destroy France? Just be careful to dodge of all the protests going on for their fabulous fiscal successes that are now demanding austerity implementation.
Yes, Larry… once we “drama queen” boomers die off, right? Then everything will be just fine.
@Mata: “Remaking” YOUR country?
Let’s look at the “remaking” of YOUR country, shall we?
We were headed for the next Great Depression. Bush/Paulson and then Obama/Geithner had a great tag team partnership to save it. The GOP offered a $500B stimulus. Obama saw that and raised by $260B. That’s because he’s a Democrat and he won the election. But it wasn’t a paradigm shift; it was just that both GOP and Dems agreed a stimulus was needed, and the Dems went $260B higher. And the money didn’t go for any new “socialist” programs; it went to give States and local government a little bit of breathing room; it extended unemployment benefits (supported, for the most part, by the GOP in later, follow-up votes), and a little bit (far too little, in my opinion) went for infrastructure improvements.
Then we have health care. Ah, yes. Better known as the Grassley-Dole plan (they are the ones who invented insurance pools and mandates), which was further refined as RomneyCare and which was tweaked only a little into ObamaCare.
And we’ve got very mainstream financial regulation. And we’ve got an end to don’t ask/don’t tell, but, dang it, that’s what he ran on and, again, he won the election.
And Gitmo is still open. And the military budget keeps growing (and Obama gets a strong passing grade on national defense by the GOP pols who have weighed in).
And we don’t have amnesty for “illegals,” and, if we ever do, well, that was supported just about 3 years back by both Bush and McCain.
We don’t have an anti-missile system in the Czech Republic, but we have converted Russia from a borderline adversary to a growing partner. That anti-missile system was a little deal for us, but a big deal for the Russians, and, because of getting rid of it, they are now our friends and we’ve got a new START treaty, which every defense expert says is a very good thing.
So, tell me, Ms. Harley, what precisely is the BFD?
How exactly has Obama ruined YOUR country?
- Larry Weisenthal/Huntington Beach, CA
Why don’t you look at the tripled spending since Obama alone, and compound that with the huge increases in spending since Pelosi/Reid Congressional majorities, ponder the behemoth that our government has become as an employer plus the payroll and pensions that the taxpayers will be saddled with, rejoice in the unfunded pensions of GM that have yet to be addressed and celebrate the loss of taxpayer money in the sale of GM shares, then marvel at how well the stimulus has not worked for all that added debt.
When you’re done with that, then get back to me, Larry.
Real johnny-come-lately on real life, aren’t you? Not only is the Pentagon and Defense budget to be slashed from the 24% of the entire nation’s spending it is today, it was projected to be 21% by 2015, dropping 1% per year.
That’s what is a “military budget keeps growing” to you? Well, considering your simplistic “the sky is blue” economic analyses, I guess so. Just doesn’t have any bearing on reality. Then, of course, there’s my new post up about just what in the military budget Obama finds important to slash…. personnel. (uh… can you say JOBS LOST here?) And how he plans on further savings… increasing the Tricare costs to military families.
What was that about “affordable health care” again? Oh yes… nothing in O’healthcare does anything to control run away costs of medical services. It just attempts to price fix premiums (while he’s raising them) and spending, while adding paying doctors for “end of life” counseling by the inept to the tune of additional spending of about $10 bil annually,.
GREG,hi on your 43, it look like the time has come that the person who get sick should go see the
insurance to appraise his sicness cost before going to the doctor, which is not a real doctor full time because his job has now include researching for what cost will he encounter versus the money he will
receive and keep close contact with GOVERNMENT new standards for that particular person’s PROFILE.
BEST TO YOU FOR 2011
@Larry #48: You said:
Can we say run on sentence? Whew! Heavy on words, not so heavy on making sense. Mata is spot on in this debate, why have the doctor get paid to tell you what you already should have knowledge of? What? Is he gonna say, “Yup, yer sick. And as soon as I bill Medicare, I can tell you what your options are.”?? Yeah, THAT’S the kind of health care system I want. /sarcasm
@Greg #49: You said:
Um, nope. I missed your reply. You have yet to answer my question, but oh well, I expected as much – or as little, in this case.
Again, when a government is the SOLE PROVIDER of healthcare and they decide that your life value just isn’t high enough to warrant giving you medical care, then who in the blue hell do you turn to?
If your PRIVATE INSURANCE PROVIDER denies you some medical services, then you have recourse. You can appeal to your insurance company, switch companies (although I will admit this option is not always easy), sue your insurance provider or even take your case to the government via your State Insurance Board. And if you are fortunate enough to have the financial means to pay for the services you need, you are able to do that. In Canada, under their Single Payer system, you cannot even pay for services on your own.
So which is it Greg? Do you want to have a say in your healthcare, or do you wish to let your government tell you that even though you probably have a brain tumor, you’ll just have to wait a few months to find out?
Why do you prefer the government telling you what medical services you will or won’t get?
/sigh
I don’t know why I ask these questions, Greg will just equivocate and dissemble to avoid being pinned down with [GASP!] an actual opinion.