Qualify for government subsidy: become a(n involuntary) unionized government employee

 Next up: doctors, section 8 housing owners, ????? Grocery stores, drug stores???

A year ago in December, Ms. Berry and more than 40,000 other home-based day care providers statewide were suddenly informed they were members of Child Care Providers Together Michigan—a union created in 2006 by the United Auto Workers and the American Federation of State, County and Municipal Employees. The union had won a certification election conducted by mail under the auspices of the Michigan Employment Relations Commission. In that election only 6,000 day-care providers voted. The pro-labor vote turned out.

Many of the state's other 34,000 day-care providers never even realized what was going on. Ms. Berry tells us she was "shocked" to find out she was suddenly in a union. The real dirty work, however, had been done when the state created an "employer" for the union to "organize" against.
Of course, Michigan's independent day-care providers don't work for anybody except the parents who were their customers. Nevertheless, because some of these parents qualified for public subsidies, the Child Care Providers "union" claimed the providers were "public employees."
Michigan's Department of Human Services then teamed with Flint-based Mott Community College to sign an "interlocal agreement" in 2006 establishing a separate government agency called the Michigan Home Based Child Care Council. This council was directed to recommend good child-care practices—and not coincidentally, to serve as a "public employer." Although the council had almost no staff, no control over the state subsidies and no supervision of the providers' daily activities, it became the shell corporation against which the union could organize.
Thus the state created an ersatz employer and an ersatz "bargaining unit" against which what was essentially an ersatz union could organize.
Today the Department of Human Services siphons about $3.7 million in annual dues to the union—from the child-care subsidies. The money should be going to home-based day-care providers—themselves not on the high end of the income scale. Ms. Berry now sees money once paid to her go to a union that does little for her. She says she is "self employed and wants nothing to do with the union."

No Connection - Hasting Center Essays Miss the Mark

The Hasting Center has published an online collection of essays called"The Values and Health Care Reform Connection" allowing the public to comment on health care and "American Values." You have to admire the awareness of the academics - not only have they noticed that the conservative, pro-life, religious “American” is concerned with values, but they are trying very, very hard to appeal to those of us with a Judeo-Christian background. I’ve only skimmed a couple of the essays so farm but I have found a glaring inability to stay on task or a basic lack of understanding of the world view of the intended target, uh, audience.

For example, in “Stewardship: What Kind of Society Do We Want?,” Len M. Nichols misses the mark in spite of peppering the essay with terms like “stewardship,” “abundant life” and “covenant” and appeals to the writings of John Locke and Thomas Jefferson.

 (Skip over the use of a faulty, biased 2009 Institute of Medicine report on the consequences of lack of universal health care insurance in the U.S., already thoroughly debunked by Steven Malloy’s “Junk Science” blog.)

In his appeal to “American Values,” Nichols attempts to define “stewardship” to include a “covenant” as a duty of property owners to ensure that the poor have food to eat. He refers to the book of Leviticus and Jewish Law that land owners leave “the corners” of their fields for the poor to glean, rather than going back to harvest all that is there.  While noting that the rule was propagated the “other books that Moses wrote,” Nichols explains that only adult males could own land "in ancient Palestine." He would have been better off referring to the “Torah” or “the Law,” which was given by G_d, not Moses, and to the Nation of Israel, since there was no “Palestine” at that time.

Nichols almost persuades me that he “gets it” in his discussion of the basis for rights: the belief that humans are created in the image of G_d. However, he asks what good is the right to life or the pursuit of happiness without access to essential health care and quotes Jefferson’s comparison of liberty with health. He does not seem to understand that both Locke and Jefferson described these as negative rights: the right not to be killed, and the right not to be enslaved or have ‘the fruit of one’s labor” forcibly taken. In other words, no one has the right to cause another to be sick, but there is no right to medicine or medical care.

Nichols does not resort to the usual call for Christians to remember the Good Samaritan. In fact, he turns to an argument that might be more appealing to Libertarians, whom he calls “a tiny group of argumentative people.” His discussion of rights and stewardship by is converted to support for the rationing of health care, noting that Leviticus does not require the landowner to bring the poor person home and cook him a meal. In this, too, he demonstrates his lack of understanding of the Judeo-Christian world view. The covenant to care for the sick and poor is between individual believers and G_d. Government hasn’t proven itself to be trustworthy enough for me to assign my duty to G_d over to its stewardship.

LifeEthics quoted about Doctors for America posts

I've been a little distracted, getting my house ready for the New Braunfels Republican Women's Christmas Tour of Homes, but I should be blogging more in the future.

Found a post at "RBO," (RealBarackObama) that quoted my reports (here and here) on the conference call with "Doctors for America," back in September. I like being known as someone capable of "serious sleuthing."

Aristotle ethics, RFK, and health care reform

The Wall Street Journal's daily newsletter by James Taranto, The Best of the Web Today, debunks a quote floating around the Internet to support the "right" to health care paid for by government. The blurb has been attributed to a translation from the writings of Aristotle, a translation from the original Greek by Robert F. Kennedy.

Unfortunately, the first reference to the quote is from 10 years after Senator Kennedy died, is credited to someone else, and the original cannot be found in the existing works of Aristotle.

From an article by Edmond Pellegrino, the last chairman of President Bush's President's Bioethics Council, written in 2008:

In attempts to establish the provenance of the text in question we have conducted an extensive search for its source and original wording. We have not been able to locate it. Our initial curiosity was aroused by several things, including that rights language did not seem to have the Aristotelian context, and health care, as such, was not included in Aristotle's works. We searched Nicomachean Ethics and Eudemian Ethics, and the Magna Moralia without successfully locating the quote. Nor could we find it in other of works of Aristotle: On Length and Shortness of Life, De Anima, Economics or the Fragments. "Rights" language certainly would stick out in Aristotle's virtue-based ethics.

That article by Dr. Pellegrino is available in pdf, here, thanks to the WSJ and Georgetown Bioethics.

Intentionally Skewed Cancer Survival Rates

 From Ann Coulter's latest report on Health Care Reform Myths:

European women are only 55.8 percent likely to live five years after contracting any kind of cancer, compared to 62.9 percent for American women.
In five cancers -- breast, prostate, thyroid, testicular and skin melanoma -- American survival rates are higher than 90 percent. Europeans hit a 90 percent survival rate for only one of those -- testicular cancer.
Most disturbingly, many cancers in Europe are discovered only upon the victim's death -- twice as many as in the U.S. Consequently, the European study simply excluded cancers that were first noted on the death certificate, so as not to give the U.S. too great an advantage.

I didn't know about that last manipulation of the cancer survival rates. 

Politics bites science

For a clear outline as to why you shouldn't believe that 45,000 people die each year because they don't have insurance, read the blog entry by John Milloy, publisher of "Junk Science" on last week's report in the American Journal of Public Health.

Forget that the authors are blatantly biased members of the "Physicians for a National Health Plan."

All you need to know is:
# Among the many problems with the study, here are four of the most glaring; all of which will likely be missed by the media:

* The researchers assumed that study subjects lacking health insurance at the time of the interviews did not subsequently gain or regain insurance coverage. In fact, a study subject could have received health coverage the very next day after the interview and this would not have been considered by the researchers.
* The researchers essentially assume that lack of health insurance at the time of interview is the causal factor in the deaths that occurred. No data was gathered to back up this assumption.
* None of the data collected during the interviews, including insurance status, was validated by the researchers.
* The study result is statistically weak. Combined with the peculiar date-of-death cutoff (the year 2000 as opposed to any other year), it raises questions as to whether the study result was produced by “data dredging” – essentially cherry-picking data that provides the desired result.

Follow up from Doctors for America

Received this message a few minutes ago.

The only people who kept bringing up "what physicians can be doing now to ensure that Congress pushes forward to create meaningful health reform" were the same guys who made sure that the rest of us were on "listen-in" mode only.

Still no mention about the close connections with Senator Max Baucus, the Obama election and transition teams, the Center for American Progress and John Podesta, or (specifically) Dr. Murthy's own role on the transition team.

If y'all would like to send your comments on to the WH Office of Public Engagement or D4A, here's the information:

-------- Original Message --------
Subject: Follow up on last night's White House call
Date: Fri, 18 Sep 2009 16:19:57 -0400
From: Vivek Murthy MD MBA, Doctors for America
To: hocndoc@flash.net

Dear Beverly,

Thank you for participating in last night's White House Physician's call. In particular we want to thank you for all of the thoughtful and substantive questions that you brought us. We hope those of you who didn't get an opportunity to ask a question during the call will still do so.

For those who didn't catch it last night, the e-mail given for the speakers on the call is: public@who.eop.gov

In recognition of the fact that the White House may not be able to reply to all e-mails expeditiously, we welcome you to cc us as well, and we will do our best to get you up-to-date information.

One of the topics that came up a few times last night is what physicians can be doing now to ensure that Congress pushes forward to create meaningful health reform. At Doctors for America, direct involvement of physicians is exactly what we do. If you haven't done so already, we welcome you to become more involved by filling out our volunteer form.

Sign up to volunteer: www.drsforamerica.org/volunteer.php.

In addition, we've created a video on our Action Center to highlight some of the things that you can do today to help ensure we take critical steps towards a better health system this year.

Watch the video to learn what you can do: www.drsforamerica.org/action_center.php.

Thank you again, for your participation and for your ongoing commitment to health reform.

Sincerely,

Vivek Murthy, MD MBA
Doctors for America

Playing doctor with the White House

Who’s playing doctor with the White House: Another example of the lack of openness in the dealings of the Obama Administration

(Informed consent blurb: Organizing for America, etc., along with all the White House websites, are collecting data including email and other information from everyone who visits or contacts their sites. I got a couple of those emails from David Axelrod last month.

Don't worry - they already have my data. I used to email President Bill Clinton at least once a month and ask him to resign for the sake of our daughters – they are about the same age - because he'd set the women's movement back 50 years. He never answered. However, it occurs to me now that maybe that's why I was named to the Bush Administration's National Advisory Committee on Violence Against Women.)

On Thursday, September 17, 2009, I was web-surfing and searching Google news hits on the September 12th March on Washington and health care reform when I found information about a conference call between "Doctors for America," the White House "Office of Public Engagement" and doctors like me who somehow found out about the conference call.

I called in, but wasn't called on to ask my questions, so I re-wrote them as an essay (see below) and emailed it to info@drsforamerica.org I'm also sending the essay to the White House OPE.

When I started writing up my notes from the call, it finally occurred to me that – even though there was no attempt at disclosure - there might be a connection between "Drs for America," "Organizing for America" (whose website address is still "http://www.barackobama.com/ ," the same url once used by - and the remains of - “Obama for America,” the Barack Obama campaign machine.

I was slow to catch on, but I was right: The leadership at Doctors for America is made up of nearly the same roster of men and women who, in 2008, were the leadership of “Doctors for Obama” in 2008. Common names are Vivek Murthy, MD MBA, Mandy Krauthamer, MD MPH, Nikhil Wagle, MD, Alex Blum, MD, and Jay Bhatt, DO MPH

And, I was wrong: there’s a disclaimer at the bottom of the “Doctors for Obama” leadership page that says “Not affiliated with Obama for America.” (Yeah, right.)

In fact, former Obama Administration transition chief John Podesta's “Center for American Progress” funds the group :

May 04, 2009
'Doctors for America' launches

This may not wind up being decisive in the health care fight, but the organizing gap between the two sides continues to widen.
Sen. Max Baucus and the Center for American Progress Action Fund are announcing a new group on a conference call later this morning: Doctors for America, which is a reincarnation of Doctors for Obama, an arm of the Obama campaign that boasted more than 10,000 members.
The question of patients' relationships with their doctors is always a flashpoint in debating changes to the health care system, so doctors are often particularly credible messengers.
Today they'll "release new reports detailing the depth and breadth of America's health care crisis and announce a new effort to amplify physicians' voices in support of health care reform," according to the advisory.
By Ben Smith 11:07 AM

Here's the bio on the President and Co-founder, Vivek Murthy, MD MBA, at the Center for American Progress website:

Vivek Murthy is an internal medicine physician at Brigham and Women’s Hospital and an Instructor at Harvard Medical School. He received his undergraduate degree in Biochemical Sciences from Harvard University, his MD from the Yale School of Medicine, and his MBA from the Yale School of Management. He completed his residency training in Internal Medicine at Brigham and Women’s Hospital. Vivek is the co-founder of VISIONS and the Swasthya Project, international health non-profit organizations focused on HIV/AIDS education and women’s health, respectively. He is also the co-founder and chairman of Epernicus, LLC a web-based professional networking service for individual researchers and scientific institutions. Vivek’s past research has focused on the participation of women and minorities in cancer clinical trials; his current research interests include physician satisfaction and burnout. During the 2008 presidential campaign, Vivek served as a member of the Obama Health Policy Advisory Committee and the Obama New England Steering Committee.

Notes on the Conference Call

I couldn't catch all the names and I am not very good at telling who was speaking, but did try to take some notes from the opening statements. The quotations are the actual words of the speakers, the rest is my own interpretation and from memory.

The moderators talked about the "public option" as though it's a done deal and strongly pitched it as just a way to provide health care for people who have lost their insurance.

We were told that everyone will be required to have insurance, and that businesses will be asked to "chip in their part."

The White House has a plan to fix the SGR that has been pushed off over and over. In fact, there are plans for a “complete reform of the physician payment system.” without incentives for doing more procedures.

The President has given instructions to begin the medical liability demonstration projects to find a way to decrease defensive medicine while "mitigating risks to patients."

We were told that we are closer than we've ever been to health care reform this year.

The moderators were surprised by the second doctor who said he was from the former Soviet Union and that the public option would soon become the only option. They were adamant that the public option is not a pathway to single payer. (And besides, we all know that being paid by and regulated to the teeth by the government is not at all like working for the government.)

Later, one of the docs who called in asked specifically about the news stories that the public option was finished and the White House representative reminded us that the legislation is not written, yet. He was adamant that we shouldn't rule the public option out and that we should advocate with our patients and fellow doctors for that option.

One doctor asked about the effect on doctors with concierge or boutique practices and the other doctors who "opted out." The answer from one of the men was that these practices were just a reaction to cash pay patients who couldn't afford insurance.

There was a lot of excitement about one doctor's suggestion that doctors be required to give two years to a sort of National Healthcare Workforce. And huffy about the shortage of doctors that a Massachusetts doc reminded them that they'd have if all the uninsured were suddenly looking for primary care.

The woman naturopath was reassured that naturopathic primary care doctors would be evaluated by the same evidence based medicine that the traditional docs were judged by.

My letter to Doctors for America and the White House Office for Public Engagement

I’m Beverly B Nuckols, MD, the National chair of the Family Medicine Section of the Christian Medical Association as well as a member of the AMA, the Texas Medical Association and the American Academy of Family Physicians. I'm not officially representing the above, but I believe that my opinions are shared by a large number of doctors.

Many of my colleagues and I see the Patient Centered Medical Home plans, the protocols at Mayo and other medical centers that have been praised are attempts to model a bureaucratic form of practice for large practices so that they can do what the family doctor does every day.

My experience is that government bureaucracy is not only more restrictive and punitive than private insurers, the clout of the Federal government results in undesired UNINTENDED consequences all across the board. Doctors used to be the good guys, but now we feel as though we are assumed to be guilty of abuse of the system, largely due to Federal legislation and regulation.

These result in time and money spent on our futile attempt to keep up with Medicare regulations in order to avoid charges of fraud, abuse and waste. For instance: HIPPA, National Provider Identification numbers, bullet points and check boxes, E & M’s, procedure and diagnosis codes and qualifiers that change each year, and a whole alphabet soup of regulators.

In addition, government cost control attempts in the '90's actually limited the numbers of graduate medical slots, while encouraging sub specialty growth in relation to numbers of primary care doctors.

Making it all worse is the fact that under current Medicare payment schemes, Family Doctors who provide the same services as sub-specialists are paid less by Medicare.

Like the laws and regulations in the past, this year's “reform bills” and proposals are overly complicated and try to guarantee too much: school based clinics, nutrition data on menus and buffet lines, an overhaul of the federal income tax code, new lists of “enhanced penalties,” taxes, fines and the mixing of all of the above abuses with an overhaul of the Federal Income Tax.

Today’s announcement about the study of liability makes me worry that our Texas laws concerning tort reform will be over come by Federal inertia and interference.

1. Why not just look at Texas’ experience with tort reform rather than wasting time and money on new studies?

2. Is it possible to make the legislation smaller in scope so that it is focused on providing help for those patients and families who cannot afford or access medical care?

3. What plans are there to ensure training and sufficient payment for family physicians and other primary care doctors who are in the best position to coordinate care for our patients in the "Medical Home?"

Edit: added this 4th question that I believe I sent to Doctors for America:

4. Could the fines and mandates be replaced with tax incentives, removal of restrictions on Health Savings accounts, return of the major medical plans and the removal of the barriers preventing patients from owning their own health care insurance?

Former Senator Explains Consequences of Bill Language

Former Senator from Tennessee, Fred Thompson, explains the consequences of the language concerning end of life care that is included in the current version of House Bill 3200.

I do read the language as making the counseling mandatory, although not necessarily a demand that doctors (or nurses, if they are the "primary care providers") tell a patient that they must refuse or be willing to withdraw medical intervention at the end of life.

Of course, there's the pesky problem that no one has written the approved counseling language or produced the approved documents, yet. That will be done by "the Secretary," if and when the Bill passes with this provision still in place.

Here's what I think happened: the Committee or staffer who wrote that section thought that offering payment for what was mandated in the "Stimulus bill" earlier this year would be a politically advantageous move.

However, since no one knows what will actually be required by the Secretary of Health and Human Services, and there is no note as to which doctors will be responsible to counsel patients, I forsee a repeat of the confidentiality snafus and stumbling blocks that happened after the "HIPAA" became law. Remember when every single doctor and pharmacy had each patient sign a disclaimer, no one knew who could talk to whom, and a whole lot of money, time and energy was wasted making sure that you knew that the provider knew that the government wanted us to keep your medical information private - at least from everyone except the government agencies who demanded documentation, ICD-9 and CPT codes and qualifiers?

Here's Senator Thompson's essay:

FRED THOMPSON: Phantom pains at The Post

Fred D. Thompson

A Page One article in Saturday's Washington Post blaring the headline "Talk Radio Campaign Frightening Seniors" states, "A campaign on conservative talk radio ... has sparked fear among senior citizens that the health care bill moving through Congress will lead to end-of-life 'rationing' and even 'euthanasia,' " and that the bill has been described as "guiding you in how to die."

The story's continuation inside -- under the headline "Conservatives Have Seniors Fearing 'Euthanasia' as Part of Reform" says that, like arguments about abortion coverage, this has become a distraction to the president's broader health care agenda.

The reader looking for examples of this "talk show" campaign will be disappointed. Not one talk-radio host is quoted, and no specific radio show is mentioned (though The Post does quote an interview done on my radio show, without telling the reader the interview was done on a radio show). However, the article does make use of information supplied by off-the-record "Democratic strategists." One is free to conclude for oneself who has launched a "campaign."

It does seem that the words attributed to unnamed conservative culprits are fairly mild compared to the hysteria coming out of left-wing Web sites and blogs. My favorite is the one found on the Huffington Post, where Republicans are accused of saying that granny would be shot in her wheelchair under a provision in the Obama-Pelosi-Waxman health care bill.

Let's discuss whether these deranged seniors are being misled by people who actually may have read the bill. (Presumably this offense cannot be laid at the feet of their representatives of Congress.) Although I have never said anything like the things attributed to radio talk hosts, the article states that "the attacks on talk radio began when Betsy McCaughey ... told former senator Fred D. Thompson (R-Tenn.) that mandatory counseling sessions with Medicare beneficiaries would 'tell them how to end their life sooner' and would teach the elderly 'how to decline nutrition -- and cut your life short.' "

The basic position of the bill's proponents seems to be that these consultations are totally voluntary, that seniors should have the benefit of such end-of-life consultations and that the consultation provision is nothing more than to get doctors reimbursed when a consultation occurs at the patient's request. The "let's get the doctor paid" rationale was swallowed whole by The Post's writer, Ceci Connolly.

Those concerned by this provision believe it to be mandatory and wonder why the government is involving itself in the doctor-patient relationship and with end-of-life decisions.

Section 1233 of the bill, having to do with Medicare, describes the "advanced care planning consultation" as between the individual (a spouse and next of kin are not mentioned) and a "practitioner," described as a physician, a nurse practitioner or a physician's assistant. (It does not appear that it is a requirement that the physician in question be the patient's physician of record.)

In legislation, an issue as to whether an action is mandatory or not can be resolved quickly by a glance at the statute, which will state that (in this case) the consultation either "shall" be taken or "may" be taken. Remarkably, neither phrase is used in the statute in question.

Rather, the statute just describes what a consultation is and then strictly prescribes in mandatory language what must be included in the consultation as well as what may be included. For example, in Paragraph 4, a consultation "may include the formulation of an order regarding life-sustaining treatment" and may include an order for "the use of artificially administered nutrition and hydration."

The drafters of the provision were either sloppy, befitting a situation in which a complicated, 1,000-plus-page bill, controlling one-sixth of the economy, is rushed through the legislative process. Or it might be that the drafters desired an intentionally vague statute, knowing administration officials would be drafting regulations for the implementation of the bill after it passed.

As it stands, there is more than ample reason to believe the provision was meant to be mandatory with regard to the practitioners. Otherwise, why have the provision in the bill at all? If getting the doctors paid for a voluntary consultation really was the provision's intent, an amendment of two or three lines would have fixed it. As it is, it is two lines in a five-page provision full of specific instructions about what doctors, nurses or doctor's aides must explain to the patients.

Seniors are reminded daily by the media that Medicare is going broke, that the country must cut Medicare costs and that the last days of life are by far the most expensive. Now they are being told by the administration -- one that has been less than transparent on this bill and a host of other issues -- that this bill will cut Medicare costs. They are learning that they are "coincidentally" being asked about end-of-life issues at the government's behest, perhaps by a stranger who is receiving Medicare reimbursement payments. How long do you think it will take a Medicare patient to figure out which decisions will cost the government money and which will save the government money?

This is no reflection on medical professionals. They clearly are being put in a position they neither have asked for nor are completely qualified for. However, I am gratified that a president who can matter-of-factly accuse doctors of routinely removing a child's tonsils solely for financial gain has newfound trust in a doctor's or some hospital employee's ability to consult and even help draw up legal documents regarding end-of-life issues.

If this is all just a misunderstanding about whether this provision is mandatory or not, it can be resolved readily. Let's see if the supporters of the provision are willing to add language to the bill making it clear that there is no requirement that these consultations take place. Better still, they should drop this provision from the bill and let patients discuss these matters with their families, their clergy, lawyers who have expertise in living wills and powers of attorney, or whomever else they desire.

So is this a conspiracy to kill off granny? No. Will seniors be forced to make decisions they don't want to make? No. But will "practitioners" be encouraged to have end-of-life discussions that include when it might be best for patients to allow their life to end earlier than it has to? Of course. And seniors have a right to be satisfied that there is not, at the heart of this process, undo consideration given to cost-cutting.

In the end, it depends on how comfortable one is with having the government in the middle of this process. That is what this discussion is really all about.

Fred D. Thompson, a former Tennessee Republican senator, hosts a nationally syndicated radio show (www.fredthompsonshow.com).

Page 425 (end of life counseling)

I received several emails over the last few days concerning page 425 of the House Bill on Health Reform, HR 3200, which outlines mandatory end of life "options" counseling.

Technically, it appears on the surface to allow doctors (and other "providers") to charge for the counseling. But, yes, it's mandated counseling and in the wrong hands, it might encourage withholding of care more than some of us would like -- and certainly more that others might like.

Can you imagine a more personal and private subject? The subject should be broached by your family doctor. But it appears that every doctor who sees Medicare patients will be responsible. I can imagine the emotional undertones of different doctors as they recite the standardized language and present the forms to be signed! And then, the counseling will be reported to the Center for Medicare and Medicaid Services, with the appropriate modifying code.

I object to the mandated repeat counseling when someone gets sick, the inclusion in the "Medicare and Me" handbook with language to be formalized by the Secretary and forms for the counseling. I've mentioned before how "hot" an issue this could be, even with my limited exposure to the debate.

I hope that someone with sensitivity is in the Secretary's office, assisting with decisions on the literature and forms.

ABC explains the Obama Administration

ABC News Senior White House Correspondent Jake Tapper has written an article, "When Academic Words Become Political Ammunition," that gives an anonymous "White House official's" rebuttal to the many concerns expressed about President Obama's choices for advisers and "czars" who will affect the shape of health care policies. He attempts to debunk criticisms of the philosophies of Ezekial Emanuel, MD (a bioethicist who is heading the push for control of health care finance and delivery in order to provide universal insurance) and John Holdren, director of the White House's Office of Science and Technology Policy.

The problem is that with Medicare and Medicaid, about half of medical care in this country is already paid for using tax dollars, and we are currently considering expanding tax dollar payment for nearly all health care in the Nation. I disagree with Ezekial Emanuel's position, referenced in the Hastings journal article, "Where Civic Republicanism and Deliberative Democracy Meet," which is linked (in pdf) at Tapper's essay:

Americans fear that if society guarantees certain services as "basic," the range of services guaranteed will expand to include all - or almost all - available services (except for cosmetic surgery and therapies not yet proven effective or proven ineffective). So rather than risk the bankruptcy of having nearly every medical service socially guaranteed to all citizens, Americans have been willing to tolerate a system in which the well insured receive a wide range of medical services with some apparently basic services un- covered; Medicare beneficiaries receive fewer services with some discretionary services covered and some services that intuitively seem basic uncovered; Medicaid beneficiaries and uninsured persons receive far fewer services.

In fact, while we are concerned about the amount of taxes that will be imposed, the Tapper essay points out that we are very much afraid that government interference in health care will result in more limitations, so that none of us will be allowed, much less "guaranteed," to seek medical care that will prolong our lives and make us feel better, unless we are seen as members of a group that is more valuable than others. The examples that Dr. Emanuel gives and our observation of the government pre-paid medical care schemes around the world lead us to believe that, the more health care is financed by tax dollars, the more expensive and rationed it becomes.

Academic mind experiments that do not draw a line between what is acceptable and what is condemned by the authors understandably will be interpreted by others as at best, neutral, at worst, in support of condemnable acts.

Congressman Henry Cuellar on Planned Parenthood

Went to this morning’s McQueeney, Texas meeting where Henry Cuellar was met with an overwhelming group of constituents upset over what's happening in Washington, DC.

Rep. Cuellar told us that he voted in favor of Planned Parenthood funding yesterday because they give care to “mothers” and he does everything he can do to support mothers. (I suggested that we go to any PP office today and that I bet no mothers come out of the building.)

The people of Guadalupe County- maybe 100 to 150? - turned out to protest the health bill and tax and cap. There were some tough questions about gas prices and about whether private insurance will survive.

People laughed when Cuellar said the bill is “revenue neutral.”

Believe it or not, the man was adamant that he has good private insurance and that he wants to keep *his* private insurance! Why not put all the government employees on Medicare or the VA (depending on their background). Why do we give and give so that our employees can have better benefits than we can afford?

He constantly talked about organizations and corporations that supported the bills, ignoring that the constituents in front of him do not. He handed out paper after paper (how green is that?) supporting the health bill and tax and cap.

He talked against the Blue Dogs, but did say that he wouldn’t allow Pelosi to bring the bill to a vote by bypassing the Committees.

Myth: doctors take out tonsils needlessly

Then, there's the charge that doctors will needlessly take tonsils out. First, it's unlikely that your Family Physician or Pediatrician does surgery. Second, I don't think the ENT's are getting paid for these anymore, unless they jump through hoops to prove that they're not over-doing it.

AP: In trying to rally support for health care overhaul, Obama described a patient who sees a physician for a sore throat, or a parent who brings in a child with a sore throat.

"Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there. ... The doctor may look at the reimbursement system and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out,'" Obama told a prime-time news conference.

The president added: "Now, that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change — maybe they have allergies. Maybe they have something else that would make a difference."

Video and here.

Obama Press Conference Transcript

The transcript of the press conference is on line at the Washington Post.

However, if you want an annotated version, try this blog.

Thoughts on Obama's health speech July 22, 2009

Why doesn't the President just say that the Executive branch employees in his Administration will get rid of their insurance and go on Medicare???

Not a doggone thing that the President is talking about tonight - except for the taxes, the increased bureaucracies and the requirements that Pharmacy companies discount meds - is in the Bills that are being proposed by the House or the Senate.

The government is not paying for those private insurance costs -- the tax cuts for insurance is not the burden that will break the federal budget.

(And by the way - the White House is the people's house. It's only being used by this man.)

Texas Legislators Seek to Limit Funds for Human Embryo Destruction

Senator Steve Ogden is a Texas Hero!

Sen. Steve Ogden, R-Bryan, though, said critics exaggerate what his 24-word "budget rider" would do. He said it simply assures that the budget's $700 million for research doesn't underwrite destruction of embryos.

"There is a significant moral concern amongst many Texans that a human embryo really meets every scientific definition of human life that's out there and that we shouldn't be using human embryos for scientific experiments," Ogden said.

The dispute flared early last week. The Senate Finance Committee, which Ogden heads, took only two minutes late Monday to consider his rider. It says, "No funds appropriated under this act shall be used in conjunction with or to support research which involves the destruction of a human embryo."

The provision was adopted, 6-5, with Sen. Robert Duncan, R-Lubbock, joining four Democrats against.

The Dallas Morning News reports (free registration required) that some Texas embryonic research advocates claim this move will "embarrass" Texas. Of course, they also claim that embryonic stem cell research only involves "embryos that would be discarded, any way" Since we know that much of the research involves specially created, "disease specific" embryos, the latter is false.

And so is the first objection. Every week, we are reading about new ways to reprogram adult cells to achieve the stem cells that are needed to study and treat disease without ever going near an embryo. Former proponents of embryonic research and producers of new embryos for stem cell research like George Daley are switching their focus toward non-embryonic research. Texas researchers have been early stars in this research, among the first to using umbilical cord blood for stem cell research.

Texas doesn't need to waste our money following the false trail of embryonic stem cell research when there is so much promise in more treatments, sooner, from non-destructive and non-embryonic research.

Why the medical home sounds good but won't work

A sister Family Physician says in her blog, "Musings of a Dinosaur,"

It is the source of endless angst among family doctors in solo and small group practice, because the structure of the PCMH excludes us by definition. The PCMH is advertised to work best in large group practices like Kaiser and the Mayo Clinic. All I can say is "DUH!"You know what the PCMH really is? Nothing more than this:

IT'S A WAY TO MAKE LARGE GROUP PRACTICES WORK MORE LIKE A SOLO DOC!!!

I am already performing every meaningful function of the PCMH. So is virtually every physician in solo and small group practice. There is absolutely nothing to be gained -- and a significant amount of money to be lost; this thing is expensive! -- by adopting any of this PCMH shit. Somehow that doesn't seem to stop our Academy from tossing us to the wolves by simply ignoring us.

The "Rescission of the Regulation Entitled 'Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law'” was posted on the Federal Register on March 10th, with the announcement of a 30 day period in which to comment. The full announcement can be read here. (PDF Acrobat document) Comments must be made by April 9th.

Please consider taking a look at the website Freedom2Care to learn more about the problem of restricting conscience. You can use one of their forms online to let the Administration and Health and Human Services Secretary Sebelius know how you feel or to tell your story.

To send a comment directly to the HHS, go to the website, http://www.Regulations.gov and fill in the form there or send an email to proposedrescission@hhs.gov.

Trust me, I have no conscience (Again and again, and again)

Siricou Raven, that gadfly of the prolife blogger, says I'm using scare tactics, that the NHS pays for dialysis, and that we pro-conscience doctors are afraid that 'THE GAYS WILL DESTROY MEDICINE!!!!' Oh, and Bush did it!

Well, what do you expect of people who don't have consciences and who are told by the Powers that be that we must violate any oaths we've taken for money and law?

It's not Gays and Lesbians we're trying to protect ourselves and our consciences from - its their lawyers. Beginning in 2005 and through last month, ACOG broke one of the strongest tenets of modern medicine: Thou shalt not put thy colleagues in greater malpractice risk.

The conscience protection ruling is a synthesis of current laws. The synthesis was only necessary because in 2005, the American College of Obstetricians and the American Board of OBGyn turned their quiet attack on pro-life residency candidates (few programs will accept pro-life doctors) into an effort to change laws (lobbying the US Senate) and amended their own ethics policies to put not only ACOG members, but all doctors at risk of losing their certification, their licenses, and increased our lawsuit risk.

Obama, what's-her-name, and Daschle are bought and paid for by Planned Parenthood and NARAL. (Daschle sent out letters against George Bush in '04, on NARAL's letter head. After the SCOTUS allowed the Partial Birth Abortion Ban, Sebelius vetoed 3 separate bills due to their limits on abortion. And Obama made his famous "first thing I do is sign FOCA" speech to PP)

Most people have access to the $4 Walmart drugs. Our little town has 2 low cost clinics, one is free of charge, one has a cost of less than $5. Everyone who can raise the money can have the latest and greatest -- not so in the NHS. A few years ago, it was illegal to sell Tamiflu in Great Britain, because NICE said it was.

Years before that, Dialysis was limited to those under 55 years old. Echoing that, this year, a man in his 50's was told he would not get surgery to stabilize his ankle until he kicked his nicotine habit.
http://www.dailymail.co.uk/news/article-481617/Doctors-refuse-fix-builders-broken-ankle-unless-quits-smoking.html

Our hospital has indigent care, as does our County. We doctors see patients for cash and are aware when their costs are out of pocket. (My phone has a program that has formularies for local insurance plans. The patient and I discuss whether they want the once a day Tier 4 drug, the twice a day Tier 3 or the 4 times a day generic.)

Obama moves to overturn Conscience rules

For a couple of years, LifeEthics has covered the conscience of physicians and what it would mean if a doctor, nurse or hospital were to be forced to go against their consciences. My review is here.

From the LA Times, we learn that President Obama plans to rescind the ruling clarifying conscience laws in force in the US today:

Conscience' rule on abortions may be overturned
The Obama administration wants to clarify a Bush policy that lets healthcare workers deny services because of moral beliefs.
By Noam N. Levey
February 27, 2009
Reporting from Washington -- Taking another step into the abortion debate, the Obama administration today will move to rescind a controversial rule that allows healthcare workers to deny abortion counseling or other family planning services if doing so would violate their moral beliefs, according to administration officials.

The rollback of the so-called conscience rule comes just two months after the Bush administration announced it late last year in one of its final policy initiatives.

Inevitably, no matter what they say, the outcome will be to further politicize abortion and to force doctors to perform abortions and assisted suicide, force Catholic hospitals to allow abortions and sterilizations and - inevitably - physician assisted suicide.

Last month without official ceremony, Obama overturned a controversial ban on U.S. funding for international aid groups that provide abortion services.

The move by the Department of Health and Human Services to throw out the conscience rule is being made equally quietly as most of Washington focuses on the president's blockbuster budget plan.

On Thursday officials stressed that before the administration finalizes the rollback, a standard 30-day comment period seeks input from people across the ideological spectrum.

"We believe that this is a complex issue that requires a thoughtful process where all voices can be heard," said one official, who was not authorized to speak on the record about the policy change.

The officials said the administration would consider drafting a new rule to clarify what healthcare workers could reasonably refuse to do for their patients.

For more than 30 years, federal law has allowed doctors and nurses to decline to provide abortion services as a matter of conscience, a protection that is not subject to rule making.

In promulgating the rule last year, then-Health and Human Services Secretary Mike Leavitt said it was necessary to address discrimination in the medical field.