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The real agenda and thought process behind Obama Care.

Discussion in 'Political Zone' started by JBond, Aug 14, 2009.

  1. JBond

    JBond Well-Known Member

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    Okay folks - is this what you want? Is it defensible? And from the brother (surprise) of the White House chief of staff, a special advisor to President Obama on reforming health care.

    Link: http://www.ncpa.org/pdfs/PIIS0140673609601379.pdf

    Ezekiel Emmanuel MD, Rahm Emmanuel’s brother, who is Barack Obama’s “Special Advisor for Health Policy”, is described by the [1] Huffington Post article as engaged in a very important mission: redesigning the US health care system.

    Emanuel and the White House are attempting to reorganize the delivery and reimbursement systems of health care, changing what the types of procedures doctors rely on, making people more aware of disease prevention, encouraging insurance companies to expand coverage, and so on. It is a process rife with sensitivities, trickeries and, of course, the potential for failure. It is not, he insists, impossible.
    “It is a complicated process and we have to try and make the choices clear and give people good reasons for making them,” Emanuel explains. “I don’t think that’s an impossible task and thankfully we have one of the great communicators, Barack Obama, at the helm of this ship of state.”

    Emmanuel recently authored an article in the Lancet describing the various models of non-market health care rationing. Titled [2] “Principles for allocation of scarce medical interventions”, its is co-authored with Govind Persad and Alan Wertheimer. In it the authors simply review the pros and cons of the various ways of deciding who gets treated and who doesn’t. The allocation mechanisms they discuss are divided into strategies and substrategies. The pros and cons of each are laid out.

    Treating People Equally
    1. Lottery
    2. First-come, first served
    Prioritarianism
    1. Sickest first
    2. Youngest first
    Utilitarianism
    1. Saving the most lives
    2. Saving the most life-years
    3. Saving the most socially useful
    4. Reciprocity (paying back people who have ‘contributed’, such as organ donors)
    The authors are not very satisfied with the current metrics used for making medical decisions based on saving the most life-years. Both the “Quality-adjusted life-years” model and the “Disability-adjusted life-years” have shortcomings which they believe can be addressed by another model of their own: “The complete lives system”, which takes all the factors into account. They write:


    Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles: youngest-first, prognosis, save the most lives, lottery, and instrumental value. … When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated … the complete lives system is least vulnerable to corruption. Age can be established quickly and accurately from identity documents. Prognosis allocation encourages physicians to improve patients’ health, unlike the perverse incentives to sicken patients or misrepresent health that the sickest-first allocation creates.

    Under this system, patients would receive scarce care according to the graph shown below.

    [IMG]

    The paper concludes: “the complete lives system combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles. Importantly, it is not an algorithm, but a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.”

    What’s not mentioned anywhere in the discussion, except by implication is the identity of the narrator. Who is the “we” in “Principles for allocation of scarce medical interventions” that decides who gets scarce medical care? The answer is tangentially provided in the paper itself, which writes that “the complete lives system is least vulnerable to corruption”.The “we” is a system; a system that can possibly be corrupted; hence Dr. Emmanuel’s efforts to design one in which such distortions will be held to a minimum.

    Ultimately health care reform is as much about politics as it is about medicine. The discussion in Dr. Emmanuel’s paper is incomplete if limited to pure public health considerations. Politics is central to the whole issue. Whatever “guidelines” are chosen, however rational, however humane, can never implement themselves. Human beings in positions of power are required to do that. And while it is important to note that even under the current system these decisions are being made by someone or by some consensus, it is also vital to realize that in any “health care reform” effort, one of the principal outcomes is to shift the power to make those decisions to someone else. That may not be a fit subject for the Lancet, but it is the elephant in the operating room in the national health care debate.
  2. MetalHead

    MetalHead Benched

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    Add John Holdren,Van Jones and some more to the already nefarious list of Obama associates and tell me this administration is not hell bent into completely destroy the America we know and love.

    Too bad the MSM is too busy talking about Michelle's toned arms.
  3. SuspectCorner

    SuspectCorner Bromo

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    Ezekiel Emanuel, Obama's 'Deadly Doctor,' Strikes Back

    By Michael Scherer / Time magazine online / Washington Wednesday, Aug. 12, 2009

    Dr. Ezekiel Emanuel, the medical ethicist and oncologist who advises President Obama, does not own a television, and if you catch him in a typically energized moment, when his mind speeds even faster than his mouth, he is likely to blurt out something like, "I hate the Internet." So it took him several days in late July to discover he had been singled out by opponents of health-care reform as a "deadly doctor," who, according to an opinion column in the New York Post, wanted to limit medical care for "a grandmother with Parkinson's or a child with cerebral palsy."
    (Read an interview with Obama on health care.)

    "I couldn't believe this was happening to me," says Emanuel, who in addition to spending his career opposing euthanasia and working to increase the quality of care for dying patients is the brother of White House chief of staff Rahm Emanuel. "It is incredible how much one's reputation can be besmirched and taken out of context."
    (See pictures of health care for the uninsured.)

    It would only get worse. Within days, the Post article, with selective and misleading quotes from Emanuel's 200 or so published academic papers, went viral. Minnesota Representative Michelle Bachmann, a fierce opponent of Obama's reform plans, read large portions of it on the House floor. "Watch out if you are disabled!" she warned. Days later, in an online posting, former Alaska Governor Sarah Palin attacked Emanuel's "Orwellian thinking," which she suggested would lead to a "downright evil" system that would employ a "death panel" to decide who gets lifesaving health care. By Aug. 10, hysteria had begun to take over in places. Mike Sola, whose son has cerebral palsy, turned up at a Michigan town-hall meeting to shout out concerns about what he regarded as Obama and Emanuel's plans to deny treatment to their family. Later, in an interview on Fox News, Sola held up the Post article. "Every American needs to read this," he declared.
    (Read "What Health-Care Reform Really Means.")

    By this point, Emanuel, who has a sister who suffers from cerebral palsy, had arrived in northern Italy, where he planned to spend a week on vacation, hiking in the Dolomites. Instead, he found himself calling the White House, offering to book a plane home to defend his name. "As an academic, what do you have? You have the quality of your work and the integrity with which you do it," he said by phone from the Italian Alps. "If it requires canceling a week's long vacation, what's the big deal?"
    (Read TIME's cover story "Can Obama Find a Cure?")

    The attacks on Emanuel are a reminder that there is a narrow slice of Americans who not only don't trust government, but also have come to regard it as a dark conspirator in their lives. This peculiar brand of distrust helps create the conditions for fast-moving fear-mongering, especially on complex and emotionally charged topics like the life and death of the elderly and infirm. Prairie fires of that kind are hard to douse when the Administration's own plan for health care remains vague, weeks away from being ready for a public rollout. The health-care bill that recently passed the House does not contain, as some have suggested, any provisions that would deny treatment to the elderly, infirm or disabled like Sola's son. One provision allows doctors to be reimbursed for voluntary discussions of so-called living wills with patients, but does not in any way threaten to deny treatment to dying patients against their will. The legislation anticipates saving hundreds of billions of dollars by reforming the health-care system itself, a process that would try to increase the efficiency of medical care by better connecting payments to health outcomes and discouraging doctors from unnecessary tests and procedures. The Obama Administration hopes that many of these reforms will be made in the coming years by independent panels of scientists, who will be appointed by the President and overseen by Congress.
    (See 10 health-care-reform players.)

    This is where the criticism of Emanuel enters the picture, since he is just the sort of scientist who might be appointed to one of those panels. For decades, Emanuel has studied the ethics of medical care, especially in situations where a scarcity of resources requires hard decisions to be made. His work sometimes deals with the hardest possible decisions, like how to choose who gets a single kidney if there are three patients in need, or the reasons that doctors order tests with little medical value. Emanuel's reputation ranks him among the top members of his field. He is published often in the best journals; he has been given multiple awards for work to improve end-of-life care. At the White House, he has taken a free-floating role at the Office of Management and Budget, advising on a wide range of health issues.

    But in a country where trust is in short supply, Emanuel has become a proxy for all the worst fears of government efforts to rein in costs by denying care. "The fundamental danger is that the American people are being asked to delegate all these life-influencing decisions," explains Betsy McCaughey, the conservative scholar who wrote the New York Post attack on Emanuel. "There is a lack of transparency here."

    In her Post article, McCaughey paints the worst possible image of Emanuel, quoting him, for instance, endorsing age discrimination for health-care distribution, without mentioning that he was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources. She quotes him discussing the denial of care for people with dementia without revealing that Emanuel only mentioned dementia in a discussion of theoretical approaches, not an endorsement of a particular policy. She notes that he has criticized medical culture for trying to do everything for a patient, "regardless of the cost or effects on others," without making clear that he was not speaking of lifesaving care but of treatments with little demonstrated value. "No one who has read what I have done for 25 years would come to the conclusions that have been put out there," says Emanuel. "My quotes were just being taken out of context."

    For Emanuel, the entire experience has been a painful education in the sometimes brutal ways of politics, something his brother has long endured and doled out. "I guess I have a better appreciation for what Rahm had to go through for years and years," Emanuel says. But that appreciation does not solve the question raised by the controversy. There is universal understanding that the nation's fiscal course is doomed without major changes to health care, but whom will the American people trust to carry it out?

    Emanuel, for his part, plans to continue his work, which is focused on finding the most equitable and ethical way for this reform to be carried out, even if he has opted against returning from the Italian Alps. "I am an Emanuel," he says. "We are pretty thick-skinned. I am not going to change my colors. I am not going to crawl under a rock."

    Read "The Five Biggest Hurdles to Health-Care Reform."
  4. adamc91115

    adamc91115 New Member

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    Its not a narrow slice anymore... Its quickly becoming a majority. As far as healthcare goes, it already is a majority.

    Why should anyone trust the government that can't even get "cash for clunkers" right?
  5. Rogah

    Rogah Well-Known Member

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    It looks to me like they are trying to pre-emptively address the arguments that are sure to arise from a system of rationing. Maybe that's because that despite the public statements we hear, they know darn well that rationing is a natural byproduct of their scheme.
  6. sbark

    sbark Well-Known Member Zone Supporter

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    With 1 facebook entry ......Palin swung this debate......by Wed. she forced Obama admin to respond to her.....but of course Rush had been saying that very thing for weeks.....

    Palin out -interneted the Internet Admin.

    http://www.foxnews.com/politics/200...asted-effort-lead-democratic-negotiator-says/


    Sen. Kent Conrad, D-N.D., one of six negotiators trying to hammer out a bipartisan compromise measure on the Senate Finance Committee, tells "FOX News Sunday" that the so-called public option simply does not have the votes to pass.

    .....for my part its part of the shell game.......I expect Liberals to use the Nuc option to pass this regardless of public sentiment.

    If the Blue dogs had not delayed this.......Obama would have signed this prior to Aug recess without anyone knowing what was in it........and he would have bragged about it......

    I expect the Liberals to bring this to a vote...use nuc option on blue dogs
    They have never been this close to changing this country to what they envision.....to rewrite history as Slick Willie would coin it.....
    --they wont let this opportunity to expoit a crisis pass.....
    --cause they probably realize they wont get this close again........
  7. MetalHead

    MetalHead Benched

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    Sorry Suspect...there is no way to defend this.
    And the sister with cerebral palsy?..of course he will not apply his methods to his own family...just yours and mine.
  8. burmafrd

    burmafrd Well-Known Member

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    Suspect agrees with all this. As long as HIS people are running the government.
  9. zrinkill

    zrinkill Diamond surrounded by trash

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    Both "sides" want control of the people.

    Thats the agenda behind Dems and Repubs.

    Dems want to control what you eat or smoke.

    Repubs want to control what you drink and snort.

    Dems want to control what you drive and where you live.

    Repubs want to control what you see and hear.

    Dems want you weak

    Repubs want you cowed.

    Both sides have the same agenda ...... just different ways to reach it.
  10. SuspectCorner

    SuspectCorner Bromo

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    Defend what, silly?

    The wingnut-cited Emanuel papers dealt with various medical ethics 'scenarios' involving scarce/limited health care resources. See, that's one of the things a top-shelf 'medical ethicist' will do - write papers dealing with medical ethics.

    I know this will come as a shock to conservative mathematicians such as yourself - but you cannot, for example, provide curative dosing to four individuals from an amount equal to three curative doses.

    Gee, some righties sure seem to have a problem with understanding the concept of context.

    Now - back to 'Right Fright Night'. :D
  11. SuspectCorner

    SuspectCorner Bromo

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    Eh, Rogah. Don't look now - but, health care...? Is ALREADY being rationed. Doh!

    Yeah, that's right. Many Americans are already being denied access to primary and catastrophic care because they're either, 1) economically shut out by an unethical for-profit system based on greedy private insurance companies and their sky-high rates, or; 2) denied care because some ****heel risk management person for the private insurer has determined that they represent a 'net loss' to the insurer. Even when, in many cases, the insured has been paying that insurer for years.

    The rightwing rationale for dashing reform based on 'rationing' - is an epic 'fail'.
  12. Temo

    Temo Active Member

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    It appears that a lot of misunderstanding (or intentional distorting) has occurred because people don't know how to read an academic paper.
  13. PBJTime

    PBJTime Semper Fidelis

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    So lets throw money at another scheme that will not change anything...

    Maybe I'll get into it a bit more when I have more time.

    +1 for ending a "logical" post with "epic fail."
  14. SuspectCorner

    SuspectCorner Bromo

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    And that's fine, PBJ. Let's dicuss THAT aspect. But let's not base our debate on flaws that ALREADY apply to the current system - and in spades.

    Hey, I look forward to your post when time allows you. :)
  15. Jarv

    Jarv Loud pipes saves lives.

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    Academic papers are many times based upon a thesis or conjecture, laws are not written that way, this is the big problem the libs are having now, heck half of them that want it passed don't understand that.

    The laws should not be based upon academic speak, but instead clear concise terms understood by the layman so they can understand what the lawmakers actually intend to enforce. Then they can make clear decisions who to elect.

    Once this is clear to the voters and it actually may be now, then the libs are in big trouble.

    Thanks for making that clear :) We appreciate that !
  16. SuspectCorner

    SuspectCorner Bromo

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    Thanks for that bit of BS misdirection, Jarv. Now please point to any part of any existing legislation that supports the claims of wingnut nitwits like Hannity and Coulter RE Dr. Zeke Emanuel. You have the floor.
  17. Rackat

    Rackat Active Member

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    I didn't think it was that hard to understand. Just because you don't like the message Jarv posted does not make it "BS misdirection". As a matter of fact, Jarv was not addressing your pet cat at all, so you scream like a little boy that fell off the merry-go-round.

    He addressed how laws were written, and that once people understood what was happening, that the liberals would be in trouble. In fact, that is already happening.
  18. SuspectCorner

    SuspectCorner Bromo

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    That's a laugh. Most of the trouble 'liberals' are experiencing in their efforts to reform the current health care system - have very little to do with 'academic speak' appearing in any legislation. Most bills aren't written in a dumbed-down form intended to please the average 8TH-grade 'grad-jee-ate'. So have a dictionary at the ready.

    Those 'troubles' have much more to do with with the 'angry (ill-informed) right' and their apparent failure to grasp plain language as it actually appears in any form of the legislation - as opposed to their utter willingness to glom onto the 'gospel' as it is presented by any lying Repuke pol and wingnut talking head (deathpanels, euthenasia, 'socialism', etc, etc, etc).

    So I'll now present YOU with the same challenge I presented to Jarv:

    Point to ANY part of ANY Dem-proposed health care legislation that supports those wild claims made by your 'Party of No' - and the accusations made against Dr. Zeke Emanuel.

    Start timer... now.
  19. Jarv

    Jarv Loud pipes saves lives.

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    Lol...Anyone making a statement like seems to me to be the angry one. I get it, you don't agree with me you are angry and ill-informed. That really is were you are the most mis-guided. I think your passionate about your cause, but you just don't get it :).

    Dude, most of the congressmen don't understand what they are voting on, its unbelievable. They have a team of lawyers giving them notes on what the bill says...Come on, get a clue here. Elitist academic speak thinking they know what we want more than we know what we want, is truly ignorant.
  20. MetalHead

    MetalHead Benched

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    Go to Drudge now...Dems ready to own it and pass it.

    Political suicide...nice to know you Barry..one and done.

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