Volume 65, No. 9 September 2009
As reported by Sarah Tobianski of ABC News, "What started as
a battle of words...when President Obama hit back at Republican
senator Jim DeMint of South Carolina for saying health care
reform could be Obama's 'Waterloo,' has turned into a fullblown
war to rally support and money behind the president's health care
On Jun 16-19, 1815, the Battle of Waterloo put an end to the
tyrannical rule of Napoleon, and marked the end of his triumphal
return from exile, "the Hundred Days."
Having beaten the Prussians at Ligny, "but not
sufficiently," and seeing that Wellington's troops were outnum-
bered, weak, ill-equipped, and inexperienced, Napoleon thought
"this affair is nothing more than just eating breakfast."
Wellington later said, "It was the nearest run thing you ever saw
in your life." The British hung on tenaciously, and the Prussians
under Blcher attacked Napoleon's right flank. The battle ended
in a rout, and as H.G. Wells wrote, "Everyone who had joined
[Napoleon] was eager now to attack him."
Organizers Deployed; Congressmen Flee
Having missed their deadline to pass a bill before the
August recess, "members of Congress will listen to their
constituents and explain reform legislation," promised Speaker
Nancy Pelosi (D-CA) and Rep. Steny Hoyer (D-MD) despite the
"disruptions." Instead of the expected pep rallies for Obama's
Change agenda, town halls featured hundreds of citizens shouting
things like "Tyranny!," or "Read the bill!"
An ad by the Democratic National Committee calls such
citizens "an angry mob." Congresswoman Gabrielle Giffords (D-AZ)
called them "manipulative racists." Other Democrats call them
"actors organized by the crazy right wing and the insurance
industry" engaging in "un-American" tactics. It's not spontaneous
grassroots activism, but organized "Astroturf."
MoveOn.org tells prospective contributors that "right-wing
extremists are crashing town hall meetings, shouting down members
of Congress, making death threats they even hung [sic]
one congressman in effigy." Washington Post business
writer Steve Pearlstein accuses dissenters of becoming "political
terrorists" bent on preventing consensus.
To "fight back against this disastrous brand of old-style
politics," Obama's Organizing for America and others are ramping
up their efforts. Ads on Craigslist seek "talented leaders" to
work for health care reform for $11-$16/hr. The Administration is
recruiting citizen snitches on "fishy misinformation." (Chief of
staff Rahm Emanuel is said to send dead fish to his political
opponents, notes Greg Scandlen.)
As the Organizer in Chief orders his citizen army to action,
the talk could stop, and the violence begin. The first physical
aggression was reported when "Purple People" from the SEIU
(Service Employees International Union) showed up to protect
congressmen from senior citizens and parents.
The SEIU's organizing philosophy is: "[W]e prefer to use the
power of persuasion, but if that doesn't work, we use the
persuasion of power" (Michelle Malkin 8/6/09). Its intimidation
tactics have been explicitly condemned by AFL-CIO president John
Sweeney, among others.
The Administration was "[t]hrown off balance by the
unexpected rude awakening of the normally silent sleeping
public," writes J.B. Williams (Canada Free Press
8/7/09). He recalls that on the campaign trail, the career
community organizer said, "I want you to go out and get in their
Despite this support, many Democrat legislators are
cancelling live town halls and resorting to telephone town halls.
As Lee Vliet, M.D., of Tucson, AZ, points out, this not only
gives the politician complete control, but eliminates the risk of
a YouTube video showing what really went on.
Who Is the Opposition to "Reform"?
At a town hall in Houston on Aug 8, Rep. Kevin Brady (R-TX)
told some 500 citizens: "The only thing standing between us and
this 1,000-page bill is you."
"Inside the...Beltway, there are only a few good soldiers
left standing. Everyone else has sold out or been bought out or
bullied out," writes John Goodman. "Yet there is one group that
was not invited to participate in the behind-closed-door
sessions.... These are the people."
Health insurers aren't paying town hall activists; they paid
congressmen, donating more than $19 million since 2007, 56% of
which went to Democrats. And they are the likely victors in a
battle that could already be over, according to Chad Terhune and
Keith Epstein (Business Week 8/6/09).
UnitedHealth, highly praised by Blue Dog Democrats, is
probably the biggest winner. This leviathan is already enmeshed
in the lives of 70 million Americans. Its Ameri-Choice unit,
whose revenue increased 34% last year, is the largest contractor
administering Medicaid. Its OptumHealth unit is in great demand
as government and big employers try to curb costs by supervising
patients more aggressively. Proposed legislation could benefit
its Ingenix data-crunching unit. UnitedHealth also owns Lewin
Group, whose data is routinely cited by Republicans Orrin Hatch
and Eric Cantor.
Although he is a proponent of a government-run competitor,
Tom Daschle sells political tips to UnitedHealth.
Contrary to the Democrats' claims, only 25% of voters
strongly support the reform effort, while 41% are strongly
opposed, writes Scott Rasmussen (Wall St J 8/7/09).
Napoleon may have miscalculated, and there may be a
Wellington and a Blcher. It could be a close battle.
Sarah Palin Denounces Government Takeover
Former vice-presidential candidate Sarah Palin, who just
stepped down as governor of Alaska, remarked:
"As more Americans delve into the disturbing details of the
nationalized health care plan that the current Administration is
rushing through Congress, our collective jaw is dropping, and
we're saying not just no, but hell no.
"The Democrats promise that a government health care system
will reduce the cost..., but as the economist Thomas Sowell has
pointed out, government health care will not reduce the cost; it
will simply refuse to pay the cost."
It would be "a point of no return for government
interference in the lives of its citizens," she added.
The elderly and the disabled would suffer most.
Law professor Harold Pollack posted a "have you no decency"
entry on the New Republic blog, about Palin's use of the
term "death panel," in quotation marks, for the bureaucracy that
will make decisions based on value to society.
In fact, notes law professor William Jacobson on the
Legal Insurrection blog, the term is an apt one for
Ezekiel Emanuel's concept of a priority curve based on a
"complete lives" concept.
And it's perhaps even more descriptive of the ideas of Peter
Singer of Princeton, who writes: "what better say of deciding
what treatments people should get than by comparing the QALYs
[quality-adjusted life years] gained with the expense of the
treatments?" (New York Times Magazine 7/19/09). Recall
that Singer would allow killing of "defective" infants.
Washington Post editorial board member Charles Lane
admits that concerns about the bill are well-founded: Section
1233 "addresses compassionate goals in disconcerting proximity to
fiscal ones." While end-of-life consultations are not mandatory,
doctors have an incentive to insist on them, and the legislation
lists what topics doctors "shall discuss" (Steven Ertelt,
Questions on White House Reports?
In a letter to Barack Obama, Sen. John Cornyn (R-TX) asks:
"How do you intend to use the names, email addresses, IP
addresses, and identities of citizens who are reported to have
engaged in 'fishy' speech?" Also, "Do your own past statements
qualify as 'disinformation'?" for example, a report on Obama's
2003 statement supporting a universal single-payer system.
Why Not Deregulate?
Private health insurance in America is extraordinarily
expensive because of regulatory requirements, writes Thomas
DiLorenzo. The quickest way to make it affordable would be to
completely deregulate the industry, as by repealing costly
mandates, and allowing a free market to develop.
"Politicians don't want to do it, of course, since they
would then no longer be able to extort campaign 'contributions'
from all those special-interest medical care/service providers.
They prefer to lie about the 'evil, capitalist health insurance
industry' instead" (lewrockwell.com
According to the American Academy of Actuaries, savings from
consumer-directed health care could be as much as 12% to 20%,
with a lowering of future trend rates by 3% to 5% compared with
traditional plans. It is already "bending the cost curve"
(Consumer Power Report 8/7/09).
It is not, however, owned by UnitedHealth.
Even if ObamaCare doesn't break the Administration, it could
well devastate the AMA. Individual members are dropping out, and
local, state, and specialty societies are voicing their dismay at
the board of trustees' endorsement of H.R. 3200. At this writing,
answers to the question "should doctors dump the AMA?" on www.aapsonline.
org are: yes, 1,246; no, 49; not sure, 38. There are 107
"Having been in health care policy for a long time, I have
read literally hundreds of six-point plans, eight-point plans,
and ten-point plans all developed by very sincere and earnest
people who think if only the world would do as they say, it would
be a better place....
"Unfortunately, that is the same chain of thought that led
to Napoleon, Mussolini, Hitler, and Stalin. I'm not suggesting
that health reformers are all little dictators (though some would
like to be), but the whole notion that a single person, or
committee of persons, can sit at a table and plan the future of
hundreds of millions of people is offensive to the ideas of human
dignity, freedom, and sovereignty.
"So when a colleague suggested that I come up with an
alternative, I was reluctant. He told me it isn't enough to be
the "Party of No!"... So here is my two-point plan:
"1. Give the money back to the people. 2. Get the hell out
of the way." (Greg Scandlen, Opposing Views).
A Modest Proposal
The Obama Administration has announced a new Cash for
Geezers program. Every American family will be eligible for a
$4,500 rebate for turning in their old entitlement-guzzling
grandparents to a hospice program. The hospice dealers will have
two days to dispose of the models, so they will never again
pollute the environment by emitting a steady stream of CO2 as
they exhale. This new program will help combat Global Warming,
stimulate the economy, and reduce the federal deficit. Truly a
Past Is Prologue
The historic "debate" between President John F. Kennedy and
Edward Annis, M.D., narrated by Alieta Eck, M.D., is preserved at
watch?v=vFesycofKk4 and www.youtube.com/w
Sep 30-Oct 3, 2009. 66th annual meeting, Nashville, TN.
Sep 15-18, 2010. 67th annual meeting, Salt Lake City,
An Assault on Citizenship
National health care is the permanent game changer, writes
Mark Steyn. Once enacted, it assures that elections are always
fought on the left's terms, as the voters identify health as
their number one concern.
Ceding responsibility for one's health to government
fundamentally changes the concept of citizenship. "If free
citizens of the wealthiest societies in human history are not
prepared to make provision for their own health, what other core
responsibilities of functioning adulthood are they likely to
forego?" Steyn asks. They might be trusted to decide what movie
to order from Netflix, or what cereal to eat for breakfast, but
for how long? "The 'right' to health care elides into the
government's right to tell you how to live in order to access
that health care." Almost any restraint on freedom can thereby be
Nationalizing health care ultimately means nationalizing
your body (www.steynon
Despite "piecemeal reforms," our largely unchanged system
remains on an "unsustainable trajectory," writes Michael E.
Porter, Ph.D. We need a "comprehensive vision" with "new
integrated care delivery systems"; bundled payments; mandatory
measurement and dissemination of health outcomes by every
provider for every condition; obligatory purchase of insurance so
younger, healthier people cannot opt out, bringing in substantial
new revenues; and central supervision by perhaps three
"Unless patients comply with care, even the best
doctor or best team will fail [emphasis added]. Simply forcing
consumers to pay more for their care is not the answer." But the
new system will "enable vast improvements in patient engagement"
(N Engl J Med 2009;361:109-112).
Is There a Constitutional Limit?
A government-dominated medical system may be uncon-
stitutional, argue David B. Rivkin, Jr., and Lee A. Casey, who
worked in the U.S. Dept. of Justice under Presidents Reagan and
George H.W. Bush (Wall St J 6/22/09).
The right to privacy, established in the 1960s as in Roe
v. Wade, was not abortion-specific, they maintain. What
could be more "central to personal dignity and autonomy" than
medical decisions? What kind of "undue burden" analysis might the
Court require for rationing decisions?
In an interview with Emily Bazelon, Justice Ruth Bader
Ginsburg expressed a different view: "Frankly, I thought that at
the time Roe was decided, there was concern about
population growth and particularly growth in populations we don't
want too many of" (NY Times Magazine 7/7/09). Thus, she
was surprised that the U.S. Supreme Court barred Medicaid funding
for abortions in 1980.
There is the "compelling state need" argument, which Obama's
science advisor John Holdren has applied, at least in the past,
to coercive population control by an armed international
organization, to protect natural resources.
It could be our last chance to choose our destiny "and the
right choices could lead to a much better world," he said.
Are there any rights that compelling need or noble
intentions do not trump?
Is an Individual Mandate Constitutional?
In assessing the Clinton health care reform proposal in
1993, the Congressional Budget Office (CBO) noted the
unprecedented nature of a mandate that required individuals to
purchase a specific product. The only analogous mandate was the
requirement to register for the draft.
Architects of the Social Security Act, who harbored grave
doubts about its constitutionality, settled on the rationale of
the taxing powers of the U.S. An individual mandate is not,
however, quite the same. Moreover, it might be problematic to use
the taxing power as the Constitutional authority, but not call
the mandate a tax for purposes of budget scoring rules.
In citing its power to regulate interstate commerce,
Congress might have some difficulty explaining how not
doing something could implicate commerce.
The mechanism of enforcement could invite even more
scrutiny. Identifying and penalizing scofflaws "may require a
degree of intrusiveness and bureaucracy that some will find
unpalatable," said Sherry Glied, Ph.D., nominated by Obama for an
assistant secretary position in HHS. (Peter Urbanowicz and Dennis
G. Smith, Constitutional Implications of an "Individual
Mandate" in Health Care Reform, Federalist Society for Law
and Public Policy Studies; 2009)
Tip of the Month: When a physician's assistant used a
physician's NPI, which he had apparently lifted from a job
application, to file fraudulent claims for motorized wheelchairs,
the physician escaped prosecution because he had not accepted the
position, nor given the PA authority to write prescriptions on
his behalf. Otherwise, he might have had difficulty defending
himself. Physicians are advised to protect their NPIs from
identity theft. NPIs are open to the public by internet, but be
especially careful when an employee who had access to the NPI
leaves. Monitor claims and reimbursements. "Most billing fraud is
committed by someone you trust with your NPI," said Susan Miller
of WEDI (Medical Practice Compliance Alert 7/27/09).
Cancel further use of a number you think has been compromised.
[Some physicians who are not HIPAA-covered entities have not
obtained NPIs, partly for this reason.]
Bureaucrats Can Overrule Doctors' Orders
The U.S. Court of Appeals for the 11th Circuit overturned a
ruling that the state could not reduce doctor-ordered care for a
Medicaid beneficiary (Moore v. Medows 08-13926). The
state had cut home nursing services for a severely disabled child
from 94 to 84 hr/wk. The state of Florida argued: "Treating
physicians...cannot be trusted with this sort of decision....
When left to their own devices, they advocate for their patients
and deem all manner of unproven, dangerous, ineffective,
cosmetic, unnecessary, bizarre, and controversial treatments as
'medically necessary'" (Health Care News, July 2009).
Fraud Enforcement Juggernaut Continues
To help offset the "shocking price tag" of proposed health
care reform, sweeping changes were enacted in the Fraud
Enforcement and Recovery Act of 2009 (FERA). A flood of new
whistleblower actions is expected, and courts will have to
revisit prior decisions. Broader classes of defendants and
conduct are liable; defenses are weakened. Compliance programs
need to be strengthened (HCFR 7/29/09).
County Society Rebukes AMA. All the officers and
committee chairmen of the Medical Society of the County of Erie,
and delegates to the state medical society, signed a letter
protesting the AMA's endorsement of H.R. 3200 with a copy to
Nancy Nielsen. Dr. Nielsen is past president of our county
society, the "hometown girl that went to great heights" as AMA
(now past) president the very one who "engineered" AMA support
for H.R. 3200. I think the AMA underestimated the strong
opposition to socialized medicine among physicians who actually
The letter reads: "[We have] grave reservations about the
recent decision by the AMA.... H.R. 3200...contains many onerous
provisions which will lead to a diminution in our ability to care
properly for our patients.... The establishment of yet more
bureaucratic entities...as [in] H.R. 3200,...will further
fracture our system.... Our community wants to...lose the "hassle
factor'...and reduc[e] third party interference."
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
Palin Nails It! Sarah Palin has called the Obama
healthcare plan evil. In one word, she summed up the most
important problem letting the state (aka politicians and
bureaucrats) decide who lives and dies. Meanwhile, most of the
Republican pols, think-tankers, and commentators without her
[fortitude] debate efficacy, efficiency, and other policy wonk
Craig Cantoni, Scottsdale, AZ
Please Report Me to the White House. I can't believe
what I am seeing on a White House post they want folks to report
"fishy misinformation" about the pending healthcare plan. Well
here is my "(mis)information": it's euthanasia of our elderly;
free abortions; taxing my employer-provided insurance or fining
them for not providing it, or me for not buying my own; a council
to decide what's necessary and what's not. The plan not only
allows the government to access your medical records but your
financial records as well....
I'm reporting myself to email@example.com, and I invite
you to report me too.... To find the exact blog, go to
whitehouse.gov and search on "fishy." Otherwise, it's hidden
among the rest of the propaganda there.
Maria Celina Salazar, Albuquerque, NM
To the White House: I would like to self-report: I am
quite critical of the unconstitutional takeover, as are my wife
and two boys. Nearly all of our family, neighbors, and friends
are opposed; some are self-insured and want to keep it that way.
We count only four who favor this government confiscation.
Kenneth D. Christman, M.D., Dayton, OH
On the Massachusetts Model. Why did Mass. need a type
of reform for "the poor" that other states limp along without,
when it has one of the lowest fractions of uninsured? It seems
that the fraud in Mass. was such that the feds were threatening
to jerk Medicaid funds. Instead of cleaning up, the state said,
"Let's paper over the bad things by forcing everyone in the state
to throw more money into the payola system we call MassHealth."
Romney could've fought it. There's nothing wrong with saying "No"
most of the time. It seems to be a primary requirement for
raising kids to be competent adults.
Linda Gorman, Ph.D., Independence Institute, Golden,
Mandatory Research. Although I do not agree with all
AAPS positions and thinking, I was, like you, deeply disturbed by
the JAMA article presenting participation in biomedical
research as a moral obligation.... Ezekiel Emanuel and his
colleagues' position placing "public good" above "individual
good" sets a dangerous precedent. Imagine the reaction by
Americans to making organ donation a moral obligation! Yet that
would probably save more lives than making participation in
biomedical research a moral obligation. Another scary thought is
to wonder to what extent this type of thinking occurs in Ezekiel
Emanuel's brother, President Obama's chief of staff.
Ronald S. Banner, M.D., Philadelphia, PA
Past Results. The guaranteed issue provision in HIPAA
has been terrible for small business. In 1996, small-group
coverage included 40 million Americans, who had average premiums
similar to those in the large-group market. In 2008, only 29.5
million had small-group coverage, with premiums 15-20% higher....
They got HIPAA right if the purpose was to collapse the
private market by increasing premiums and decreasing coverage.
[And what is the goal of reform? Ed.]
Mark Litow, F.S.A., Brookfield, WI
Sold Out. Washington-based trade and professional
associations have sold their souls for a "seat at the table,"
casting their lot with the most far-left elements in America:
SEIU, Families USA, and the Obama Administration. Even Wal-Mart
has sold out American business for 30 pieces of silver. We know
what eventually happened to Frenchmen who "went along to get
along." Like today, the Vichy government argued that they had to
be realistic: the Nazis were in power, and maybe by collaborating
they could get the Nazis to be less mean.
Greg Scandlen, Heartland Institute
One Word. I was asked by a Congressman what word best
describes the plan by Obama et al. The simple, honest, direct,
analytical, sad but truthful answer: fascist.
Dave Janda, M.D., Ypsilanti, MI