Freedom and Liberty
While I’m sure the specials last night on the deaths of Farrah Fawcett and Michael Jackson vastly outdrew the ABC’s Obama healthcare special the other night (no I didn’t watch it – I was being disappointed by the Yankees/Braves game), there were some very telling moments apparently. And, being the curious type, I found the transcript and read the whole thing.
Let’s say Mr. Eloquent was less than convincing. But he did shed some light on what he’d like to see the final product look like.
Naturally there were some moments that were instantly reported by the media and other bloggers. For instance when he essentially said that if that he’d use his wealth if necessary to go outside any system that denied his family the healthcare he thought they needed. The obvious point is he concedes that his system will do so – i.e. ration care through denial. Of course that’s one of the big complaints he’s had about private healthcare – rationing through denial.
But there were some other things said which only a careful reading of the transcript reveal. Let’s start with this question:
DR. JOHN CORBOY, NEUROLOGIST & MEDICAL PROFESSOR: Well, I think you still have to provide the appropriate care. And I think we all know that there is a significant amount of care that actually is inappropriate and unnecessary.
And the question then is — for you, Mr. President, is, what can you convince — what can you do to convince the American public that there actually are limits to what we can pay for with our American health care system?
And if there are going to be limits, who is going to design the system and who is going to enforce the rules for a system like that?
This question is loaded with key words and phrases. The first is “appropriate”, as in “appropriate care”. Who gets to decide? If you listen to a glib Obama, he constantly says medical decisions should be left to doctors. But this question isn’t being addressed to that point, is it? If there is an “appropriate care” standard, someone is going to have to define it.
And that is precisely what Corboy asks – “who is going to design the system and who is going to enforce the rules?” In fact, who gets to decide what the rules are?
I think you know the answer, but let’s look at the President’s answer:
OBAMA: Well, you’re asking the right question. And let me say, first of all, this is not an easy problem. If it was easy, it would have been solved a long time ago, because we’ve talking about this for decades, since Harry Truman.
We’ve been talking about how do we provide care that is high-quality, gives people choices, and how can we come up with a uniquely American plan? Because one of the ideological debates that I think has prevented us from making progress is some people say this is socialized medicine, others say we need a completely free market system.
We need to come up with something that is uniquely American. Now what I’ve said is that if we are smart, we should be able to design a system in which people still have choices of doctors and choices of plans that makes sure that the necessary treatment is provided but we don’t have a huge amount of waste in the system. That we are providing adequate coverage for all people, and that we are driving down costs over the long term.
OK, let’s stop for the moment right there. We begin with Obama in stump-speech mode. That’s a time buyer. He’s fumbling for an answer and is filling time. By the third paragraph he’s beginning to formulate an answer. Of course, I had to laugh because a uniquely American solution would be to have government back off and let the market take the ball and run with it. But obviously that’s not his plan. I think what he’s saying here is he hopes for a Euro-socialist plan with an American twist.
Anyway, in the third paragraph we’re again into some key words – this time “necessary” and “adequate”. Again, who will decide what is “necessary” and what form of coverage is “adequate”? Well, trust me, it won’t be you or your doctor, because his priority is what? That’s right – “driving down costs over the long term”. So “necessary” treatment will be considered in the context of “driving down costs”. I’m sure you figure out what that means.
Then there’s the “we should be able to design a system”. He’s not talking about you or the market here. He’s talking about government. He’s a part of the ‘we’ – you’re not.
Last, of course, is the overriding priority – drive costs down. He claims health care is the reason for the current deficit. So the obvious first priority for this so-called reform is to cut costs.
But let’s add 47 million new insured while driving costs down. Make sense to you? And if it does, then you have to admit that lesser cost, if possible, will have to come from some part of the current health care system. He has his ideas, and we’ll cover that in a different post.
Moving on with the answer:
If we don’t drive down costs, then we’re not going to be able to achieve all of those other things. And I think that on the issue that has already been raised by the two doctors, the issue of evidence-based care, I have great confidence that doctors are going to always want to do the right thing for their patients, if they’ve got good information, and if their payment incentives are not such that it actually costs them money to provide the appropriate care.
Here we find a very critical clue to the plan for your health care – the term “evidence-based care”. This is the new way of saying “we’ll decide for you”. Evidence based medicine claims to use the scientific method to determine optimum treatment decisions. The Centre for Evidence Based Medicine says it is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”
Said another way, a group somewhere doing research decides that certain diseases or conditions should be treated in certain ways. Those treatments are then applied to individual cases without any caveat for unique situations. The cost savings comes with uniform procedures and uniform care – no deviations. In other words, for the most part, decisions on how to treat individual cases will most likely have to conform to EBM guidelines or be considered outside the system. So what Obama said with that simple term is “we’ll decide how you will be treated, not your doctor”.
Of course critics of EBM are many and claim that it has some utility in outlining suggested treatment for populations as a whole, but has limited utility when taken down to the individual situation since each is unique.
And then there’s the inference that medicine to this point hasn’t been based on science. As Abraham Verghese said:
“Evidence Based Medicine” is a term which makes about as much sense as “Sex-based intercourse”–Were we practicing based on zodiac signs before EBM came along?
That brings us to the bit about “doctors always want to do the right thing for their patients”. Yes, of course. But what he says next hints that “the right thing” may be what the technocrats think is right, not necessarily what the doctors might think is right. He says doctors will do that “if they’ve got good information, and if their payment incentives are not such that it actually costs them money to provide the appropriate care.”
Anyone know right now instances when “appropriate care” costs a doctor “money to provide”? Yup, Medicare and Medicaid. It’s the reason so many opt out of treating Medi patients.
How then does he plan on changing their payment incentives so it doesn’t cost them money? Well to do that you either change the reimbursement rate or you change what is “appropriate”, don’t you? EBM promises the latter.
That brings us to the final part of his answer:
And right now, what we have is a situation, because doctors are paid fee-for-service, and there are all sorts of rules governing how they operate, as a consequence often times it is harder for them, more expensive for them, to do what is appropriate.
And we should change those incentive structures.
Now this is simply a load of road apples.
Litigation is part of the problem. Obama refuses to address that as a basic health care cost problem. It drives up costs and it also induces doctors to use unnecessary tests in a CYA gambit. Want to “change incentives?” Here’s a great place to start.
The second problem is chronic underpayment by the government through Medicare and Medicaid – something Obama and Congress want to again reduce by up to 20%. That causes cost shifting to the private side of things. But insurance companies have gotten smart and now refuse, in many cases, to pay more than the Medis. That is an artificial distortion of the market introduced by government arbitrarily deciding what a medical procedure is worth.
And the rules under which doctors operate are no less stringent under the Medis than under any private insurance plan.
That’s one question from the staged ABC “town hall meeting”. There was an amazing amount of info in that one question and answer. Enough information that you should be absolutely shaking in your boots, because what he said is he plans on doing precisely what he has been telling you he wouldn’t do – design a system which will decide how your doctor will treat you. It is all there, and no one has even bothered to take the close look it deserves.
I’ll parse a few more questions from the interview as I have the time, but suffice it to say, if you look hard enough you can figure out exactly where this guy wants to take us.
Apparently it will according to some who have actually beaten their way through the entire bill and read the contents:
The Ways and Means Committee’s proposed bill language (pdf) would virtually require that the president impose an import tariff on any country that fails to clamp down on greenhouse gas emissions.
Of course in this full bore onslaught of major life changing legislation which the Democrats seem determined to push through the Congress as quickly as they can (citing the imminent crisis it will foment if they don’t), this issue seems to be lost in the shuffle:
“This is a sleeper issue that lawmakers have not been paying enough attention to,” said Jake Colvin, vice president for global trade issues at the National Foreign Trade Council, which represents multinational corporations like Boeing Co. and Microsoft Corp. advocating for an open international trading system.
“The danger is, you focus so much on leveling the playing field for U.S. firms, that you neglect the potentially serious consequences that this could have on the international trading system,” Colvin said.
Nancy Peolosi is aiming for a vote in the House this Friday, before the July 4th recess. That obviously will mean very, very limited debate, if any. As NRO notes:
Not content to tempt political fate by imposing huge carbon taxes on the American middle class, Democrats have added a provision which imposes stiff tariffs on our trading partners if they don’t adopt aggressive carbon restrictions of their own.
You heard correctly: progressives have authored a bill that earns the mortal enmity of domestic energy consumers and our most crucial trading partners at the same time. Economy-killing climate policies and a trade war — together at last!
The devil is in the details:
Leaks from Hill offices indicate that the president would now be forced to impose the carbon tariffs — and could only opt out of doing so with permission from both chambers of Congress. Carbon-intensive imports would be subject to penalties at the border unless the country of origin requires emission reduction measures at least 80 percent as costly as ours. (The original Waxman-Markey bill had a threshold of 60 percent.)
Brilliant. Of course, some are going to argue that such measures surely will not be in the Senate version and not survive the reconciliation process when the two versions are merged. With this Congress I wouldn’t bet the farm on that.
There’s some talk that the blue dogs are going to oppose this bill. Obviously you would expect the GOP to oppose it as well. Are there enough other Dems to oppose so as to defeat it? Pelosi may not be the sharpest knife in the drawer when it comes to many things, but over the years she has learned to count votes I’m sure.
Bottom line: this bill is an economy killer, plain and simple. But it is also a progressive wet-dream shared by Pelosi. She is going to do everything in her power to push it through the House.
It took almost two weeks of brutalizing their own people, but the invitation for Iranian diplomats to attend Fourth of July parties at U.S. Embassies around the world has finally been rescinded. Of course this was done about a day after President Obama gave this mealy-mouthed answer to a question on the subject:
Q: Are Iranian diplomats still welcome at the embassy on the Fourth of July, sir?
THE PRESIDENT: Well, I think as you’re aware, Major, we don’t have formal diplomatic relations with — we don’t have formal diplomatic relations with Iran. I think that we have said that if Iran chooses a path that abides by international norms and principles, then we are interested in healing some of the wounds of 30 years, in terms of U.S.-Iranian relations. But that is a choice that the Iranians are going to have to make.
For those of you who need a translator, the answer was “yes”. Today the answer is “no”.
I’m glad they’ve awakened up there to the reality of what is happening in Iran and finally made some sort of move, no matter how trivial or symbolic, to show their disapproval. But it has taken unrelenting pressure to get them to move off of their “engagement at any cost” policy. In the case of 4th of July celebrations, it would have been a travesty to have representatives of the present brutal regime present. Ed Morrissey asks what they’d have been present for anyway:
Besides, what Independence Day values would the Iranian regime want to celebrate with us? Freedom of speech? Freedom of religion? The freedom to peaceably assemble or petition government for a redress of grievances?
Obama rather arrogantly reminded us that “only I am President of the United States”. But as former Secretary of State Lawrence Eagleburger reminded Obama, that means he represents the people of the United States when he speaks and in the case of the Iranian violence, he hasn’t represented them very well at all.
Don’t forget that the 1979 Iranian revolution took about a year to gestate after the initial protests. And it picked up support from other elements of society as it grew.
In a blatant act of defiance, a group of Mullahs took to the streets of Tehran, to protest election results that returned incumbent President Mahmoud Ahmadinejad to power.
Whether these clerics voted for Ahmadinejad or one of the opposition candidates is unknown. What is important here, is the decision to march against the will of Iran’s supreme leader who called the results final and declared demonstrations illegal.
This is an indicator that what happened in ’79 may be beginning to happen in ’09 as well.
In the Islamic Republic of Iran, Mullahs rule supreme. They are the country’s conservative clerics; the guardians of the Islamic revolution and its ideologies. They’re loyal only to God and Iran’s supreme leader, Ayatollah Ali Khamenei.
Obviously that particular equation is under assault with these clerics physically making the point that their loyalty is elsewhere. Check out the article for the picture of these clerics among the protesters.
If so, in terms of presidential press conferences, that’s a real “freedom of the press” no-no. Dana Milbank of the Washington Post is pretty sure that a question from the Huffington Post was, in fact, staged:
After the obligatory first question from the Associated Press, Obama treated the overflowing White House briefing room to a surprise. “I know Nico Pitney is here from the Huffington Post,” he announced.
Milbank reports that he knew Pitney was there because Pitney had been contacted by the White House and was escorted by White House staffers to the reporters area and told he’d probably be called on. Milbank takes it from there:
Pitney asked his arranged question. Reporters looked at one another in amazement at the stagecraft they were witnessing. White House Chief of Staff Rahm Emanuel grinned at the surprised TV correspondents in the first row.
The use of planted questioners is a no-no at presidential news conferences, because it sends a message to the world — Iran included — that the American press isn’t as free as advertised.
I bring this up because while it may seem trivial to some, it points to the lengths this White House will go to stage manage even such events as press conferences. Manipulation of the press is usually much more circumspect than this and doing it as they did with a grinning Rahm Emanuel standing on the sidelines points to a certain arrogance and cavalier attitude toward the tradition of freedom of the press.
But yesterday’s daytime drama belonged primarily to Pitney, of the Huffington Post Web site. During the eight years of the Bush administration, liberal outlets such as the Huffington Post often accused the White House of planting questioners in news conferences to ask preplanned questions. But here was Obama fielding a preplanned question asked by a planted questioner — from the Huffington Post.
Pitney said the White House, though not aware of the question’s wording, asked him to come up with a question about Iran proposed by an Iranian. And, as it turned out, he was not the only prearranged questioner at yesterday’s show. Later, Obama passed over the usual suspects to call on Macarena Vidal of the Spanish-language EFE news agency. The White House called Vidal in advance to see whether she was coming and arranged for her to sit in a seat usually assigned to a financial trade publication. She asked about Chile and Colombia.
Milbank says what wasn’t discussed was Afghanistan, Iraq, or many other critical topics with the time, instead, given to those with the prearranged questions. Not good. Not healthy. But, as Milbank points out, pretty ironic.
Part 2 happens tonight with the ABC informercial for the President’s health care plan.
From watchdogs to lapdogs, the media, with the exception of those like Milbank, simply play along.
So far my favorite (yes I’m being sarcastic here) government program to date has been the “clunkers for dollars” scam. We’re suffering from overspending and over-extended credit and the government puts together a program in which it tries to entice people with old, but probably paid off cars to go into debt for a new one by giving them $4,500 dollars of your money to buy a more fuel efficient model.
But I have to say, this one is also a great (sarcasm again) program as well:
It can be difficult to keep straight all the billions going to auto companies. But today the Department of Energy is reportedly set to announce that it will begin doling out sums from a $25 billion loan program for the development of fuel-efficient cars. The money comes from a bill passed last September and signed by President Bush and is totally separate from the TARP.
Among the first recipients are Ford, Nissan and Tesla, the small electric car company. The amounts will be announced today, but Ford has requested $5 billion. Nissan is getting the money to build a battery-electric car in its Tennessee plant.
A few points – one, does anyone hear the public clamoring for electric cars out there? They may be, but I’ve sure missed it. Why in the world is my money going to these companies to build something I’m not asking for and really don’t want – especially given the stage the technology is in right now. Yup, its government picking winners and losers again and we know how that seems to always turn out.
Two – although I’m completely against this, it is obvious it is going to happen, so I have to ask, why are we subsidizing a foreign auto maker with my money?
Three – and I know this is a completely silly question, but would some Constitutional scholar out there point me to the part of said document that makes this all kosher?
The political fallout within Iran of the protests against the regime and the election seems to be pretty dramatic. For the first time in 30 years, the mullahs who actually run the place are split and are looking closely at their method of ruling the country and considering what they would see as some rather drastic modifications.
One thing that some of the mullahs are unhappy with (finally) is the power concentrated in the position of “supreme leader”.
Iran’s religious clerics in Qom and members of the Assembly of Experts, headed by Ayatollah Rafsanjani, are mulling the formation of an alternative collective leadership to replace that of the supreme leader, sources in Qom told Al Arabiya on condition of anonymity.
As mentioned before, the Assembly of Experts has the power to remove both the president of the country and the “supreme leader”. Rafsanjani has been at loggerheads with the current supreme leader, Ayatollah Khamenei. 5 members of Rafsanjani’s family were arrested (and later released) during last week’s protests.
Members of the assembly are reportedly considering forming a collective ruling body and scrapping the model of Ayatollah Khomeini as a way out of the civil crisis that has engulfed Tehran in a series of protests,
The discussions have taken place in a series of secret meetings convened in the holy city of Qom and included Jawad al-Shahristani, the supreme representative of Ayatollah Ali al-Sistani, who is the foremost Shiite leader in Iraq.
Serious stuff. And again, going back to what I mentioned in another post, a very large crack in the foundation of “divine authority” the regime is supposed to have.
The reformist clerics are calling for the protesters who’ve been arrested to be released as well. They claim that will help ease tensions. My guess is it will refuel the protests. No word on the clamp down on the media or the internet.
A couple of interesting quotes from protesters:
“The robocops beat us up badly,” one protestor told AFP. “Men and women were beaten up…. My whole body is bruised…. They confiscated my camera.”
Another witness said: “Lots of guards on motorbikes closed in on us and beat us brutally. “As we were running away the Basiji were waiting in side alleys with batons, but people opened their doors to us trapped in alleys.”
According to statements posted by witnesses on the social networking site Facebook, foreign embassies even opened the doors to injured protesters, among them the Danish embassy. The report was not confirmed by the Danish foreign ministry.
Meanwhile, in the US, the phrase of the day is “pass the hotdogs”.
He sets it up with these observations:
1. There is nothing at all that any Western country can do to avoid the charge of intervening in Iran’s foreign affairs. The deep belief that everything—especially anything in English—is already and by definition an intervention is part of the very identity and ideology of the theocracy.
2. It is a mistake to assume that the ayatollahs, cynical and corrupt as they may be, are acting rationally. They are frequently in the grip of archaic beliefs and fears that would make a stupefied medieval European peasant seem mentally sturdy and resourceful by comparison.
3. The tendency of outside media to check the temperature of the clerics, rather than consult the writers and poets of the country, shows our own cultural backwardness in regrettably sharp relief. Anyone who had been reading Pezeshkzad and Nafisi, or talking to their students and readers in Tabriz and Esfahan and Mashad, would have been able to avoid the awful embarrassment by which everything that has occurred on the streets of Iran during recent days has come as one surprise after another to most of our uncultured “experts.”
And he brings it home with this:
That last observation also applies to the Obama administration. Want to take a noninterventionist position? All right, then, take a noninterventionist position. This would mean not referring to Khamenei in fawning tones as the supreme leader and not calling Iran itself by the tyrannical title of “the Islamic republic.” But be aware that nothing will stop the theocrats from slandering you for interfering anyway. Also try to bear in mind that one day you will have to face the young Iranian democrats who risked their all in the battle and explain to them just what you were doing when they were being beaten and gassed. [emphasis mine].
For those of you who continue to miss this point, there it is, perfectly stated.
And, for those who find “hot dogs on the 4th” still acceptable for members of a regime presently engaged in viciously and murderously silencing their own people, one has to assume you believe in rewarding bad behavior by pretending it hasn’t happened. That’s not “diplomacy”, that’s simply an abysmally poor choice that signals weakness.
Dale and I once interviewed Ezra Klein about health care on our podcast. Klein held the VA system up as a shining example of good government health care. Of course that was before the shameful condition of Walter Reed had been discovered. Since then other problems (for instance, contaminated colonoscopy equipment in various locations) have been discovered.
A commenter once asked “if VA is good enough for our veterans, why isn’t it good enough for us.” My answer was “it isn’t good enough for our veterans, it is instead what they’re stuck with.”
Today brings another example of the problems this sort of medicine is bound to have. It is a bureaucratic nightmare, even at the relatively small size of VA.
For patients with prostate cancer, it is a common surgical procedure: a doctor implants dozens of radioactive seeds to attack the disease. But when Dr. Gary D. Kao treated one patient at the veterans’ hospital in Philadelphia, his aim was more than a little off.
Most of the seeds, 40 in all, landed in the patient’s healthy bladder, not the prostate.
It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear.
He simply rewrote his surgical plan to match the number of seeds in the prostate, investigators said.
The revision may have made Dr. Kao look better, but it did nothing for the patient, who had to undergo a second implant. It failed, too, resulting in an unintended dose to the rectum. Regulators knew nothing of this second mistake because no one reported it.
That as they say, was the tip of the iceberg. No one reported the problem because there was no peer review. And, this was one of many mistakes made by this doctor that apparently no one knew about:
Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years — and then kept quiet about it, according to interviews with investigators, government officials and public records.
The team continued implants for a year even though the equipment that measured whether patients received the proper radiation dose was broken. The radiation safety committee at the Veterans Affairs hospital knew of this problem but took no action, records show.
Six years and no one had a clue. In fact, if you read the article in full, as you should, you’ll see that the discovery of this was essentially an accident.
This is government health care. This is what our vets are stuck with. This is not something we, as a society, should want any part of.
There have probably been moments where I’ve been more disgusted with my country’s leadership, but I’m having great difficulty bringing them to mind. Somehow, having repressive and murderous regimes over for lunch clouds my memory of indiscretions gone by:
The United States said Monday its invitations were still standing for Iranian diplomats to attend July 4 celebrations at US embassies despite the crackdown on opposition supporters.
President Barack Obama’s administration said earlier this month it would invite Iran to US embassy barbecues for the national holiday for the first time since the two nations severed relations following the 1979 Islamic revolution.
“There’s no thought to rescinding the invitations to Iranian diplomats,” State Department spokesman Ian Kelly told reporters.
“We have made a strategic decision to engage on a number of fronts with Iran,” Kelly said. “We tried many years of isolation, and we’re pursuing a different path now.”
The only thing I can think to say is, how dare you?
How dare the representatives of a country founded on freedom from tyranny and the principles of inalienable rights not give any thought — no thought whatsoever — to reexamining its invitation to theocratic sponsors of terrorism who violently deny their own people access to any say in how their lives are governed?
How dare the supposed leader of the free world not ponder, even for a moment, that perhaps treating thuggish dictators as legitimate state actors, on our nation’s birthday no less, might be sending the wrong signal?
How dare the supreme ambassadors of everything we hold dear as a country extend anything more than a single, firmly-flexed digit in the direction of a bully state that clearly has no business pretending to represent the interests of its citizens?
President Obama, how dare you slap your own countrymen in the face with such a rude and thoughtless gesture?
How dare you forgo “thought” on the matter; aren’t you supposed to be the intellectual president … y’know, The One who thinks about things?
I can only hope that our government hasn’t become so comfortable with its own power-grabbing that it fails to recognize blatant state repression when it’s invited over for hot dogs and fireworks.
It’s one thing to hold one’s tongue, or to speak in moderate tones when addressing momentous historical events as they unfold. It’s entirely another thing altogether to look tyranny in the face and smile as you invite it into your home. Even more significantly, our duly elected representative to the world is doing all this on the day to commemorate the culmination of the blood, sweat and tears our forefathers spent in casting off the yolk of dictatorial control so that we might have a nation of laws, and freedom to pursue our own individual happiness — freedoms that our “guests” routinely spit upon. President Obama should be ashamed.
[HT: Hot Air]
UPDATE: Bruce helpfully makes the point I was trying to get at above, but somehow failed to include in my rant:
And, for those who find “hot dogs on the 4th” still acceptable for members of a regime presently engaged in viciously and murderously silencing their own people, on has to assume you believe in rewarding bad behavior by pretending it hasn’t happened. That’s not “diplomacy”, that’s simply an abysmally poor choice that signals weakness.
Obviously we’ve coddled repressive regimes before, to our and their people’s detriment, but I’m not trying to suggest that we simply disengage from any discussions whatsoever. There are times and places for diplomatic discussion, even with tyrannical governments such as Iran’s. While that regime is busy slaughtering peaceful protesters and on a national holiday celebrating our hard-won freedoms is not such a time.