In the first presidential debate of this election, held recently in Denver, the court of popular opinion tagged Republican candidate Mitt Romney as the decisive winner.
And indeed, President Obama seemed tentative and unprepared, a stammering mess of nebulous rhetoric and empty repetition. His uninspired performance tightened up a race that many had written off as a foregone conclusion.
In the middle of all of this, however, was one exchange between the two candidates that served as a microcosm of why most physicians — while in favor of some sort of universal health care coverage — do not trust the version of health care provision outlined in the Affordable Care Act, commonly known as “Obamacare.”
Mitt Romney: “Obamacare will create an unelected board, an appointed board, who are going to decide what kind of (medical) treatment you ought to have.”
Barack Obama: “No, it isn’t.”
Right there, in print, is your president lying to you.
The Obamacare legislation contains a provision about the setup of an Independent Payment Advisory Board (IPAB). This Board, a group of 15 presidential appointees subject to Senate confirmation, would make recommendations for reducing Medicare costs, which must be enacted by Congress by Aug. 15 of each year, beginning in 2014.
If Congress fails to enact the IPAB recommendations (or fails to propose alternative recommendations that engender similar savings), the IPAB recommendations become law by default.
Proponents of the use of the IPAB say that Congress, subject to the influence of lobbyists and the inherent pressures of re-election, has been unwilling to make the tough choices necessary to restrain the exponential growth of Medicare expense. Fair enough. And the law explicitly states that the IPAB “cannot include any recommendation to ration health care.”
But the term “ration” is not defined anywhere in the legislation — and just about any restriction of funding to an area of medical care is, in act, de facto rationing.
The salient point here is this: Can the American people trust a gaggle of political appointees, chosen without any pre-existing stipulations as to their background or fund of knowledge, to determine how our country’s Medicare dollars are to be spent?
Me thinks not.
The Obama administration appointees for health-related fields have been notoriously devoid of experienced health care providers. Kathleen Sibelius, the secretary of Health and Human Services, has a B.A. in political science and a master’s degree in public administration. She has served as governor of Kansas.
Marilyn Tarver, the new head of the Center for Medicaid and Medicare Services (CMS), is a nurse whose entire career has been in health care policy. Most political appointees to health care positions, in fact, are not practicing clinicians — meaning that they make their decisions in a clinical vacuum, without the front-line experience necessary to allow them to make intelligent choices about issues that impact the lives of millions of Americans every day.
Even the American Medical Association is in the government’s back pocket, since its copyrighted CPT system is the sole coding entity used by Medicare and Medicaid — and accounts for the bulk of that organization’s annual revenues.
Only about 15 percent of the AMA’s annual budget comes from physician dues — which is why most doctors view the AMA as a mere mouthpiece for federal government policy. We simply don’t believe anything they say anymore. The American people shouldn’t, either.
I have practiced medicine for 25 years. Like most physicians, nurses and health care providers, my top priority is the provision of safe, cost-effective health care for my patients.
My decisions are evidence-based, firmly rooted in what is stated in the current medical literature. And I do not trust Federal agencies, Congress, the state government or insurance companies — all of whom are motivated by forces other than issues regarding patient care — to provide any sort of direction for health care provision that keeps the patients at the epicenter of the discussion.
Here’s a novel idea: Instead of having a bunch of presidential appointees convene in Washington every year to decide how Medicare and Medicaid dollars are spent, how about having the federal government distribute CMS funds for these entities to the individual states in block grants, and then mandate that each state allocate those resources by using a rotating board of state-licensed physicians and nurses appointed by the individual state Medical and Nursing societies?
This board would use the guidelines for disease management published by the national specialty medical societies as their templates.
The American College of Cardiology recommendations would be followed for management of coronary artery disease, for example. Blood pressure management guidelines by the American College of Physicians would shape the management of hypertension. State Board members would be prohibited from accepting any gifts from or having discussions with any sort of lobbyist.
The use of published guidelines, appointment of members by non-government entities and the non-involvement of lobbyists would help to insure that the decisions made would be free of any contaminating influences. Moreover, the decisions would reflect local medical priorities, which are
not the same in Georgia as they are in, say, Idaho.
Benjamin Disraeli once said that “there are three kinds of lies: Lies, damn lies and statistics.”
Most people running for public office are guilty of propagating all three varieties.
If I had a choice, I’d take health care decision-making away from the liars in Washington and give it to those who truly have the patients’ best interests at heart.
Universal health care coverage for all Americans is a noble goal.
Universal government control of health care, however, would be an absolute nightmare.
Mark Murphy, M.D., is a Savannah physician and writer. He recently published his first novel, “The Shadow Man.”
-----------------------------------------------------------------------------------------------------------------------------------------------------------3)How America Became a Communist Nation
By Porter Stansberry
As I showed you yesterday, the Greeks may be the most notorious of the world's profligate nations… but they are not the real problem.
The real problem is much larger and more complex.
The root of the problem the world is facing right now isn't really governments… or banks. The real problem is simply a very bad idea – the idea that the State ought to sit in the center of society. Let me explain…
The last 100 years (since 1914) saw not only the end of the classic gold standard, but also the fantastic ascendancy of the nation-state.
These two trends are inherently and dangerously related.
Until World War I, the central government of the United States, for example, played a small role in the lives of its citizens. Its powers were strictly limited, as were its revenues. It was specifically barred from taxing citizens directly. It was a humble government that interacted with the individual states in the union, but didn't interact much with individual citizens.
The first signs of change came after the Civil War. "Progressive" ideas began to emerge. Most of these ideas came from Germany, from philosophers like Karl Marx and Friedrich Engels. The core of these ideas was that the State itself was superior to its citizens. Therefore, the argument went, society ought to be organized to better accomplish the goals of the State.
Today, most Americans have no idea that the foundations of our modern State are based – nearly verbatim – on the demands of Karl Marx's Communist Manifesto.
In 1848, Marx threatened to organize a workers' revolution unless European governments:
1. Abolished property rights and applied all rents towards public purposes.
[Modern corollary: Don't pay your property taxes, lose your house. So who really owns your house?]
2. Levied a heavy, progressive income tax to equalize wages.
[Modern corollary: Combined federal and state marginal income and payroll taxes approach (or surpass) 50% in many U.S. states.]
3. Abolished all rights of inheritance.
[Modern corollary: The estate tax.]
4. Confiscated the property of all emigrants.
[Modern corollary: The 2008 "Heroes Act," which forces people leaving the U.S. to pay the equivalent of their estate taxes on their global assets before they turn in their passports.]
5. Centralized access to credit in the hands of the State by means of a national bank and an exclusive monopoly.
[Modern corollary: Fannie Mae and Freddie Mac, which make more than 90% of all of the mortgages in the U.S. and have dominated the market for mortgages for decades.]
6. Centralized the means of communication and transport in the hands of the State.
[Modern corollary: AT&T was a legal monopoly for decades. Amtrak is a ward of the states. The government owns all the roads. And the State controls all air traffic.]
7. Provided free education for all children in public schools.
[Note the emphasis on public schools. Paying for education isn't enough. What counts is indoctrinating the kids in glorifying the State.]
8. Produced a common agricultural policy to maximize the productivity of the land.
[Modern corollary: Massive ethanol and agricultural subsidies.]
Most people in democracies like these ideas for one simple reason: They hold the allure of getting something for nothing. They are the siren song of living at the expense of your neighbor.
These ideas became extremely popular over the last 100 years, all around the world. As a result, as democracy spread, so did these ideas. Politicians of each party and persuasion throughout the Western world quickly adopted them as their own (and never mentioned Marx).
As these ideas took hold, one big problem developed… How do you pay for them?
Progressive politicians believed they had the answer. They just took Marx's big innovation: A progressive income tax. Let the rich pay!
It's a popular idea – but it never works because decisions to add more benefits don't take into account the expense of paying for them. It doesn't take long for the budget to get out of control. Or said another way, everyone can't live at the expense of his neighbor. His neighbor can't afford it… and he moves.
More serious, the flaw in communism is obvious. Communism doesn't account for the fact that people expect to control the fruits of their labor. People don't like their assets being stolen and their wages being heavily taxed by a government that regulates their businesses and sends their children off to war. Incrementally, people stop working. Wealthy people flee… or hide their incomes.
Tax revenues fail to meet projections. Deficits grow. Deficit spending soars. And debts mount.
That's where paper money comes in. Paper money isn't only good for financing a war. It's also perfect for closing the gap between what an economy ought to produce and its paltry real production when it has been beaten into submission by communist ideas. I like to explain it this way…
The central truth of economics is scarcity. There can never be enough of anything to satisfy everyone. The central truth of politics is patronage: promising to give everything to everyone. Paper money is the bridge between economics and politics.
The unpaid debts of an entire generation of people in Western countries are coming due. The so-called "baby boomers" grew up in a world dominated by Marxism and Keynesian economics. These are bad ideas. They are destined to collapse.
And the collapse is here.
Regards,
Porter Stansberry
AAC
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