Let's make a deal

I see from Gateway Pundit and Hot Air that Obama’s press secretary Robert Gibbs says that Obama is willing to be a one-term president if that’s what it takes to make him president-for-life in the new totalitarian socialist regime that will result from enacting Obamacare.

Oh, wait — we were supposed to believe Gibbs meant Obama is willing to make himself so unpopular with voters by getting Obamacare enacted that he will lose the presidential election currently scheduled for November 2012. Of course, now I see — yes, that’s much better.

Now that we know Obama is willing to negotiate, my follow-up question for Mr. Gibbs is, “What do we have to do to get Obama to resign, oh, say, RIGHT NOW?”

Little Miss Attila is a genius …

… for her brilliance in getting people to understand the non-neutral, non-benevolence of government-required education sessions with this analogy in her reply to Charles Krauthammer, M.D., and his column today on “death panels,” including his unfounded invalidation of Gov. Palin’s contribution to the healthcare reform discussion.

See also:

Chiropractor and blogger Melissa Clouthier says, “People telling Sarah Palin to ‘shut up’ should shut up.”

Dan Riehl has a theory on Dr. Krauthammer’s problem with Sarah Palin.

Conservatives4Palin point out that by Dr. Krauthammer’s third paragraph, he is agreeing with Gov. Palin that Obamacare would create “death panels.” How crazy are you when you say you do not agree with someone, ask them to “leave the room,” and then re-state their point of view as your own?

First expand the supply THEN increase the demand — UPDATED: IBD survey says 45 percent of doctors will shut down their practices or retire early if Obamacare is enacted

I have been pondering a post for several days on the probability that one of the first effects of Obamacare will be to reduce the number of doctors. If Obamacare is passed, I believe that from that moment, thousands of doctors will start to plan how to sell or close their practices and change careers.

I do not think doctors are going to say, “Yes, Obama, I do not deserve to make a good living as a doctor. I will take what you hand out. If it’s not enough to cover my current expenses, including my malpractice insurance since healthcare reform did not include tort reform, I will sell my house and move to a cheaper neighborhood. I’ll shop at Wal-Mart and Goodwill. I’ll fire the employees that I need to ensure prompt care and get along with the bare minimum of staff.”

My observation of the doctors I’ve worked with over the last 25 years as a caregiver for my late life partner and my parents is that in high school they were the smart, scientifically-inclined, ambitious kids who wanted to be their own boss yet were too risk-averse to be real entrepreneurs, so they chose medicine because it provided the independence they desired within a structured environment for career advancement and the near-certainty of making a six-figure income — and more if they were prudent, invested well or were real entrepreneurs able to found and build successful ventures. Oh, and they also crave honor and go to considerable lengths to earn it.

So doctors are not the type of people who passively accept having everything they’ve worked for yanked away — income, autonomy, honor, meaningful careers — as Obamacare would do.

What I predict will happen is that a significant percentage of doctors will decide that their skills are transferable to another profession where they will have the income, autonomy and honor they have earned and deserve. Maybe they will switch to a medically-related business. But what will really hurt public access to healthcare is that they will not be practicing medicine anymore.

The loss of this amount of training and talent — the death of so many medical careers — as one of the first consequences of Obamacare if it is passed, will be a type of Holocaust. It will be chillingly comparable to Stalin’s murder of plant geneticist Nikolai Vavilov and purge of a generation of biologists who defied Lysinkoism and dialectical materialism.

What prompted me to write this post was reading at Newsbusters the following statement by Dick Morris today from their full transcript of an interview with him this morning (8/21/09) by CBS’s “Early Morning” co-host Maggie Rodriguez. I have boldfaced the points I think are the most important:

MORRIS: I’m in favor of covering everyone, but I think the way to do that is first expand the number of doctors and the number of nurses. Expand the supply before you expand the demand. How is Obama going to cover 50 million new people without any more doctors or nurses? And the answer is he’s not. And what that’s going to mean is rationing, which primarily means that the elderly don’t get the medical care they get now. And I take this personally. My dad’s 99, and I can under – he’s doing fine. But I can understand the rationale that says, ‘well, he’s 99 and so on and so on.’ But-

RODRIGUEZ: Well, no, no, that’s – he still deserves it.

MORRIS: Boy, those years – those months and years are precious to me.

RODRIGUEZ: But yesterday, the President guaranteed that this would not only pass, but that it would pass without reducing [increasing] costs, without cheating anyone of care that they deserve, and by not adding to the federal deficit.

MORRIS: Well, first of all, how is he going to cut $200 billion from Medicare without cutting Medicare?

RODRIGUEZ: Well, he said – and I remember in July, I looked back at my notes this morning – he said it would not affect Medicare benefits.

MORRIS: He’s cutting Medicare by $200 million – $200 billion.

RODRIGUEZ: So we have to hold him to it is what you’re saying?

MORRIS: Well, what he’s saying is ‘I’m going to cut reimbursement rates to doctors and to hospitals.’ But if you cut reimbursement rates to doctors, you get shorter office visits and fewer office visits. And if you cut them for MRIs, you get fewer MRIs. And what this is going to ultimately lead to is fewer and fewer doctors, because their income is being cut, more and more patients, because the coverage is being expanded. And then when you say, ‘okay, who’s going to not get the medical care here?’ It’s the elderly, because they’re the ones that aren’t, quote, ‘fully entitled’ to it. They don’t benefit from it as much as a younger person. And I think this is just a catastrophe.

RODRIGUEZ: Well, maybe he can compromise with the Republicans, as you encouraged Bill Clinton to do, back in the day.

MORRIS: I don’t think he’s – I don’t think compromise is on his agenda there.

Rodriguez is functioning here not as a devil’s advocate but as a true believer of the White Queen School of True Believing whose graduates elected Obama due to their discipline of believing six impossible things before breakfast every day,* thus enabling them to believe ALL of the impossible and mutually-exclusive promises Obama made and makes to get their money, power, labor and votes with no intention of keeping the majority of his promises. Only people who truly have mastered magical thinking and abdicated their critical powers of analysis are able to believe that Obama is telling the truth when he says $200 billion in cuts to Medicare will not result in cuts in service and access.

I’m going to keep saying it until a critical mass of voters grasp this point: Obama is a sociopath who tells people what they want to hear in order to gain their trust and then he makes promises he does not intend to keep in order to get them to give him willingly whatever he wants from them. Whenever people realize he has ripped them off, he has a repertoire of behaviors to fend them off, invalidate their complaints and/or lead them on. He was trained in these techniques by followers of Saul Alinsky. But it also is how sociopaths behave. They are able to act in this way — making contradictory and mutually exclusive promises, alternating between charm and bullying, between persuasion and force — because they do not have the faculty that would give their behavior consistency to a set of values: they lack a conscience. Sociopaths also lack empathy, which results in their inability to feel the full range of emotions. The only emotion they fully feel is the thrill of power.

That is why Obama does not have compromise on his agenda. That is why Obama’s healthcare reform package will not make healthcare cheaper and more available by increasing the number of doctors, nurse practitioners, physician’s assistants and nurses. That is why Obama’s healthcare reform package does not include tort reform, or encourage competition by allowing the purchase of health insurance across state lines, or ban illegal immigrants from receiving healthcare or uncouple health insurance from employers. Obama’s healthcare package is intended to nationalize the healthcare industry — to transfer the power of making medical decisions from the patient-doctor relationship to bureaucrats who are not accountable to the people whose care decisions they will make. And that is why there is no fixing Obamacare. It must be defeated. And Republicans should be doing the hard work of drafting their own capitalism-based healthcare reform package — as Saul Alinsky pointed out in Rule 11 of his “Rules for Radicals,” you will not get a seat at the bargaining table if you just work to defeat a plan you don’t like — you must have an alternative to propose.

Expanding the supply of homegrown healthcare professionals before increasing the demand seems to me like one of the very best places to start.

* Through the Looking Glass by Lewis Carroll, Chapter Five:

Alice could not help laughing at this, even in the midst of her tears. ‘Can you keep from crying by considering things?’ she asked.

‘That’s the way it’s done,’ the Queen said with great decision: ‘nobody can do two things at once, you know. Let’s consider your age to begin with — how old are you?’

‘I’m seven and a half, exactly.’

‘You needn’t say “exactly”,’ the Queen remarked. ‘I can believe it without that. Now I’ll give you something to believe. I’m just one hundred and one, five months and a day.’

‘I can’t believe that!’ said Alice.

‘Can’t you?’ the Queen said in a pitying tone. ‘Try again: draw a long breath, and shut your eyes.’

Alice laughed. There’s no use trying,’ she said, ‘one can’t believe impossible things.’

‘I daresay you haven’t had much practice,’ said the Queen. ‘When I was your age, I always did it for half-an-hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast. There goes the shawl again!’

Yikes, I just realized even the White Queen doesn’t believe Obama can do two things at once. Probably because she’s a RAAAAAACIST! Off with her head!

Update, 9/16/2009, Wed.: Via Michelle Malkin, just as I predicted:

Investor’s Business Daily reports on the results of its heart-stopping poll of doctors:

Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted, a new IBD/TIPP Poll has found

The poll contradicts the claims of not only the White House, but also doctors’ own lobby — the powerful American Medical Association — both of which suggest the medical profession is behind the proposed overhaul.

It also calls into question whether an overhaul is even doable; 72% of the doctors polled disagree with the administration’s claim that the government can cover 47 million more people with better-quality care at lower cost.

Successful quadriplegic ex-football player on cover of August 24 Sports Illustrated

Marc Buoniconti became a quadriplegic due to an injury in a college football game when he was 19. Now he is president of the Miami Project to Cure Paralysis, an organization whose discoveries have transformed the practice of medicine. He is shown in his sip-and-puff power wheelchair, which allows him to use his breath to direct his wheelchair independently.
Marc Buoniconti became a quadriplegic due to an injury in a college football game when he was 19. Now he is president of the Miami Project to Cure Paralysis, an organization whose discoveries have transformed the practice of medicine. He is shown in his sip-and-puff power wheelchair, which allows him to use his breath to direct his wheelchair independently.

I took Dad to the dentist today and the latest issue of Sports Illustrated was on top of all the other magazines with a cover story about quadriplegic ex-football player Marc Buoniconti, so I eagerly picked it up to read the story. What a contrast between Buoniconti’s story and that of the Australian former athlete and economist, Christian Rossiter, who is now imprisoned in a nursing home for the crime of needing too much assistance with activities of daily living* and assistive devices to lead a rewarding life and has just won the right to refuse nutrition and fluids through his feeding tube — supposedly because of his unfixable quadriplegia but more likely because he is dying of boredom THAT IS READILY FIXABLE!

Once he wakes in the expansive South Miami high-rise apartment where he has never taken a step, Marc Buoniconti, 42, calls into a nearby speaker to the full-time nurse. Some days it’s Lance, some days Peter, some days Mike or Martin. Within seconds the man appears, places pills in Buoniconti’s mouth, pours medicine down his throat and inserts a catheter into his penis to drain the urine. After removing the catheter he unrolls onto Buoniconti’s penis a condom that is connected to a plastic bag strapped to one leg. He checks Buoniconti’s vital signs, stretches his limp arms and legs and examines him for skin lesions or swelling or redness. He pounds Buoniconti’s chest to clear his lungs. If Buoniconti is due for a bowel routine, he places suppositories in his rectum. Then he picks Buoniconti up, places him in a waterproof wheelchair and guides him to the shower.

Sometimes it’s three hours before Buoniconti is fully dressed. Still, he is far better off than most quadriplegics. That he has survived nearly 24 years in this state is testament to his deep reservoirs of patience and grit, not to mention the power of money. Much of Buoniconti’s $500,000 annual nursing bill, as well as the cost of his $60,000 customized van and $24,000 electronic wheelchair, is covered by the health-care package that his father, Dolphins Hall of Fame linebacker Nick Buoniconti, received during his post-NFL days as president of U.S. Tobacco.

“My dad did well for himself, but if we didn’t have the insurance I have, we’d be broke trying to take care of me,” Marc says. “No—I’d probably be dead.”

It does not cost this much to give every quadriplegic an active and meaningful life. Buoniconti’s family is prosperous and the American can-do spirit has created a system where indoor and outdoor environments are wheelchair-accessible and assistive devices have been invented and made available in the market to allow a quadriplegic to have a useful and rewarding life.

I really recommend reading the whole story. But, even allowing that Buoniconti is in a rare situation because he has family money, influence and support to empower him, when we think of healthcare systems that abandon quadriplegics and create the conditions in which almost anyone would want to die, like Charles Krauthammer, he represents what is possible to accomplish, when properly empowered, even with quadriplegia:

The iPhone rings beneath his fingers. Peter hustles over, holds the phone up to show who’s calling, pushes the button and stands there, arm extended, as Buoniconti speaks. He gets calls all day—from family members, buddies, staffers at the Miami Project to Cure Paralysis—and answers in a voice that ranges from near whisper to brassy baritone as he takes the shallow breaths afforded by a diaphragm operating at 30%. Afternoons he spends at the Miami Project, a few Dan Marino bombs from where the Orange Bowl used to be. In January 2008, Buoniconti became president of the 23-year-old organization, making official what had been clear for years: He is the project, the animating force behind the 250-person staff; the decade-old, $40 million research center; the mind-boggling $300 million that has been raised for research by the Buoniconti Fund.

University of Miami surgeon Barth Green, the project’s cofounder and chairman, had been rejected for an NIH grant two months before The Citadel played in Johnson City in 1985. But in Buoniconti, the cause suddenly had a stirring story to tell, complete with a famous dad who could tap all his moneyed contacts in sports and the media. Nick [Mark’s father]raised $2 million the first year alone, and once his 20-year-old son left the hospital, once Marc appeared at halftime of a Dolphins-Jets game before 80,000 standing fans, the cause had its irresistible face, young and tragic and disarmingly upbeat. Marc Buoniconti—an incorrigible flirt with pretension-puncturing wit and a knack for charming everyone from kids to civic leaders—could get jocks, entertainers and business types to write checks like no one in a lab coat ever dreamed of.

Without Marc? The Miami Project, Green says, would still be a small-scale research center incapable of assembling the team that pioneered its hypothermia treatment, which helped Bills tight end Kevin Everett to walk again after a helmet-first hit in 2007 dislocated the same two cervical vertebrae that Buoniconti broke. Without Marc, Green and his team probably would not be poised to begin, pending FDA approval, the first testing regime for the effectiveness of Schwann cell transplants on human subjects—a regime already proved to restore 70% of spinal-cord function in lab animals.

“Every hospital in the world and paramedics are using hypothermia for cardiac arrest, in cardiac and vascular surgery, and in the future they’ll be using it for brain injury and spinal-cord injury and stroke,” Green says. “Even though we haven’t cured paralysis, we’ve done a lot to change the practice of medicine. Physical therapists are using electrical stimulation because the Miami Project proved [its effectiveness] scientifically. Doctors in operating rooms all over the world are checking patients’ brains and spinal cords because the Miami Project got monitors approved by the FDA. We’re making babies from paraplegics and quadriplegics because we changed a research project into a clinical practice. We’ve made some good contributions to the quality of life for people who are and aren’t paralyzed.

“Marc was the catalyst. And Marc is truly the president: He makes the policies, he’s the speechmaker—a much better talker than his old man and me put together. Used to be, I didn’t want to follow Nick on the stage. Now I don’t want to follow Marc.”

The ingredients that make people want to live are loving and being loved, feeling needed and having a place in the world, and having power to fulfill your desires — by which I mean the basic ones: the kind of care you want, the foods you enjoy, the clothes you prefer, the music and books and TV shows you like. Quadriplegia may not be fixable. But there IS a marketplace where the ingredients for the will to live are readily available. And the recipe for the will to live is VERY fixable.

* “Activities of daily living,” or ADLs, is a term that is defined in medicine and law as the basic activities a person must be able to do in order to live without the assistance of anyone else: ambulate, get to the toilet, bathe, brush teeth, brush hair, shave, put on make-up, dress and undress, cook and clean house, to mention several.

NOW I know why Gay Patriot denounces Barney Frank so often

I’ve been reading Gay Patriot since last fall, but I have been puzzled all that time about why Gay Patriot and Daniel Blatt (formerly known as Gay Patriot West) hated, denounced and ridiculed Democratic Massachusetts Congressman Barney Frank with so much venom.

Until today when I saw a few minutes of Barney Frank’s psychotic rants against his constituents who object to Obamacare at one of his town meetings on CNN this afternoon. And now I am up to speed.

First Frank went crazy over a question from a woman comparing Obama to Hitler — the era in which it was patriotic to compare the U.S. president to Hitler when you objected to his policies appears to have ended at 11:59 am, January 20, 2009. CNN failed to report that the woman is a Lyndon LaRouche Democrat, according to John McCormack of the Weekly Standard (H/T Memeorandum). Details, details. But Obamacare is a totalitarian program that seems structured more to destroy capitalism than to provide healthcare and there really IS a basis for the comparison. A sane person could have answered the question without the histrionics Frank employed.

Then when anyone booed, Frank took the opportunity for additional rants about how insulting your opponent in a debate is unfruitful. These amounted to hypocrisy because in the next breath he would insult the people who disagreed with him without any awareness of the obvious irony that he was revealing he wanted nothing less than a fruitful dialog. Toward this end he also made his rants very long, in order to filibuster and run out the clock.

CNN’s commentator said Frank is like this all the time.

So that is that between Barney Frank and me.

Discovery of an amino acid in a comet says NOTHING about the origin of life

funny pictures
moar funny pictures

Instapundit has linked a story about the discovery of the amino acid glycine in a comet. This is supposed to support the hypotheses that amino acids in solution through the laws of physics and chemistry one day linked up and voila! life originated AND that we don’t have to worry our pretty heads about how amino acids originated and that there is no geologic evidence of a pre-biotic soup BECAUSE the amino acids were delivered from other planets, where, naturally, we don’t have to concern ourselves with how amino acids originated because life exists and therefore it was inevitable.

OH.

MY.

GOD.

If you will pardon the expression.

THIS is why my father, Hubert P. Yockey, has been saying since the 1970’s that scientific explanations for the origin of life are based as much on faith and miracles as all of the religious ones combined.

Studying the origin of life through physics and chemistry is exactly the same as studying literature through the chemistry of ink and the physics of how ink is arranged on a page.

The non-material thing that distinguishes life from matter is information. Information is recorded in DNA by a 64-letter alphabet of codons (the four nucleotides in 64 combinations of three). Because it is recorded by an alphabet, it is digital. Because the letters of the alphabet are separate from one another, it is segegated. And because the “meaning” or capacity to create life through a series of instructions comes from the sequence of the letters, it is linear. This means that life is the first digitally recorded information and that the genome — the non-material information recorded in DNA — is digital, segregated and linear.

Information is recorded in DNA, transferred from the 64-letter alphabet of DNA to the 64-letter alphabet of RNA — the letters for DNA and RNA are called “codons” — and then to the 20-letter alphabet of protein, i.e., the amino acids. You cannot discover the origin of life by tracing it back from the amino acid alphabet to the RNA alphabet because some of the amino acids are matched in the genetic code to more than one RNA codon. (The genetic code tells which letters of DNA are coded to which letters of RNA — a one-to-one code — and which letters of RNA are matched to which letters of protein — a several-to-one code.) So you can never know with precision which RNA codon selected those amino acids. Therefore, just as the Central Dogma states, information flows only between alphabets of the same number of letters, or from larger alphabets to smaller ones.

Therefore, as Charles Darwin and Niels Bohr stated, and as Hubert P. Yockey has shown, the origin of life is an axiom of biology, just as the origin of matter is an axiom of physics and chemistry.

So whatever the discovery of glycine in a comet means, it has nothing whatsoever to do with the origin of life anywhere.

Obama's ignorance during his healthcare press conference and town halls more than cancels Palin's bad interviews

When I was watching Obama’s July 22 press conference in which he clumsily tried to sell his healthcare reform legislation, I was astonished at how much he revealed that he is — what’s a nice way of saying this? — intellectually uncurious, uninformed, misinformed and lazy. And that was before he announced he knew nothing about Sgt. Crowley arresting his friend but thought that Sgt. Crowley had acted stupidly. He has only added evidence for these characterizations of him during his town hall meetings.

Let me be the first to say that Obama’s public performances just from the July 22 press conference and his town hall meetings MORE than cancels out Sarah Palin’s bad interviews.

Two of the um, uninformed things Obama said about his healthcare reform bill were that we would choose better between the red pill and the blue pill, which I believe means choosing more frugally between generics and patented drugs. This was low-hanging fruit in cutting the costs of healthcare and is already being done. The second was claiming doctors would routinely perform tonsillectomies instead of treating a child with antibiotics because the surgery is more profitable. No. That’s not the way that works.

Is Obama so accustomed to having other people do his homework and taking credit for it that he has concluded from all the adulation that he does not have to do his homework on healthcare reform and the proposed legislation in Congress and no one anywhere will be informed enough to know the difference?

Wrong, Obama. Wrong.

Thanks to Hot Air I have come across a piece by Dan Calabrese that details Obama’s techniques as a “bullshitter” with great insight — it turns out the type of bullshitter Obama is matches the descriptions I’ve been giving of Obama as a sociopath (I boldfaced the most important points):

In a devastating commentary in the Wall Street Journal, Dr. Scott Gottlieb – a practicing internist, former official at the Centers for Medicare and Medicaid Services and currently a fellow at the American Enterprise Institute – demonstrated convincingly on Friday that President Obama simply doesn’t know very much about the practice of medicine.

If you want the details, read Gottlieb’s piece. But I reference it here because it fits a larger and very troubling pattern about the president: The more he talks, the more he reveals himself not to understand the very subjects about which he waxes on with such seeming eloquence.

There is a name for a person with a talent like this: He is an expert bullshitter. And I will be honest and tell you it’s a talent I share. Deploying this talent can be a lot of fun, and I don’t have a big problem with it if it’s used innocuously. Many a great con artist will stand there and talk with such confidence about this or that, you are absolutely convinced this guy knows exactly what he’s talking about. The truth is that he doesn’t have the slightest idea, but he’s very smooth in his use of the language and his tone of voice, so he convinces you he’s on solid ground when he really isn’t.

[snip]President Obama is one of the most talented bullshitters I have ever seen. He knows all the tricks. He reframes every issue so he can keep it focused on the stuff he wants to talk about, and avoids having to address things he knows nothing about. He tells you what you already think, and he does it so convincingly that you don’t remember you never mentioned thinking any such thing. And most impressively of all, he blatantly makes things up, and says them with such conviction, you can’t imagine they’re not true.

[snip]

This is what Obama does all the time. He waxes on about the economy, and about the decisive action that must be taken to address it. But if you actually consider carefully the statements he makes about the economy, you’ll start to figure out that he doesn’t really understand economics at all.

Obama went to the Middle East and made a series of speeches about strategic issues, about the Israeli-Palestinian conflict and about the wars in Iraq and Afghanistan. They sounded smooth, but for the careful listener, they betrayed a shocking lack of knowledge about the subjects he was addressing.

This should really surprise no one. We elected a president who has never worked in the private sector, who has never functioned as an executive at any level, and whose very brief work in the U.S. Senate consisted of no significant accomplishments. He has spent his entire life spouting left-wing inanities with great eloquence, but he has learned very little about how the real world works.

And yet he was elected president, in part, because people were convinced he was brilliant, and they were tired of the “dumb” George W. Bush, who had not only run a large state for six years, but had also run several businesses and earned a master’s degree from Harvard.

Turns out Barack Obama doesn’t really know very much about anything, a fact that is troubling enough by itself. But when you combine it with his apparent conviction that he should be put in charge of regulating all these things he knows nothing about, and then you add in his talent as a first-rate bullshitter – you end up with the most ignorant guy in the room making the decisions for the rest of us.

I call bullshit.

I still call sociopathy. “Bullshit” is just too benign a connotation to describe Obama’s rhetorical techniqes.

OK, so I checked out the piece that inspired Calabrese to write the piece above, and it has this hidden gem, which I have boldfaced:

Regulating medical decisions should not be the responsibility of a remote Washington bureaucracy. The only way to instill more reflection at the point of medical decision making is to give doctors and patients reasons to consider the cost of various options.

For doctors whom Medicare pays per intervention, the problem isn’t the fee-for-service model, but the way that the government program sets the fees. Fees are set according to a fixed price schedule with no tie to the physician’s quality, experience level, or the outcome of the service.

A more rational system would pay doctors for entire “episodes of care,” rather than individual procedures. Private health systems like the Geisinger Clinic and some Blue Cross plans have adopted this model and pay doctors for taking care of an entire illness.

Medicare doesn’t have the ability to track episodes of care. It has struggled to adopt even modest payment reforms such as restricted panels of providers, value-based insurance, and account-based coverage, where consumers control their own spending—all techniques used by private insurers to improve efficiency.

Medicare’s size demands that it keep payment systems simple. Thus it relies on fixed prices for checklists of services tied to discrete billing codes. These uniform payment rules reward low and high quality care the same. What’s troubling is that the heart of the president’s plan—a government-run “public” insurance program—is modeled directly on Medicare.

There are two reasons to pay attention to the proposal to pay doctors for “episodes of care.” One is, it rewards the behaviors that lead to the better outcomes. The other is, most people do NOT realize that NO ONE is helping them wind their way through the medical system any more — not since the 1990’s when costcutting measures were instituted to discourage doctors from referring patients to a network of specialists of their own creation. When that practice was halted, doctors were discouraged from looking at you and your illness as a whole and they were punished for guiding you through the healthcare system. Instead, diagnoses, tests and procedures were given billing codes — so medicine has been tilted toward practicing to meet billing codes. Insurance companies now are the ones that build networks of specialists. But still — before the 1990’s, your doctor would see you through, now no one does. Well, actually, very prosperous people can pay a medical concierge service to do this, or see a boutique doctor who has limited his or her practice to 800 or so patients who pay a monthly or yearly fee in addition to insurance for the doctor’s care. Or you have a spouse or parent or child or friend or caregiver like me. Those are the options.

I don’t think there’s anything wrong with concierge medicine or boutique doctors. But I especially want people over 40, who grew up with a doctor managing their care and guiding them through the system, to know that medicine isn’t practiced this way any more so that they know from the git-go of meeting with a doctor that they must be their own case manager and patient advocate. Changing the payment model to “episodes of care” is probably our best shot at putting the doctor back in his rightful place as a patient’s guide and protector in the healthcare system. But until that model is widely adopted, be aware: in our current system, you’re on your own and must take care of yourself despite the fact that you are sick and have the least ability to do the job well and wrongly believe that others are looking out for you.

Australian quadriplegic granted right to die, but I think he was driven to this decision

My late life partner, Margaret Ardussi, before we met, was a champion swimmer, ballet dancer, hiker and mountain climber. However, she could only limp a couple of blocks when I met her and became paralyzed from the chest down due to her MS in April 1992. Within a couple of years she lost most of the use of her hands, so Margaret was quadriplegic due to multiple sclerosis the last 10 years of her life. I cared for Margaret throughout our 20-year relationship and she died under hospice care in our home with me at her side on Dec. 7, 2004.

So I know a little bit about coping with quadriplegia.

The most important thing I know about coping with quadriplegia, or any progressive, debilitating and ultimately terminal illness is what makes people want to live:

  1. People you love who make you feel loved and needed.
  2. Power to do things you want to do and have your choices for yourself honored.

Feelings of meaning and purpose to your life help, too.

And I am positive that the story that came out yesterday of a quadriplegic man in Australia winning the right to refuse food and fluids in order to die is being reported by people who have NO IDEA about what are the right questions to ask to see if this man has not been been driven to this decision by a number of circumstances and therefore has not really made it of his own free will.

Here’s how CNN is reporting it — I have boldfaced the points I think are the most telling:

An Australian high court ruled Friday that a quadriplegic man has the right to refuse food and water and can be allowed to die, a rare legal finding that some see as a major victory for right-to-die campaigners.

The ruling means that the nursing facility in which Christian Rossiter has lived since November 2008 cannot be held criminally liable for allowing the patient to die, the Supreme Court of Western Australia said.

“I’m happy that I won my right to die,” Rossiter, 49, said afterward. But he added that he will further consult with a doctor because he may change his mind.

A leading Australian right-to-die advocate called the ruling a significant victory.

“I don’t know that many people will want to die this way. But for people who do, it’s a very important decision,” said Dr. Philip Nitschke, founder and director of Exit International, a leading global voluntary euthanasia and end-of-life advocacy group.

Nitschke noted that Rossiter’s case is significant because his mind is fully functional.

“This is the first time that it’s come up with a person that’s rational and lucid,” Nitschke told CNN. “This is unusual. It’s very rare.”

Chief Justice Wayne Martin noted that distinction in his order, saying, “Mr. Rossiter is not a child, nor is he terminally ill, nor dying. He is not in a vegetative state, nor does he lack the capacity to communicate his wishes. There is therefore no question of other persons making decisions on his behalf.

“Rather, this is a case in which a person with full mental capacity and the ability to communicate his wishes has indicated that he wishes to direct those who have assumed responsibility for his care to discontinue the provision of treatment which maintains his existence.”

[snip]

Rossiter has suffered a series of injuries since 1988 that have left him with limited foot movement and the ability to wriggle only one finger. He is fed through a stomach tube. He relies on staff at the Brightwater Care Group nursing facility in the city of Perth for such routine care as regular turning, cleaning, assistance with bowel movements, physical and occupational therapy and speech pathology.

Australian law gives patients the right to refuse life-saving treatment, but helping someone commit suicide is a crime that can carry a life prison sentence. The Brightwater nursing facility sought the ruling to make sure it would not be held liable if it complied with Rossiter’s request to stop all nutrition and hydration, except to be given enough liquid to make it possible to take pain medication.

Rossiter attended the hearing in a wheelchair, breathing through a tracheotomy tube in his throat. He told the judge he wants to die.

It’s a point he has been making publicly.

“I can’t move,” Rossiter said in a televised interview this week. “I can’t even wipe the tears from my eyes. And I’d like to die. I’m imprisoned in my own body. I have no fear of death. Just pain.”

Rossiter pointed out in a recent interview with the PerthNow news outlet that he once led an active life.

“This is living hell,” he is quoted as saying. “I used to be a cyclist, I used to be a keen walker. I bushwalked around the world. … I’ve rock climbed in Yosemite Valley in California up very steep cliffs. I’ve got a degree in economics and now I can’t even read a newspaper, I can’t turn the pages.

Rossiter joined the Exit International right-to-death organization about three months ago, said Nitschke, who talked with him before the hearing.

Frankly, I think Exit International went to work on Rossiter to get him to want to die because he would make great case law they can use as precedent to induce more quadriplegics to kill themselves.

Here’s the thing: Rossiter is in a nursing home ONLY because of the number of activities of daily living (ADLs, this is a term that is defined in both medicine and law) he requires. He is intelligent and lucid. He has an education and a profession. There are assistive devices that would make it possible for him to read anything he wants. A computer with voice recognition software and access to the Internet would let him work and communicate with the world. A sip-and-puff wheelchair would allow him freedom of movement. (In the U.S., thanks to the Americans with Disabilities Act, he would be able to use public transportation, especially in large cities. He also would be able to visit public accommodations like stores, theatres, museums and parks.)

Would you like an example of someone who is a quadriplegic and is able to have a productive, fulfilling and lucrative life? CHARLES KRAUTHAMMER IS A QUADRIPLEGIC!!!

I will grant that to have a fulfilling life a quadriplegic also needs an assistant, in addition to an appropriate wheelchair and living and working environments that meet accessibility regulations. But these things exist. AND ROSSITER DOESN’T HAVE THEM. Instead, he has been jailed in a nursing home for the crime of needing too much help with his personal care requirements — his ADLs (bathing, brushing his teeth, etc.). It looks to me like he has been deprived of the assistive devices that would allow him to be productive and have a fulfilling and meaningful life. He has been deprived of the assistance and transportation that would allow him to go places he would find fulfilling and interesting.

What does all this mean?

Rossiter doesn’t want to die because he has quadriplegia. Rossiter wants to die because he has terminal boredom — a condition that can readily be cured.

And here’s my proof that Exit International is a group of death junkies who work to destroy the social supports for the disabled, the frail, the chronically ill and the elderly — all of the people they consider unworthy of a society’s duty to empower and care for as individuals — instead of doing the simple things that would make Rossiter’s life filled with joy and meaning, they went to work on him to get him to want to die so he would kill himself and they could make it look like their hands are clean. Well, they aren’t.

While I agree with U.S. law that nutrition and fluids provided through a feeding tube are medical treatment that people must be as entitled to refuse as any other medical treatment, I know it is possible for quadriplegics to have long and rewarding lives IF THE SYSTEM IS SET UP TO ALLOW IT. Our duty is to ensure that system is available. Only then is it truly a free will decision by a quadriplegic to refuse nutrition and fluids through a feeding tube in order to die. But absent that, it is not a right-to-die case, it is a case of murder — perhaps a death by a thousand cuts, but murder nonetheless.

Update, 8/16/09: Mark Steyn at National Review Online has some worthwhile observations — here’s a sample and I recommend reading the whole piece (I boldfaced the points I think are the most important):

The problem with government health systems is not that they pull the plug on Grandma. It’s that Grandma has a hell of a time getting plugged in in the first place. The only way to “control costs” is to restrict access to treatment, and the easiest people to deny treatment to are the oldsters. Don’t worry, it’s all very scientific. In Britain, they use a “Quality-Adjusted Life Year” formula to decide that you don’t really need that new knee because you’re gonna die in a year or two, maybe a decade-and-a-half tops. So it’s in the national interest for you to go around hobbling in pain rather than divert “finite resources” away from productive members of society to a useless old geezer like you. And you’d be surprised how quickly geezerdom kicks in: A couple of years back, some Quebec facilities were attributing death from hospital-contracted infection of anyone over 55 to “old age.” Well, he had a good innings. He was 57.

The Islamic republic of Michigan is thinking about taking Gitmo prisoners

I don’t see anyone in the MSM or blogosphere posting the names of the states with dangerously large populations of Muslims — who will be using democracy to destroy democracy — but Michigan is one of them. Ask Saginaw. And Dearborn.

Now various news reports say Standish, Michigan, has a prison that is about to be closed and the town officials are looking to keep it open by taking prisoners from other states, or the Gitmo prisoners.

Thanks to the MSM refusing to report on the requirements of Islam to convert or kill all non-Muslims — I believe their zeal for the truth is tempered by sincere bomb threats and the examples of actual murders of their more defiant colleagues — most people in the U.S. think Islam is just one more religion to tolerate and that they would be bigots is they thought there is any difference between being a Muslim and being a Methodist.

I can think of seven: taqiyya, jihad, fatwa, sharia, burka, female genital mutilation and honor murders.

Why is no one in Standish considering what friends, family members, colleagues and employees of the terrorists in Gitmo, who have not been allowed contact with their favorite terrorist during his incarceration in Gitmo, but who will be ready, willing and able to move close to him if he is re-located to the United States?

Because I’m thinking there’s more to consider here longterm than boosting the local economy.

And now Glenn Beck — I told you THE BULLIES WOULD MULTIPLY

funny pictures
moar funny pictures

In June and July after David Letterman’s attacks on Gov. Palin and her children, I posted repeatedly that conservatives had to make an example of David Letterman and get him fired or else the bullies would multiply and drive more conservatives out of the marketplace of ideas. See here and here, or my “Fire David Letterman” category here. I was finishing my last post on how to get Letterman fired on July 3 just as Gov. Palin announced she would resign at the end of July.

Now Erick Erickson at Redstate reports the bullies are going after Glenn Beck. He has a helpful list of contact information for the sponsors so you can let them know of your support for Glenn Beck AND THEIR PRODUCTS IF THEY CONTINUE TO SPONSOR HIS SHOWS. However, he only provides the name, e-mail address and phone information of the people to contact. That is not enough.

Please see my July 3 post about how to get Letterman fired and print out the instructions for what to do to support Glenn Beck that will be the most effective. I have the complete contact info for Johnson & Johnson. If someone finds the other info, please let me know in the comments. It involves snail mail, but Sebastian Gray of HillBuzz reports that this is what really makes sponsors change their behavior. Oh, and rest assured: the Left already knows these tactics are the most effective and is already using them. That’s why they are winning. We are fighting for the future of America, gentle readers — bestir yourselves!

For the most effective instructions on how to fight for Glenn Beck, here are my posts with instructions on how to influence sponsors, which I wrote for my campaign to get David Letterman fired:

“Your handy ‘Fire David Letterman Kit,’ Part One

Your handy ‘Fire David Letterman Kit,’ Part Two

How to bring the campaign to FIRE DAVID LETTERMAN to your local Tea Party” (which is part three of the “Fire David Letterman” kit).

P.S.

Cuban Diva BFF LOVES Glenn Beck, so it is ON, now, gentle readers: IT. IS. ON!

Update, 8/14/09: Dana Loesch has a more complete list of Glenn Beck’s advertisers to contact to let them know you will buy their products if they continue to sponsor his shows.

Human Events reports that an advisor to the Obama administration is linked to the boycott of Glenn Beck.