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August 31, 2009

Health Care post Kennedy- A MIGHTY WIND?


The moral case for health care reform is NOT clear-cut

The last Kennedy brother has passed from the scene & we now face the 'legacy' argument. When LBJ pressed for landmark civil rights legislation in the wake of John Kennedy's premature death, a moral wind was at his back – and the country was not yet broke.

LINK: http://jaygaskill.com/HealthCareWind.html


New to the POLICY THINK SITE ( www.jaygaskill.com ), Copyright 2009 by Jay B. Gaskill. Permissions & comments: law@jaygaskill.com .

The moral case for health care reform is NOT clear-cut.

The passage of ONE specific bill (HR3200) has been presented as an overriding moral issue. That simply is not the case. [For the curious, patient and legally astute, you can locate the full text of the pending House Bill in pdf format at this LINK: http://energycommerce.house.gov/Press_111/20090714/aahca.pdf.]


All ‘reform’ initiatives affecting large numbers of people over long periods of time need to be tempered by the time-honored world prudential concerns, among them these cardinal four:

  1. The ‘first, Do no harm’ caution;

  2. The Utopian trap caution, ‘Don’t let the pursuit of the unobtainable perfect block the attainable imperfect improvement’;

  3. The ‘Murphy’s Law’ caution, ‘Large scale changes should proceed with great care’, preferably incrementally, preserving the option to repair and reverse course;

  4. The anti-bureaucratic caution, ‘Always allow for creative organizational and technological innovation by rejecting one-size-fits-all prescriptions’.

Politicians, especially the ideology-driven subset, tend to conflate everything to the category of a burning moral issue, even the need to drive down the cost of US medical care. But finding practical ways to contain health care costs, for example, is a primarily prudential issue...while doing so without compromising the quality of care to those now receiving it may well be a moral issue.


Cutting through the fog of debate, we can identify two laudable policy goals that are well supported by a societal moral consensus.

1. Making health care insurance available to the non-indigent who are currently priced out or completely blocked by preexisting conditions exclusions.

2. Providing reasonable, life-saving access to medical care for the indigent and near-indigent subpopulation.


  • Children are now provided for, regardless of their financial circumstances, by the SCHIP program (LINK: http://www.cms.hhs.gov/home/chip.asp http://www.cms.hhs.gov/home/chip.asp ).

  • Senior Americans are provided for by the Medicare program as are most disabled under 65 (LINK: http://www.medicare.gov/medigap/under65.asp ).

  • The adjusted number of uninsured Americans (from the 47.5m number published for 1997) is about 27m (subtracting non-citizens and SCHIP eligible minors not yet enrolled) represents less than 16% of the total population. Put another way, at any given time about 84% of Americans are covered by heath insurance.

  • Hospital emergency rooms are required to – and do – provide care to indigent persons on application. Though cumbersome and inefficient, the ER has become the indigent care provider of last resort. I note this New York Times report from 2003 - ‘The Bush administration is relaxing rules that say hospitals have to examine and treat people who require emergency medical care, regardless of their ability to pay. Under the new rule, which takes effect on Nov. 10, patients might find it more difficult to obtain certain types of emergency care at some hospitals or clinics that hospitals own and operate. The new rule makes clear that hospitals need not have specialists ''on call'' around the clock.’

Obviously, the current system 'NEEDS IMPROVEMENT' both from a prudential and a moral perspective. But is it morally bankrupt? HARDLY.

Among the morally founded concerns being debated, these six animate most of the discussion:

  1. Our common humane concern for the plight of the less fortunate.

  2. Our natural wish to mitigate the inequities of life, especially where they affect access to medical treatment;

  3. The physician’s ethical duty to make his or her individual patient better – this is the core of the Hippocratic Oath;

  4. Our common AFFIRMATIONS of health over illness and life over death;

  5. Our desire to continue the beneficial fruits of creative medical innovations, especially in America;

  6. The inherent justice that promises relied on are to be kept and earned benefits are not to be taken away.

Here's the dirty little secret of the current debate:


This 'quality downgrade' effect will be revealed over time in 'new' medical doctrines that impede the Hippocratic oath (sacrificing individual patients for the 'common good'), in new bureaucratic rules that promote or reward the pursuit of life saving cures for more 'cost-effective' approaches (one prominent administration 'reformer' proposes using pain killers in lieu of chemotherapy as general policy), in an actual reduction in the rate of creative medical innovations, and in the denial of levels of care that had been contractually or morally promised.

To be clear: The real discussion is not between some morally enlightened government solution and the retrograde forces of darkness: it is between sets of solutions that are likely to make things better for a large number of people without making things worse for an even larger number, versus a set of politically managed and poorly constructed 'paper' solutions designed to mask a general reduction of care quality in the name of 'equality'.

There is no actual societal consensus about 'justice' when it comes to health care. Just consider these competing ideas:

1. Social justice, the perspective that differences in one’s social circumstances and well being should be ‘evened out’ in the name of equity.

2. Individual justice, the perspective that one’s own actions should produce appropriate consequences to be enjoyed or suffered as the case may be.

3. Ameliorative justice, the perspective that the adverse circumstances imposed without fault by the actions of others or the cruel turns of fate should be ameliorated.

4. Creative justice, the perspective that the conditions that ‘grow the pie’ through creative innovation and development should be allowed to trump temporary inequities.


Let me propose a practical approach, one framed around two, time honored principles:

[1] Do no harm. Let's commit to limit changes in the American health care system to ones that will not degrade the care now provided the great majority of us who are sufficiently satisfied with our present arrangements that we don't want them to be 'messed with' in the name of 'comprehensive reform'. We are to be forgiven for our world-weary skepticism about the Utopian promises of government officials. We have been burned before.

[2] Slow down and proceed with great care. Reforms should be targeted at the carefully defined problem areas, employing a metric by which their efficacy can be measured, allowing a clear opportunity for review, amendment or even reversal of course. The current plan is designed to become so embedded that reversal will quickl become a practical impossibility.

So – What would I support?

  • A supply-side American physician program, cutting tuition costs of medical education, including specialists. [You want to drive down prices, try increasing suipply.]

  • Universal access to shared risk-pools for catastrophic health insurance, scaled to achieve a reasonable wholesale premium level without denying coverage for preexisting conditions. [Private insurers, individuals, businesses and government agencies would then contract with these risk pools to supplement other arrangements and these pools would become the default coverage for all employers (including part time jobs) as well as the default COBRA coverage with no time limit.]

  • More tax-free health insurance savings accounts for all adults and children up with no-penalty charitable sharing with others in need.

  • A fast track, special bankruptcy proceedings for medical costs only – repeatable in 3 years as necessary.

  • Reversal of the ever more intrusive and inefficient bureaucratization of medical care, allowing America’s health care sector to remain open to creative, flexible, non-bureaucratic innovations lest it mutate into death care.


From a real world perspective, the needed constructive discussions first require congress to just say NO to the current bills, and NO to the strong-arm tactics of the current congressional leadership.


August 22, 2009


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LINK: http://jaygaskill.com/HEALTHCAREIsItReallyTimeToSayNO.htm


Companion article LINK: (the HMO from Hell): http://www.jaygaskill.com/HMOfromHell.htm




The heath care juggernaut is being run by anti-democratic ideologues.  You doubt this? Where were the congressional hearings? 


“This is an issue of vital concern to every American, and I'm glad that so many are engaged," Obama said Saturday in his weekly radio and Internet address.
“But it also should be an honest debate, not one dominated by willful misrepresentations and outright distortions, spread by the very folks who would benefit the most by keeping things exactly as they are.” Barak Obama as quoted by NPR 8-22-09



THE HEARINGS DIDN’T TAKE PLACE because the ruling clique in congress has decided to ram the ‘official’ plan through with as little debate (and as few ‘distracting amendments’) as possible.  In the bargain these leaders are now applying ruthless pressure on moderate and conservative democrats to ignore both their constituents and their personal qualms in order to tow the party line.   


The August town hall firestorm was an inevitable consequence.





“No physician or credentialed health care provider may be prohibited or prevented from or penalized for performing medical services outside the scope and/or coverage of the government or government approved plans for any private patient, patients or party on a fee for service basis.”



“No patient or other individual seeking medical care, services or consultation may be prohibited or prevented from or penalized for  privately contracting with a physician or other health care provider for any medical prescription, treatment, procedure or consultation, whether or not enrolled in any government sponsored, approved or regulated plan or other health care provider system.”



“No physician, nurse or other heath care provider working under the direction of such physician may be penalized, discouraged or prevented in any way by the government, its agents, agencies, departments, bureaus or commissions, for the exercise of his or her clinical/medical judgments that, in the physician’s independent professional judgment, are in accordance with the Hippocratic Oath.  Any medical doctrine to the contrary that is contained in the Act or promulgated by officials proceeding under the act shall be null and void.”




Why to I believe this to be the case?  The current congressional leadership is committed not to allow any amendments that will dilute or impede the march to mandatory single payer (i.e., government) care, especially when those amendments might actually pass.  


If you doubt this, I invite you to take a look at the record so far.  The following amendments were either blocked at their inception or were defeated at the recommendation of the current congressional leadership:


Amendment from Rep. Eric Cantor (R-VA) would have preserves Americans’ freedom to choose & keep the coverage they like. i.e., high deductible plans, Health Savings Account (HSA)
Amendment from Rep. Cliff Stearns (R-FL) would have guaranteed that nothing in the bill could prevent individuals from keeping their current health benefit plans.
Amendment from Rep. Mike Rogers (R-MI), Rep. Jim Matheson (D-UT), and Rep. Phil Gingrey (R-GA) would have allowed HSAs plans (the medical savings accounts model with a catastrophic coverage supplement) in the bill’s definition of a “qualified health benefits plan.”
Amendment from Rep. Paul Ryan (R-WI) would have allowed us to keep the insurance we like by opting out of the government-run ‘option’.
Amendment from Rep. Dave Reichert (R-WA) would have us to continue to enroll in private individual market health plans. [Note the president only said we could remain in our existing plans as long as they are offered.]
Amendment from Rep. Charles Boustany (R-LA) would have stopped the Health and Human Services Secretary from forcing providers to participate in the government-run plan (Democrats defeated this amendment: 25-16)
Amendment from Rep. Wally Herger (R-CA) would have stopped the Centers for Medicare and Medicaid Services (CMS) from using the Act to make coverage determinations.
Amendment from Rep. Kevin Brady (R-TX) would have eliminated the public plan whenever enrollees suffered longer wait times than in private health plans, allowing them to switch to private health plans.
Amendment from Rep. Dean Heller (R-NV) would have required that the government actually verify that only citizens can access federal health care.


In other actions, the congressional leadership has prevented measures stopping bureaucrats from making personal medical decisions for patients; waiving the employer mandate if it will cause layoffs, worker salary cuts, or reductions in hiring; creating small business health plans; requiring the government-run plan to operate under the same rules as private health plans; preventing seniors from being stripped of their health care choices, keep the federal government from choosing “favored” physicians, or allow states to opt out.

Several surveys of this sorry record of legislative manipulation (in blatant disregard of popular sentiment) have been posted at the following LINKS:






Okay:  What is REALLY going on here?


There is a clear pattern.  The new congress, heady with its power to override the opposition, has begun to curtail debate on all of the high priority issues by choking off the amendment process.  It is in connection with an amendment to a pending bill that debate is allowed.  In the health care agenda, it is crystal clear that the minor amendments that do not slow down the march to a single payer model are tolerated, but nothing else will be allowed to get in the way.


A very determined subset of the liberal establishment has decided the “the time has come” to shoehorn everyone who is now insured into an inferior and inevitably underfunded health care system (the HMO from hell) in the quixotic attempt to produce more “equity” among all. 


Pursuit of this single minded (and I must add, simple minded) objective will bankrupt our heath care system and degrade the overall quality of care.  It will do far more harm and far less good than directly addressing the needs of the poorest among us.


Given the intransigence of the congressional leadership, egged on by White House staff, the best thing to do is simply block the effort completely until such times as the ‘reform’ proponents, the White House and congressional leadership agree to an orderly, thorough and segmented debate, during which any bill is open to all amendments. 


Three subject matter groupings seem logical here: [A] expanding coverage opportunities for non-indigent persons who are being rejected for preexisting conditions; [B] finding ways to provide out patient care for the indigent and near-indigent throngs who fill urban emergency rooms with non-emergency cases; [C] exploring innovating, low cost insurance options (like the blend between catastrophic care insurance and cost-shared pay for services models) that individuals and small businesses can readily join.  But that kind of orderly debate, accompanied by post-partisan congressional hearings has been trumped by an ideology-driven power play.


We are presented with a faux emergency and fake crisis that is nothing more than a blatant attempt to exploit a fleeting opportunity to ram a poorly constructed piece of radical legislation past the normal checks and balances. 


Is it really time to say ‘no’ to health care reform?  Of course not. 


But the time has arrived to give this group of manipulative, deceptive and deluded would-be-reformers the one message that will send this sorry mess of a project back to the starting gate where saner minds will have a chance to be heard: 







August 12, 2009

Saving Obama from Himself

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All contents, unless otherwise indicated are
Copyright © 2002, 2003, 2004, 2005, 2006, 2007, 2008 & 2009 by Jay B. Gaskill
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Just say – NO!



From Today’s Rasmussen’s Poll: 


‘Overall, 48% of voters say they at least somewhat approve of the President's performance. That matches the lowest level of total approval yet recorded. Fifty-two percent (52%) now disapprove.’

As Hoover Scholar, Victor Davis Hanson (a conservative democrat) recently put it:


LINK: http://victorhanson.com/articles/hanson081009B.html


‘August 10, 2009
Obama’s Great Race to Change America

Tribune Media Services

‘Why does President Obama want to implement radical changes in American foreign policy, environmental policy, education, health care, and the tax code all at once?

‘The answer is easy: If he does not achieve these initiatives soon, he never will.

‘Almost none of Obama’s proposed policies any longer enjoy majority support among voters — and many of them were not clearly outlined to voters during the campaign.

‘Current polls show more Americans are against than in favor of his version of health-care reform. Nearly seven in ten are wary of government takeovers of the economy, like the bank and car bailouts. Over half do not want more borrowing and higher deficits.

‘In response, Obama and the technocrats around him insist they know better than the average voter what is in America’s long-term environmental, health, educational, and financial interests.’

And as I have been arguing recently,


‘The Coming Populist Rejection Of The Obama Promise
‘The Democratic Party has lost its populist roots.  Its elites have led us to the edge of a cliff. 
‘By the cliff, I mean that the sheer scale of the ‘bread and circuses’ extravagance of the federal government, running downhill on empty, chased by a growing army of creditors is beyond rescue. 


‘We will not simply be able to ‘grow out’ of a multi-trillion dollar fiscal CRATER.  When the prospect of being trapped in that hole dawns on the American people (and we are at that tipping point right now) there will be electoral hell to pay.
‘Here’s a populist maxim:  “You can’t keep on borrowing.” Here’s another, “I earn it, I get to keep it.”  How far the democratic leadership has strayed.
‘Bill Clinton has plausible populist roots and instincts.  Only a populist democrat, for example (albeit under prodding from  populist conservatives) could implement welfare reform.
‘Mr. Obama lives and breathes the air shared by the country’s liberal elites.  His populist street cred is minimal, conferred externally by adoring black voters (whose innate social populism drove the defeat of the gay marriage initiative in California).’




As a ‘Truman democrat’, I can easily detect the deep uneasiness among the ‘ordinary’ democratic rank and file and the growing rebelliousness among the democratic elected officials who are not in tune with the arch-liberal subset who have captured the power-levers, but not the soul of America’s once-populist political party.


From friends in the academy, I hear worries about the uncivil ‘tone’ of the recent ‘town hall’ protests.  My friends are tone deaf.  This is exactly what happens when the ‘we know-better-than-you’ elites overreach, when their elected ventriloquist dummies are forced to pretend to listen, and when the ‘common people’ sense, at the deep gut level, that they are booing conned.


This is no small thing.  A breach of trust has taken place.  Rather than repair it, by ACTUALLY LISTENING, the Obama Administration has chosen to plow through to drive a ‘victory’ that belies the projected image of Obama as a post-partisan healer.  This would be a classic pyrrhic victory, one for which the current democrat establishment will pay a deep and lasting price.  Even that would be worth it, except for one problem.  The price will be shared by the country at large.


Those Obama supporters who hope for a better legacy for their president would do well to stop his utopian juggernaut in its tracks.  A better presidency will result….







August 06, 2009

Obama is at the tipping point - ALMOST



Overall, 50% of voters say they at least somewhat approve of the President's performance. Forty-nine percent (49%) disapprove.


Thursday, per the respected Rasmussen Tracking Poll:

'Overall, 49% of voters say they at least somewhat approve of the President's performance. Fifty-one percent (51%) disapprove.'

This will change, of course, but the time for the grand gesture, as a power in its own right, has ended. 




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