Squaring the Culture




"...and I will make justice the plumb line, and righteousness the level;
then hail will sweep away the refuge of lies,
and the waters will overflow the secret place."
Isaiah 28:17

08/20/2009 (12:55 pm)

Death Panels Already Exist

ezekiel_emanuel1One of my readers directed my attention to this article from American Thinker, which makes the case that Congressional Democrats have already created the mechanisms through which the government will make, then enforce, care decisions according to cost-benefit algebra. Death panels are not in Obama’s plan because they already exist.

Of course, “death panel” is not precise; it’s just gruesome jargon. This portion of the health care debate rages over how, when, and by whom decisions should be made to cease treatment of the elderly or terminally ill because the cost of further care is greater than somebody wants to pay. In a sane system, care ends when the patient chooses not to pay. Under national health care, care ends when a bureaucrat chooses not to pay. Defenders of Obama’s or the Democrats’ plans love to point out that today, care ends when the insurer chooses not to pay, but they are badly mistaken for several reasons. First, shortages are not nearly so severe, and prices not so prohibitively high, when the government is not manipulating the market, so fewer such decisions are necessary in a free market; second, even if the insurer says “No,” private care is available at the patient’s expense that would not be available under a government plan; and third, appeals (and, if necessary, lawsuits) are possible with an insurer that would not be possible under a government plan. Even with insurers in the mix (who are so prominent in our current system because of government meddling), the final decision is made by the patient and his or her family where it should be made, and not by an unconnected bureaucrat.

However, the Democrats have apparently side-stepped the debate (who’s surprised?) by inserting language into unrelated legislation, the Stimulus bill. Pay attention; you’re going to learn how vague laws and unread legislation can be used to implement tyranny. This is tricky.

Critics call attention to two regulatory boards created by the Health Care portions of the Stimulus bill: the National Coordinator of Health Information Technology (HIT), and the Federal Coordinating Council for Comparative Effectiveness Research (CER). The HIT coordinator is the administrator responsible for building a national patient record system, a measure that will certainly improve health coordination if the system is built correctly. The portion of the Stimulus bill that creates the HIT coordinator position spells out the process of creating, coordinating, and propagating this new, central database of health information to public and private health care providers around the nation. In my mind, this is a rare measure that might actually fall within a legitimate definition of the role of the national government, and if our nation’s fiscal health were not in crisis, I might even favor it — but wait ’till you hear what’s buried in it.

The HIT legislation states that it “…reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information….” Then the legislation sets up the means by which a nationwide information system will be created, with review, strategic planning, testing, and financing. Finally, it says it will phase itself in over several years by paying a financial bonus to doctors and hospitals who become “meaningful users” of the system. “The Secretary [of HHS] shall seek to improve the use of electronic health records and health care quality over time by requiring more stringent measures of meaningful use selected under this paragraph,” it adds, regarding the payment standards for doctors and hospitals separately.

Now, if I were paranoid, I might note that this is vague enough that literally anything might be slipped in, in the definition of a “meaningful user.” I might further note that the bill contains a mechanism by which the Secretary of HHS might add new restrictions at will, without oversight from any source, and without the public’s knowledge. Since it is entirely at the whim of the Secretary of HHS, he or she could say that a “meaningful user” is one who uses the system’s recommendation of the most cost-effective treatment — after inserting a cost-benefit calculus into the system. In this manner, a clever definition of “meaningful user” could incent doctors and hospitals to implement a value-assessment standard for care decisions, like the one Democrats have been favoring.

Why would I be so paranoid as to imagine such a thing?

Two reasons. The first is that former Senator and nominee for HHS secretary Tom Daschle wrote a book in 2008 entitled Critical: What We Can Do About the Health Care Crisis, in which he described measures almost identical to those in the Stimulus bill, and explained how he would use them. His intentions and the legislation by which he would achieve them were covered back in February by New York’s former Lieutenant Governor Betsy McCaughey in this article on Bloomberg. Since the bill she wrote about at the time was an interim version, I verified that the wording on which she reported actually remained in the final bill. It’s all there. With Daschle or somebody familiar with his intentions at HHS (like, say, the radically pro-abortion Kathleen Sebelius), we can expect doctors and hospitals to be required to use the new patient and treatment database as a means of restricting care by cost, or forfeit healthy incentive payments by the government.

madbobThe second reason is the other commission, Federal Coordinating Council for Comparative Effectiveness Research (CER). Remember when I said that given fiscal health, I might even favor the national patient information system? The Comparative Effectiveness Research body is another story; the government has no business performing this analysis at all.

“Comparative effectiveness” is jargon in the Progressive policy world for rationing on the basis of cost-benefit analysis, using language uncomfortably reminiscent of the Eugenics craze of the early 20th century. Naturally, the language speaks of “social justice,” but such justice is defined as certain citizens sacrificing their rights (not voluntarily) for the benefit of other citizens who produce more. You are blessed, citizen! You have been selected to sacrifice for the good of all! And it speaks of the “maturity” to enact such “difficult” measures, like this smug essay by a medical school prof at UCSF.

Take the comments by CER board member Ezekiel Emanuel (Rahm’s brother), taken from recent medical journals by Betsy McCaughey:

…Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.

Many doctors are horrified by this notion; they’ll tell you that a doctor’s job is to achieve social justice one patient at a time.

Emanuel, however, believes that “communitarianism” should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (JAMA, Feb. 27, 2008).

Translation: Don’t give much care to a grandmother with Parkinson’s or a child with cerebral palsy.

He explicitly defends discrimination against older patients: “Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years” (Lancet, Jan. 31).

By Emanuel’s logic, discrimination against blacks, women, gays, Jews or any other group would be justifiable, so long as that group is given the opportunity to pay it back against their oppressors at some other time. This is insane, but it’s the sort of rationalization that has been going on for years among Progressives, who wonder whether humankind is a cancer on the planet.

The CER panel is modeled after the board in the UK’s national health system called the National Institute for Health and Clinical Excellence, or NICE. NICE is, simply put, the UK’s health care rationing board. It decides what sort of care is appropriate on the basis of a cost-benefit calculus that says that Britain can only afford to spend up to $22,000 to extend a life for 6 months.

From the Wall Street Journal:

What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. For example:

In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs — including Sutent, which costs about $50,000 — that would help terminally ill kidney-cancer patients. After last year’s ruling, Peter Littlejohns, NICE’s clinical and public health director, noted that “there is a limited pot of money,” that the drugs were of “marginal benefit at quite often an extreme cost,” and the money might be better spent elsewhere.

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: “When treatments are very expensive, we have to use them where they give the most benefit to patients.”

And it is this board that the Stimulus bill recreates in the form of the CER. But it is delusional to think that Obama’s health care proposal contains death panels. We’re bearing false witness, says the most patently dishonest President in our history (yes, worse than Clinton.) With all due respect, Mr. President, you can shove that self-righteous posturing right up your ass.

McCaughey, in the Bloomberg article, states that the Stimulus bill language requires that Medicare care decisions include the findings of the CER. This is not entirely clear in the language, but then, that’s the point. The Secretary of HHS has latitude to define a “meaningful user” as anything he wishes, and to impose more stringent standards as time goes along. Without oversight. Or letting anybody know, aside from the hospitals who must comply if they are to be reimbursed for installing the patient records system.

No, there are no laws saying “We are going to withhold care from granny.” Who was naive enough to imagine that there would be, if such a thing were to come about? But Daschle explained how he would slip it in, empowering an unelected bureaucracy to make the hard decisions about health care rationing that elected politicians are politically unable to make. They are unaccountable for our good, don’t you see?

The demographic impact of the Baby Boom on medical care and Social Security has been apparent for some time now. It has been amplified by the loss of 50 million potential wage-earners to abortions. But now, it appears that Progressives have chosen to deny the Boomers any say in their own demise; simply because it is convenient, not to mention consistent with their misanthropic world view, the Obama administration is preparing to solve the demographic crisis by simply allowing the Boomers to die with only minimal care. He’ll never say so, of course. We’re bearing false witness if we mention it. Holocausts never arrive through the front door.

07/25/2009 (3:00 pm)

The Holocaust Begins

buchenwald16

I argued back in February that the weakened life ethic produced by abortion and by the selfishness of the Boomer generation, a decade of economic hardship, and the coming collapse of Social Security, will combine to produce mass killing of the elderly, first as “voluntary” euthanasia and later (but not much later) becoming a lot less voluntary. Several events in the advocacy of President Obama’s national health care scheme are vindicating my prediction.

The current House resolution for health care reform, H.R. 3200, contains a clause entitled “Advance care planning consultation” (Section 1233) requiring senior citizens to meet with a health professional every five years to discuss living wills and limits on measures to be taken when life-threatening conditions occur. Why a state-employed health professional? Why not a private attorney? Why is it required by the state? The clear answer is that with the state paying for medical care, ending life sooner reduces expenses for the national system. Patient’s rights advocates correctly note that the measure is likely to pressure seniors into making life-limiting legal decisions they might not otherwise make. In fact, that’s the point of the consultations.

Erick Erickson from RedState also circulated an email message on Friday reporting an overheard conversation between an aide to Rep. Paul Tonko (D, NY) and an alleged lobbyist regarding the House health care bill. The conversation included the observation that “probably the best part of the bill is the increase in Hospice care which will solve the prolonging of life issue.” Hospice care, as opposed to hospital care, limits access to life-extending technological procedures. To claim that hospice care “solves the prolonging of life issue” suggests that a national health plan will cover hospice care but not hospital care for certain, life-threatening illnesses, with the result that patients will be required by the state to die quietly rather than prolong their lives.

It’s really been pretty obvious that that’s where we’re heading from the discussions of health care “rationing” that we’ve been hearing. Erick at RedState.com listed several prominent progressives who have publicly advanced the weird survival calculus that supports consciously weighing dollar cost against survival odds; Peter Singer wrote just 10 days ago advocating a specific scheme, accompanied by an incredible flood of disingenuous rationalizations supporting the ethics of such a scheme.

They argue that since the calculation is taking place already, there is no reason the state should not engage in it. What they omit is the fact that whatever such calculations take place today, take place in the mind of the person whose survival is on the line, or among that person’s responsible family members. It is one thing for an individual to decide that his own wealth should be saved for his children rather than spent prolonging his life; it is another thing entirely for the state to make that assessment. The former is self-sacrifice; the latter is murder.

The moves to limit care for the elderly give the lie to the entire premise for national health care. Advocates for Obama’s plan argue that the reason for a national program is that some individuals cannot obtain care. Their solution does not provide care for more people, it simply shifts the right to decide who gets care from the market to the government. Just as many people will be denied care, but executive-branch bureaucrats get to decide which ones. I cannot see this as an improvement.

The holocaust has been predictable for decades. We’re just now beginning to see the pieces of it come together. As can be predicted by anybody familiar with 20th century history, wherever Marxian notions appear, mass deaths are likely to follow.

We are so screwed…

02/14/2009 (2:42 pm)

An American Holocaust

bookofgloom1Here’s a cheerful little thought to brighten your weekend.

This week a German medical team reported on new, comprehensive research demonstrating clearly that abortions increase the risk of premature births in later, “wanted” pregnancies, and that the risk increases with the number of previous abortions. This is hardly surprising; the medical knowledge about the risk of abortions has been mounting steadily for decades. There have been 17 studies over the years concerning abortion and premature births, and every one of them has reported the same thing. It would not be difficult to build a case for banning abortion except for emergency circumstances simply on the basis of the medical risk.

Of course, reason has nothing to do with the abortion debate. From the beginning, the arguments raised for the defense of abortion have had the character of badly-formed rationalizations. The defenders of legal abortion stalwartly ignore the findings of medical science regarding their pet procedure; there could be 300 such findings, and they would not admit a problem.

Even the current refrain that “nobody likes abortions” is nothing but the defensive whining of adolescents — it’s offered as though the fact that the person committing the act feels regret actually has bearing on whether the act is moral or not. If feelings have any bearing at all, they serve to illustrate that we all understand innately that the act is immoral; feelings of regret never justify a moral choice.

In fact, “nobody likes abortions” is obfuscation, a pretense that the issue is really “choice.” This is not merely nonsense, it’s disingenuous nonsense. Indeed, Cal Thomas, an opponent of legal abortion, has offered in public debates to leave current abortion laws unchallenged if only the purveyors of abortion would agree to present complete medical warnings concerning the risk of the procedure to every one of their clients, giving women a truly informed choice — and women’s rights advocates would not agree to it. And now, thanks to President Obama’s promised Freedom of Choice Act, medical professionals may no longer have a choice whether to offer such services or not, the government overruling their consciences. Choice, indeed.

But that’s all beside the current point. Facing, as we are, economic hardship in the Age of Obama, the more convincing case against abortion is actually socio-economic. The practice of abortion is likely to initiate the next major holocaust, this one right here in America, and probably ensuing within about 20 years.

prolifesign18We Boomers, as a generation, by contriving to kill our children in order to empower our self-gratifying sexual misconduct, have accomplished three things: 1) we’ve weakened the ethic of life, so that killing is increasingly acceptable as a solution; 2) we’ve broken the nation’s ability to produce wealth, by borrowing to live beyond our means both personally and governmentally, and by behaving as though economic reality did not apply to us; and 3) we’ve created a huge demographic bubble that will soon reach retirement age.

This will bring about the last generation of the long-term Ponzi game we’ve played with retirement accounts (I’m referring to Social Security). A Ponzi game is an economic pyramid scheme in which each succeeding generation of recruits into the game finances the profit of the previous generations. Each generation profits until the next generation is not large enough to support the preceding ones, at which point the game ends and the last generation shoulders the cost of the entire game. The Baby Boom was always likely to produce a demographic problem at retirement, but the loss of 50 million potential wage earners to abortion, resulting in fewer than two workers per retiree, guarantees that the Boomer generation will be retiring as the Ponzi game collapses. Thus, even if the current worldwide economic collapse only lasts a decade or so, we’ve guaranteed severe economic hardship to our children and grandchildren — and there are reasons to believe that the current collapse will extend hardship well into the next several generations.

With the weakened life ethic, voluntary euthanasia will be legalized, I would guess within a decade from now. Then, as economics makes supporting retirees unmanageable, it will become less voluntary, as younger folks choose to avoid the economic hardship of supporting their elderly parents. Even today, in European countries where euthanasia is legal, it’s often questionable whether a euthanasia decision was voluntary; how much more, when the alternative seems like financial ruin?

Thus will we reap the whirlwind from the wind to which we have sown: we chose to kill our children to protect our prosperity and freedom, and our children will choose to kill us to protect theirs.

True to our character, we elderly Boomers will go to our deaths feebly protesting the denial of our rights. For once we’ll be correct, but who will be around to hear us that has not been poisoned by our irresponsibility?

It has never really been necessary to raise religious issues to rebut abortion as a practice; abortion is a disaster on every possible measure of evaluation, especially those addressing the well-being of women. Unfortunately, like every selfish, evil act, it carries within itself the seeds of its own punishment. By choosing abortion, we’ve chosen our own end.