Tuesday, July 28, 2009

Obama Supports Violating Constitution . . . of Honduras

Obama's State Department revoked the visas of Honduran officials appointed by the constitutional interim government of Honduras.

How are we not to interpret that Obama believes that our Constitution should be ignored as readily when he finds it equally inconvenient.

For text of the Honduran constitution in English see this post.

Monday, July 27, 2009

Killing the Elderly

Obamacare would have the de facto effect of saving money in many entitlements:
1. Medicaid;
2. Medicare;
3. Veteran's Hospitals;
4. Social Security Retirement;
5. Social Security Disability;
6. SCHiP, etc.

Five out of the six are mostly for the aged. Each of these programs will save money for every year one of their beneficiaries dies earlier than currently expected.

Assume that Medicaid would cost $3,000 per year per patient in their last ten years of life only. In that period, that saves $30,000 per patient. Nursing homes in Indiana cost a measly $120 per day or $3600 per month or $43,200 per year. The average patient is only in for two years, so we don't actually see $100,000 per patient in Indiana. But New York or California might. Indiana's still close.

One third of patients will need this type of care. The actual projected cost per patient should be the actual cost times the probability of care or $28,512 per person over 65.

If we quit paying for life-extending care in persons aged 85 and up, that would save the last two years of life expenses on much of that 33% of the population. The $28,512 per person over a population of 2.1 million people in 2010 (National Institutes of Health, Institute on Aging), that could save $59.9 billion. For the next age cohort of 75 to 84, find a way to reduce their projected population 17 million in 2010 or 18 million in 2015 or 20 million in 2020 by 10% and you save another $59 billion on the same math.

Reduce every other age cohort through attrition of bad care by 0.5% to 1% with cost per patient of $3,000 in an America of 300 million inhabitants, you can save $90 billion per year.

I have shown a very dramatic example by reductio ad absurdum. No American will tolerate this methodology imposed nakedly. Bury the method behind rhetoric and "for the good of the country" nonsense and a quick incentive to kill the elderly will creep in.

Smaller populations reduce healthcare costs. Abort them. Let them die early. Obamacare saves money.

The problem is that healthcare costs cannot go down, as I have suggested in earlier posts.

So now the costs keep rising because supplies of providers dwindle and need to be replaced in a very expensive fashion; the ability to provide care must be rationed to maintain the current level of care for some preferred portion of the country. According to Dr. Ezekiel Emanuel, one of Obama's health advisors, that preferred portion of the population is late middle-aged.

In Logan's Run, the solution to knocking off people over 30 was Carousel.



Is Obamacare going to implement this?

Tuesday, July 21, 2009

How sure are you?

Comments on Strata-Sphere

Strata-Sphere is a blog that I read religiously. AJ is a joy to read about science, logic, and foreign affairs. I rarely disagree with those conclusions and often am educated to extraordinarily intricate levels. He does a wonderful job of making complex ideas simple.

Then he gets mad at the Republicans, particularly conservative republicans that insist on consistency. These he treats as pariahs. Admittedly I am one of those. Like every other person, I want people whom I respect to respect me in turn. I have no problem earning that respect. So, am I eligible to earn that respect?

1. Harriet Miers should never have been on the court. Justice Alito is superb. Conservatives erred in seeking an upgrade? The point of confirmation, according to the Federalist Papers, is to avoid having the presidents' friends of dubious quality be appointed without comment. How does this differ from that ideal?

2. AJ hates the attempt to block immigration legislation. Fiat justitia ruat caelum: Let justice be done though the heavens may fall. A bit bold in tone but actually in my practice a way to get things cleaned up quickly. If a case gets knotted up with a judge trying to dictate a "fair result," it often is highly inefficient and likely to reward the wrong-doer. If the judge flatly enforces the rules quickly and efficiently, the result is more likely to be that the parties resolve the issue themselves in a more efficient manner. This is the problem with the immigration debate position that AJ takes, he is interested in being fair to the law breaking immigrants. Unfortunately, he would reward the rule breakers and claim jumpers at the expense of those immigrants wishing to play by the rules. Experience has quickly shown us that refusal to give jobs in states to illegals and a weakening economy quickly reverses the net immigration flow. If we take a few more steps to tighten those up by more aggressive enforcement against cheating business owners, the immigrants leave quickly. The experience of history with immigrants is something like an eight-to-one ratio: eight leave voluntarily for every one that suffers enforcement of the rules. I suggest that ratio would go higher as the immigrants believe the free-ride of welfare, education, false automatic citizenship, and tax evasion (i.e., under the table payments) are closed down. Legal immigration will be much easier to justify.

I would add that I am in favor of immigration, but I want a small ratio from any one country. Diversity of country of origin will weaken the down side of immigration allowing more divergent strengths to appear. Too much of one profile is damaging.

3. Pushing Specter out. If jumping from the party is seen as detrimental, the party will build cohesion. Specter got a temporary advantage of going with the Democrats. The Democrats have helped the Republican cause by treating him like a pariah. Less likely to get followers. Now if a person stays, he is going to be more sensitive to primary voters. Independents naturally get mad at this result, because they don't want to lower themselves to belong to a party.

In fact, the more people that join a party and regularly vote for it in the primaries, the more the party will move toward the center. The parties would serve themselves well by making party primary participation be more valuable: discourage open primaries and make challengers easier. That will push the parties toward the center of their end of the spectrum. A party should never be in the center, because then there is less benefit from changing parties by voting. The weaker party is always the most centrist because they feel they need to imitate the winner.

I would argue that 60% of the population tells Gallup that they live and act conservatively in daily life. If the Republicans can show how their ideas better reflect these habits, we will persuade more.

4. AJ does not radical sounding language. The problem is that parties build loyalty by activating their followers passions. I wish it were not so, but people are persuaded by their emotions nine times out of ten. Put another away, market research on convincing clients to implement one legal strategy over another shows only 10% of the population can be persuade by "the bottom line" of accounting numbers. Why is a legal strategy implemented by Congress different?

In fact Democrats own most of the population either in party identification or means of persuasion because they show a reckless disregard for the truth when passions will get them what they want. Lie, cheat, steal . . . who cares, they say, just win.


I want Republicans to get the best people in the job, that strictly adhere to the rules, and argue on logic with the ability to show passion simultaneously and to clearly identify friend from foe.

Compromise where it actually moves your agenda forward. Stand firm where compromise only weakens your cause.

If that makes me a radical, then radicalism in the defense of liberty is no vice.

Monday, July 20, 2009

Bankruptcy for Doctors

Doctors will face an increase in bankruptcies. As a result, websites like www.bankruptcyfordoctors.com will spring up in many places.

The key question is how bad and how fast. The key problem will be landlords on 5-year term leases and equipment financing.

Well-managed bankrupt doctors will layoff staff aggressively. Poorly managed will not pay payroll taxes or staff and increase the issues to dispute in court.

Parsing Universal Healthcare

Now that we know that "Universal Healthcare" means whatever the Democrats want it to mean at that moment, let's look at it in English in order to compare and contrast the results.

"Universal" means
u⋅ni⋅ver⋅saladjective
1. of, pertaining to, or characteristic of all or the whole: universal experience.
2. applicable everywhere or in all cases; general: a universal cure.
3. affecting, concerning, or involving all: universal military service.
4. used or understood by all: a universal language.
5. present everywhere: the universal calm of southern seas.
6. versed in or embracing many or all skills, branches of learning, etc.: Leonardo da Vinci was a universal genius.
7. of or pertaining to the universe, all nature, or all existing things: universal cause.
8. characterizing all or most members of a class; generic.
9. Logic. (of a proposition) asserted of every member of a class.
10. Linguistics. found in all languages or belonging to the human language faculty.
11. Machinery. noting any of various machines, tools, or devices widely adaptable in position, range of use, etc.
12. Metalworking.
a. (of metal plates and shapes) rolled in a universal mill.
b. (of a rolling mill or rolling method) having or employing vertical edging rolls.

So it means that care should be available to everyone. Do we have that now?

If you go to the emergency room, is it available to you regardless of race, creed, or color? Yes.
When will you get turned away? Triage demonstrates nothing to treat. Demanded type of care (like radiation treatment) is not offered at the ER. Inability to pay is not allowed as a reason to refuse care, so price has nothing to do with it.

If you go to a private physician, when will you get turned away? Nothing to treat. Demanded care not offered. Inability to pay.

So the quick conclusion is that Universal Healthcare already exists, if you have something that the doctor in question offers the skills and equipment at the ER but never if you have nothing to treat. Other doctors get to pick and choose their patients.


Now, let's go to imaginary Obamacare with the assumption that Congress cannot allow healthcare to make us go bankrupt. (Stop laughing! Congress will impose some limits on how much it will spend some day. Why, when, and how is harder to predict.) They will limit doctors' pay. They will limit who can be paid, if Dr. Ezekiel Emanuel, Obama's health advisor and brother of Obama's chief of staff Rahm Emanuel, is to be believed. He wrote in The Lancet that healthcare costs should be focused on the middle aged with older allowed to die with reduced care.

So now we will have doctors getting less compensation. They will go bankrupt or retire at abnormally high rates as soon as Obamacare goes into effect. They will consequently cease providing care. Supply will dwindle overnight.

Patients will have more ability to demand care, increasing demands on the system overnight.

Those two functions alone will cause waiting rooms, where they still remain, to fill up overnight. Even if Obama offers cheaper care per treatment per patient, he will have lines because no one is able to provide the required level of care.

Obama or his successors will have to increase compensation for doctors. Costs go up. Care won't improve because the retired doctors still don't want to be in The System. Now prices go up but no improvement in quality of care.

So we don't have everyone getting treated. With this proposal, we will have moved from existing Universal Care to Obama Limited Care.

Thoughts on Words in Obamacare Debate

Universal Healthcare. What does it mean to you?

1. Geographic Availability. Healthcare available everywhere on US soil?
2. Gratuitous. Healthcare is free for every patient?
3. Condition. Only the middle-aged get care because the young rarely need it and the elderly are too expensive?
4. Management. The universe -- I mean, the government -- controls who get care, how they get care, when they get care, from whom they get care, why they get care?
5. Quality. All get first class care.
6. Timeliness of Care. Care is available immediately on demand?
7. Assistance in Obtaining Care. Assistance on entering The System is available to all at no cost?
8. Pricing. Healthcare prices are set so that no one cannot pay?
9. Qualitative Availability. Healthcare is available to all of equal quality?

Do you think that I have same answers to the questions above that you do? Simply put, Universal Healthcare is phrase that sounds wonderful to all but has utterly no meaning. No one will object to it in polls, so the Democrats can push whatever they want on the American public and claim that the vast majority want it.

Friday, July 17, 2009

Jobs

Vanishing Physician: Heal No One

We are about to witness a disappearance similar to something the comic writer Douglas Adams envisioned in his sequel to the Hitchhiker's Guide to the Galaxy, called So Long and Thanks for All the Fish. In the sequel, whales leave the earth and take all the fish.

What we are about to witness is the departure of private healthcare that takes with it all the physicians.

We all have heard that government will cut their pay. Often that is where the discussion ends. In fact, that is where the real consequences begin.

A doctor suddenly thrown into Obamacare will see his time even more consumed by government paperwork than currently is with insurance paperwork and CYA anti-lawyer paperwork (which won't go away, either). His compensation per patient will be set by the government. His private-pay clientele will evaporate. In essence, the soon-to-be-gone are the patients whose bills hide the existing catastrophe of government care in TriCare (that is veteran), Medicare, Medicaid, and Social Security Parts A and B. Those private payors are where the profits are hidden.

When profits disappear, doctors, espcially in sole- or small-practices, will be forced to close existing practices. Many of those practices are in commercial buildings with 5-year leases with options for additional 5-year terms. If the doctor just signed up for another 5-years, he will lose his profits but keep his lease liability. He will have to file for bankruptcy. If the doctor was lucky and is at the end of the lease, he may be able to negotiate a deal. Those in between are going to have to roll the dice.

So we can safely say that doctor bankruptcies will be on the rise. Those small-practice doctors will lose their life savings and have little chance to recover.

Older physicians in larger-group practices will sell their practices for a song to the younger physician-partners. Those older physicians may only be 50 or 55 and have a good decade of service left in their bones, but the headaches and loss in compensation will drive them out of practice. Why not play golf than take these slim pickings?

The younger physicians will have a higher proportion that still owe med school loans or loans for starting their practices. Their compensation hit will make their predicted revenue very small compared to what the projections were when they took the loans. More bankruptcies.

Those that survive will be pressed into ever larger groups. The groups will have to restructure how new doctors are hired. Now many practices pay off the new doctor's student loans after a few years of service. Call it a deferred compensation package. These packages will go away, first slowly, then more rapidly.

That means that younger doctors will have less money to live like they wished when they entered med school. Disillusionment will drive some into the business world. They didn't sign up to be bureaucracts. They had better visions for life.

So where will the replacements come from? India, China, Latin America. Very quickly our health system will wither because the talent leaves the building.

We have a system built on real talent and real science that is the envy of the world. We can destroy it overnight, but it can only be rebuilt over decades. Why destroy it?

Thursday, July 16, 2009

Obamacare set to Consume Private Healthcare

This is no joke. Rep. Kevin Brady asked his staff to map out the House Leadership’s proposed healthcare plan. The result was the attached map.



Today, some readers have pointed out that private health insurance will be forbidden. On page 16 of the Government Publishing Office’s official version of the bill you can read the section for yourself at the Government Publishing Office website. What it says is,
________________________________________
Section 102: PROTECTING THE CHOICE TO KEEP CURRENT HEALTHCARE
(a) GRANDFATHERED HEALTH INSURANCE DEFINED.—Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term ‘‘grandfathered health insurance coverage’’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:
(1) LIMITATION ON NEW ENROLLMENT.—
(A) IN GENERAL.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.
________________________________________

In other words, Obama will keep his promise that you will can keep your current healthcare. What it does not say is that you will ever get the choice of private healthcare again. If you have it, you can keep it -- for now. If don’t have it, you’ll never get it.

This is government competing against the private sector. As my 9-year-old son is now fond of quoting Rep. Mike Pence (R-Muncie, Ind.), “Government competing against private companies is like an alligator competing against a duck: the alligator consumes the duck.”

This bill is a flat-out a nationalization of healthcare. All new insurance has to play within the new rules. All existing policies will be shut down under their own weight, due to lack of new, young, healthy enrollees. Complete nationalization won’t be immediate but it will legally be inevitable.

Is government-owned healthcare what you would wish on your worst enemy, let alone your family and friends?

UPDATE: February 3, 2017, it is nice to see a quote from later Governor and now Vice-President Pence still holding up after nearly eight (8) years.