Thursday, September 3, 2009

Wither Disparate Impact

"The cost of caring for patients who are near death accounts for a big piece of the government's medical spending. But a furor over a provision for government-paid counseling to plan for end-of-life care is steering lawmakers away from the issue. ... Opponents say the provision shows that architects of the health-care overhaul want to ration seniors' care. Democratic lawmakers say no part of the House bill calls for rationing care. Physician counseling would be voluntary. ... Dumping the counseling provision would thwart a broad effort in recent years by doctors and hospitals to encourage patients to plan for end-of-life care. Advocates say such planning relieves the burden on families and helps doctors know how to treat those who are very ill. ... But spending during the last year of life accounted for 27.4% of total Medicare spending, the report found. ... The Urban Institute, a non-partisan research center, found that the government could save $90.8 billion over 10 years by better managing end-of-life care", Janet Adamy at the WSJ, 13 August 2009, link:

"Ezekiel Emanuel, a top health-care adviser and older brother of White House Chief of Staff Rahm Emanuel, is emerging as a target of conservatives critical of Democrats' health-care effort. ... Critics are using his writings to suggest Dr. Emanuel favors withhold care from the elderly and disabled. ... In another article, in the Lancet last January, Dr. Emanuel said age was one of several factors that could be considered in deciding who receives scarce organs or vaccines. 'Unlike allocation by sex or race, allocation by age is not invidious discrimination,' he wrote. 'Every person lives through different stages.' ... Other Republicans, including former Alaska Gov. Sarah Palin and former House Speaker Newt Gingrich, have suggested the Democrats' plans could lead to euthanasia, a notion dismissed as ludicrous by the bill's authors", my emphasis, Naftali Bendavid at the WSJ, 13 August 2009, link:

"A health clinic in this blue-collar city north of Oakland, partly funded by the county, is saving local hospitals thousands of dollars in emergency-room visits by treating uninsured patients who suffer only non-urgent ailments. A watchdog group is now calling on county officials to cut funding for clinic patients who can't prove they are in the US legally, a debate certain to surface in the national health-care overhaul ... A provison in the House's health-care-overhaul bill rules out federal funding for illegal immigrants. But in many ways, illegal immigration is at the nexus of two key health issues: uninsured and ballooning costs. ... Like others who can't afford medical care, illegal immigrants tend to flock to hospital emergency rooms, which, under a 1986 law, can't turn people away, even if they can't pay. ... The role illegal immigrants play in US health-care costs is 'one hot button that no one wants to touch,' says Stephen Zuckerman, an economist at the Urban Institute, a nonpartisan think tank in Washington", my emphasis, Miriam Jordan at the WSJ, 15 August 2009, link:

"There was a time when rushing a thousand-page bill through Congress so fast that no one has time to read it would have provoked public outrage. But now, this has been attempted twice in the first six months of a new administration. ... But the first bill simply spent hundreds of billions of dollars. The current 'health care' bill threatens to take life-and-death decisions out of the hands of individuals and their doctors, transferring those decisions to Washington bureaucrats. ... The mainstream media are again circling the wagons to protect Barack Obama, but this time in may not work. ... At one time, it would have been none of Dr. Emanuel's business if your physician prescribed the latest medications for you, rather than the cheaper and obsolete medications they replaced. ... As for a 'death panel,' no politician would ever use that phrase when trying to get a piece of legislation passed. 'End of life' care under the 'guidance' of 'some independent group' sounds so much nicer--and these are the terms President Obama used in an interview with the New York Times back on April 14. He said, 'The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out there.' he added: 'It is very difficult to imagine the country making those decisions just through the normal political channels. That is why you have to have some independent group that can give you guidance'," my emphasis, Thomas Sowell (TS), 17 August 2009, link:

"Although administration officials are eager to deny it, rationing health care is central to President Obama's health plan. The Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will recieve. The White House Council of Economic Advisers issued a report in June explaining the Obama administration's goal of reducing projected health spending by 30% over the next two decades. That reduction would be achieved by eliminating 'high cost, low-value treatments,' by 'implementing a set of performance measures that all providers would adopt,' and by 'directly targeting individual providers ... (and other) high-end outliers.' ... One reason the Obama administration is preparing to use rationing to limit health care is to rein in the government's exploding health-care budget", my emphasis, Martin Feldstein at the WSJ, 19 August 2009, link:

"But now I am finally scared of a White House administration. ... But the Obama administration claims those fateful consultations are 'purely voluntary.' ... As more Americans became increasingly troubled by this and other fearful elements of Dr. Obama's cost-efficient health care regimen, [Wesley] Smith adds this vital advice, no matter what legislation Obama finally signs into law: 'Remember that legislation itsef is only half the problem with Obamacare. Whatever bill passes, hundreds of bureaucrats in the federal agencies will have years to promulgate scores of regulations to govern the details of the law.' ... Condemning the furor at town-hall meetings around the country as 'un-American,' Harry Reid and Nancy Pelosi are blind to truly participatory democracy--an many individual Americans believe they are fighting, quite literally for their lives", my emphasis, Nat Hentoff (NH), 20 August 2009, link:

"And while [Sarah Palin] has been fairly criticized for hyperbole about the end-of-life counselors in the House bill, she drew such attention to the provision that Democrats chose to dump it rather than debate it. ... But Medicare is a system whereby 140 million working Americans pay 2.9 percent of all wages and salaries into a fund to pay for health care for 42 million mostly older Americans. And Medicare is going bust. ... In 2000, the Average American male in a population of 300 million lived to 74, the average female to 80. But in 2050, the average male in a population of 435 million Americans will live to 80 and the average female to 86. ... Now if a primary purpose of Obamacare uis to 'bend the curve' of soaring health care costs, and half of those costs are incurred in the last six months of life, and the number of seniors will grow by scores of millions, how do you cut costs without rationing care. And how do you ration care without denying millions of elderly and aged the prescriptions, procedures and operations they need to stay alive?," Pat Buchanan (PB), 20 August 2009, link:

Mike Shedlock smacks Obamacare at Mish's, 20 August 2009: Who does "He" think he's fooling?

"Dr. Ezekiel Emanuel, health adviser to President Barack Obama is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. ... Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. ... Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained 'to provide socially sustainable, cost-effective care'," my emphasis, Betsy McCaughey at the WSJ, 27 August 2009, link:

How much could Uncle Sam save by rounding up all people over 80 and shooting them? Over $9.1 billion a year? How can Obamacare save money without rationing? I can see the "near death" concept changing as the need arises, just like the CPI, PPI, etc. You're 70, you're near death. How do we know? "He" said so. Counseling? To do what? Voluntary? You eat at the King's table, you follow his rules! How much could Uncle Sam save by deporting millions of illegal aliens and ending birthright citizenship? Obamacare is designed to extend illegal aliens medical care. As Yves Smith would say, "it's a feature, not a bug". All else is secondary. Counseling, like a Big 87654 firm "counseling out" an employee in lieu of firing him?

I agree with Palin. She sees where this is going. Not "invidious discrimination". According to Table 8 of National Vital Statistics Reports, 17 April 2009, the average life span of American white men is 75.7 years, women 80.6, Negro men 69.7 and women 76.5. How much counseling will be aimed at old white women? Assume most. Where are our feminists? Well Gloria Steinem? You're 75. Not invidous? How did the Ivy League discriminate against Jews? See my 7 July 2009 post: Identify a characteristic related to the characteristic of interest and use it. Like disperate impact, see Steve Sailer's 28 June 2009 comment, link: Will Obamacare survive the 4/5th rule? Well Eric Holder?

The provision making illegal aliens ineligible for Obamacare will not be enforced. Who are guys like Peter Orzag kidding? Can't turn people away? When there is no more money, law or no law, that will happen. Hey Obama, repeal the 1986 law. Or does "He" think he can incarcerate all say Vallejo, California taxpayers for not suppporting illegal aliens? Hey, Zuckerman, I'll touch it. I have an idea for you, advocate "counseling" illegal aliens, to leave. Now.

Thank you TS. 80% of the relevant health care spending goes to the chronically ill and elderly. How does "He" expect to save money if not denying these groups care? The mainstream media are protecting "Him"? Really now.

Yes, Professor Feldstein. Let's make this easy for His Obamaness, kill all old people. Now we the second benefit: saving social security! Sarah Palin, is correct, we will have "death panels", which will be given some euphemism.

Yes, NH. War story time. I opposed 1964's Civil Rights Act. Racist, racist, racist! Really? I remember Martin Luther King and Hubert Humprey both said the bill would not lead to quotas. I concluded both were fools or lying. As to Obamacare, why might Obamites want computerized medical records? To determine average patient cost for each gerontologist. As to those whose costs are "too high", "Doctor, we summon you to the local health commissar to explain yourself". Why not, the DEA monitors physicians' pain killer prescriptions. Oops. Pain killers? Hmm. Obama may now have the mechanism to run death panels. Deny the elderly pain relievers to encourage them to commit suicide. Paranoid? I don't think so.

Yes, PB, how indeed. I'll go further.

Yes Mish.

The "usual recommendations" are window dressing The thrust of the Obamacare is letting old people, predominantly white females, die. Make no mistake.


Anonymous said...

Deep water here.

Pity this is being rushed through the Congress. That approach opens up the plan to demonetization and emotional responses... which are legitimate but not a coherent way to craft a national plan.

Huge, huge topic.

I'm not sure that the arguments are class or race based.

I think the discussion should center more on our collective responsibility to massively obese people. Should we ration care to those who weigh 3,4,5 or 600 pounds? Or smoke?

Health behaviors create high systemic costs... should we charge differential premiums or limit care? Incentive changes in behavior? And yes this would involve some "panel" developing specifics for care... doesn't this happen already in Medicare and insurance company reimbursement?

Anonymous said...

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Anonymous said...

You have to express more your opinion to attract more readers, because just a video or plain text without any personal approach is not that valuable. But it is just form my point of view