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Old August 14th, 2009, 09:32 AM   #1
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http://online.wsj.com/article/SB1000...152168372.html

Elderly Americans are turning out in droves to fight ObamaCare, and President Obama is arguing back that they have nothing to worry about. Allow us to referee. While claims about euthanasia and "death panels" are over the top, senior fears have exposed a fundamental truth about what Mr. Obama is proposing: Namely, once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived the longest will find their care the most restricted.

Far from being a scare tactic, this is a logical conclusion based on experience and common-sense. Once health care is a "free good" that government pays for, demand will soar and government costs will soar too. When the public finally reaches its taxing limit, something will have to give on the care and spending side. In a word, care will be rationed by politics.

Mr. Obama's reply is that private insurance companies already ration, by deciding which treatments are covered and which aren't. However, there's an ocean of difference between coverage decisions made under millions of voluntary private contracts and rationing via government. An Atlantic Ocean, in fact. Virtually every European government with "universal" health care restricts access in one way or another to control costs, and it isn't pretty.

The British system is most restrictive, using a black-box actuarial formula known as "quality-adjusted life years," or QALYs, that determines who can receive what care. If a treatment isn't deemed to be cost-effective for specific populations, particularly the elderly, the National Health Service simply doesn't pay for it. Even France—which has a mix of public and private medicine—has fixed reimbursement rates since the 1970s and strictly controls the use of specialists and the introduction of new medical technologies such as CT scans and MRIs.

Yes, the U.S. "rations" by ability to pay (though in the end no one is denied actual care). This is true of every good or service in a free economy and a world of finite resources but infinite wants. Yet no one would say we "ration" houses or gasoline because those goods are allocated by prices. The problem is that governments ration through brute force—either explicitly restricting the use of medicine or lowering payments below market rates. Both methods lead to waiting lines, lower quality, or less innovation—and usually all three.

A lot of talk has centered on what Sarah Palin inelegantly called "death panels." Of course rationing to save the federal fisc will be subtler than a bureaucratic decision to "pull the plug on grandma," as Mr. Obama put it. But Mrs. Palin has also exposed a basic truth. A substantial portion of Medicare spending is incurred in the last six months of life.

From the point of view of politicians with a limited budget, is it worth spending a lot on, say, a patient with late-stage cancer where the odds of remission are long? Or should they spend to improve quality, not length, of life? Or pay for a hip or knee replacement for seniors, when palliative care might cost less? And who decides?

In Britain, the NHS decides, and under its QALYs metric it generally won't pay more than $22,000 for treatments to extend a life six months. "Money for the NHS isn't limitless," as one NHS official recently put it in response to American criticism, "so we need to make sure the money we have goes on things which offer more than the care we'll have to forgo to pay for them."

Before he got defensive, Mr. Obama was open about this political calculation. He often invokes the experience of his own grandmother, musing whether it was wise for her to receive a hip replacement after a terminal cancer diagnosis. In an April interview with the New York Times, he wondered whether this represented a "sustainable model" for society. He seems to believe these medical issues are all justifiably political questions that government or some panel of philosopher kings can and should decide. No wonder so many seniors rebel at such judgments that they know they could do little to influence, much less change.

Mr. Obama has also said many times that the growth of Medicare spending must be restrained, and his budget director Peter Orszag has made it nearly his life's cause. We agree, but then why does Mr. Obama want to add to our fiscal burdens a new Medicare-like program for everyone under 65 too? Medicare already rations care, refusing, for example, to pay for virtual colonsocopies and has payment policies or directives to curtail the use of certain cancer drugs, diagnostic tools, asthma medications and many others. Seniors routinely buy supplemental insurance (Medigap) to patch Medicare's holes—and Medicare is still growing by 11% this year.

The political and fiscal pressure to further ration Medicare would increase exponentially if government is paying for most everyone's care. The better way to slow the growth of Medicare is to give seniors more control over their own health care and the incentives to spend wisely, by offering competitive insurance plans. But this would mean less control for government, not more.

It's striking that even the AARP—which is run by liberals who favor national health care—has been backing away from support for Mr. Obama's version. The AARP leadership's Democratic sympathies will probably prevail in the end, perhaps after some price-control sweeteners are added for prescription drugs. But AARP is out of touch with its own members, who have figured out that their own health and lives are at stake in this debate over ObamaCare. They know that when medical discretion clashes with limited government budgets, medicine loses.
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Old August 14th, 2009, 09:49 AM   #2
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Lies. All Lies. It is not expressly written in the proposal, therefore, it can never happen. This is all stuff made up by right-wing conservatives spurred on by the leader of the republican party, Rush Limbaugh.

I thought I'd say this before Sova does.
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Old August 14th, 2009, 09:59 AM   #3
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Well, based on what's not in the bill, they are also going to use it to justify killing all puppies and kittens with wood chipper. Just because it doesn't say it in the bill, doesn't mean it won't happen.
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Old August 14th, 2009, 10:04 AM   #4
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Well, based on what's not in the bill, they are also going to use it to justify killing all puppies and kittens with wood chipper. Just because it doesn't say it in the bill, doesn't mean it won't happen.
My thought exactly, it doesn't say that thier are death panels in the bill but we know that they are there, its all in the wording and how to read between the lines. It's the agenda of the obama machine, say one thing and do another
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Old August 14th, 2009, 10:23 AM   #5
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My thought exactly, it doesn't say that thier are death panels in the bill but we know that they are there, its all in the wording and how to read between the lines. It's the agenda of the obama machine, say one thing and do another
again, I
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Old August 14th, 2009, 11:24 AM   #6
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Well, based on what's not in the bill, they are also going to use it to justify killing all puppies and kittens with wood chipper. Just because it doesn't say it in the bill, doesn't mean it won't happen.
have you read the pertinent points of the bill that us conservatives have pointed out?

while I think the death panels are indeed a stretch and deliberately inflammatory choice of words, there is much to be afraid of.

a health czar that has far reaching policy decisions, which are not subject to judicial review?!

I can't find the specific article as I deleted it from my facebook page due to the few, but vocal head-in-sand lefties cluttering up my wall with effeminate postings about how I'm being racist, spiteful, and venemous for disagreeing with obama's new world order, or thinking that pelosi and reid need to just have a one way ticket to cuba.
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Old August 14th, 2009, 01:28 PM   #7
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again, I
What is the all about? Did you not hear today that the provision in the bill to do with end of life counselling, it has been removed, wonder why, maybe just maybe there is some truth to it.
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Old August 14th, 2009, 02:24 PM   #8
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What is the all about? Did you not hear today that the provision in the bill to do with end of life counselling, it has been removed, wonder why, maybe just maybe there is some truth to it.
Great. Rather than seniors getting counseling regarding the options available to them so that they can make those decisions ahead of time and make those wishes known to their family and doctors, they now may go in unprepared and rather than being able to make their own choice of what level of care they receive and when to say enough is enough and let them die peacefully their doctors will be making those decisions for them. All because the paranoid conservatives think everyone’s out to get them.

We’re making real progress now.
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Old August 14th, 2009, 03:51 PM   #9
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Great. Rather than seniors getting counseling regarding the options available to them so that they can make those decisions ahead of time and make those wishes known to their family and doctors, they now may go in unprepared and rather than being able to make their own choice of what level of care they receive and when to say enough is enough and let them die peacefully their doctors will be making those decisions for them. All because the paranoid conservatives think everyone’s out to get them.

We’re making real progress now.
GASP..... not legislationg responsibility............. Double GASP.

While there is a need for said decisions to be made it is not the governments place to step in here. These are family and doctor ( to be made together) decisions not some goverment agencies. What do you think social work and hospice planners do now? To say that people will go without services they need in times of planning is obsurd at best.
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Old August 14th, 2009, 04:11 PM   #10
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Great. Rather than seniors getting counseling regarding the options available to them so that they can make those decisions ahead of time and make those wishes known to their family and doctors, they now may go in unprepared and rather than being able to make their own choice of what level of care they receive and when to say enough is enough and let them die peacefully their doctors will be making those decisions for them. All because the paranoid conservatives think everyone’s out to get them.

We’re making real progress now.
They have people in place for this now. not the government. Next time you go to the doctor ask him yourself and I'm sure he would give you an answer.
Just another way to waste tax payer dollars.
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Old August 14th, 2009, 04:41 PM   #11
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GASP..... not legislationg responsibility............. Double GASP.

While there is a need for said decisions to be made it is not the governments place to step in here. These are family and doctor ( to be made together) decisions not some goverment agencies. What do you think social work and hospice planners do now? To say that people will go without services they need in times of planning is obsurd at best.
Yes, how absurd. We certainly don’t the government doing anything to encourage the people who are on the government program to act responsibly. That’d be crazy. And of course it’s not the government’s job to decide what services the government program should pay for. What was I thinking.
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Old August 15th, 2009, 08:27 AM   #12
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GASP..... not legislationg responsibility............. Double GASP.

While there is a need for said decisions to be made it is not the governments place to step in here. These are family and doctor ( to be made together) decisions not some goverment agencies. What do you think social work and hospice planners do now? To say that people will go without services they need in times of planning is obsurd at best.

Yes, they will go without exactly what you are describing.

I really wish you people would understand what the provision was for. It did not legislate any action on the part of the patient, doctors, etc. It provided for funding, through Medicare, for exactly the type of social work you are describing.
The provision did put some government weight behind the documents describing the patients desires. But it never, not once, mandated anyone to do anything.
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Old August 15th, 2009, 08:28 AM   #13
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They have people in place for this now. not the government. Next time you go to the doctor ask him yourself and I'm sure he would give you an answer.
Just another way to waste tax payer dollars.

And now Medicare will not cover this service for seniors.
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Old August 15th, 2009, 09:18 AM   #14
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And now Medicare will not cover this service for seniors.
My mother inlaw past away 2 years ago and she did have that option, her doctor advised her about what she could do, hospice care, chemo or not, meds that would help for pain, discomfort etc.
And this was under the bush administration, go figure that the would actually care for the sick.

PS. it is not medicare that will not help the seniors it is the democratic government and thier policy

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Old August 15th, 2009, 09:49 AM   #15
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My mother inlaw past away 2 years ago and she did have that option, her doctor advised her about what she could do, hospice care, chemo or not, meds that would help for pain, discomfort etc.
And this was under the bush administration, go figure that the would actually care for the sick.

PS. it is not medicare that will not help the seniors it is the democratic government and thier policy
If it was there for her, why would you want to do away with it? Because that is exactly what you are saying should happen. Eliminate the provision completely. So people can say, it's not in the bill so it will not be paid for under this program.

Have said it before, it exists in present policies and is supported by Republicans as well as Democrats.

But, because it is in a reform bill supported by Obama, it is all of a sudden scary and evil.

You do realize that not everything in the reform bill is new, right? Some of it just strengthens what is already happening and available today.

It is not the Democratic administration that will harm seniors, it is the narrow minded, fear mongering, win at all costs people on the right.
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Old August 15th, 2009, 10:48 AM   #16
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If it was there for her, why would you want to do away with it? Because that is exactly what you are saying should happen. Eliminate the provision completely. So people can say, it's not in the bill so it will not be paid for under this program.

Have said it before, it exists in present policies and is supported by Republicans as well as Democrats.

But, because it is in a reform bill supported by Obama, it is all of a sudden scary and evil.

You do realize that not everything in the reform bill is new, right? Some of it just strengthens what is already happening and available today.

It is not the Democratic administration that will harm seniors, it is the narrow minded, fear mongering, win at all costs people on the right.
Having a discussion with your physician is not a billable item
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Old August 15th, 2009, 11:13 AM   #17
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Again, the Bible-thumpers have taken the lead role in the , portraying the party as representing the views of the vocal minority religious right instead of conservatives. Exactly why I identify myself as a "conservative" rather than .

Nothing wrong with hospice care.

That said, Obamacare is still an unspeakably bad idea.
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Old August 15th, 2009, 11:54 AM   #18
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Having a discussion with your physician is not a billable item

Having a discussion with your doctor is not, if it is included in a regular visit.

However, there is much more to "end-of-life" issues that can not simply be dealt with by having a discussion with your doctor.

ANd for the sake of this argument, the term "end-of-life" is not exclusive to a persons actual death. It involves a wide variety of issues facing senior citizens in this country. Wills, living wills, power of attorney, senior living arrangements, long term medications, healthy living information, dietary, exercise, etc., etc.
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Old August 15th, 2009, 11:57 AM   #19
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Again, the Bible-thumpers have taken the lead role in the , portraying the party as representing the views of the vocal minority religious right instead of conservatives.
Valid and right on the money.

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Exactly why I identify myself as a "conservative" rather than .
I still like you though

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Nothing wrong with hospice care.
Hospice care is a very caring and merciful thing. When you know death is coming, wouldn't you rather be with family in a loving environment and at ease, as much as possible given the circumstances?

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That said, Obamacare is still an unspeakably bad idea.
I just don't agree fully with this statement. Something needs to be done, IMO, and I have seen no real alternatives for any real change for the better.
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Old August 15th, 2009, 12:12 PM   #20
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If it was there for her, why would you want to do away with it? Because that is exactly what you are saying should happen. Eliminate the provision completely. So people can say, it's not in the bill so it will not be paid for under this program.

Have said it before, it exists in present policies and is supported by Republicans as well as Democrats.

But, because it is in a reform bill supported by Obama, it is all of a sudden scary and evil.

You do realize that not everything in the reform bill is new, right? Some of it just strengthens what is already happening and available today.

It is not the Democratic administration that will harm seniors, it is the narrow minded, fear mongering, win at all costs people on the right.
Not eliminate the provision, keep it as it is. What is wrong with it the way it is right now?
See my concern is when the government takes control they have the power to do as they please, money runs out or costs sky rocket then health care rationing begins. We have seen the government ration other programs that they hand in thier control because of high operating costs such as the public school system.
We need to look the bill over carefully and agreeing before the signing of it, but you have heard obama himself and others say the bill is too lengthy to read or understand.
With this type of mentality of our government we as citizens may as well be lead to drink the kool-aid that they themselves have been drinking.
Why are you so eager to have this go through when you yourself have heard this? I am sure that there are items you do not agree with throughout this bill and do you have any concerns about how you or your loved ones will be cared for under this new socialized health care bill. The debt for starters will be very, very high. Don't kid yourself when obama says free health care. We will all be taxed to death.
I have said it before the health care in other countries does not compare to what we have here. It needs fixing, yes, but a complete overhaul, no
And for who will take care of the seniors? The children of the elderly parents should help with that and not leave it up to the government, but that is a whole different issue
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