Monday, September 10, 2018

Obama bureaucrat critiques Trump health care

Once you get past the introductory Trump abuse (which I omit below), Donald M. Berwick makes an intelligently-stated case to the effect that American health care has been damaged by actions of the Trump administration. Like all Leftist writing, however his leaves out half the story.

He is probably right in saying that the administration has been hasty in winding back some aspects of Obamacare but he does not ask why.  His default explanation appears to be that the Trump adminstration is evil, a typically brainless Leftist claim.  What he takes no account of is that the Donks rammed through the ACA legislation with not one skerrick of bipartisan consultation or support.  They treated the GOP and its reservations as beneath contempt.  What did they expect of that?  What they now have to live with is the GOP treating their baby with contempt. It's not Christian but in the real world contempt breeds contempt. Conservatives often do turn the other cheek to Leftist attacks on them but the Left cannot expect that to go on forever.

And in his third point he says :"Modern health care, for all of its flaws, espouses and generally tries to act on science as its guide. Much of the US public is not so sure. The reasons for that doubt lie beyond the scope of this essay, but the effects on public debate and political positioning are strong"

He is right about that but again he glides over the causes of it.  The current "replication crisis" in medical and psychological research found that up to 70% of research findings were "unreplicable" or "wrong" in layman's terms.  What are people supposed to make of that?

And then, on top of that, we have the vast global warming hoax that goes on despite scientific findings against it purely on the basis that "the experts say so".  Throughout the world, the conservative side of politics mostly thinks global warming is a lot of hokum.  How can you expect respect for science in that situation?  It is thoroughly deplorable that science has become so disrespected but it is not conservatives who have created that disrespect.

His final point is that the intervention of government is needed to ensure proper healthcare for all.  He is probably unaware that libertarians challenge that.  In the Victorian era very good health insurance was available to the worker -- though friendly societies.  Most occupations had a body associated with a particular occupation to which they could subscribe for a modest sum.  And if the subscriber got sick he could go to the society doctor and get treated for free.

But there were always some feckless people who did not contribute and their plight caused a gradual intrusion into the issue by way of government hospitals being set up which would treat the uninsured.  And that binary system continues to this day in most countries.

In Australia, where I live, the contrast between the two systems is stark.  As with all "free" hospital systems, care is rationed in non-monetary ways, principally by waiting lists -- so much so that some people die while waiting. In my State (Queensland) there are in some cases even waiting lists to get on waiting lists.  There was one notorious case in Queensland where a man waited seven years for a cataract operation, during which time he could not see well enough to read and TV was rather mysterious too.  The impact on his life of such poor "care" was obviously severe.

But 40% of the Australian population is privately insured, despite the availability of the "free" system. They have heard many reports of what the free system is like.  And they get private care as good as anything in the world.  When I needed a cataract removed, I had private insurance so waited barely a week for an appointment to a private eye hospital and my treatment was brilliant. I experienced minimal discomfort both during and after the procedure.  And when I got a sudden and very painful attack of kidney stones I was on the operating table same day  -- and paid zero "deductibles". So there is an alternative to government healthcare and and it makes government healthcare look prehistoric.

But what about the 60% of Australians who do not take out private insurance?  Health insurance is very cheap in Australia -- from as little as $150 per month -- so even people in humble employment  can afford it.  Many people on low incomes choose to spend that $150 on beer and cigarettes instead but that is their choice.  They get the "free" government care.  And the Australian system is well settled and accepted. It is not a political football, as it is in the USA.  Any propositions to change it are greeted with widespread outrage.

So Dr Berwick would do well to broaden his horizons. Government healthcare is and always will be inferior healthcare.  It is best avoided.  Working on ways to get more people into private health insurance is the logical course to pursue.  Obamacare theoretically did that but in practice it has de-insured many -- with rocketing premiums and stratospheric deductibles.

When I served as administrator of the Centers for Medicare & Medicare Services, hardly a day passed—and never a week—without a direct request or instruction from a congressional office or White House official bearing on clinically relevant decisions, such as coverage for a new technology, payment levels for a care sector, interpretation of a Medicaid regulation, classification of a hospital as “rural” or “critical access,” measurement and reporting of quality, or, most famously, coverage for physician counseling on end-of-life care options. The private lobbyists were equally relentless, pleading their cases, usually for more money, directly or, more often, indirectly through congressional offices.

The politicization of decisions affecting clinical care was not confined to one political party. Conservative members of Congress pressed against almost every implementation detail of the ACA, with nary a single opening for rational, authentic inquiry about facts and logic. As quickly as they could, Republicans slashed the ACA investments in preventive care and services. Political opponents of President Obama promulgated uninformed and frankly ridiculous accusations about my agenda and beliefs as CMS Administrator but almost never engaged in any serious conversation about how to protect and improve the health of patients.

But also, one of the most liberal members of the Senate accompanied me to his technology-rich state in part to meet with a bevy of executives of medical equipment manufacturers, who explained the value of their products—in effect, a trade show for an agency head hosted by a US senator.

Purists might ask simply to “get politics out of health care.” That would be nice, but it is quixotic. Today, federal and state governments fund about 50% of all US health care (65% if coverage of government employees and various tax breaks are included).4 That proportion has increased from 31% in 1965.5 It would be inconceivable—indeed, irresponsible—for that level of public investment in any enterprise not to fall under government oversight, and, in a democracy, with such oversight authority come political pressures.

With government in the picture, politics has at least 4 on-ramps to health care.

First, and biggest, is money. Health care comprises almost one-fifth of the US economy. A nation that values entrepreneurship and protects private profits cannot expect that those motives will fail to engage the enormous financial opportunities through every possible channel of influence. The fragmentation of ownership, governance, and oversight of US health care makes it possible for a vast industry of political pressuring to flourish. With the US commitment, so far, to an enormously complex system of health care payment and provision comes the opportunity for every single organization with an economic stake in health care, whether motivated by private interest or public interest, to find multiple pressure points for influence.

Second is doctrine. The Federalists and Republicans at the birth of the nation became viciously divided as to the proper role of states and the central government. The North and the South became divided, and eventually fought a war, over attitudes toward slavery. Today, public discourse is also riven into factions according to deeply held beliefs about matters no less fundamental than human nature, individual responsibility, and the role of compassion in public affairs. Health care is an inevitable battlefield for that contention. The disputes take shape over laws, regulations, judicial decisions, and other governmental actions about assertions that reflect those underlying doctrines: assertions that health care is a human right; that richer people ought, through government, to help poorer people; that the rights of women should prevail over those of the unborn; and that health status is as much a collective responsibility as an individual one.

Third is trust in science and institutions. Modern health care, for all of its flaws, espouses and generally tries to act on science as its guide. Much of the US public is not so sure.6 The reasons for that doubt lie beyond the scope of this essay, but the effects on public debate and political positioning are strong. The current administration in Washington, exploiting public doubt, has in many scientific sectors, including medicine, weakened the commitment of agencies to use scientific evidence in exercising their duties.7 This has chilled action and research on such topics as environmental threats to health, US Food and Drug Administration guidance, and reports on risks from the Centers for Disease Control and Prevention.8 Weakening science through political action ultimately weakens care and harms patients.

Fourth, and finally, politics enters health care though attitudes toward solidarity. The commitment to mutuality—that government exists as a mechanism for acting on responsibilities for one another—is as deeply embedded in most other western democracies as it is fragile in the United States. The basic credo of physicians—to put the interests of patients before their own—at its best reflects a form of solidarity: that those who are fortunate are duty-bound to help those who are less fortunate. Opponents in Washington criticized me for making the assertion that in a civilized nation, the pursuit of health as a human right must be to some extent redistributional because poverty and ill health are correlated. That that logic could be questioned depends not on data—the data are incontrovertible—but rather on the degree of belief in the concept that ultimately, the nation is of one people, responsible in some measure for each other’s well-being, especially with respect to misfortunes not of a person’s own making. Government, and therefore politics, is the avenue for the expression or the negation of that sense of solidarity.

Physicians who want politics out of health care are going to be disappointed. If they value the principles to which they pledged as healers, then they ignore politics at their peril and their patients’. The sidelines are safe places for neither.



The NYT article: Are Trump's enemies proving his conspiracy theories TRUE?

He always said dark forces were out to get him... now, after revelations of a ‘resistance’ inside the White House, the BBC's JON SOPEL asks if the President has a point

This treacherous article concludes with the self-justification that he or she is part of the ‘quiet resistance’ putting ‘country first’. But listen to an alternative argument. The country went to the polls. Nearly 63 million Americans voted for Trump, and by the rules of the electoral college he was the duly elected President.

And furthermore, no one can say he’s not doing what he promised. Renegotiating trade deals, tougher immigration laws, confronting North Korea, cutting taxes, exiting the Iran nuclear deal, winding back regulations, are exactly what he promised during the campaign.

As Sarah Sanders noted, while it may not always be pretty, Trump’s economic policies are paying dividends, with 200,000 new jobs created, salaries growing at their fastest rate in nine years, and unemployment at a historic low of 3.9 per cent.

So what legitimacy does the writer have in declaring that he or she is the guardian of US democracy? For better or worse, the ballot box is where elections are decided and in November 2016 the American people spoke.



Hate in Politics Today Goes Beyond Anything This Nation Has Ever Experienced

Charlie Daniels

To anybody who will admit the truth, the animosity and downright hate that exists in the political arena goes way past anything this nation has ever experienced before. The vitriol has grown to the point that party power comes before patriotism for many of these jaded partisans, to the point they will fight tooth and nail to defeat things that would be beneficial for the country just because it’s the opposing party’s idea.

They’d literally rather do harm to the people they are sworn to serve than lose any political ground. They develop hyperbolic phrases, “tax cuts for the rich, throw Grandma off the cliff” resorting to kindergarten claptrap, trying to inflate the situation into dire warnings of impending doom to intimidate and terrify the electorate.

The Internal Revenue Service, the Federal Bureau of Investigation, the Justice Department have all been politicized, federal officials have been granted sweeping powers which is reminiscent of the motto of Lavrentiy Beria, head of Russian secret police under Joseph Stalin, “Show me the man and I’ll show you the crime.”

We have two standards of justice in America now, as one side is being exposed to the most painstaking, needle in a haystack scrutiny, while the other side is being ignored, even exonerated, while anybody with enough gray matter to walk through a door without bumping his head knows that there’s way too much smoke in the Hillary camp not to be some fire somewhere.

The politicians who defend open borders, at least in my opinion, couldn’t care less about the illegals they so gallantly defend. They just look at them as future voters. Their ideas are so far afield, they can’t win in that arena, so the coordinated complaints against a wall that would go a long way toward preventing illegal border crossing of people, drugs, and no telling what else, is nothing more than importing a loyal political base.

All the passionate appeals from the Democrats about “separating children from their parents” is shouted from the rooftops by people who care not a whit about the millions of unborn children separated from their mother’s womb and from a chance at breathing every year.

If Donald Trump is guilty of treason, collusion with our enemies or any other offense that is detrimental to this nation, I want him tried for it.

Conversely, how can paying a foreign intelligence agent for a dossier filled with cloudy, unverified information, using it and laying the groundwork for the FISA court warrant to mount surveillance on American citizens not be worthy of further investigation?

And how can destroying thousands of documents that have been subpoenaed by Congress not be a crime?

And why has a former CIA Director – who was actually caught on television lying to a congressional committee – not been prosecuted?

Why has the Russian acquisition of America’s uranium under Obama-Clinton not been thoroughly investigated?

And why has Obama’s blocking of the records of Holder’s part in the Fast and Furious debacle not been unsealed?

Andrew America “was never that great” Cuomo, Obama, Hillary Clinton and the preponderance of the progressive elite are globalists. They think America needs to be overhauled, our wealth passed around and our military power blunted.

Before Trump, America, along with practically every other industrialized nation on earth was merrily tripping down the primrose path to globalism. Hillary’s election was to be the lynchpin, the long-awaited consolidation of power, the open borders and legalization of millions of illegal immigrant voters, the appointment of Supreme Court judges that would take care of any little details, that for one reason or another should fall through the legislative cracks.

The cock assuredness of a landslide Hillary victory made some people careless to the point that they left some loose ends, made some glaring mistakes, but never mind, when Hillary got in, there were no worries, everything would be buried so deep it would never be found.

Along comes brash, outspoken, abrasive, unafraid Donald Trump, and the corks went back in the champagne bottles, the balloons were not released, and the strategy hurriedly went from celebration to CYA and bring down this president before he can get the economy hopping, build up the military, move the American Embassy to Jerusalem, banish silly business-killing regulations and attract businesses back to American shores.

The proverbial square peg had inserted itself into the round hole, demanding that we put America first and threw a monkey wrench into globalist aspirations for the foreseeable future.

The resurgence of American manufacturing businesses, tax cuts, fewer regulations, a strong military and an “America First” attitude does not foster globalism.

Being a Bible-believing Christian, I hate globalism with a passion.

Globalism is the kingdom of the antichrist, and it happens when the nations of the world hand their sovereignty and power over to a person, masquerading as an angel of light, who seems to have all the answers to the world’s problems, but is actually the embodiment of evil.

That is the ultimate act of mankind putting their trust in other men rather than Almighty God.

That’s when the term “hell to pay” becomes a reality.

What do you think?

Pray for our troops, our police and the peace of Jerusalem.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCHPOLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated),  a Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here (Pictorial) or  here  (Personal)


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