by Doug Edelman

President Obama’s budget speech of April 13 may well go down in history as one of the worst Presidential speeches ever broadcast. But it still bears analysis and commentary! While Vice President Biden was sleeping through it, I was taking notes – so here goes. We’ll take Mr. Obama’s most salient statements, and lay them against a plumb line of reality. This may be a lengthy piece – but there is quite a lot to examine!

This debate over budgets and deficits is about more than just numbers on a page, more than just cutting and spending.  It’s about the kind of future we want.  It’s about the kind of country we believe in.

Precisely. This is a battle vision and philosophy. The Big Government, Wealth Redistributing, Nanny State Leftists versus the Self Reliance, Personal Responsibility, Free Market Right.

From our first days as a nation, we have put our faith in free markets and free enterprise as the engine of America’s wealth and prosperity.  More than citizens of any other country, we are rugged individualists, a self-reliant people with a healthy skepticism of too much government.

Obama throws a bone to the majority of America! Unfortunately he and the left don’t BELIEVE it, as we’ll see in the rest of the President’s remarks!

Part of this American belief that we are all connected also expresses itself in a conviction that each one of us deserves some basic measure of security.  We recognize that no matter how responsibly we live our lives, hard times or bad luck, a crippling illness or a layoff, may strike any one of us.  “There but for the grace of God go I,” we say to ourselves, and so we contribute to programs like Medicare and Social Security, which guarantee us health care and a measure of basic income after a lifetime of hard work; unemployment insurance, which protects us against unexpected job loss; and Medicaid, which provides care for millions of seniors in nursing homes, poor children, and those with disabilities.  We are a better country because of these commitments.  I’ll go further – we would not be a great country without those commitments.

So, let’s understand: We DESERVE security at the hand and responsibility of the FEDERAL Government? Do we all deserve compassion? Certainly. Charity? Of course. FAMILY responsibility? Resoundingly, yes. Perhaps even state governments can constitutionally choose to involve themselves in such services. But the enumerated powers granted the Federal Government under our Constitution provide no authority, much less a mandate for any such programs! And Obama thinks that we WOULD NOT BE A GREAT COUNTRY without entitlements? Does he believe we sucked before FDR?

For much of the last century, our nation found a way to afford these investments and priorities with the taxes paid by its citizens.  As a country that values fairness, wealthier individuals have traditionally born a greater share of this burden than the middle class or those less fortunate.  This is not because we begrudge those who’ve done well – we rightly celebrate their success.  Rather, it is a basic reflection of our belief that those who have benefitted most from our way of life can afford to give a bit more back.  Moreover, this belief has not hindered the success of those at the top of the income scale, who continue to do better and better with each passing year.

Books could be written on this paragraph alone! But I’ll try to be brief. Half the people in this country pay NO Federal Income Tax at all! They are the ones who benefit from this “way of life”. The rich have striven for, worked for, risked for and EARNED their success, only to have it APPROPRIATED for redistribution to those who have not done so! Many of these “beneficiaries” have their homes, heat, food, daycare and many other expenses paid for, and have nicer cars, televisions, cell phones and clothes than many who work hard for their sustenance! Perhaps the “beneficiaries” who now live on Government Largesse at no expense to them should pay THEIR fair share!

The so called wealthy already pay far more than the lion’s share of taxes. They already see half or more of what they work for taken in Federal, State and other taxes. At what point does confiscation of wealth become UN-fair? The American Dream is that ANYONE has the opportunity to work hard and become successful. But if you attain that success you become the enemy and your wealth must be confiscated for redistribution to those who did not take the initiative to utilize their opportunities that you did? If you ATTAIN the American Dream, do you then deserve to have it TAKEN from you?

Now, at certain times – particularly during periods of war or recession – our nation has had to borrow money to pay for some of our priorities.  And as most families understand, a little credit card debt isn’t going to hurt if it’s temporary.

TEMPORARY? Our nation has lived on the credit card as a major part of our budget for generations! This isn’t new, and it’s never been “temporary!

But as far back as the 1980s, America started amassing debt at more alarming levels, and our leaders began to realize that a larger challenge was on the horizon.  They knew that eventually, the Baby Boom generation would retire, which meant a much bigger portion of our citizens would be relying on programs like Medicare, Social Security, and possibly Medicaid.

The “1980s” and “amassing debt” comment is an implied dig at Reagan. Reagan cut taxes, and was blamed for increasing the deficit. Yet the reality is that Reagan’s tax cuts DOUBLED revenues. It was the Democrat Congress, led by Tip O’Neal, (who declared Reagan’s reasonable budgets “dead on arrival”), which increased spending by $1.84 for every dollar in tax-cut generated new revenue!

Yes, the Dems DID see the age-wave of the Baby Boomers coming… and welcomed it as a voter boom! As they aged, they’d become more dependent on Government! The ideal situation for the party of the nanny state!

To meet this challenge, our leaders came together three times during the 1990s to reduce our nation’s deficit.  They forged historic agreements that required tough decisions made by the first President Bush and President Clinton; by Democratic Congresses and a Republican Congress.  All three agreements asked for shared responsibility and shared sacrifice, but they largely protected the middle class, our commitments to seniors, and key investments in our future.

As a result of these bipartisan efforts, America’s finances were in great shape by the year 2000. We went from deficit to surplus.  America was actually on track to becoming completely debt-free, and we were prepared for the retirement of the Baby Boomers.

This is almost laughable!

Prior to the Gingrich revolution of 1994, the Democrats had a death-grip on Congress, where budgets/spending take place! Interestingly, starting in 1994, we saw deficit reduction fiscal responsibility under the GOP majority that lead to a couple years of actual SURPLUSSES which, of course, Bill Clinton took credit for, though he was dragged kicking and screaming by the GOP Congress to budgets of austerity! And now Obama’s claiming it to have been a BI-PARTISAN effort!

But after Democrats and Republicans committed to fiscal discipline during the 1990s, we lost our way in the decade that followed.  We increased spending dramatically for two wars and an expensive prescription drug program – but we didn’t pay for any of this new spending.

It wasn’t until the perfect storm of the dot-bomb, 9/11, and the prosecution of 2 wars that we had to pick up that credit card again! Bush’s worst deficit (and the worst deficit in history to that point) was in 2003, at 420 Billion (a mere PITTANCE by today’s standards!).

The “dramatic increase” for 2 wars: Remember the $87 Billion that Kerry voted for before voting against? We ran 2 wars for a year on $87 Billion. Remember the $787 Billion Bailout? That was 9 times bigger!!

The Bush Tax Cuts (that Obama wants to roll back, as we’ll discuss later) did what tax cuts ALWAYS do… they raised revenues! Our deficit declined in EACH of the following 3 years, so that when the power shifted back to the Democrats in 2006, the deficit had been reduced to a mere 120 Billion. The Bush tax cuts REDUCED the deficit by 300 Billion in 3 years – or about 100 Billion a year!

Bush took office with our national debt at 4 Trillion. He and the GOP Congress were deservedly criticized for increasing that by 50% to 6 Trillion in the first 6 years of the Bush Administration. Bush raised the debt by 2 Trillion in 6 years, and was “rewarded” with the return of power to the Democrats and Pelosi and Reid took the helm of Congress.

Unfortunately, as bad as Bush’s fiscal leadership had been… it was exponentially better than what followed. In their first year, Pelosi/Reid tripled the previous year’s 120 Billion dollar deficit to 450 Billion – 30 Billion worse than Bush’s WORST deficit in 2003! But the following year, they tripled THAT to 1.2 TRILLION! Pelosi and Reid started their tenure in charge with a 120 Billion dollar deficit and 6 Trillion in debt. In merely 4 years they increased the deficit EXPONENTIALLY, to 1.6 Trillion (1600 Billion) and they raised our debt by 2 1/3 times to 14 Trillion! It took 43 Presidents and 230 years to amass a 6 Trillion dollar debt… and these clowns added 8 Trillion to it in 4 years!

Instead, we made the problem worse with trillions of dollars in unpaid-for tax cuts – tax cuts that went to every millionaire and billionaire in the country; tax cuts that will force us to borrow an average of $500 billion every year over the next decade.

To give you an idea of how much damage this caused to our national checkbook, consider this:  in the last decade, if we had simply found a way to pay for the tax cuts and the prescription drug benefit, our deficit would currently be at low historical levels in the coming years.

So that’s how our fiscal challenge was created.  This is how we got here.  And now that our economic recovery is gaining strength, Democrats and Republicans must come together and restore the fiscal responsibility that served us so well in the 1990s.  We have to live within our means, reduce our deficit, and get back on a path that will allow us to pay down our debt.  And we have to do it in a way that protects the recovery, and protects the investments we need to grow, create jobs, and win the future.

WOW! There’s a mouthful! Most of it false!

First, he’s still playing to that economic myth that the left strives so hard to promote: The “Tax Rates are Directly Proportional to Revenues” myth. This theory has been disproven every time Tax Cuts have been tried! Revenues INCREASE when tax rates are reduced. Kennedy proved it. Reagan proved it. Bush proved it. So if revenues go UP when tax rates go DOWN, then rates and revenues are NOT directly proportional and tax rate adjustments have BEHAVIORAL effects on the public which can cause DYNAMIC expansion and contraction of the economy.

This brings us to the second sacred myth of the Left: The “Zero Sum Game” theory of the Economy. Under this theory, the economy is a fixed size and there is only so much sand in the sandbox. Piling up too much in one corner deprives the rest of the sandbox. If someone is too successful and amasses too much wealth, someone else somewhere is denied the opportunity to have enough. This is the very FOUNDATIONAL truth of class warfare! If you make the rich poorer, axiomatically you improve the lot of everyone else, as if by magic!! But the economy is not static. It dynamically expands and contracts with the behavior of the producers. Wealth is created every time a new idea comes to market! Every time a business grows and adds workers. It contracts when the producers feel the need to protect their assets and minimize risk. An adversarial relationship between Government and the producers in this country and anti-business tax and regulatory policies drive the producers into a defensive posture, contracting the economy and reducing tax revenues. Raise rates on business, and you’ll net LESS revenue.

Now, before I get into how we can achieve this goal, some of you might be wondering, “Why is this so important?  Why does this matter to me?”

By the end of this decade, the interest we owe on our debt could rise to nearly $1 trillion.  Just the interest payments.

Just to remind you: 2006 debt, 6 Trillion. After 4 years of Pelosi/Reid, debt is 14 Trillion.

Then, as the Baby Boomers start to retire and health care costs continue to rise, the situation will get even worse.  By 2025, the amount of taxes we currently pay will only be enough to finance our health care programs, Social Security, and the interest we owe on our debt.  That’s it.  Every other national priority – education, transportation, even national security – will have to be paid for with borrowed money.

In other words, the government made promises it can’t keep! The nanny-state Socialists are running out of other people’s money! Obama talked about 2525 – far enough away that folks will dismiss it as “the future”… but the fact is that TODAY our discretionary spending IN TOTAL is 1.3 Trillion while our deficit is 1.6 Trillion. If we funded ONLY Entitlements and interest on the debt, we’d be 300 billion short!! We’re ALREADY paying for 1/3 of our budget with borrowed money… and 2/3 of our budget is entitlements and interest on the debt! In fact he admits it below, though with obfuscation:

So here’s the truth.  Around two-thirds of our budget is spent on Medicare, Medicaid, Social Security, and national security.  Programs like unemployment insurance, student loans, veterans’ benefits, and tax credits for working families take up another 20%.  What’s left, after interest on the debt, is just 12 percent for everything else. That’s 12 percent for all of our other national priorities like education and clean energy; medical research and transportation; food safety and keeping our air and water clean.

Note that he included National Security (Discretionary) in with Medicare, Medicaid and Social Security (so-called Mandatory entitlement spending), and he separated interest on the debt (mandatory) out. Let’s look at ALL mandatory spending as distinct from Discretionary: In 2010, Medicare (519 Billion), Medicaid (273 Billion) and Social Security (701 Billion) totaled 1.493 Trillion out of a 3.5 Trillion dollar budget. That’s 1/3 of the budget by itself. Add in Interest on the debt (202 Billion) and “Other Mandatory” spending like welfare and food stamps (433 Billion) and you’re up to 2.128 Trillion out of 3.5 Trillion!

Up until now, the cuts proposed by a lot of folks in Washington have focused almost exclusively on that 12%.  But cuts to that 12% alone won’t solve the problem.  So any serious plan to tackle our deficit will require us to put everything on the table, and take on excess spending wherever it exists in the budget

Our Defense budget (692 Billion) and all the rest of our Discretionary budget (666 Billion) totals 1.358 Trillion. Less than 1/3 of the entire budget… and non-Defense Discretionary spending isn’t 12% it’s 19%, but that still means that less than 1 out of every 5 dollars we spend is non-Defense Discretionary spending.

One vision has been championed by Republicans in the House of Representatives and embraced by several of their party’s presidential candidates.  It’s a plan that aims to reduce our deficit by $4 trillion over the next ten years, and one that addresses the challenge of Medicare and Medicaid in the years after that.

Those are both worthy goals for us to achieve.  But the way this plan achieves those goals would lead to a fundamentally different America than the one we’ve known throughout most of our history.

A 70% cut to clean energy.  A 25% cut in education.  A 30% cut in transportation.  Cuts in college Pell Grants that will grow to more than $1,000 per year.  That’s what they’re proposing.  These aren’t the kind of cuts you make when you’re trying to get rid of some waste or find extra savings in the budget.  These aren’t the kind of cuts that Republicans and Democrats on the Fiscal Commission proposed.  These are the kind of cuts that tell us we can’t afford the America we believe in.  And they paint a vision of our future that’s deeply pessimistic.

Actually, Mr. President, the Ryan Plan’s vision is one that begins to move on the path not only to prosperity and sustainability… but to constitutionality!! There is no constitutional authority nor mandate for ANY of the so-called Mandatory Budget… outside of interest on the debt that was unconstitutionally amassed! And within the Discretionary budget are many Departments, Agencies and Programs which have no constitutional justification for their existence as well! We could EASILY afford to fund a government which was LIMITED by the constitutional limitations they have ignored!

It’s a vision that says if our roads crumble and our bridges collapse, we can’t afford to fix them.

Actually, Sir, infrastructure IS one of the expenses AUTHORIZED under the Constitution’s enumerated powers!

It’s a vision that says America can’t afford to keep the promise we’ve made to care for our seniors.

We CAN’T! Our entitlement system is a Ponzi Scheme. A pyramid where those at the bottom pay for those at the top! The problem is that it’s an inverted pyramid and there are more dependents than the producers can support, and the demographics are shifting to INCREASE that problem!

Worst of all, this is a vision that says even though America can’t afford to invest in education or clean energy; even though we can’t afford to care for seniors and poor children, we can somehow afford more than $1 trillion in new tax breaks for the wealthy…

…There’s nothing serious about a plan that claims to reduce the deficit by spending a trillion dollars on tax cuts for millionaires and billionaires.  There’s nothing courageous about asking for sacrifice from those who can least afford it and don’t have any clout on Capitol Hill.  And this is not a vision of the America I know.

“…More than $1 trillion in new tax breaks for the wealthy”??? WHAT new tax breaks? We have passed no new tax cuts – we PREVENTED the automatic INCREASE to rates that have been in effect for nearly a decade! No one is even TALKING about further rate reductions! So what’s he talking about? He views NOT making those increases in tax rates as a NEW CUT!

And how does he put a dollar amount of a trillion dollars on these failed tax rate increases? As we showed earlier, raising tax RATES is not directly proportionate to revenues. If he wants to increase revenues he should consider a further REDUCTION in rates which would spur economic growth and generate new business expansion, more jobs, more workers earning more taxable income etc.

No, the tax rate debate is not about revenue, or deficits, or budgets. It’s about wealth redistribution and that 2^nd economic myth. The Zero Sum Game theory implies that if you make the rich poorer, you magically make the poor richer!! It’s a fallacy… but the left BELIEVES it and promotes it!

Today, I’m proposing a more balanced approach to achieve $4 trillion in deficit reduction over twelve years…  The first step in our approach is to keep annual domestic spending low by building on the savings that both parties agreed to last week… But as the Chairman of the Joint Chiefs, Admiral Mullen, has said, the greatest long-term threat to America’s national security is America’s debt… Just as we must find more savings in domestic programs, we must do the same in defense…  The third step in our approach is to further reduce health care spending in our budget.  Here, the difference with the House Republican plan could not be clearer:  their plan lowers the government’s health care bills by asking seniors and poor families to pay them instead.  Our approach lowers the government’s health care bills by reducing the cost of health care itself…That includes, by the way, our commitment to Social Security.  While Social Security is not the cause of our deficit, it faces real long-term challenges in a country that is growing older.  As I said in the State of the Union, both parties should work together now to strengthen Social Security for future generations.  But we must do it without putting at risk current retirees, the most vulnerable, or people with disabilities; without slashing benefits for future generations; and without subjecting Americans’ guaranteed retirement income to the whims of the stock market.

While I won’t state the Defense Budget is an untouchable sacred cow… Democrats have historically been eager to cut the lean with the fat. If we eliminate fraud, waste and abuse in the Defense budget, and cut wasteful or ineffective programs while BOLSTERING spending on modernization, research & development of new weapons systems and recruitment, retention, training, equipping and PROVIDING FOR our military personnel… then Military spending is fair game to be on the table… but don’t expect huge savings if these things are properly approached!

ObamaCare is a fiscal boondoggle and everyone knows it. The left can put all the whitewash they want on it, but even the CBO has continued to issue report after report… each worse than the one before it… declaring Obamacare as a money-sucking black hole that will not improve care, access or costs! Yet Obama is determined to preserve it, though the Supreme Court will ultimately find it unconstitutional as 2 lower courts have. Meantime businesses must make the expenditures to gear up for implementation that may or may not be funded, and may or may not be dismantled ultimately by SCOTUS. This uncertainty is bad for the economy – and recovery could be accelerated by simply abandoning and repealing ObamaCare utterly, as though it never occurred!

Social Security is about to go bankrupt. The President is correct in saying Social Security is not the cause of the deficit… but the decision under Democrat Administrations to eliminate the “trust fund” and “lock box” aspects keeping Social Security separate from the general fund of the US treasury IS a cause. Social Security might have remained solvent if it were not raided by prior administrations to fund their pet vote buying schemes!

The fourth step in our approach is to reduce spending in the tax code.  In December, I agreed to extend the tax cuts for the wealthiest Americans because it was the only way I could prevent a tax hike on middle-class Americans.  But we cannot afford $1 trillion worth of tax cuts for every millionaire and billionaire in our society.  And I refuse to renew them again.

Beyond that, the tax code is also loaded up with spending on things like itemized deductions.  And while I agree with the goals of many of these deductions, like homeownership or charitable giving, we cannot ignore the fact that they provide millionaires an average tax break of $75,000 while doing nothing for the typical middle-class family that doesn’t itemize.

This is the most egregious Orwellian NewSpeak in the entire speech. SPENDING IN THE TAX CODE? Let’s see… So ALL our money is the Governments, and anything we’re allowed to KEEP is a Government EXPENDITURE???

Obama views itemized deductions… in other words, DOING those things that are deductible from ones tax obligations like paying home mortgage interest or making charitable contributions, is like sending the government a bill for payment? We know that leftists don’t like private charity. It is a competitor for Government Programs that buy votes! Why have a church food pantry when the government can give food stamps? And subsidizing private home ownership? Personal Property Rights? Another of our rights under assault by the left!

And what about that “$75,000 tax break” that millionaires get while the typical middle class family doesn’t get because they don’t itemize? If someone’s a millionaire, then with only ONE million that average $75,000 tax break represents only 7.5%! If they’re RICHER than that $75,000 represents an even lower percentage!

The STANDARD DEDUCTION for a typical family is over 11,000 so if you earn less than 110,000 and don’t itemize that deduction represents more than 10%, and the less you earn, the higher that percentage!

Of course, there will be those who disagree with my approach.  Some will argue we shouldn’t even consider raising taxes, even if only on the wealthiest Americans.  It’s just an article of faith for them

Exactly right. Americans are NOT under taxed. Congress over spends. As I outlined in my recent article: http://www.examiner.com/conservative-in-st-louis/after-the-shutdown-showdown-reality-still-bites, “…the revenue side of the equation is simply not an option.”

Others will say that we shouldn’t even talk about cutting spending until the economy is fully recovered.  I’m sympathetic to this view, which is one of the reasons I supported the payroll tax cuts we passed in December.  It’s also why we have to use a scalpel and not a machete to reduce the deficit – so that we can keep making the investments that create jobs.  But doing nothing on the deficit is just not an option.  Our debt has grown so large that we could do real damage to the economy if we don’t begin a process now to get our fiscal house in order.

Obama is talking to the true Keynesians in his own party here. They TRULY BELIEVE that they can spend their way out of debt… as counter intuitive as that sounds (and as false as it IS!). Obama has come to realize that, while he’s “sympathetic to this view”… that is, he, too, is a Keynesian at heart – but he recognizes that to hold firm to the theory would now be political suicide! This is a politically motivated moderation… not a change of heart!

Finally, there are those who believe we shouldn’t make any reforms to Medicare, Medicaid, or Social Security out of a fear that any talk of change to these programs will usher in the sort of radical steps that House Republicans have proposed.

Here comes the dig that “Republicans will take Grandma’s check and give it to the rich while she starves and freezes in her cold, empty shack!” But Obama will make kinder, gentler “reforms”.

Indeed, to those in my own party, I say that if we truly believe in a progressive vision of our society, we have the obligation to prove that we can afford our commitments

Yes, you have that obligation… and to date you have failed to offer that proof!

“I still believe.  I believe in that great country that my grandfather told me about.   I believe that somewhere lost in this quagmire of petty bickering on every news station, the ‘American Dream’ is still alive…

The American Dream IS alive. We are the land of equal OPPORTUNITY, not equality of outcome. If you seize the opportunities with both hands, work hard, and are willing to take risks… there are rewards. The biggest danger to the American Dream is the threat that as soon as you achieve it, the IRS will be there to take it away!

Copyright © 2011 by Doug Edelman

Doug Edelman is a conservative political analyst and commentator, and was a contributing editor for The Conservative Voice. His work has appeared on ChronWatch, Western Front American, Small Government Times, Western Journalism, News By Us, The American Daily, The Post Chronicle, New Media Journal, Capitol Hill Coffee House and more. Mr. Edelman is also an IT Consultant/Contractor and owner of a Computer Services Business.  He has taught PC Maintenance & Repair and Networking at his local Community College, and maintains a blog at http://starboard.blogtownhall.com.

 

WesternFront America

So, with the announcement/unveiling of PelosiCare, the Heath Care debate has heated up once again. Here’s my take on several of the debated issues.

Death Panels:  First, let me say that have a strong dislike for this term.  I believe it to be the hyperbolic, and not accurate to the true form and function of the heath care rationing that is to come.   That being said, there are some are some patterns in the actions of the government that suggest that there will be rationing decisions made that will end lives.  When Sara Palin suggested that people are going to be before “death panels” that would decide who live and dies, she was stretching the truth a bit.  Life and death decisions will be made, just not in that particular context.

End of life counseling, i.e., the “Death Panels,” are back.  The Democrats took it out of one of the earlier bills, after initially denying it existed.  They made a big deal out of removing it; yet apparently expect us to forget the whole thing.  In all honesty, I really don’t have an issue with end of life counseling.  Patients and doctors might see the need to discuss that issue.  However, it is completely inappropriate for the government to mandate it.  A medical professional knows when the “writing is on the wall,” and is fully capable, and trained, to bring up medical topics at the appropriate time.  Mandating it seems to be a “one size fits all” government approach.  Until, that is, you consider some of the other actions of the government.  When you look at the components of the change, and what the advisors and other are saying and doing, the real picture emerges.

Next, let’s take a look at this from CNS News.

Slashing Medicare payments to hospitals that readmit ailing senior citizens–a component of the health care reform bill under consideration in Congress–could have serious consequences for the hospitals, including raising costs on hospitals an estimated $19 billion over 10 years, according to the American Hospital Association.

A plan to reduce preventable hospital readmissions is included in all of the health care bills before Congress and would impose a fee on hospitals that readmit patients for certain conditions, such as pneumonia and heart failure.

The details on how the readmissions policy would work, however, are largely left up to the Health and Human Services Department (HHS), a fact that concerns the nation’s hospitals. The penalties would only apply to hospitals where the readmission rates were well above the national average.

OK then, since when is admitting someone for pneumonia or heart failure preventable?  I mean, if someone is having a heart attack, is there a more efficient alternative than admitting them…other than letting them expire in the ER waiting area?

Then, we must consider that the legislation in this case, does not set any criteria or qualifications for this, they simply charges Heath and Human Services with creating them.  Who is going to write them?  Will that process be open to debate?  Will we even be made aware of the rules, or will a “czar,” or will a special interest group write them?  Will the rules change with each new administration?  Will the rules ever make sense?  These are questions that need to be asked, however, we have to remember that this will be a “one size fits all” approach, so there will be little logic involved.

Here’s some more…

The Senate Finance Committee left the definition of a “selected condition” up to the HHS, specifying only that the government use eight conditions with a high rate or cost of readmission. The government can expand the list of selected conditions after three years, in 2016.

As the summary states, “Three years after implementation of the readmissions policy, the [HHS] Secretary would have the authority to expand the policy to other conditions. Additional conditions would be selected based on: (1) high spending on readmissions or high rates of readmissions; and (2) other criteria as determined by the Secretary.”

The American Hospital Association (AHA), in comments submitted to Baucus May 15, said that the Finance Committee’s plan could lead to “serious consequences” if the government does not get the details right.

“Hospital leaders and clinicians who care for patients recognize that some readmissions can be prevented,” the AHA said.

“But there are a number of factors beyond the hospital’s control that affect whether a patient is readmitted, including the natural course of the disease, the limited availability of post-acute and ambulatory health care services, high levels of poverty among some hospitals’ patients, and a lack of community-based social services,” it added.

“If these factors are not accounted for, they will lead to payment penalties, inequities and other serious consequences–intended and unintended–for hospitals, particularly safety-net hospitals,” said the AHA.

Now, they appear to be intent on punishing the hospitals for things that might be out of their control.  For example, what If the patient doesn’t go to follow-up appointments?  That’s a common occurrence.  What if the aftercare practitioner isn’t taking more patients dues to being ripped off by the government plan, or has retired as they can no longer make enough money to justify their effort?  What if the patient simply gets sick again?  That’s the problem with a “one size fits all” plan, it cannot see or take into consideration the individual needs of each patient, or facility.  There are facilities that are in areas with large senior populations.  That population, statistically, will be sicker, as well as have more repeat episodes.  Will hospitals in these areas simply have to cut back services as a whole?  Or will they discourage certain patients from returning?

One more thing…  What happens when the patient’s government insurance stops paying for an episode of care and wants the patient discharged?  Then, the patient gets sick again, and the facility is penalized for doing what the government told them to do?  Sounds like the banks being ordered to make bad loans, and then being blamed when the bad loans clobber the banking system, doesn’t it?  Might this cause facilities to find ways not to admit or treat certain patients?  Is this part of a way to penalize facilities for treating senior citizens?

Next up, this from the Wall Street Journal…

• Expanding Medicaid, gutting private Medicare. All this is particularly reckless given the unfunded liabilities of Medicare—now north of $37 trillion over 75 years. Mrs. Pelosi wants to steal $426 billion from future Medicare spending to “pay for” universal coverage. While Medicare’s price controls on doctors and hospitals are certain to be tightened, the only cut that is a sure thing in practice is gutting Medicare Advantage to the tune of $170 billion. Democrats loathe this program because it gives one of out five seniors private insurance options.

So, their denial that they are going to gut Medicare was yet another lie?  Of course, they seem to hate anything that is privately controlled.

In discussing the “death panels,” we have to take yet another look at Ezekiel Emanuel.  Besides being the brother of Obama’s chief of staff, Rahm, Dr. Emanuel is a prominent if medical ethicist that has, shall we say, some rather interesting ideas about medical treatment.  Here are some quotes from Dr. Emanuel:

This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.

So, the government will have the authority to deny treatment for those individuals that they deem unfit for living.  What criteria would be use?  Do you get to appeal?  Do you have any choice?  Under a government controlled plan, I would venture to guess no.

Source:  First Things

“Strict youngest-first allocation directs scarce resources predominantly to infants. This approach seems incorrect. The death of a 20-year-old woman is intuitively worse than that of a 2-month-old girl, even though the baby has had less life. The 20-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects…. Adolescents have received substantial substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments…. It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies, and worse still when an adolescent does.”

Note that the decision has been made based on the amount on money the government has spent “developing” a human.  He is essentially reducing the value of human life to the amount of resources that society has expended upon the said human.  Now, the left can decry the 2% profit margin of the insurance companies; yet engage in far more sinister statistical calculations for who gets care and who gets to die?

“Ultimately, the complete lives system does not create ‘classes of Untermenschen whose lives and well being are deemed not worth spending money on,’ but rather empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible.”

This is phenomenal wordsmithing.  He denies in the first part of the sentence, and endorses in the second.  Sir, just saying that the grass isn’t green does not make it orange!

“When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated”

So, I am to be “attenuated?”  Can we say that this is discrimination based on age?  Are all AARP members reading this?  How many times have the Democrats claimed that the Republicans are going to freeze, starve, or kill of the old people? -  Just about every election cycle.  However, look at who is openly proposing to do it!!!

“Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration’s health-reform effort.”

As I have said many, many, times, government assistance comes with strings attached.

Source: NCPA

“Doctors take the Hippocratic Oath too seriously, as an imperative to do everything for the patient regardless of the cost or effects on others”

So, is this simply redistribution of wealth, or is it something more?  I believe that this is really about creating a system of scarcity, and using it as means to manipulate population.  It also de-emphasizes ethical considerations, and switches that emphasis to an economic one, especially ironic from a man who is a medical ethicist!

Source: Journal of the American Medical Association, June 18, 2008

“There is a widespread perception that the United States spends an excessive amount on high-technology health care for dying patients. Many commentators note that 27 to 30 percent of the Medicare budget is spent on the 5 percent of Medicare patients who die each year. They also note that the expenditures increase exponentially as death approaches, so that the last month of life accounts for 30 to 40 percent of the medical care expenditures in the last year of life. To many, savings from reduced use of expensive technological interventions at the end of life are both necessary and desirable.”

“Many have linked the effort to reduce the high cost of death with the legalization of physician-assisted suicide. One commentator observed: “Managed care and managed death [through physician-assisted suicide] are less expensive than fee-for-service care and extended survival. Less expensive is better.” Some of the amicus curiae briefs submitted to the Supreme Court expressed the same logic: “Decreasing availability and increasing expense in health care and the uncertain impact of managed care may intensify pressure to choose physician-assisted suicide” and “the cost effectiveness of hastened death is as undeniable as gravity. The earlier a patient dies, the less costly is his or her care.”

America, are you reading this?  These people are making economics out of death!  Beyond that, they are projecting savings that can be achieved if you die early.  Combine that with their other actions, and it appears that they are trying to save a buck!  Isn’t that what the left hates about the “evil” insurance companies?  There is a difference though…the state wants to industrialize and manage it at the federal level!

“Although the cost savings to the United States and most managed-care plans are likely to be small, it is important to recognize that the savings to specific terminally ill patients and their families could be substantial. For many patients and their families, especially but not exclusively those without health insurance, the costs of terminal care may result in large out-of-pocket expenses. Nevertheless, as compared with the average American, the terminally ill are less likely to be uninsured, since more than two thirds of decedents are Medicare beneficiaries over 65 years of age. The poorest dying patients are likely to be Medicaid beneficiaries. Extrapolating from the Medicare data, one can calculate that a typical uninsured patient, by dying one month earlier by means of physician-assisted suicide, might save his or her family $10,000 in health care costs, having already spent as much as $20,000 in that year.”

Excuse me for being a bit cynical here, but after reading all of this, can we say that they are trying to sell families on killing off their own family members?  Are they going to sell this to the families as a cost savings for giving granny the “pain pill?”

Source: What Are the Potential Cost Savings from Legalizing Physician-Assisted Suicide? New England Journal of Medicine, July 1998

I think that anyone who reads this should be frightened.  This has happened before, particularly in Nazi Germany, with their T4 program.  While the T4 program focused on the mentally ill and mentally retarded, it did strike on similar themes, particularly cost savings.

One might ask, why question what a medical ethicist that works for the NIH thinks in regard to the heath care debate?  That is a good question.  In that capacity, those questions should be asked.  I view ethicists as philosophers; they are supposed to ask the difficult or uncomfortable questions. That’s what they are supposed to do.  However, Dr. Emanuel isn’t with the NIH right now.  Why do I say this?  Well, here is the NIH site for Dr. Emanuel:

Ezekiel J. Emanuel is Head of the Department of Bioethics at The Clinical Center of the National Institutes of Health and a breast oncologist. He is on extended detail as a special advisor for health policy to the director of the White House Office of Management and Budget.

So, he is a White House adviser…for health policy???  This leads to the question; why have this guy as a special adviser if the administration was not at least evaluating his ideas? And, what does that say about the administration’s stance towards rationing?

It is useful to note that, just like the “czars,” Dr, Emanuel is claiming that his statements are being taken out of context.  That seems to be the claim du jour from the left.  Van Jones, Cass Sunstein, The POTUS, Barney Frank, and the others have all made this claim.  However, I’ll leave the judgment to you.  After all, the doctor has written multiple articles on the topic, and they all end up in the same place.

So, when the Democrats state that there is nothing called a “death panel” in the legislation, they are being truthful, at least superficially.  The real “devil,” as Ross Perot used to say, “is in the details.”  There are cuts in care for the elderly, the mandated “end of life” counseling, and a White House advisor that has repeatedly published his ideas about cutting off care for the elderly and for those “not worthy of life.”  Add this all together (and a few more details- I didn’t want to write a book here), and the pattern emerges.  They do speak to limiting care, and to whom it is to be limited.  They are translating that into their legislation, but not stating it openly.  They do it by creating circumstances in which it will be done, while at the same time denying any complcity.  I beleive that they hope that once the legislation is passed, and takes effect, there will be nothing to do to stop it.  In the end, we arrive at the same place that Sara Palin fears-just in a different form.  Nancy Pelosi, Harry Reid, Barak Obama, and Ezekiel Emanuel are taking us there.

H/T: Jeff Head; Notes from Dr. RW

 

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