Adult ADHD: Why so common (I’m looking at you, law school colleagues).
On the Next Justice: Questions to ask, and what we shouldn’t bother asking.
Can exercise be as effective as drugs in treating depression?
Linda Greenhouse on the implications of immigration jurisprudence.
Just in case you still care about Romney’s relationship to health care.
Michigan college offers money-back guarantee on getting a job.
Filed under Unkategorized
Filed under Unkategorized
For decades doctors have urged women to get frequent mammograms starting in their forties. When it comes to breast cancer—the second deadliest cancer for women—doctors have always advised women that early detection saves.
Today the U.S Preventive Services Task Force, a panel within the Department of Health and Human Services, marked a sharp withdrawal in policy promoting breast cancer awareness. According to new Task Force recommendations, women don’t need mammograms until they’re into their fifties. Women should hold off on mammograms until they hit 50, and even then they should cut back from the previously-recommended two mammograms annually to just one exam every other year.
Wait, WHAT?! Isn’t this the same Task Force that sounded an urgent alarm just six months ago, when statistics showed a slight decline–only 1%–in annual mammograms among women in their forties? The same Task Force that cried out that women in this age bracket were risking their lives if they forgo annual exams?
The downward trend, however slight, has breast cancer experts worried. Mammograms can enable physicians to diagnose the disease at early stages, often before a lump can be felt. “When breast cancer is detected early, it often can be treated before it has a chance to spread in the body and increase the risk of dying from the disease,” says Katherine Alley, medical director of the breast health program at Suburban Hospital in Bethesda.
The U.S Preventive Services Task Force, an independent panel of experts working under the Department of Health and Human Services, recommends that women older than 40 get a mammogram every one to two years. The task force finds the test most helpful for women between ages 50 and 69, for whom it says the evidence is strongest that screening lowers death rates from breast cancer. Other groups, including the American Medical Association, suggest a more rigorous schedule, saying the test should be done every year; insurers often pay for annual tests.
But experts say they are seeing gaps beyond two years in many cases. Carol Lee, chair of the American College of Radiology’s Breast Imaging Commission and a radiologist at the Memorial Sloan-Kettering Cancer Center in New York, says many women understand that they need to have a mammogram but don’t go back for repeat tests after the first one. In Bethesda, Alley said she has even heard anecdotal reports of breast cancer survivors forgoing recommended mammograms.
How could breasts have changed so much in six months? Or is it women in their forties who have changed? Ah, that’s right too—it was health care that changed. A mere six months after panicking over a mere one percent decline in mammograms among the forty-something set, today the Task Force issued an abrupt about-face:
“We’re not saying women shouldn’t get screened. Screening does save lives,” said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday’s Annals of Internal Medicine. “But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully.”
Several patient advocacy groups and many breast cancer experts welcomed the new guidelines, saying they represent a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy.
But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.
“Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it,” said Daniel B. Kopans, a radiology professor at Harvard Medical School. “It’s crazy — unethical, really.”
No, ladies, neither breasts nor women have changed in the last six months. What’s changed is that the Department of Health and Human Services is an agent of an administration suddenly responsible for paying for these exams once ObamaCare passes. This public health care omnibus claims it will shoulder the cost of preventative exams. Mammograms represent the quintessential “preventative exam.” But rather than pay for the care doctors have long urged women to demand for themselves, the government is simply pressuring health officials to redefine what women need.
Government-rationed health care will put a strain on resources like doctors and hospital space. Many providers will prove eager to avoid dealing with government-imposed conditions, red tape, and poor compensation rates. But rather than stand up and defend women’s efforts to protect themselves with preventative care, this government panel simply manipulates doctors’ advice to redefine what women need. In fact, while more than half of the doctors behind these new recommendations are women, none are oncologists. Nor is the Task Force a research organization; instead, it’s part of an agency under the Executive branch of the government, responsible for neither health nor research but rather implementing policy:
The USPSTF reviews the evidence, estimates the magnitude of benefits and harms for each preventative service, reaches consensus about the net benefit for each preventative service, and issues a recommendation.
At least we know what bias to expect. This is not a group of doctors acting on behalf of one patient at a time. It’s a group of policy-minded clinicians attempting to ration a tax-funded government pot among every American needing care. Women in their forties may not be ObamaCare’s top priority. But advising women to stop getting checked redefines reckless and brings to light insidious danger women face under the public option.
Evidently the Department of Health and Human Services knows which side of its bread is buttered under the new health care bill! This administration promised to prioritize life-saving preventative care. Instead, less than two weeks after ObamaCare passed in the House, public health officials have begun rolling back decades worth of doctors’ wisdom.
So the elderly won’t be the first to get thrown under the public health care bus — it’s women.
At The New Agenda.
Filed under Unkategorized
Charmaine Yoest’s op-ed, “Tax Dollars Shouldn’t Fund Abortion” (op-ed, Oct. 14) blatantly misrepresents the amendment I offered to health reform legislation now before Congress.
My amendment would maintain the status quo on federal funding of abortions by extending current law forbidding federal dollars from being used to pay for abortion, except in the cases of rape, incest or to protect the life of the woman.
My amendment allows plans in the Health Exchange to offer abortion coverage, but requires that those services to be paid for only out of premiums paid by consumers. No federal dollars may be used. This is the same principle currently used with Medicaid, which must follow the Hyde Amendment: No federal dollars may be used to pay for abortion services in Medicaid, but the 17 states that opt to cover the procedure can do so by paying for it with state dollars.
This is hardly a “radical departure from the status quo.” In fact, it is an extension of the status quo.
Rep. Lois Capps (D., Calif.)
Santa Barbara, Calif.
Charmaine Yoest states that the Capps Amendment “would make abortion coverage a part of the public option, funnel tax dollars to private health plans that cover abortion, and ensure that every area of the country will have at least one health insurance plan that covers elective abortion.” Ms. Yoest worries that the federal government is poised to enter “the business of funding the destruction of unborn human life.”
We’re already there. Planned Parenthood performs 62 abortions (305,310 abortions in 2008) for each adoption it facilitates. Planned Parenthood survives partly on tax dollars and government contracts that pay directly into this abortion giant’s operating fund. In the 2007-08 fiscal year, $350 million in “government grants and contracts”—those are our tax dollars—padded these controversial coffers.
Controversial choices deserve a hearty debate. Government’s intrusive fingers do not merely threaten to dictate the terms of that debate, as Ms. Yoest suggests. We are already there.
Kathryn Ciano
Arlington, Va.
Filed under Unkategorized
My name is Kat, and I love Insurance law.
I realize it’s unhip to buck the hue and cry trend over reform, but I keep thinking about reforming what we’ve already got, on a market level. The operative premises are:
1. The goal is not to get as many people insured as possible; it’s to get as many people care as possible. That lawmakers keep framing the debate as the former represents, I think, a major oversight.
2. Market evolution suggests that what exists is exactly what we want. “Reform” is to throw a stick in the spokes of a bicycle the entire market is riding in tandem. It’s dangerous and foolish, but #1 prevails so this thought experiment is about doing something.
3. This experiment is strictly about insurance, which is to say the articulation of finance and law. Obviously (!) the answer to health care reform is tort reform. But I will save torts for another day.
So. The thing that makes Insurance fascinating is that it’s a) private; and b) a sophisticated contract between sophisticated parties.
Insurance has nothing to do w/ outsourcing one’s well-being. W/ issues like public safety, we blithely outsource decisions regarding protection to Big Government, and we squirrel away military bases largely away from metropolitan areas, but we rely on that protection just the same.
Insurance is not outsourced; it is not unseen. We make an active choice to join a private network. We pay frequently, and big bucks for that safety net. It’s a contract and a long-term commitment. From the start we know that if we break that contract we’ll be faced with risk, uncertainty, and we’ll likely have to pay dearly for our own accumulated liability when looking to replace that K relationship.
The way the safety net works is that we all pay in and hope we never have to pull out. When we pull out it’s because we’ve had a problem, an illness, an accident. Everyone’s certainty and well-being is bolstered by this paid-in community.
Problems can arise, of course. If the community itself quakes, as in the aftermath from hurricane Katrina, then the entire safety net falters.
Many of these quakes are fascinating (see the operative payout system from the World Trade Center’s layered insurance K’s for a great example). But as with any market system, the key is to create a strong core. Insurance law is about creating incentives for insurance companies to cement solid financials. This way, when disaster strikes, companies can and will pay out, and they will do it properly.
Because we’re pursuing a single goal — getting as many people care as need it, and getting that care properly — we need to examine the problem. First, most uninsured Americans aren’t uninsured bc they can’t afford it; they’re uninsured bc they choose not to keep insurance.
Not keeping insurance is a perfectly valid choice. Perhaps not the most sophisticated choice, but it’s a valid choice nonetheless. Indeed, for those healthy or wealthy enough not to fear uncertainty, those thousands of dollars a year saved on unrealized insurance premiums can certainly fund any problems encountered later in life.
It’s for those endgame problems that insurance companies collect such high premiums. Yes, it sounds expensive to pay in now, but consider the cost of therapy later on.
When a patient undergoes chemotherapy, for example, one incidental cost covers daily vials to replenish or replicate lost immunity when white blood cells falter. Each vial costs over three thousand dollars. Add to this the other major non-incidental costs, and insurers’ high premiums come into stark perspective.
It makes sense that insurers would be so diligent about keeping pre-existing conditions out. But what if there were some provision to cover cancer patients, rather than simply dropping them at the first loopholed opportunity?
The way the system works now is that an insured keeps paying roughly similar premiums over the course of his insurance. Those premiums rise under certain conditions, but by and large insurance companies simply let patients pay a deductible up to the cost of a treatment. Insurance companies pay strict attention to which treatments patients pursue, and the companies govern when and how patients may try a given route.
What if insureds had an option to switch from, say, Aetna to a wholly-owned subsidiary, like Aetna Cancer, upon diagnosis? Patients would pay much higher premiums upon switching, but they would also gain a huge array of better options. Treatment centers closer to home, for example, or a more permissive range of experimental treatments.
Would companies go for this? Financially it likely makes sense. If I know Aetna allows me to switch and maintain this option if I get diagnosed, I may well choose this company over one I know will keep me on a strict plan if I get cancer. So the market would likely respond favorably by buying more regular Aetna, and possibly paying higher premiums all along, to preserve that right to Aetna C.
What about preexisting conditions? I can’t help but think I’d pay more for Aetna, to preserve switchability, if I know cancer runs in my family. The entire market response may well correspond to each respondent’s anticipated risk.
How would this change Aetna’s screening diagnostics for hopeful insureds? Aetna would have to consider the fact that each insured will have the option to pay more later in life and get a better range of choices. May Aetna change the point at which a condition becomes “preexisting”? Can a company do that, legally?
Do insurance companies ask for detailed family history now? Is it harder for adopted folks to get insurance? If someone has an insuppressible family history and is denied insurance because of it, does that constitute discrimination? If a healthy person w/ a family history of heart disease and a predilection for beef is denied, is that discrimination on a too-loose definition of “preexisting condition”?
The major benefit of letting people switch to better subsidiary coverage is that doctors would still get paid. This wouldn’t accomplish the same sort of wave to better care that we’d get w/ tort reform, but it would slightly loose our grip on doctors’ shorter hairs such that they wouldn’t be quite so unwilling to touch a patient — or, perhaps more insidious, to medicate a patient rather than treat.
More to come. This is interesting.
Filed under Unkategorized
Who’s afraid of the swine flu?
Since school started this fall every one of my professors has warned us of the swine flu procedures in place. Evidently health specialists predict that schools will close for weeks at a time as students fall in TB-like numbers.
I attend a law school attached to a sometimes-climbing, occasionally-inept university. Today students received an email advising i part:
Another simple way to prevent contracting or spreading influenza is to exercise good personal hygiene and avoid contact with others if you become ill:
1. Cover your mouth and nose when you cough or sneeze.
2. Wash your hands frequently with soap and water.
3. Avoid touching your eyes, nose or mouth.
4. Avoid close contact with people who are sick.
5. Stay home when you are sick and avoid public or social settings.
6. Practice good health habits; Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
Normally I chuckle at fear-mongering techniques as a shepherding advice. The specific draw of H1N1 hits a nerve though; it seems to be the year of the 18-30 year old. This demographic bolstered and elected our President; this demographic suffered the most in this economic crisis; and it is this demographic experts predict will bear the brunt of whichever pandmic finally hits — avian or swine or fear.
What do you think? Swine flu, a pandemic problem for our inchoate working class? Solution to the employment crisis, when we all suddenly find temp-to-perm jobs? Or, more likely, intentional fear-mongering to keep health — and thus health care — at the forefront of voters’ minds?
Filed under Unkategorized
Lawmakers pushing to add the prefix “Kennedy” to the health care bill have grasped the late Senator’s passing as an opportunity to refresh flagging interest in the reform.
What Congressmen think this means:
“KennedyCare” advocates hope to capitalize on the Lion’s brain cancer as an illustration of one ailment subject to health care. Ideally this soldier’s falling will refresh waning interest in Kennedy’s last stand:
[T]he real question raised by Kennedy’s death is whether it can help rally fellow Democrats who have wavered on certain aspects of health-care reform such as a public insurance option.
KennedyCare advocates see Teddy as a unifying figure immune to party lines. The health care debate knows no partisanship. Stance on gov’t health care has less to do with party lines and rests more in a person’s faith in individuals’ ability to make personal decisions based on the inevitable tradeoffs in life versus faith in the state’s heavy handed effort to relieve us of our choice.
What this actually means:
Those who hope to memorialize Kennedy with a health care bill named for him cite his death as one that could have been postponed with enhanced medical care. But Kennedy was a Senator. He enjoyed the Senate health insurance plan — notably different from the plan Senators offer private individuals — and was wealthy enough to afford the best treatments in the world.
Responding to this argument, Senator Grassley said that in countries with government-run health care, Kennedy “would not get the care he gets [in the US] because of his age.” Instead, the government would decide to spend health care resources on younger people “who can contribute to the economy”:
GRASSLEY: In countries that have government-run health care, just to give you an example, I’ve been told that the brain tumor that Sen. Kennedy has — because he’s 77 years old — would not be treated the way it’s treated in the United States. In other words, he would not get the care he gets here because of his age. In other words, they’d say ‘well he doesn’t have long to live even if he lived another four to five years.’ They’d say ‘well, we gotta spend money on people who can contribute more to economy.’ It’s a little like people saying when somebody gets to be 85 their life is worth less than when they were 35 and you pull the tubes on them.
Using a colleague’s death to revive a political agenda cheapens the agenda and reflects horrific disrespect for the departed.
Disrespect for life is what frigthens KennedyCare opposition most. Ted Kennedy was not a symbol; he was a man. He died a lonely death, and spent the last months of his life suffering from a painful medical condition. If colleagues cared about their fallen comrade at all they would not begin using his death as a tool even before Kennedy’s funeral.
This attitude reflects opponents’ precise objection to the health care bill. We are all men, not statistics. Sweeping statistics that fail to account for self-reporting and “unseen” errors (like the fact that most of the “uninsured” Americans are students who choose to save their money and pray for no accidents) reduce everyone to sheep, helpless except under the nanny hand of our shepherd.
Kennedy personified this exact bias in his private life. He touted health care reform from his fortunate, wealthy position that kept him immune to what he deemed good enough for “the masses.” Indeed Kennedy’s reliance on his family’s influence infamously kept him immune to what any other private citizen would have endured under similar circumstances.
Health care reform in its current form will fundamentally change the relationship between individuals and the state. Naming this sweeping bill after a paternalistic favored son eager to pay forward his father’s protective wing perpetuates the dark underbelly of politics. The wealthy will always angle for power and more wealth. The poor will seldom surpass strict thresholds set by their fortunate peers.
Kennedy would not have traded his position of influence for the position of those he was trying to help. Senators cling to the idea that they always “know best.” Had Kennedy truly believed in the sacrosanct plight of those trying to make ends meet, he would have borne their struggle inasmuch as it fell on him to bear. But when he had an opportunity to learn how the other half lives, he ducked responsibility — and the obligation to try to save one life — to hide behind his father’s coattails.
I sincerely hope Ted Kennedy finds forgiveness for his errors, as I hope we are all forgiven. But again: forgiveness is not ours to give. Exploiting a senator’s death does not gloss the choices he made in life.
Unfortunately, naming a critical bill after this symbol of political corruption simply memorializes the very disrespect for life that fuels opposition and, indeed, partisan politics at large.
Filed under Unkategorized
In an attempt to quell the uproar claiming that public health care will drive private providers out of market, Obama said:
[I]f the private insurance companies are providing a good bargain, and if the public option has to be self-sustaining — meaning taxpayers aren’t subsidizing it, but it has to run on charging premiums and providing good services and a good network of doctors, just like any other private insurer would do — then I think private insurers should be able to compete. They do it all the time. I mean, if you think about — if you think about it, UPS and FedEx are doing just fine, right? No, they are. It’s the Post Office that’s always having problems. (emphasis mine)
The error in this thinking almost speaks for itself. Economist Milton Friedman famously observed: “The government solution to a problem is usually worse than the problem itself.”
Differentiating between right-leaning and left-leaning politics requires nothing more than determining how much each side trusts individuals to think for themselves.
Right-leaning politicians believe that people are basically rational and will make choices based on what’s best for themselves. Thus these right-leaners reject proposed insurance mandates as bordering on facsism, and fear that public health care will deal a deadly blow to the private market, decreasing the number of options available for individuals to realize their choices.
Left-leaning politicians believe that people are basically helpless and will not make proper choices without government assistance. These politicans suggest that Government — personalize it by imagining Rahm Emmanuel at the helm and you and I keeping the system afloat — should help even sophisticated decision-makers. Because after all, without the big, sloppy hand of government, who are we to know what’s best for us?
Indeed, if men were angels, no government would be necessary. If angels were to govern men, neither external nor internal controls on government would be necessary.
Even if an angel like Rahm Emmanuel takes the helm of a monolithic public health care system now, he will have to pass those reins on in the future. The problem with the left-leaning vision of government is that the future always promises some man who is not an angel waiting to govern men. To avoid leaving our well-being in the hands of someone who does not know better than we do, we should not concentrate that power into one man’s hands now.
Government, by its nature, makes mistakes. I tend to lean right because I believe that people prefer to decide what they want than to be told what they will have. Both sides have erred, and both will continue to err. But to avoid turning our hospitals into a Postal Service, a Katrina, a $900 toilet seat, we should avoid permitting that kind of power to congeal into a mass tangible in one person’s hands.
Filed under Health Care
Americans have been waiting for nearly a century for quality, affordable health care.
By Nancy Pelosi and Steny Hoyer
Great start. Why engage with your detractors when you can just levy an ad hominem attack and point a sweeping finger instead?
Health coverage for all was on the national agenda as early as 1912, thanks to Teddy Roosevelt’s Bull Moose presidential run. Months after World War II came to an end in 1945, President Harry Truman called on Congress to guarantee all Americans the “right to adequate medical care and protection from the economic fears of sickness.” From President Lyndon Johnson to President Bill Clinton, to President Obama’s winning campaign on the promise of reform, there hasn’t been a more debated domestic issue than the promise of affordable health care for all.
This is a classic call for central planning. Remember in Animal Farm when Snowball seemed genuinely interested in the entire farm’s best interests, and then Napoleon took over? Napoleon was interested only in power. That’s the problem with centralizing power in one person’s hands: Absolute power corrupts absolutely.
The “un-American” dissenters that bother Pelosi are not only concerned with the ramifications of public health care (though those are also grave concerns). We are concerned with changing the individual’s relationship to the state, and the state’s requited relationship to the individual.
Even if Snowball was in fact a good and faithful leader, this centralized power will inevitably pass to the next set of hands. People who crave power over policy are typically interested in having that power, NOT in the well being of all affected by the policy. Rather than marginalize a collected will to central consciousness, we should encourage growth along a strong, lower center of gravity. The free market may seem vulnerable to shocks and bumps in the short run, but it is invincible to sustained Napoleonic manipulation. Central planning, though invulnerable to the short-term jostling that makes a market strong, remains susceptible to more invidious power transfers that eventually cause the fall of whichever nation adopted it.
It’s frustrating that “Snowball’s” policies are not the most efficient. But the real problem lies in the fact that centralizing all control in one helpful soul’s hands leaves that balled power entity ripe for Napoleon to pluck and do with what he pleases.
We believe it is healthy for such a historic effort to be subject to so much scrutiny and debate. The failure of past attempts is a reminder that health insurance reform is a defining moment in our nation’s history — it is well worth the time it takes to get it right. We are confident that we will get this right.
Already, three House committees have passed this critical legislation and over August, the two of us will work closely with those three committees to produce one strong piece of legislation that the House will approve in September.
In the meantime, as members of Congress spend time at home during August, they are talking with their constituents about reform. The dialogue between elected representatives and constituents is at the heart of our democracy and plays an integral role in assuring that the legislation we write reflects the genuine needs and concerns of the people we represent.
However, it is now evident that an ugly campaign is underway not merely to misrepresent the health insurance reform legislation, but to disrupt public meetings and prevent members of Congress and constituents from conducting a civil dialogue. These tactics have included hanging in effigy one Democratic member of Congress in Maryland and protesters holding a sign displaying a tombstone with the name of another congressman in Texas, where protesters also shouted “Just say no!” drowning out those who wanted to hold a substantive discussion.
I’ve never been a fan of really radical dissent. Discussing the merits of ideological fringe—like libertarians promoting anarchy—does nothing more than remove your ideas from discourse, alienating the strong, centered base capable of making change. The point of having ideas isn’t to navel-gaze among those who already agree with you.
A more fruitful course of action requires debate, dissent, and “come to Jesus” moments on both sides. If one or both debaters resist the necessity to engage actively in the discussion then neither side gets anywhere.
Pelosi whines that she wants a “substantive discussion,” but she misses the point: her constituency is shouting “Just say no!”
Our government is structured around the idea that those who care most about an idea will come to the forefront of relevant discussion. Whichever “faction” cares most about government subsidies for sugar will be front-and-center when the time comes to lobby for sustained subsidies, and those of us who have better things to do than care about sugar subsidies will not get involved. This disparate cost compared to contained benefit means that lobbyists perpetuate subsidies; taxpayers simply aren’t interested enough to lobby against paying.
Pelosi claims she wants a discussion, but she is ignoring what her constituents say. No, Nancy! Just say no to National Socialism; just say NO to socialized health care! You want to ignore the loud, passionate faction that just drowned out your comrades, but the more acutely-affected faction appears determined to be heard.
Let the facts be heard
These disruptions are occurring because opponents are afraid not just of differing views — but of the facts themselves. Drowning out opposing views is simply un-American. Drowning out the facts is how we failed at this task for decades.
Health care is complex. It touches every American life. It drives our economy. People must be allowed to learn the facts.
In fact, both sides have chosen a set of facts that drive their arguments. Your facts rest on speculation, and the ever-more-insistent call for Hope and Change. The townhall-crashers no doubt look to existing examples of public health care—including, close to home, the miserable option available to the military—as ominous specters of our future. As the summer wears on we are reminded of the aphorism: The more things change, the more they stay the same. Power will always fall into the hands of those who intend to use it. Paternalistic politicians will always ignore the cries from a constituency the politician deems helpless.
The first fact is that health insurance reform will mean more patient choice. It will allow every American who likes his or her current plan to keep it. And it will free doctors and patients to make the health decisions that make the most sense, not the most profits for insurance companies.
Reform will mean stability and peace of mind for the middle class. Never again will medical bills drive Americans into bankruptcy; never again will Americans be in danger of losing coverage if they lose their jobs or if they become sick; never again will insurance companies be allowed to deny patients coverage because of pre-existing conditions.
The current administration has been successful because they never directly disparage free markets. Rahm Emmanuel never says “the free market is a myth”; he claims that “with a little intervention” that market will be stronger.
Yet intervention effectively freezes the pipes through which a market economy flows. “Reform will mean stability and peace of mind for the middle class,” but cryogenically freezing them would obtain the same effect. I feel for those who need in-vitro fertilization to conceive, I really do, but I don’t think I should pay for it. Nor does it make sense to tax everyone enough to cover the broad range of abortions permitted in this country. While I would not necessarily condemn either procedure, I am not willing to pay for yours. We already fund Planned Parenthood, which uses 80% of its national funding to subsidize abortions. Need we pay more into this controversial pot?
Doesn’t it make more sense to leave money in the spenders’ pockets, to spend as they wish? Then the market for services will mirror demand for those services. Instead, Pelosi suggests that we take just a little bit more out of people’s pockets to contribute to a central pot, to be redistributed per whatever method “the factions” choose. I’d rather decide my fate than leave that up to a committee. I’m sure Nancy would rather decide hers, too. What’s good for the goose is good for the gander, Nancy. Why can’t you just leave us free to decide?
Lower costs, better care
Reform will mean affordable coverage for all Americans. Our plan’s cost-lowering measures include a public health insurance option to bring competitive pressure to bear on rapidly consolidating private insurers, research on health outcomes to better inform the decisions of patients and doctors, and electronic medical records to help doctors save money by working together. For seniors, the plan closes the notorious Medicare Part D “doughnut hole” that denies drug coverage to those with between $2,700 and $6,100 per year in prescriptions.
This would take two strokes of a legislative pen to fix. No need to write a thousand page referendum full of additional unforeseen oversights that will no doubt become the “hook” for selling your next reform.
Besides, a “doughnut hole” in legislation is a classic characteristic of government planning. When one central power-at-be who “knows better” takes it upon himself to distribute according to what he assumes “the people want,” he will always overlook some groups. Medicare Part D is nefarious because it overlooks a critical faction who could not speak for themselves.
It would make more sense to leave it to the people to buy what they need (which necessitates lowering taxes or promoting competition so drug prices will all fall in the long run) and avoid gaps, rather than than take people’s taxes and redistribute what you think they need, subject to gaps and holes.
Reform will also mean higher-quality care by promoting preventive care so health problems can be addressed before they become crises. This, too, will save money. We’ll be a much healthier country if all patients can receive regular checkups and tests, such as mammograms and diabetes exams, without paying a dime out-of-pocket.
This month, despite the disruptions, members of Congress will listen to their constituents back home and explain reform legislation. We are confident that our principles of affordable, quality health care will stand up to any and all critics.
Now — with Americans strongly supporting health insurance reform, with Congress reaching consensus on a plan, and with a president who ran and won on this specific promise of change — America is closer than ever to this century-deferred goal.
This fall, at long last, we must reach it.
Nancy Pelosi, D-Calif., is speaker of the House and
Steny Hoyer, D-Md., is House majority leader.
Perhaps there is nothing more “American” than debate. Rather than face her opposition tete-a-tete with interest and curiosity, Pelosi disparages them with her pen. She chooses a medium unlikely to reach her dissenters—an oped in the USA Today—so her appeal falls dead on arrival.
This is not a discussion. This is a whine. Pelosi reveals that she understands precious little about how our Constitutional Republic works. Reform is indeed necessary. But this step away from market competition will leave the public welfare in government’s often-incapable hands. Switching to a public system cannot be undone. Leaving private choice with regard to health is the first step down a path yet unchartered in American history. Future government interference with private lives will differ only in degree, but not in kind.
Discouraging debate and ignoring factions is not what politicians are hired to do. Pelosi’s decision to avoid confrontation by whining to the USA Today rather than facing her shouting (“Just say no!”) constituents like an adult perfectly characterizes the relationship she wishes individuals had with the state.
With all due respect, Ms. Pelosi, that is what I would call “un-American.”
Filed under Furthering the Debate, Government
The White House blog makes a McCarthy-era request:
There is a lot of disinformation about health insurance reform out there…These rumors often travel just below the surface via chain emails or through casual conversation. Since we can’t keep track of all of them…we’re asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to flag@whitehouse.gov.
The White House will weigh the perpetrators. Subversive e-mailers heavier than a feather will be burned at the stake.
Here’s the GOP’s response. If only we knew Obama’s real health care goals in the President’s own words.
Filed under Politics
An aside from this post:
*Let me just air this compaint now: I saw Bill Kristol on the Daily Show last week, and he completely ceded his argument against public health care when he stumbled on the military plan. Jon Stewart caught him admitting that a single-payer works for the military, and Kristol was at a total loss to backpedal from having admitted that it can be possible and good.
In fact, if he had one iota of experience with TriCare he’d be able to cite countless first-, second-, and third-person tales of utter, abysmal failure. Most military people use private doctors for everything save their STD tests. Those who can’t afford private care simply leave for the private sector as soon as they’re able. In fact, the sinking ship that is TriCare is likely responsible for a huge percent of military attrition that makes us do things in economic booms like waive felony disqualification, permit tattoos on the hands, etc.
I used to work with someone who died because the VA kept pushing back his appointment to remove his gangrenous finger. Even I, with no medical experience, know that gangrene kills vast tracts of healthy tissue like leprosy within a matter of weeks, not months. This was not a complicated procedure, and the VA failed miserably even at remedying that. I was so, so sorry to see Kristol flounder and lose that debate when the answer was so clear.
Phone a friend, Bill! I have stories for you! I can explain how military health care is an excellent illustration for why public health care will act like gangrene in a healthy individual-to-state relationship!
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