Death Panels – Real or Imagined?

Posted by Tina

Two different parts of the Obamacare bill sparked controversy during the health care debate. One had to do with the end-of-life directive and the other with the Independent Payment Advisory Board. In both cases the words “death panel” became a lightening rod for arguments. Proponents and defenders of the bill did as they often do and took aim at messengers (Michelle Bachman – Sarah Palin) rather than engage in conversation about the bill. The controversy truly heated up when Sarah Palin posted the following to her Facebook page on August 7, 2009:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

Health care by definition involves life and death decisions. Human rights and human dignity must be at the center of any health care discussion. Rep. Michele Bachmann highlighted the Orwellian thinking of the president’s health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff, in a floor speech to the House of Representatives. I commend her for being a voice for the most precious members of our society, our children and our seniors. (emphasis mine)

A good article pointing to the “Orwelian thinking” Bachman is referring to can be found at Medical Progress Today:

In his March 23, 2012, “Opinionator” column for the New York Times, Dr. Ezekiel Emanuel, previously a CMS official closely tied to the White House, proudly points to the accomplishment of PPACA and suggests that even if the individual mandate is struck down, we’re all better off because of PPACA. His analysis reflects an arrogance and blind faith in the power of the State.

Dr. Emanuel is very familiar with PPACA; he was frequently called upon to help craft the legislation by the Senate Finance Committee, in particular guiding language related to Accountable Care Organizations (ACOs) and Comparative Effectiveness Research (CER). He is a physician by training and his economic views, widely critiqued, emphasize making societal choices reflecting the utilitarian philosophy of John Stuart Mill… the greatest good for the greatest number. In this thinking, investments in public health benefitting society as a whole are better than investments that benefit individuals, especially late in life. (emphasis mine)

But what was Sarah Palin referring to when she used the words “death panel”? Since she referred to Michelle Bachman’s floor speech regarding the opinions of Dr. Ezekial Emanuel, and since she quoted his words directly (see highlighted quotes above), I’d say she was referring to the Independent Payment Advisory Board (IPAB).

The American Spectator cuts through the fog and hyperbole about the legislation to make sense of what this panel will mean for the elderly, the very sick and the aged in America:

IPAB was created pursuant to section 3403 of the ironically named Patient Protection and Affordable Care Act (PPACA), and its ostensible purpose is to “control costs.” In reality, it will do nothing at all about costs. Instead, the board’s fifteen “experts” will impose old-fashioned price controls. Before Obamacare was signed into law in March of 2010, only Congress had the power to make changes to Medicare’s reimbursement rates. But PPACA, for all intents and purposes, transfers that power to this tiny cadre of presidential appointees who will have no accountability to the voters. In theory, IPAB can only propose changes to Medicare’s payment rates. In practice, however, the board’s proposals will take effect automatically unless Congress passes contrary legislation and the President signs it into law.

This concentrates a huge amount of power in the hands of these fifteen people. As Obama’s former Director of the Office of Management and Budget, Peter Orszag, phrased it last year in a discussion at the Economic Club of Washington: “This institution could prove to be far more important to the future of our fiscal health than, for example, the Congressional Budget Office. It has an enormous amount of potential power.” This comment suggests that the Obama administration always intended to maintain the country’s “fiscal health” by stinting on Granny’s physical health. Hyperbole? Consider Orszag’s description of the automatic implementation feature of IPAB’s proposals: “So the default is now switched in a very important way on the biggest driver of our long-term costs, which is the Medicare program.”

Considering that IPAB’s mission involves Medicare cuts, one can’t help but wonder if Obama’s political team was comfortable with how much emphasis he put on it during last week’s budget discussions. He made it abundantly clear that, if spending rises faster than expected, he “will give the independent commission the authority to make additional savings by further improving Medicare.” But the relevant provision of PPACA was obviously written to keep IPAB below the radar until the President, and the Democrat majority in the Senate, have survived the 2012 election cycle. The law doesn’t require the board to produce its first recommendations until 2014. Thus, a safely reelected Obama would have time to submit even controversial nominations for IPAB membership, which a friendly Senate would happily confirm.

I highly recommend this Spectator article to you. The bill is deceptively written in some areas to give assurances but the bureaucracy and the slow moving wheels of government can never guarantee that safeguards are held to specifically, in fact, the opposite will more likely be the case. The Spectator article concludes:

Unfortunately, choice is not a popular concept with the President and his health care apparatchiks at the Centers for Medicare and Medicaid Services (CMS). For them, “cost control” means government-imposed rationing of care to the elderly.

Obama’s CMS administrator and lead health czar has often praised IPAB’s deadly British prototype, the National Institute for Health & Clinical Excellence (NICE) and has famously averred that “The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.”

Other areas of the law give unlimited power to the Health and Human Services Secretary exclusively. The result will be rationing and denial of coverage for certain procedures and medicines. As reported once again by The American Spectator:

As the Health and Human Services Secretary, she (at present Kathlene Sebelius) has unprecedented power under Obamacare to control health care decisions, the approval of medical products and the national biomedical research agenda. The Secretary is not only the key player; she is the only one on the field. “The Secretary shall…” is mentioned more than 1000 times in the new health care law.

In law the word shall is not used indiscriminately. It has a specific purpose; it is a command!

Still not convinced the law includes death panels? Perhaps the scholars at CATO will be more persuasive:

IPAB consists of up to 15 unelected government “experts.” Its stated purpose is to restrain Medicare spending. If projected spending exceeds certain targets, Obamacare requires IPAB to issue “legislative proposals” to reduce future spending. Those proposals could include drastic cuts that jeopardize seniors’ access to care, leading some critics to label IPAB a “death panel.”

But the really dangerous part is that these are not mere “proposals.” Obamacare requires the secretary of Health and Human Services to implement them — which means they become law automatically — unless Congress takes certain steps to head them off. Congress may replace the Board’s proposal with its own cuts, at least initially. But Obamacare requires a three-fifths vote in the Senate to pass any replacement that spends more than the Board’s proposal. In other words, to override IPAB’s proposal completely, opponents must assemble a simple majority in the House and a three-fifths majority in the Senate and the president’s signature.

That makes IPAB more than an advisory board. It’s a super-legislature whose members are more powerful than members of Congress. If eight members of Congress propose a bill, all that’s necessary to block it is a majority of either chamber, or one-third of either chamber plus the president.

Worse, Obamacare forbids Congress to repeal IPAB outside of a brief window in the year 2017 — and even then requires a three-fifths supermajority in both chambers plus a presidential signature. Under Obamacare, after 2017 Congress could repeal Medicare, but not the board it created to run Medicare. Congress and the states could repeal the Bill of Rights — but not IPAB.

What kind of laws will these super-legislators impose? Obamacare supposedly prohibits these super-legislators from raising taxes or rationing care. Yet those restrictions are unenforceable and meaningless. For instance, the statute lets IPAB define “rationing” and protects that definition — along with the secretary’s implementation of IPAB’s edicts — from administrative or judicial review. The prohibition on raising taxes is likewise toothless. IPAB can raise taxes as surely as it can cut Medicare spending.

Anyone that has observed big government programs for more than a nanosecond knows that what government says will happen and what actually happens are two very different things. A video highlighting what did happen in the state of Oregon is a reminder of what the death panel will bring to the nation:

This video represents real life on the ground under a government “good idea”. Words on a page are just words and politicians are good at forming words to convince people of their good intentions. The deceptively soothing words used by those with designs to control our health care industry will mean nothing once this law is fully implemented and it was written to be fully implemented and funded only after the next election…yet another deceptive move!

Chief Justice John Roberts, in his opinion last week, issued a warning to the American people when he wrote, “It is not our job to save the people from the consequences of their political decisions.” Justice Roberts is correct in that respect. The American people elected the super majority Congress and President Obama, the team that gave us this monstrous law with its death panel and central planning controllers. It will be up to the American people to elect leaders with enough courage and fortitude to repeal it.

Mitt Romney remarked after the courts decision, “Our mission is clear — if we want to get rid of ObamaCare, we’re going to have to get rid of President Obama.”

If we want to be rid of the ominous threat of death panels we are going to have to put free market thinkers in both Congress and the White House. Whether you believe Mitt Romney is the best candidate or not he is the only candidate with a shot at winning over Obama. If elected, Romney will need a lot of help in Congress. We conservatives, both Democrat and Republican, and Independents are constrained in California by progressive majorities but that doesn’t mean we are helpless in the fight. We can help by donating to Romney’s campaign and in congressional races in key battleground states. We can also continue to speak out here at Post Scripts. Here’s my opinion on this topic: The death panel is REAL! Whether you choose to use those words to describe the panel that will make life and death decisions about what medicare will cover and what it will not cover to keep costs down is up to you…but it is still just your opinion.

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23 Responses to Death Panels – Real or Imagined?

  1. question says:

    I am not sure what point your trying to make. Your saying there are death panels? In another blog you said they weren’t.
    now they are?
    what will we call ’em next week?
    Or, are you referring to the private death panels of the health insurers who deny coverage to people who have paid premiums all their lives?
    You know! Like the privately-run death panel that killed Nataline Sarkysian.
    Are THOSE the death panels you speak of?
    worry not!
    Obamacare has put an END to death panels!

  2. Libby says:

    Will you trot that tired trophe back into the barn!

    Lest I match it with another, somewhat lest artful phrase: “lifetime policy limit.” That’s what Aetna trots out when it’s decided you’ve cost them quite enough, and are gonna die anyway … and then, guess who starts picking up the tab.

    Go on, take a guess.

  3. Tina says:

    Libby obviously you are looking for free care…as if that could EVER exist. You are looking for healthcare and life without risk…that is a fairy tale.

    The difference under private insurance, which has been pointed out to you countless times, is that if you don’t like what AETNA has to offer you are free to go elsewhere for your insurance coverage. Before signing on to any health insurance agreement it is customary to read the policy. If you do you will know IN ADVANCE what is covered, what is not covered, and what the monetary limit of coverage will be. Every year you are given the option to go over what will be covered in the next year and what will not. At that time you can renew your policy or seek coverage elsewhere. It isn’t perfect, no system is, but it is not healthcare by government edict.

    You favor the ultimate end to this nightmare which is single payer government care. There are mechanisms built in to Obamacare that will move us fairly quickly in that direction. Once that goal is achieved there won’t be any other option available to people.

    I don’t favor big government control of our healthcare because I can see where its going (single payer), because I don’t like the death panels, because it will cost the American people a ton of money, much of which will deliver bureaucracy rather then healthcare, and because it will create a mountain of new debt for future generations. That is a recipe for deep, deep, deep…deep ugly!

  4. Princess says:

    Insurance companies are the real death panels. They decide every day if people can get coverage or not. And the fact that people don’t have insurance is another death panel. The News and Review has a great article this week from a doctor’s point of view.

    This death panel thing is a tragedy. It is not real, people should be able to have end of life planning with their doctor. I am very concerned with how much government is getting involved in health care decisions like birth control. We are losing privacy.

  5. Libby says:

    “… is that if you don’t like what AETNA has to offer you are free to go elsewhere for your insurance coverage.”

    Fool. Come on, people. Explain to her she’s a fool.

    The only insureds who don’t come under this rubric are them as pony up $800 a month for extravagant coverage … and in 2014 will be assessed an additional 40% excise tax on their “cadillac” coverage.

    Me heart bleeds.

  6. Jim says:

    “… is that if you don’t like what AETNA has to offer you are free to go elsewhere for your insurance coverage.”

    “Fool. Come on, people. Explain to her she’s a fool.”

    Well it’s very hard to do that now. You are often likely to get dropped if you get sick.

    But I have good news, under Obamacare, it WILL be possible to switch insurance companies and shop around for a better deal.

  7. Joseph says:

    Dang, Libster you are fired up today.

    What they heck are you drinking today out of that skull mug?

    If you want to see how Oramacare will work just look at what is happening in Taxachusettes.

    http://www.lewrockwell.com/blog/lewrw/archives/114898.html

    Writes Ed Smith:
    
    When we file our annual income tax returns in Massachusetts, there's a multi-page form on which we're required to specify the type of medical insurance we have, whether or not our coverage is "substantially compliant" (which the insurance plans have to tell us by sending us an annual form) and then, if our coverage isn't "substantially compliant," another form, with a lengthy worksheet, to compute the penalty tax which turns out to be a function of "Modified Massachusetts Adjusted Income"the computation of which requires the filling out of another lengthy worksheet after adjusting for various deductions and credits (the computation of which requires yet a third worksheet).
    
    At a dinner party this past Friday evening, I was chatting with a physician friend, a family/primary care physician. I asked him how his practice has been faring under Romneycare and what he thought of Obamacare. He told me that since Romneycare came on board, he and his colleagues, in their office practice, can only hope to make ends meet on volume, scheduling five to ten minute routine appointments, twenty minutes for "serious cases," and annual physicals (which take fifteen minutes) booked up to six months in advance. From 5:00 p.m. to 6:30 p.m. each day, he and his staff sit down to attend to paperwork.
    
    Has Romney care led to cost reductions and better care for patients, I asked him. No way, he told me. It's only been better for the insurance companies. What about Obamacare? He rolled his eyes. "We've been sold a bill of goods." He and his family live modestly. He's certainly not getting rich from his medical practice. His wife works to make ends meet. She's a nurse. At your office? I asked him. No, at one of the public clinics where she does better than she could do at his practice, "no fooling."
    
    
  8. Chris says:

    This is idiotic. The IPAB exists to cut unnecessary and wasteful spending–you know, that thing you always say you’re against? They are explicitly forbidden from rationing care or reducing benefits to seniors. They are also forbidden from raising costs to seniors or raising the eligibility age.

    In contrast, your own party’s major economic proposal, the Paul Ryan plan, also makes major cuts to Medicare, but offers no restrictions on reducing benefits, raising costs or raising the eligibility age–in fact, according to the CBO, it would do all of these things!

    So do you think it’s fair to characterize the Ryan plan as “rationing,” or as including death panels? Of course you don’t, because you are a gigantic hypocrite.

  9. Tina says:

    The thing is the Ryan plan is irrelevant at this point. The Ryan plan has not been foisted on America and in particular it has not been passed with tricks, bribery and slight of hand!

    Obamacare is relevant.

    If and when we ever get an opportunity to discuss the possibility of a completed bill by Ryan, as changed through the usual process in Congress, we can discuss the pros and cons of the Ryan plan…until then…

    YES I am totally against Obamacare and YES I realize we must reform Medicare because it is unsustainable.

    My initial goals would be to bring insurance and healthcare costs down for everyone, preserve the doctor patient relationship, use means testing in Medicare, create greater competition in the insurance industry, enact tort reform, preserve the safety net for the truly needy by giving power to the states.

    Trading insults…in terms of experience and with respect to the ability of the federal government to deliver on its promises and intentions you are a babe in the woods and if Obamacare stands, babe, your future earning/spending power is sooooooooooooooooo scr*#ed.

    (See “Single Payer Blues” soon to be posted…its where Obamacare will take you in no time at all)

  10. Chris says:

    Fine, forget the Ryan plan. The fact is that “Obamacare” cannot cut services or raise costs for seniors. Even if “rationing” is not clearly defined in the bill, certainly these prohibitions are more clear cut. So the claim that the IPAB represents a “death panel” that will get between doctors and patients is pure nonsense. There is no merit to it at all. The IPAB can’t do anything that would cause someone to be denied a certain treatment. They are only there to cut wasteful spending in Medicare.

    I may be young, but the “death panels” lie may be the most cynical, horrendous thing I have ever seen in politics in my (admittedly short) lifetime. Palin using her own son and his medical condition to promote this lie was, frankly, despicable. You claim that the critiques against her and Bachmann were “attacks on the messenger,” but they were completely justified. They lied, plain and simple. And so are you, every time you promote this ignorant, conspiratorial crap.

    If you find my language hostile, my recommendation is to stop telling lies. I will not mince words on this issue, and I will not pretend that your promotion of the “death panels” smear is merely a difference of opinion, worthy of respect. It is not. It is a lie. So stop repeating it.

  11. Tina says:

    Chris: “The IPAB can’t do anything that would cause someone to be denied a certain treatment.”

    Naive Chris…very naive. I implore you to read CATO again carefully:

    IPAB consists of up to 15 unelected government “experts.” Its stated purpose is to restrain Medicare spending. If projected spending exceeds certain targets, Obamacare requires IPAB to issue “legislative proposals” to reduce future spending. Those proposals could include drastic cuts that jeopardize seniors’ access to care, leading some critics to label IPAB a “death panel.”

    But the really dangerous part is that these are not mere “proposals.” Obamacare requires the secretary of Health and Human Services to implement them — which means they become law automatically — unless Congress takes certain steps to head them off. Congress may replace the Board’s proposal with its own cuts, at least initially. But Obamacare requires a three-fifths vote in the Senate to pass any replacement that spends more than the Board’s proposal. In other words, to override IPAB’s proposal completely, opponents must assemble a simple majority in the House and a three-fifths majority in the Senate and the president’s signature.

    That makes IPAB more than an advisory board. It’s a super-legislature whose members are more powerful than members of Congress.

    Nancy Pelosi and Harry Reid had to bribe legislators to pass this bill and they had a super majority requiring zero republican votes. How easy will it be for Congress to change what the HHS and her panel of 15 experts set in motion to “reduce costs”? It will be impossible!

    Better yet…you tell me what you would do to cut costs without denying services or treatments. You are a smart guy…give it your best shot! How will you avoid denying services or treatment or delays in services and treatments? Will the inadequate payments to docs and hospitals result in shortages of docs? Could that result in unnecessary deaths? Take some of that outrage and apply it to the problem. You aren’t selling this pie in the sky pig in a poke anymore…now you actually have to administer it and make it work.

    You can’t…we can’t handle Medicare now and the boomers are coming…

    Government has NEVER delivered a program at projected costs…never! LBJ was accused of being a liar and Democrats and media scoffed…now we know his projections were crap. FDR talked the same trash about SS…we now know it was crap. They were the liars and now Obama is lying about what will happen under Obamacare. I suggest you read this carefully:

    http://spectator.org/archives/2009/03/10/obamas-lbj-syndrome/print

    So how much was Medicare supposed to cost the American people?

    Promised a solemn LBJ: $500 million a year.

    You read that right. The cost of Medicare was projected to be $500 million — million with an “m” — a year. So said LBJ himself. Repeatedly, as he noted in his 1971 memoirs. So too did a March 11, 1965 story in the New York Times insist that: “Federal appropriations of about $500 million a year from general tax revenues would be required” to pay for Medicare.

    What has the actual cost turned out to be?

    In a report in February 2008, barely a year ago, the Wall Street Journal noted the trustees of Medicare admitted “Medicare’s unfunded liability is $74 trillion.According to the Congressional Budget Office, health-care spending is on a course that could crowd out all other government programs.”

    Crowd out all other government programs. Think of what that means. The current Obama budget proposal is a mind-bending $3.5 trillion. It funds everything from the entire Pentagon to all those 9,000 earmarks up to and including Iowa Senator Tom Harkin’s now infamous study of smelly Iowa pigs. Yet it would vanish inside the black hole of the fiscal universe that is Medicare without a trace.

    Crowed a gleeful LBJ in his memoirs about securing passage of his Medicare bill: “Forecasts of disaster continued right up until the day Medicare went into effect. There were predictionsthat the system would collapse under its own weight. The Commissioner of Social Security, the Secretary of HEW [Health, Education and Welfare, the predecessor bureaucracy to today’s Department of Health and Human Services] and I personally tried to reassure the public that such ominous predictions would not materialize. After one such reassuring statement had been issued, I said to John Gardner [the Secretary of HEW]: ‘John if you’re wrong in your calculations, we’re both going to look like the worst kind of damn fools.'”

    FORTY-FOUR YEARS LATER, disaster looms. The Medicare system (along with other government-sponsored enterprises like Fannie Mae) is collapsing of its financial weight right in front of our eyes. John Gardner was in fact wrong in his calculations. LBJ’s promise of the cost of Medicare now makes him look exactly like the “worst kind of damned fool” if not, as was frequently charged at the time, a serial liar with a “credibility gap.” In 2009 the country is $74 trillion hell and gone from the LBJ promise that $500 million a year and a few tax tweaks here and there would usher in the milk and honey of affordable health care for seniors.

    The Baby Boomers are beginning to retire…in terms of cost we ain’t seen nothin’ yet… we can’t cover this program and you think the best solution is to make the government “solution” even bigger?

    If this stands you will be saddled with very high taxes and a healthcare system that is even more broken than what we have now. You will pay this high high price just to cover the cost of the big fat bureaucracy, the waste and fraud, the interest on debt…and somehow you think everything will be okay? Please explain how, Chris, before you go calling me a liar again.

    Our problem is that the government inserted itself into the medical industry and made promises it couldn’t keep. LBJ lied just like FDR. Obama and his HHS are lying about what they can deliver. You may not like hearing it but it is the absolute truth.

  12. Chris says:

    “Those proposals could include drastic cuts that jeopardize seniors’ access to care,”

    Cato’s claim here is completely false. They do not mention that the IPAB is explicitly prohibited from making proposals that do this. And I think it is relevant, and revealing, that Cato supports the Paul Ryan plan, which actually would make drastic cuts that jeopardize seniors’ access to care. It’s absurd for them to make this accusation toward the PPACA, which does not do this, while supporting a plan that actually does.

    It doesn’t matter that the Ryan plan hasn’t been administered or the kinks haven’t been worked out; that doesn’t change the fact that Republicans actually SUPPORT drastic cuts that jeopardize seniors’ access to care, as long as Republicans are the ones making those cuts. Then they turn around and accuse Democrats of doing that, when that charge is completely false. The old “accuse your opponent of doing what you’re doing” approach.

  13. Chris says:

    I’m confused. Are you suggesting, Tina, that we’d be better off as a nation had Medicare never passed? If it just didn’t exist? If that’s your position, then how can you then turn around and criticize Obama for cutting Medicare? That’s completely inconsistent.

    But then, the entire Republican position on this issue is inconsistent. Republicans have been advocating cuts to Medicare longer then I’ve been alive. They are still advocating cuts to Medicare, even as they condemn Obama and the health care bill for making cuts to Medicare in the very next breath. I watched Paul Ryan do exactly this with George Stephanopoulis on Sunday morning. How does it make sense for Republicans to criticize Obama for doing exactly what they have always wanted to do? I smell partisan gameplaying, and it doesn’t smell good.

    And I wonder if you’ve given any thought to how short-sighted this gameplaying is, and how it will backfire on you in the future. If Medicare cuts = death panels and rationing, then that means any time you advocate Medicare cuts in the future, your opponents can accuse you of favoring death panels and rationing. If Romney is elected president in November, he will likely endorse the Ryan plan. As previously mentioned, this plan, unlike the PPACA, actually will result in less services and higher costs for seniors. It will also raise the eligibility age. Democrats can then say that Republicans have the “real” “death panels,” and you will have handed them this smear on a silver platter. Does the phrase “hoisted by your own petard” mean anything to you? What about the phrase “coming back to bite you on the bum?”

  14. Tina says:

    Chris: “They do not mention that the IPAB is explicitly prohibited from making proposals that do this.”

    Some language in the bill does prohibit. Other language in the bill compels savings by whatever means the HHS and “the panel” deems necessary or prudent and places a difficult bar for congress to breach in order to block HHS provisions. What do YOU think will happen?

    Here is what the doctors caucus in Congress thinks:

    http://doctorscaucus.gingrey.house.gov/news/documentprint.aspx?DocumentID=298444

    There is bipartisan concern that the IPAB could harm Medicare and limit access to care for seniors. The IPAB is a panel of 15 unelected, unaccountable government bureaucrats empowered to reduce the per capita rate of growth in Medicare spending. In the text of the healthcare law, it states that while the law prohibits any recommendation to ration health care, it does not prohibit slashing payments to physicians and other medical providers.

    Members of Congress from both parties have voiced concerns that such cuts could lead to fewer medical providers accepting Medicare benefits and limit seniors access to care. If thats not rationing, we dont know what is.

    Members of Congress raised this issue with Sebelius at two separate hearings before the House committees on Energy and Commerce and Ways and Means. The secretary testified she was certain her department would define the term rationing when writing regulations. Unfortunately, she would not agree to prohibit IPAB from jeopardizing seniors access to care. According to language in the healthcare law regarding the IPAB, it only acknowledges physician access to the extent feasible when meeting mandatory spending targets.

    Forty-eight House members wrote to the secretary in March, warning: We do not believe you can fix this fatally-flawed provision through regulations. Please specify whether or not you intend to prohibit IPAB from pushing Medicare cuts that limit seniors access to needed care, and describe the scope of your authority to do so. The secretary essentially brushed off this letter, including concerns it raised about the boards limits on necessary clinical expertise and the lack of public comment on IPAB decisions.

    Our concerns over IPAB are real and substantive. For example, cuts proposed by the IPAB are to be considered using fast-track procedures, and without a three-fifths vote of the Senate, Congress can only modify the type of cuts, not their size. Should Congress fail to act on the boards recommendations, they automatically go into effect. And it gets worse the IPABs decisions cannot be challenged in the courts.

    Even supporters of the law agree that the IPAB could harm seniors with dangerous Medicare cuts. AARP said the board could have a negative impact on [seniors] access to care. Former House Minority Leader Dick Gephardt (D-Mo.) has written that IPAB actions are likely to have devastating consequences for the seniors and disabled Americans who are Medicares beneficiaries because, while technically forbidden from rationing care, the Board will be able to set payment rates for some treatments so low that no doctor or hospital or other healthcare professional would provide them.

    See Rep Price, a doctor, offer his opinion on You Tube

    http://www.youtube.com/watch?v=SD_YOlUBoIk

    “Cato supports the Paul Ryan plan, which actually would make drastic cuts that jeopardize seniors’ access to care.”

    Chris, I think you are wrong.

    The Ryan plan is a joint effort. Democrat Ron Wyden worked with Ryan to write the plan using free market principles to bring costs down. They explain their plan in the WSJ; here is an excerpt:

    http://online.wsj.com/article/SB10001424052970203893404577098681919780636.html

    Americans currently over the age of 55 would see no changes to the Medicare system. For future retirees, starting in 2022, our plan would introduce a “premium support” system that would empower Medicare beneficiaries to choose either a traditional Medicare plan or a Medicare-approved private plan. Unlike Medicare Advantage, these private plans would compete head-to-head with traditional, fee-for-service Medicare on a federally regulated Medicare exchange.

    This reformed Medicare program would include the toughest consumer protections in American government.

    Low-income seniors who qualify for both Medicare and Medicaid would continue to have Medicaid pay for their out-of-pocket expenses. Other lower-income seniors would receive fully funded savings accounts to help offset any increased out-of-pocket costs, while wealthier seniors would receive less help.

    All health plans that participate in the Medicare exchange would be required to offer benefits that are at least as comprehensive as those covered by traditional Medicare, and participating plans would be forbidden to charge discriminatory premiums and would be required to cover everyone regardless of age, gender or health status.

    The direct federal contribution to health plans that cover the sickest seniors would be higher than it would be for plans that cover healthier seniors, thus ensuring that more help goes to seniors with greater health-care needs.

    Our plan wouldn’t merely ensure that American retirees have more health-care options than they have today. By allowing private plans to compete directly with traditional Medicare, our plan would also spur a wave of innovation to lower health-care costs and provide higher-quality health care.

    The reason is simple: In order to offer better benefits and lower costs than traditional Medicare, private plans will have to develop better delivery models and design better ways to care for patients with chronic illnesses. Imagine health plans tailored to help patients manage diabetes, prevent heart disease, or combat high blood pressure.

    In the event that these efforts did not stem the rising tide of Medicare spending, there would be a cap on the program’s rate of growth. But unlike other proposals, spending that exceeds the cap would neither be addressed through bureaucratic cuts nor passed on to seniors by default as higher premiums.

    Instead, Congress would be required to do its job: Determine why the costs exceeded the cap andwhen the evidence meritsreduce payments to providers, drug companies, or others who may be responsible for escalating costs.

    By giving seniors the power to choose among competing plans, our plan would add a level of cost control, customization and quality to the health security of older Americans that today’s Medicare is not in a position to achieve. (emphasis mine)

    Cost control is achieved by competition and incentive. Note too that this plan doesnt require a big expansion of costly federal bureaucracy or thousands of new IRS agents.

    People in your party complain that insurance companies and hospitals make profits at the expense of the consumer/patient and yet you support solutions that protect them from competition and the need for efficiency and innovation. Instead you favor a plan that expands government and oppresses caregivers.

    Your future is at stake. You better be sure you can trust these people that deceived the American people just to gain more power in government. It will create more dependency. It will discourage people from becoming doctors. It will stifle development of new innovations and cures. It will be very very expensive…that means higher taxes and more debt.

    I hope you will give more thought to this on this very special American holiday, the Fourth of July…Independence Day!

  15. Tina says:

    What I am saying is that time has shown us that big government programs do not work. They are expensive and wasteful of resources. Ultimately they become unsustainable, creating massive debt increases in taxes and/or cuts to other budgeted programs. The bureaucracy does not deliver inexpensive care that is more accessible. It just creates a lot of make-work expense and waste.

    Possibly you cannot get this because you are young and do not understand the workings of business or government. You do not understand even in a fundamental way what causes costs to rise and fall. You do not understand how incentives, positive or negative, cause humans to change behaviors. You don’t even understand how suggesting that you can provide more services to more people with a bigger, more expensive bureaucracy at a lowered cost (As the President promised) is a totally ridiculous notion! You are instead bewitched by promises of something for nothing: inexpensive healthcare for all.

    If Democrats who profess to care so much about seniors that can’t afford care, or the poor that can’t afford care, would put their community organizing skills to work creating private sector solutions they would find they could take care of those people in their communities for a lot less money while at the same time delivering personalized care. Such a solution would also eliminate most fraud and abuse. The money raised for advocacy (ads on TV…fun runs…political outreach) spent instead on actual healthcare (clinics & elder care centers) would make a difference in peoples lives rather delivering symbolic gestures. But that would require a personal commitment and a lot of effort.

    There will always be a need for safety net programs. Expanding the safety net at the federal level to include everyone makes it not a safety net but a fascist takeover of healthcare.

    There are better ways to deliver affordable healthcare to the all of the citizens of this great, FREE, nation!

    The comparisons you make between the two plans exposes your ignorance about how business and government work and how they impact in citizens lives. As I said…we are at an impasse.

  16. Chris says:

    Tina: “Some language in the bill does prohibit. Other language in the bill compels savings by whatever means the HHS and “the panel” deems necessary or prudent and places a difficult bar for congress to breach in order to block HHS provisions. What do YOU think will happen?”

    I think the “prohibiting” language obviously sets limits on the “whatever means…necessary or prudent” language, if it exists. I do not think the IPAB will be able to ration care, raise costs, lower services, or raise the eligibility age, because they are prohibited from doing that.

    The GOP Doctors Caucus says:

    “Members of Congress from both parties have voiced concerns that such cuts could lead to fewer medical providers accepting Medicare benefits and limit seniors access to care. If thats not rationing, we dont know what is.”

    I’m sorry, but in that case, they do not know what rationing is. Seriously. Rationing has a very specific meaning. It doesn’t mean “any decision, ever, that could possibly lead to less people getting Medicare.” By that logic, we could also accuse the Ryan plan of rationing, since the CBO says it will limit seniors’ access to care. But I wouldn’t do that, because it would be stupid.

    I do agree we have reason to be concerned about the low payments made to doctors who accept Medicare. These payments keep getting lowered and more and more doctors have been chooosing not to accept Medicare because of this. But this has been a problem for years, long before the PPACA was created. The PPACA did not directly address this problem, and IMO, it should have, because it could become a serious crisis facing our health care system. If the IPAB cuts payments even further as part of their cost-saving measures, then that could exacerbate the problem.

    But that still wouldn’t be “rationing,” which is the practice of allotting certain amounts of a good or service to certain people. To use such an inflammatory and inaccurate word when discussing this subject is to harm one’s credibility. The Doctors Caucus has legitimate concerns about low payments to Medicare doctors, but they’re acting like boys who cried wolf by employing such hyperbolic rhetoric. This helps no one.

    “Chris, I think you are wrong.”

    Well, I trust the CBO’s estimation more than yours or the opinion of those who wrote the bill. They say it will raise costs and lower benefits for seniors.

    “What I am saying is that time has shown us that big government programs do not work.”

    This is too vague to answer my question. I asked, do you think our country would be better off if Medicare had never been passed?

  17. Tina says:

    Chris: “I do not think the IPAB will be able to ration care, raise costs, lower services, or raise the eligibility age, because they are prohibited from doing that.”

    The HHS Secretary will follow the law in the same way that Pelosi followed the rules of Congress when she wrote and passed the bill. Like I’ve said, Chris, you are too young to have seen how government operates.

    The docs caucus wrote:

    she HHS Sec Sebelius) would not agree to prohibit IPAB from jeopardizing seniors access to care.

    …Minority Leader Dick Gephardt (D-Mo.) has written that IPAB actions are likely to have devastating consequences for the seniors and disabled Americans who are Medicares beneficiaries because, while technically forbidden from rationing care, the Board will be able to set payment rates for some treatments so low that no doctor or hospital or other healthcare professional would provide them.

    Of course the HHS and this panel will find a way to disallow and cut treatments and ration care.

    “…do you think our country would be better off if Medicare had never been passed?”

    You are asking me to answer the impossible, Chris, and I think you know that.

    Generally speaking I do think our country (and the people) would be better off today if government had stayed out of both the retirement/savings and medical fields. Our debt certainly would not be what it is today. However other factors come in to play. Since the educational system has failed so miserably and since the moral fiber of the country has also gone to hell, we have made the problem of dependency greater by these other means as well. Dependency will grow under this bill. You will be one of the few paying the bills. How high do you think your tax rates will go to feed this beast? How many totally dependent families are you willing to carry on your back? these are questions you should start to consider, Chris because they will definitely be part of your future.

  18. Libby says:

    “Generally speaking I do think our country (and the people) would be better off today if government had stayed out of both the retirement/savings and medical fields.”

    Tina, before the SSA, the elderly and infirm in this country … they starved to death.

    You really think that was “better”?

  19. Chris says:

    Tina: “The HHS Secretary will follow the law in the same way that Pelosi followed the rules of Congress when she wrote and passed the bill.”

    Wow, I didn’t know Pelosi wrote and passed the entire bill herself.

    I have read your opinion on the legality of how this bill was passed, and I think it is based on exaggerations and out-of-context half-truths. In reality, the bill was passed legally and appropriately.

    You then quote the doctors’ concerns about low payments to Medicare doctors again, meaning that I have to once again explain to you that this doesn’t meet any reasonable definition of rationing. Nor does it meet the definition of a “death panel.” Those terms are not just exaggeration. It’s crazy talk.

    By your logic, any decision that could possible lead to less people on Medicare could be called “rationing.” Are you prepared to face that term yourself if and when Republican policies lead to less people on Medicare? That’s what you’re inviting with this ridiculous smear.

    “You are asking me to answer the impossible, Chris, and I think you know that.”

    Ridiculous. I asked for your opinion. You won’t express it fully because it’s politically incorrect, not because it’s “impossible.”

    “Generally speaking I do think our country (and the people) would be better off today if government had stayed out of both the retirement/savings and medical fields.”

    If “government staying out of the medical field” would yield such great results, it shouldn’t be hard for you to find a country where this has been tried and worked. Can you name one? Are there any countries that have successful health care, completely unsoiled by the heavy hand of government? I’ve never heard of one.

    In reality, every industrialized country in the world has some form of government involvement in the health care system.

  20. Tina says:

    Chris: “In reality, the bill was passed legally and appropriately.”

    This bill was anything but “appropriately” written and passed. It was finalized largely in secret (we have to pass it so we can see what is in it) behind the closed office door of then Speaker Nancy Pelosi. At least three legislators were given deals (bribed) in exchange for their votes. The Obama administration made deals with healthcare providers and the pharmaceutical industry. See here:

    http://www.politico.com/news/stories/1209/30877.html

    And here:

    http://www.youtube.com/watch?v=tbWZA0fLX4I

    And here:

    http://www.foxnews.com/politics/2012/05/31/house-gop-releases-documents-on-health-care-deals/

    An $80-billion financial commitment by the drug companies gave Obama some momentum.

    The deal included better prescription coverage for Medicare recipients. Broad outlines were known at the time.

    Drug makers succeeded in avoiding new requirements to pay rebates to the government for Medicare drugs. Ultimately, they were also able to preserve an existing ban against patients importing lower-priced medications from overseas.

    The powerful House Energy and Commerce Committee obtained the emails from industry.

    “…meaning that I have to once again explain to you that this doesn’t meet any reasonable definition of rationing.”

    Or you could pull your thick head out and realize that it might not meet the definition but in practice it will feel just like rationed healthcare to patients when doctors who accept medicare patients become scarce. You don’t seem to care much about what happens. Your only concern is to make sure nobody says anything bad about this insane law.

    “death panel…crazy talk”

    People with cancer that are denied drugs will surely think so…once again the “bad words” are offensive but the result is just fine with you! And I’m the one talking crazy? You are one funny guy.

    “Are you prepared to face that term yourself if and when Republican policies lead to less people on Medicare? That’s what you’re inviting with this ridiculous smear.”

    Lets see if that happens and then we can talk about it.

    “I asked for your opinion. You won’t express it fully because it’s politically incorrect, not because it’s “impossible.”

    In thought you were asking me to be a seer. Nobody can determine the outcome of something that didn’t happen. My opinion is easy to express. I think we would be better off without federally run programs.

    “Are there any countries that have successful health care, completely unsoiled by the heavy hand of government?”

    I could do with less of that snide attitude, Chris. I realize you have only a few years experience and I realize you have relied heavily on government help to get where you are so this all looks fine and dandy from your perspective. You are safely wrapped in a cocoon and have yet to get a sense of the mountain of debt and shortage of doctors that is coming your way. As a taxpayer your life will be miserable unless something is done to get government reigned in.

    The United States of America, prior to 1965, had affordable healthcare. Insurance was available for expensive emergency care. Hardships were dealt with in various ways. We had county hospitals and doctors and hospitals had the option of helping people at their own discretion and often did. Kaiser was one model that worked very well and might have been duplicated had government not gotten involved. There is no way to know what state and local governments might have done to assist the very poor or disabled.

    It is absolutely true that adding layers of government bureaucracy and regulation pushes healthcare costs up. Simple logic tells you that. It is also illogical to think you can cover more people for less money by making government a third party.

    “In reality, every industrialized country in the world has some form of government involvement in the health care system.”

    And all of them are in debt up to their ears, have populations that lack incentive and urge to generate wealth or to work hard, and consistently fail to deliver adequate healthcare. The people who think those healthcare systems are wonderful are mostly people who don’t need it for anything big like cancer treatments, heart surgery, knee replacement.

    There are better ways to deliver healthcare to our citizens and with a lot less cost, waste, fraud and rationing. It is insane that stubborn leftist ideologues just can’t let go of that nanny state solution!

    The following is a little long but it is very informative for those interested in understanding what causes our health insurance to be so costly:

    http://www.thefreemanonline.org/features/rising-health-care-costs-whos-the-villain/

  21. Chris says:

    Tina: “Or you could pull your thick head out and realize that it might not meet the definition but in practice it will feel just like rationed healthcare to patients when doctors who accept medicare patients become scarce. You don’t seem to care much about what happens. Your only concern is to make sure nobody says anything bad about this insane law…
    People with cancer that are denied drugs will surely think so…once again the “bad words” are offensive but the result is just fine with you! And I’m the one talking crazy? You are one funny guy.”

    This shows how little you care about the truth and accuracy. You are essentially arguing that if you think a policy will have bad outcomes, you are morally justified to say literally anything about that policy, no matter how extreme or inaccurate, in order to defeat it.

    You just admitted that the government making smaller payments to Medicare doctors does not meet the definition of rationed health care, but you think it is OK to call it rationing anyway because it will “feel like” rationing. Yes, I call that crazy talk. It is not a reasonable, honest position for you to take. Nor is it very Christian of you. Nor does it contribute anything of value to political discussion.

    By your standards, I could call Mitt Romney a Nazi just because I think his policies aren’t best for America. Why should that be off limits? Why should anything? You think that you can say anything you want to about your political opponents, without facing criticism yourself. You seem to believe that lying is OK as long as it serves the greater good. That’s why you think it’s fine to falsely claim that the PPACA includes “death panels” and “rationing,” even though you just admitted that those do not actually exist in the law. As long as it gets people on your side and against this law, you think you are doing the right thing.

    You also falsely claim that I “don’t seem to care much about what happens,” that my “only concern is to make sure nobody says anything bad about this insane law,” and that “the result” (by which you mean less doctors taking Medicare patients) “is just fine with” me. You wrote this after I expressed genuine concern about the government (and possibly the IPAB in particular) lowering payments to Medicare doctors! I stated quite clearly that this concerns me and that I think the law should have addressed this growing problem. So you have no grounds to argue that I am simply trying to quell any kind of criticism against the law. Rational criticism is perfectly fine with me. Obviously, since I just criticized the law myself!

    But hyperventilating about “death panels” and “rationing” is not rational criticism, Tina. It is dishonest, desperate fear-mongering promoted by liars and conspiracy theorists. That, I am definitely against, and I will make that known every time you engage in such despicable and deceitful rhetoric.

    “I could do with less of that snide attitude, Chris…”

    It was a yes or no question, Tina. The correct answer is “No.” There are no countries with successful healthcare systems without government interference.

    “The United States of America, prior to 1965, had affordable healthcare.”

    Riiiiight. More proof that the modern right is desperately clinging to a nostalgic fantasy world that never really existed.

  22. Tina says:

    Chris: “You just admitted that the government making smaller payments to Medicare doctors does not meet the definition of rationed health care…”

    I said it might not and insisted that it doesn’t matter what the definition is the result is what matters. The way one of my medications is administered has already been changed. this medication helps to stop the destruction of joints and connective tissues in my body. Now that I am receiving a smaller dose than has been prescribed for literally decades. My prospects for remaining healthy, and pain free, has already been diminished. It will save trillions over time but it will also mean I will need more of those other little pills the President is so certain will be fine for those of us who are aging and don’t count because we are passed the age of contribution. On top of that it might more quickly lead to the need for joint replacement surgery. Will that too be limited and how long will I have to wait? I already know the prosthetic joints they use will cost more since they are being taxed to pay for this monstrosity. Bah!

    Have you taken a look at the system in England lately? Their system was the model for the death panel that will be foisted on our system. Tell the people over there how great this panel of unelected ego driven do-gooders without a clue are as they suffer and die while waiting months for surgery because of the shortages and bureaucracy. Here’s an article about what surgeons are saying…the part about “invisible waiting” is really interesting:

    http://www.bbc.co.uk/news/health-12964360

    Here’s one about Canada’s system:

    http://www.city-journal.org/html/17_3_canadian_healthcare.html

    “By your standards, I could call Mitt Romney a Nazi just because I think his policies aren’t best for America.”

    Not even close.

    ” That’s why you think it’s fine to falsely claim that the PPACA includes “death panels” and “rationing,” even though you just admitted that those do not actually exist in the law.”

    If you stuck a turd in front of me and claimed it wasn’t I would have the same reaction. You refuse to get that the term is descriptive of what will result from this stupid, oppressive, tyrannical, central planning law. You think that just because people won’t be given death sentences that there is no possibility for “death” to result directly from the actions of this board. You are wrong in my opinion and I have every right to think so.

    “I stated quite clearly that this concerns me and that I think the law should have addressed this growing problem.”

    That’s just having it both ways…a typical liberal progressive stance. You are the good guy right? Just care so much. Well, I tell you what. You don’t care if you are willing to pretend that the words “death panel” used to describe this unelected, unaccountable, distant body that will include life and death decision making in it’s job description is harmless after all you’ve been told about it.

    “But hyperventilating about “death panels” and “rationing” is not rational criticism, Tina. It is dishonest, desperate fear-mongering promoted by liars and conspiracy theorists.”

    So you say. I’m sorry Chris but that is your opinion and it is not shared by most Americans. If it seems I am hyperventilating that’s good. It is important to your future that you understand what is happening here.

    That’s quite a number of times you have called me a liar Chris and once again I have to say I do not appreciate it. My position isn’t dishonest it is the same opinion held by a whole lot of very smart people. It also isn’t intended as fear-mongering but a heartfelt warning. You don’t have to agree but you also don’t have to disrespect those who disagree with you.

    “There are no countries with successful healthcare systems without government interference.”

    It’s working so well that people have come from countries with single payer (The end game of Obamacare) to America for care they cannot get at home.

    “More proof that the modern right is desperately clinging to a nostalgic fantasy world that never really existed.”

    And you know that because you were alive then.

    I don’t mind your thinking you know everything Chris or that you favor big government control of everything. I really mind that you have not been taught enough about your own country to save you from the dismal future that is in store for you if you and others continue to embrace this collectivist bureaucratic crap.

  23. Chris says:

    Tina: “I said it might not and insisted that it doesn’t matter what the definition is the result is what matters.”

    This is double-speak. If the result doesn’t meet the definition of a “death panel,” then don’t call it a death panel. Same with the word “rationing.”

    “The way one of my medications is administered has already been changed.”

    I will need more details here. What medication, and why was it changed? I don’t think the PPACA has implemented any changes in how medication is administered. You certainly can’t claim that this is evidence of a “death panel,” since the IPAB has not even been appointed yet and is not expected to act for several more years.

    Do you get this medication through Medicare? That’s the only program the IPAB is allowed to touch.

    “Have you taken a look at the system in England lately? Their system was the model for”

    No, it wasn’t. The system created by the PPACA is nothing like the nationalized system they have in England.

    “Not even close.”

    Really? “Nazi” isn’t close to “death panel?” They both conjure up the same images to me.

    You seem to be asking for a different standard of behavior from your political opponents than you are willing to adhere to yourself. You think it is fine to throw around words like “rationing” and “death panel” but calling Mitt Romney a Nazi is off limits? There’s no consistency there.

    “That’s just having it both ways…a typical liberal progressive stance.”

    No, I am not “having it both ways.” One can criticize the law and also recognize that it doesn’t contain rationing or death panels. Just like I can criticize Mitt Romney and not think he is an evil Nazi. I can’t believe you find that strange. Does everything you’re against have to automatically be the Devil? There is no room for nuance and complexity?

    “So you say. I’m sorry Chris but that is your opinion and it is not shared by most Americans.”

    I would like to see a poll showing whether most Americans think that the “death panels” charge is fair before you make such proclamations. I think if most Americans agreed with you that this charge was fair, support for the law would be much lower than it is now.

    “That’s quite a number of times you have called me a liar Chris and once again I have to say I do not appreciate it.”

    As I’ve said before, the solution to this problem is for you to stop lying. I am right to show disrespect toward the disgusting and malicious “death panels” charge. It is not worthy of my respect. It is one of the worst smears I have ever seen.

    “And you know that because you were alive then.”

    Come on, Tina, one does not have to have lived before 1965 to know that we have a better healthcare system now then we did then. That is what’s called common sense.

    I have a few questions for you, Tina, that I hope you will answer.

    1) Do you favor cuts to Medicare?

    2) If so, where should these cuts be made?

    3) You seem very concerned with the issue of the government lowering Medicare payments to hospitals. In fact, the possibility of the IPAB doing this is the only real reason you have offered to justify the “death panels” and “rationing” charges. But these cuts have been taking place for years. What do you suggest we do to stop this from happening in the future? If Obamacare is repealed, what should future healthcare plans do to avoid this, thus also avoiding a charge of having “death panels” from you?

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