July 2009 (vol. 25, #5)
Lack of “universal coverage” in the U.S. is an emergency requiring a “fix” before the end of the year, claims the Obama Administration. “We can't afford to wait.”
Although lack of socialized medicine in the last bastion of freedom in the industrialized world has been periodically called an emergency since 1943 and earlier, “we have never come this close,” claim prominent Democrats–to setting what Lenin called the “keystone in the arch of the socialist state.”
Reportedly, there are 46 million Americans “without health care” who are jamming emergency rooms–where they are receiving very costly care, at the expense of insured persons and taxpayers. The proposed solution: to force taxpayers to pay through a different mechanism, compulsory “insurance” (third-party payment), which adds overhead to the cost.
Only about half of “recommended” care is allegedly delivered, yet the U.S. spends much more per capita than other countries, and provides perhaps 30% “too much” care.
Obama states that doctors should make decisions, not bureaucrats, yet proposed legislation creates 53 new administrative agencies (bureaucracies).
The contradictions sound a lot like a Hegelian dialectic: thesis v. antithesis–with the solution being a Marxist synthesis: unified control by the One central authority. Social justice requires redistribution of wealth, and of medical care–in the name of population health.
In a dystopic 1967 novel and a 1976 film that bears slight resemblance to it, people have a palm flower or lifeclock implanted at birth. On Lastday at age 21 or 30, respectively, people are supposed to report voluntarily to the Sleepshop. If they don't, a Sandman such as Logan 5 is sent to dispatch them. When his own palm flower turns black, Logan 5 himself becomes a Runner. Parenthetically, there is no need for elders in this world: an all-wise computer runs everything perfectly.
The circuitry in the 2009 version of the lifeclock is far more sophisticated. It can also calculate the QALYs (quality-adjusted life-years) and DALYs (disability-adjusted life-years) expected from various medical interventions. The permitted lifetime is longer; there's a thin tail extending past age 60. But the probability of receiving a medical intervention, according to what Betsy McCaughey calls the Reaper Curve of Obama Rationer-in-Chief Ezekiel Emanuel, peaks around age 20 and heads sharply downhill around age 55 (Wall St J 8/27/09). The curve is based on the “complete lives system” that includes societal “investment” at each age (Lancet 2009;373:423-431).
Since society is “not yet ready” for involuntary euthanasia, and even physician-assisted suicide remains controversial, there is no explicit provision for Sandmen–or “death panels”–in pending legislation. “Counseling” in how to give advance directives to withhold life-sustaining care–including food and water–is already widespread, even if it does not yet get a boost from additional federal funding as proposed. The “Death Book for Veterans” (Your Life, Your Choices) suggests, in sixth-grade language, that veterans should worry about becoming a burden.
In nations that already have socialized medicine for everyone, not just for seniors and indigents, Sandmen are diligently at work. In the UK, continuous deep sedation may account for as many as one in six deaths, although euthanasia is illegal (BBC News 8/12/09; Telegraph 9/2/09).
Distant bureaucrats will not be signing death warrants; they'll just be writing “voluntary guidelines.” Doctors as part of care teams will write the actual orders for patients. They can “deviate” if they choose, but every patient encounter will be documented in an electronic record and tracked. A physician's livelihood will depend on how well he meets the “standards.” Moreover, providing “medically unnecessary” treatment is increasingly being considered a form of “waste, fraud, and abuse.” In House legislation, already harsh penalties are increased to $50,000 per episode, and can include prison.
Obama and retainers assert that the country is awash with myths and misinformation, all being spread by “mobs” and special-interest operatives, well disguised as ordinary Americans of every age and walk of life. Hence the need for the website www.whitehouse.gov/realitycheck. One purpose may be to replace the email@example.com email, to which Americans were urged to report purveyors of “fishy” misinformation, until there was a noisy public outcry.
The Congressional Budget Office (CBO) is apparently complicit with the mob, producing inconvenient cost estimates even as the Administration and MoveOn.org assure us that “we can't afford not to do it.” Even Obama, however, admitted at a Montana forum that “I can't cover another 46 million people for free.” More than $1 trillion in extra revenue is needed.
Huge new revenue streams are anticipated in premiums (non-taxes) from people who now forgo insurance, low-risk individuals who will have to pay community-rated rather than risk-rated premiums, and people forced by government to buy gold-plated rather than “bare bones” policies. “Savings” (non-taxes, non-benefit cuts) of $622 billion from Medicare and Medicaid are estimated. More savings can be realized by trimming or eliminating tax breaks (not the same as increasing taxes) on employment benefits.
The CBO only evaluated the first 10 years. Full implementation of proposed legislation would not occur until after that time. Then, a “debt canyon” would open (Wall St J 8/6/09). Moreover, all previous government programs have resulted in enormous cost overruns: for example, of 644% for Medicare (see www.youtube.com/watch?v=QZEVBogXFFg).
ObamaCare could be different. It's “time to get serious [about cost control]” writes Daniel Callahan of the Hastings Center (N Engl J Med 7/29/09). That requires the “strong hand of government.” Or, as Charles Krauthammer suggests, we could have “the perfect finesse–government health care by proxy” (Wall St J 8/8/09). Nominally private entities will do the dirty work of rationing life, with bipartisan support.
Will there be a Sanctuary to which patients, like Logan 5, can flee to escape from the Deep Sleep Operatives?
What Is the Hegelian Dialectic?
Today, Hegelian-Marxist thinking affects our entire social and political structure, explained Niki Raapana and Nordica Friedrich in October 2005. “The Hegelian dialectic is the framework for guiding our thoughts and actions into conflicts that lead us to a predetermined solution.” Its primary tools are dialogue and consensus-building; terror and intimidation are also acceptable ways to reach the goal.
These writers give the example that if (A, the thesis) my idea of freedom conflicts with (B, the antithesis) your idea of freedom, then (C, synthesis) neither of us can be free until everyone agrees to be a slave.
Hegel, who used the term “Whole” rather than “synthesis,” wrote that “We then recognized the State as the moral Whole and the Reality of Freedom....” He also stated that “the State has the supreme right against the individual, whose supreme duty is to be a member of the State...for the right of the world spirit is above all special privileges.”
Raapana and Friedrich write: “Twisted logic is why cons are so successful.” Hegel's brilliant ability to confuse and obfuscate the true motives of central planners is one reason why, after 150 years of repeated disasters, people have failed to figure out that central planning doesn't work.
“Communism” has been replaced by “communitarianism,” still based on Hegelian principles, which have come to dominate U.S. policy. Intervention, confiscation, and redistribution are replacing Constitutional principles (www.crossroad. to/articles2/05/dialectic.htm).
White House Sued over Free Speech Violations
The Office of the President and other White House officials are defendants in a lawsuit filed by the Association of American Physicians and Surgeons (AAPS) and the Coalition for Urban Renewal and Education (CURE) for “unlawfully collected information on political speech.” The White House solicitation to report “fishy” comments was an illegal use of its power to chill opposition to its plans for health care reform (www.aapsonline.org).
The Constitution and the Denial of Medical Care
In a memorandum to Walter Zelman of the [Clinton] White House Health Care Task Force, Appellate Litigation Counsel Douglas Letter discussed Constitutional issues in the implementation of “health care reform.”
There might be Tenth Amendment difficulties if the federal government directly ordered States to undertake certain activities such as forming health-care cooperatives. To get around this, the requirements should be attached to conditions of receiving health-related federal funding, Letter recommends.
While wage and price controls on medical services have been upheld by courts, there are some aspects that could cause problems; for example, if the restriction keeps a life-sustaining treatment, for which an individual is willing to pay, from being offered at all. Letter writes:
“There are two ways of protecting a system against constitutional vulnerability on this score.” One is to offer doctors “strong incentives to come ‘voluntarily’ within the system,” without making an absolute requirement–thus preserving some “escape hatch.”
Public-private partnerships greatly reduce Constitutional problems. “The Supreme Court has allowed private entities to become very heavily involved in federal regulatory schemes without becoming governmental actors subject to due process restrictions.” (To read the complete memorandum, search www.aapsonline.org for “Zelman.”)
Not Just Rounding Errors
Obama's estimate for what a surgeon gets paid for a foot amputation: up to $50,000. Actual: < $1,000.
Obama's estimate of what the average American family pays because of cost-shifting from the uninsured: “thousands.” Actual: $200 (Kaiser Family Foundation).
Obama claimed his budget would decrease federal spending by $2.2 trillion over 10 years. Actual: a $2.7 trillion increase, a $5 trillion error (CBO).
Obama says the U.S spends $6,000 more on average than other countries on health care. Actual: U.S. per capita spending is $2,500 more than the next highest (OECD). OMB says Obama meant per family, but the standard comparison, and the one used by OECD is per capita. (www.factcheck.org/ politics/print_obamas_health_care_news_conference.html).
On July 27, Rep. Tom Price (R-GA), Chairman of the Republican Study Committee, announced that the U.S. Treasury once again broke records by auctioning off more than $200 billion in debt in eight separate auctions–the busiest week in 24 years.
A $15 Trillion End Run
In FY 2008, the official federal budget was $488 billion. In 2009, it is four times larger, writes Paul Craig Roberts (Chronicles, August 2009).
“We are out of money now,” admitted Obama on May 23. So what the government is doing is bailing out the financial system–with debt. There is no need for the Chinese if the U.S. government can finance itself by buying its own debt; the Federal Reserve planned to purchase $300 billion of Treasury debt by the end of August.
Congress authorized $700 billion in Bailout funds. The Bush and Obama Administrations have committed $15 trillion in cash, purchases, guarantees, and loans, to be doled out by 27 “programs”–for which the Treasury Dept. has cited no statutory authority. Although the U.S. Constitution provides that “No money shall be drawn from the Treasury but in consequence of appropriations made by law,” the Supreme Court has signaled that it will not interfere, writes William J. Quirk (Chronicles, August 2009).
If the U.S. monetizes its 2009 budget deficit, the U.S. money supply will double in one year, and if it monetizes the 2010 deficit, the money supply will have tripled in two years. The U.S., an import-dependent nation, will not be able to pay for her imported goods.
“Once the Romans debased their currency, they were finished,” writes Roberts (op. cit.).
“In one lifetime the United States will have passed from superpower to Third World beggar. An amazing compression of history. The fall of Rome took centuries.”
One alternative to a Treasury default, equally unprecedented and dramatic, would be a repudiation of promised benefits, e.g. Medicare (J.R. Hummel, econlib.org 8/3/09). First, there will be severely rationed care, and devaluation of life.