The Victorious Opposition

Here’s the gist:

With her boyfriend in severe abdominal pain, Sharon Edge called 911 for an ambulance in the early morning hours of Feb. 6.
...
Nearly 30 hours later — and 10 calls from the couple to 911, four 911 calls to them and at least a dozen calls between 911 and paramedics — Curtis Mitchell died at his home.

Now here comes the meat of the issue:

In all, three ambulances were dispatched at separate times. In each case, Mitchell was told he’d have to walk to them — and he canceled the calls.

As the hours went by, Mitchell’s pain intensified and he began to have shortness of breath. Because he complained of abdominal pain, which is generally not considered life-threatening, he was initially ranked as a medium priority. About 11:20 a.m. Saturday, his priority level was upgraded, but not as an emergency.

Obviously, this death could have been avoided.  However, the exceptional circumstances involved with this case, in terms of weather, makes it difficult for me to indict the responders at face value.  I have a few questions that I hope our resident (former) EMT could address.  First, how does the priority system affect the response?  It sounds as if they were willing to provide the ambulance (amber lamps?), but not door to door service, due to the weather.  So, if there had been a higher priority, would that have changed their aggressiveness in getting this man out of the house?  For example, if this had been a heart attack, would the responders still have demanded that the patient walk to the vehicle? 

This sounds like an example of extremely unfortunate timing but I’m curious if there is any culpability—even with the weather, 30 hours seems like an awfully long amount of time to insist that an ailing person walk through snow—if the responders couldn’t easily make it through, what made them think that this ailing man could?

Dwex?

With a title like “Putting Americans In Control Of Their Health Care”, you’d think that maybe some libertarian concepts had actually crept into the White House health care plan.

You’d be wrong.

It’s pure window dressing. Top to bottom. Not a single substantive change from the Senate bill. True, there is no “public option” and there is no single-payer model (there are still exchanges, but they’ve taken the public option out of them). There’s still an individual mandate. The system is still fundamentally employer-centric, rather than individual-centric, making the portability thing a pure fiction. They say:

Nothing in the proposal forces anyone to change the insurance they have.  Period.

Leaving out the entire “as long as you remain with the same employer and the employer doesn’t change the plan”.

There is no attempt at actual Medicare/Medicaid reform. It pretends that elimination of fraud & waste is enough. Even assuming such were possible, that’s a ludicrous concept. They even spend more on Medicare by closing the Part D “donut hole”. Let’s not forget that Medicare Part D is unfunded in the first place.

They pay lip service to including GOP ideas (there’s a “Republican Ideas” page that lists the things they’ve pulled from GOP bills). None of these are remotely substantive. Pure window-dressing.

To make things worse, the Democrats are apparently planning to go the reconciliation route after all:

Democratic officials said the president’s proposal was being written so that it could be attached to a budget bill as a way of averting a Republican filibuster in the Senate. The procedure, known as budget reconciliation, would let Democrats advance the bill with a simple majority rather than a 60-vote supermajority.

I have, of course, written to the President and my Congress-critters yet again to object to this move, as I’ve done every time it’s come up for the last year. A couple of Democrats have said they’ll oppose reconciliation. We shall see.

A month ago I asked why the GOP wasn’t taking the lead on health care. Seems to me that window has closed. The Democrats are now back on track. And the election of Scott Brown won’t amount to either diddly or squat at the end of this debate.

The most aggressive response to come from the GOP so far has been Rep. Paul Ryan’s “Roadmap For America’s Future”, which I discussed previously. Unfortunately, the GOP leadership has hung Ryan out to dry over this:

“Paul Ryan, who’s the ranking member on our budget committee, has done an awful lot of work in putting together his roadmap,” Boehner said. “But it’s his. And I know the Democrats are trying to say that it’s the Republican leadership. But they know that’s not the case.”

(emphasis in the original)

So Thursday’s “televised health care summit” will be exactly the dog-and-pony show that people are predicting. And the Democrats will ramrod some egregious form of health care “reform” through within the next month or so.

While the GOP continues to eat their young and think they can do better.

Politics as usual. Wonderful. Pelosi and Boehner need to be replaced. Maybe Ryan and Cantor can stage a coup; I’m not sure who I’d root for to stage a coup for Pelosi’s job, but pretty much anyone would be better.

I think I’ve mentioned before that I started having problems with my shoulder again last summer - pain, range-of-motion limitations and weakness. After a couple months of ibuprofin and getting back into my home PT program didn’t help, I went back to the orthopod. Went back on the high-dose anti-inflammatories, and did a month of physical therapy. Which got the pain under control and resolved the range of motion problems, but my shoulder is still crazy weak - I basically can’t lift more than 10 lbs or so if my arm is away from my body (i.e. no deficit if I lift something straight up at my side, but insanely weak if I have to lift or carry anything with my arm outstretched). We did another month of PT, with modest improvement of strength.

The big concern was that I had a rotator cuff tear. When I had my surgery in 2008, there was a tiny hole in one of the rotator cuff tendons, but they decided not to repair it, since repairing a tendon requires immobilization, and the problem we were in there to fix (the impingement) required that I get moving as quickly as possible after surgery. So there was concern that rather this hole had progressed into a significant tear, which would require another surgery and horrible long recovery. With school coming up, and the end of COBRA coverage expiring at about the same time, we decided we needed to figure this out quick, and if I absolutely had to have the surgery, to get it done ASAP.

So at the end of December I had an arthro-MRI done on my shoulder (a combination of an arthrogram with an MRI). This was a two-part procedure, done by two doctors in adjacent suites in one of the office buildings at the local hospital. For the first part, using a flouroscope, they injected a contrast dye into the shoulder joint (cool to watch, not a lot of fun to experience). Then over to the other suite for an hour-long series of MRI scans of the shoulder joint. The arthrogram is used for this because if there were a tear, the dye would flow into the gap between the tendon and the bone, and be highly visible.

Fortunately, there’s no issue that requires surgery. Unfortunately, my arm is still crazy weak. It’s improving - very, very, very slowly. So we’re sticking with anti-inflammatories, routine stretching, and weights three times a week to try to get it better. For the time being.

Anyhow, back on point. Let’s look at the billing, insurance payments and out-of-pocket payments for this. Since I’ve still got my old employer-sponsored insurance, via COBRA, it’s a good plan - an Aetna PPO with a modest deductible and co-insurance post-deductible.

In discussion about the State of the Union Address, Rich pointed us at the latest plan from the GOP, entitled A Roadmap for America’s Future. This is a just-updated version of a plan from 2008, which appears to be being driven by Rep. Paul Ryan of Wisconsin (aside - whenever I hear “Rep. Ryan”, this douchebag is who comes to mind - I need to break that habit, because they are completely different people).

The website is useful, and if you drill down enough, you can find this 100 page PDF document which really explains what’s going on. It’s not the best-structured document of all time - the actual proposals don’t show up until almost fifty pages into it, and while the stuff before that does a decent job of trying to explain what’s wrong, it’s both overly dense and overly terse at the same time (it goes into gory details on some issues, sometimes several times, and yet still depends on terminology and concepts that are probably unfamiliar to many of the people these detailed explanations are targeted at). This made it a much harder read than I expected. I hope that they restructure this document - perhaps summarizing the proposals first, then the details on the problems these proposals are designed to address, then the detailed versions of the proposals.

Anyhow, you should at least review the website, and skim through the document, if not read it fully.

Rep. Ryan introduced H.R.4529 on Wednesday, entitled “To provide for the reform of health care, the Social Security system, the tax code for individuals and business, job training, and the budget process.” (I love the grandiose titles that wind up on a lot of bills). The text of the bill still isn’t available yet; so it’s difficult to assess what they’re really proposing, so we’ll come back to that when the text is available. (Update: I found a link to the draft legislation drilling down through other stuff on their website. It’s 630 pages. I haven’t read it yet…)

There is a lot to like in this proposal as it currently stands, though I do have some major concerns. Let me get to my big concern first, though.

The GOP message on health care right now seems to be “We need to start over”. Period. It was said repeatedly, in almost exactly those words, on the Sunday AM shows (Orrin Hatch, John McCain, Mitch McConnell all said something of that ilk). Well, I agree with that sentiment. What I don’t get is - why isn’t there a concrete proposal for the common ground Hatch & McCain are saying is there? Why are they stuck on talking about the process, and not taking the lead on the substance?

It’s quite clear to pretty much everyone that the Democrats are currently in complete disarray on this topic - the House Democrats are at polar opposite ends of the spectrum from each other as their leadership tries to get them to pass the un-amended Senate bill. The Senate Democratic leadership is sitting on its heels with “wait and see” (which, actually, is an appropriate and somewhat commendable position for them to be taking). The White House is all over the place, backing absolutely everybody on every proposal, and hence having absolutely nothing useful to say on the topic.

I think people truly believe there is common ground. And there are GOP agenda items that are enormously popular (e.g. tort reform) that could be driven back into the conversation. Why aren’t we hearing this? In the GOP’s response to the President’s weekly message on Saturday, Rep. Boehner didn’t address it. As I mentioned, the Sunday morning talk show guests didn’t address substantive program ideas. TBH, I am unsurprised by this, but continue to be perturbed by it.

There is a short window here; it’s not impossible that the window closes Wed. night at the President’s State of the Union address, where he might re-take the initiative on this front. I was really hoping to see some leadership from the GOP. The GOP leadership continually claims to have ideas, plans, etc, but repeatedly fail to deliver any of that message, falling back into pure opposition politics. As I’ve said before - maybe that’s a viable tack to take on “stimulus” (although I continue to believe they just handed the Democrats victory with that tactic), but on health care, things absolutely need to be addressed on a range of topics that both parties agree on (e.g. pre-existing conditions, dropping coverage/coverage limits, access to insurance plans, drug costs, etc). There isn’t agreement on how to do these things, but there is agreement on issues (e.g. on the access issue, Democrats want the government to do it and Republicans want market changes to let the market do it, such as removing the interstate barriers, or on the drug cost issue, Democrats want regulation and Republicans want tort reform).

So I ask you - why is the GOP letting this golden opportunity to take control of the agenda slip away from them? Maybe they won’t succeed in getting their agenda through, but if they would take this fleeting moment to drive a concrete message to the public, they would completely flip the debate and show themselves as the party of ideas and the Democrats as the obstructionists. Right now they seem to be continuing to open the door for continuation of the “party of no” label, by failing to capitalize on the Democrat’s “party of better than nothing” moment.

Thoughts?

One-upping their previous most repugnant step of bypassing conference committee for the health care bill, the Democrats are now making plans for what happens when they lose their super-majority:

A top House Democrat said Tuesday that the Senate health care bill is “better than nothing,” an indication that the House of Representatives is considering passing the more conservative Senate measure with no alterations.

The House Democratic leadership may resort to that course of action if Massachusetts Republican state Sen. Scott Brown wins Tuesday’s race to fill the vacancy created by the death of Democratic Sen. Ted Kennedy.

Brown’s victory would deprive Democrats of their 60-seat Senate supermajority and give the GOP enough votes to block future Senate votes on health care and other White House priorities. If the House passes the Senate bill as currently written, however, the measure could proceed straight to President Obama to be signed into law.

Every day these people come up with a new way to make me sick to my stomach. I will, of course, be writing to my Congressman about this, and the President, and watching to see how many of the House Democrats decide to sell their souls to partisan politics (e.g. the Senate version of the bill doesn’t have the abortion-funding restrictions so many Democrats in the House got all moralizing about). I see a whole lot of Bill Nelson moments coming.

Right now I’m wrestling with whether “Party of No” is more or less evil than “Party of Better Than Nothing”. In this context, I’m afraid I’d have to fall on the side of “Party of No”, because while I adamantly believe health care reform is needed, this bill is much worse than nothing, and the process it’s taking is partisan evil incarnate.

My current Facebook status:

The Democrats truly suck. First they completely bypass conference committee to try to create a health care bill completely excluding the other team. Now that they might lose their super-majority, they are attempting to convince the House Democrats to pass the Senate bill unchanged (hence removing the need for new votes). Complete, utter bullshit.

No feedback on that yet. We’ll see how many open-minded liberals unfriend me over it this time…

From CNN today:

Top Democrats are prepared to short-circuit the traditional legislative process and exclude their Republican counterparts during final congressional health care deliberations, senior Democratic sources have told CNN.

Democrats are trying to prevent the Republicans from using Senate rules to slow the push for final passage of a comprehensive reform bill, the sources added.

...

Formal House-Senate negotiations, under the ordinary legislative process, would likely have started shortly after both houses of Congress reconvene. Democratic concerns over the GOP’s ability to slow the process, however, may result in the traditional process being replaced with informal, high-level talks, sources stated.

Via Congress.org, I sent the following note to the President, my Senators and my Representative, with the same title as this post:

In August, 2008, in a town hall meeting, candidate Obama said “I’m going to have all the negotiations around a big table. ... what we will do is, we’ll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies.”

PolitiFact.com has already called this out for the broken promise that the “health care reform” process has been. But the administration and Democratic Congressional leadership continue to take this even farther. It is difficult to put into words how astonished I was to read today that the leadership is going to exclude the opposition party from the negotiation process by holding private negotiations, bypassing the normal conference committee process.

This is the most repugnant step yet in what has been a repugnant process. Both parties deserve to be held up for their ill behavior in this process. Besides the lack of openness promised by candidate Obama, we have “we won, get over it” from the Democrats, and the “party of no” from the GOP. We have “you lie” from a GOP Representative, and “they want you to die” from a Democrat Representative. We have lies, spin, deception and scare tactics from both parties about what’s in and what’s out. And at the end, we have Democratic leadership buying off members of their own party to get the bill passed in the Senate.

There is much common ground to be had on health care reform issues. But rather than trying to craft a bill that starts from the common ground, the administration and the Democratic leadership have tried to redefine an entire industry and massive portion of our economy, with no consensus within even their own party.

I’ve written before about the budget reconciliation issue that has been proposed to get this bill passed, and I am pleased to see that, at least so far, the Democratic leadership has avoided going this route. As I said in those notes - the Democrats have a virtual super-majority (58 + 2 independents). If you cannot get 3 people to vote with your near-super-majority then maybe, just maybe, the bill doesn’t deserve to be passed.

I call on my representatives to oppose this latest abuse of power. It is better that nothing be passed than have this horrid process, with its horrid legislation, be brought to such a horrid conclusion.

I am a political independent, and this process has reinforced for me why an am such, and why I will remain such. Please pull back from this partisan power play before it is too late.

Sincerely,
dwex

I see via Fox that C-SPAN is calling out the President:

The head of C-SPAN has implored Congress to open up the last leg of health care reform negotiations to the public, as top Democrats lay plans to hash out the final product among themselves.

C-SPAN CEO Brian Lamb wrote to leaders in the House and Senate Dec. 30 urging them to open “all important negotiations, including any conference committee meetings,” to televised coverage on his network.

“The C-SPAN networks will commit the necessary resources to covering all of the sessions LIVE and in their entirety,” he wrote.

In a Tuesday afternoon press conference on health legislation negotiations, House Speaker Nancy Pelosi appeared to object to the premise behind the request.

“There has never been a more open process for any legislation in anyone who’s served here’s experience,” she said.

If that’s true, that’s about the most damning condemnation of Congress I’ve ever heard from one of its leadership.

In an attempt to prevent future Congresses from overturning provisions of the new health care law, the current bill has some, umm, “interesting” language in Section. 1899A(d) (page 1019 of the 2000 page bill):

(3) LIMITATION ON CHANGES TO THE BOARD RECOMMENDATIONS.—

(A) IN GENERAL.—It shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, or amendment, pursuant to this subsection or conference report thereon, that fails to satisfy the requirements of subparagraphs (A)(i) and (C) of subsection (c)(2).
(B) LIMITATION ON CHANGES TO THE BOARD RECOMMENDATIONS IN OTHER LEGISLATION.—It shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report (other than pursuant to this section) that would repeal or otherwise change the recommendations of the Board if that change would fail to satisfy the requirements of subparagraphs (A)(i) and (C) of subsection (c)(2).
(C) LIMITATION ON CHANGES TO THIS SUBSECTION.—It shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report that would repeal or otherwise change this subsection.
(D) WAIVER.—This paragraph may be waived or suspended in the Senate only by the affirmative vote of three-fifths of the Members, duly chosen and sworn.
(E) APPEALS.—An affirmative vote of three-fifths of the Members of the Senate, duly chosen and sworn, shall be required in the Senate to sustain an appeal of the ruling of the Chair on a point of order raised under this paragraph.

Note the requirement for a 3/5 super-majority for Congress to approve changes. There are interesting questions about whether or not the actions of one Congress are binding on future Congresses (a future Congress could just pass a new law revising this provision, one would think).

But that’s not the truly interesting part. This is:

while cloture to end debate on legislation ordinarily takes “three-fifths of all the Senators duly chosen and sworn” (60 senators when all seats are occupied), cloture on any proposed change to the Senate’s standing rules takes “two-thirds of the Senators present and voting,” or 67 senators if all 100 are on the floor.  (Both of these requirements are in Senate Rule XXII.)  Ironically, the two-thirds rule can be easier to satisfy when the active quorum of senators is smaller; it could take as few as 34 senators when a bare-minimum 51 senators are present.  But any time more than 90 senators are present, it will take more than 60 votes to end debate on any statute that works a change in the Senate’s standing rules.  Thus a good argument can be made that the mere 60 votes obtained in the recent cloture vote were insufficient to end debate on the Reid bill—because it contains at least one change to the Senate’s standing rules.

The problem is, though - the Democrats control the parliamentary procedures, and such there is nothing anyone can really do about it. The Constitution is quite clear that each chamber of the legislature is responsible for its own rules, and there’s no way whatsoever any court is stepping into this.

Interesting times we live in, huh?

H/T: The Volokh Conspiracy

How many people remember this little bit from Candidate Obama:

Ah, I so love science:

A rather bizarre study carried out by German researchers suggests that staring at women’s breasts is good for men’s health and increases their life expectancy.

According to Dr. Karen Weatherby, a gerontologist and author of the study, gawking at women’s breasts is a healthy practice, almost at par with an intense exercise regime, that prolongs the lifespan of a man by five years.

She added, “Just 10 minutes of staring at the charms of a well-endowed female, is roughly equivalent to a 30-minute aerobics work-out.”

OK, time to go visit the greatest website ever created.

Wow. Things are getting way ugly in the Democratic party trying to get a health care reform bill passed in the Senate.

First topic - a move is afoot to change the rules of cloture to make it easier to break GOP filibusters:

Given what he sees as the abuse of power by a couple members of his own party whom he said are threatening to join the minority party if their every demand is not met, Harkin is considering reintroducing the legislation.

“I think, if anything, this health care debate is showing the dangers of unlimited filibuster,” Harkin said Thursday during a conference call with reporters. “I think there’s a reason for slowing things down ... and getting the public aware of what’s happening and maybe even to change public sentiment, but not to just absolutely stop something.”

...

He said for instance if 60 senators could not agree to end debate, it would carry on for another week or so and then the number of votes required to end debate would drop by three. Harkin said it would carry on this way until it reached a simple majority of 51 votes.

“You could hold something up for maybe a month, but then, finally you’d come down to 51 votes and a majority would be able to pass,” Harkin said. “I may revive that. I pushed it very hard at one time and then things kind of got a little better.”

I think I’m gonna break out the “H” word here and call Harkin a hypocrite, even though it is the same legislation he introduced fifteen years ago. The difference? Then, his party was the minority, and this legislation would have reduced the power of his own minority party to hold up the work of Congress - something most of us would probably consider commendable. This time, his party has a near super-majority (everyone says the Democrats have a supermajority, but fail to recall that it’s actually 58-40-2). He’s basically introducing this as a way to ensure that his majority party gets its way, not some altruistic ideal of making Congress more efficient. So he gets the “hypocrite” banner of the day.

Second item - It appears Harry Reid is refusing to use reconciliation:

OK, we need a little change of pace, something a little less rancorous, and I can’t think of better topic than brew.

In fact, they took their beer so seriously, if you brewed a bad batch your punishment was to be drowned in it.

Which validates the old adage ,“Too much of a good thing…............is bad”.

Some other useful factoids:

Which country drinks the most beer?

Which country has the most beer brands?

The worlds most expensive beer?

And general facts on beers of the world, broken down by each country.

Of course, all this is really superfluous, the best beer in the world is the one icing down in your frig.

I like the whole concept of “Viking Heaven”, but substitute Scarlett Johansson for the goat, and I am definitely on board.

Consider this slant on health care issues:

Is Female Health Care Under Attack for the Second Time in a Week?

Days after a government task force radically changed its guidelines for using mammograms to screen for breast cancer, another critical preventive test — Pap smears – is under the microscope, heightening concern that both might be a first step down a slippery slope toward health care rationing.

So, I must ask, where was the outrage last fall when the same organization issued the same type of recommendations for prostate cancer screenings and colorectal cancer screenings last year? I don’t recall hearing anything, then or now, about male healthcare being under attack or slippery slopes towards rationing.

Both of these areas are big deals for the dwex family - I’m at elevated risk for prostate cancer due to family history, and mrs. dwex is at elevated risk for breast cancer due to family history. My doctor and I have discussed the issues surrounding PSA tests for a couple of years, including the false-positive issue (which I’ve mentioned in other posts). Even with the elevated risk, we’ve decided to avoid PSA testing until I’m at least 50, unless I have symptoms, because the false-positive rate combined with the risks of biopsy are just not worth it.

When routine early screening leads to complications (e.g. false positives leading to biopsies that can have serious complications), early screening needs to be questioned. On the flipside, when detection and treatment leads to no longevity benefits and reduced quality of life, the rationale for continued screening should be questioned. These studies have raised issues that warrant discussion as part of the broader healthcare debate. They shouldn’t be used as political footballs.

People need to have this type of information. And they need to talk to their healthcare providers. These are recommendations about routine procedures for average people. Individuals will make their own decisions with their medical providers - which is how things happen anyhow.

I’m really tired of all this fear-mongering nonsense. This crap with cancer screenings is right up there with the “death panel” nonsense, having no correlation to reality but making for good press.

Just in case you’re suffering from insomnia, you can take a gander at the 2100 page Senate version of the bill.

Ugh. As someone pointed out, the original Social Security Act was something like 60 pages long. How’s that for ever-expanding government?

Just in case anyone is looking for it here’s the House Ways & Means Committee page with the new health care bill and a bunch of other supporting documents.

The Senate apparently hasn’t posted its bill online; when there’s a link, I’ll update this post.

Harry Reid may be pushing forward a modified public option, but it’s not going to pass; he doesn’t have enough votes. And he’s lost one more. Joe Leiberman just came out against it:

Sen. Joe Lieberman told reporters Tuesday that he will support Senate Majority Leader Harry Reid on a procedural motion in order to start the health care debate - but opposes any kind of public option, including state opt-out and trigger provisions, and will ultimately not vote to approve any health care bill that includes any version of a public option.

...

“I can’t see a way in which I can vote for cloture on any bill that contained a creation of a government-operated-and-run insurance company, it’s just asking for trouble,” he said. He also rejected the idea of a “trigger” option that would allow for the launch of a new public option if the insurance industry failed to meet certain coverage benchmarks. “I feel this way about a national government-run health insurance company whether it’s a trigger or not,” he said.

I agree with Leiberman. This stuff needs to come to the floor and be debated. Enough behind-closed-doors. Time for on-the-record debate. There are some good, important things in these bills. There’s also a ton of bogus junk, including the “public option.” I naively hope that a compromise will emerge that lets some of the market reforms happen (e.g. disclosure, cross-state, etc that we’ve discussed). And tort reform, electronic records management, etc. These are all good things. But the “public option” needs to die, along with “death panel” rhetoric, and get down to real debate about real issues.

There’s still a push by some Democrats to “fast track” health care reform via reconciliation, but I’m not at all convinced that they can even muster the 51 votes needed for that bogus tactic, given the opposition from the Blue Dog Democrats, and now Sen. Leiberman. They certainly aren’t going to break a filibuster over this.