Tuesday, October 29, 2013

Morality of Decision Making in Healthcare

VALS conf talk: Morality of Decision Making in Healthcare

So You Want Affordable Care? Common Sense from a Practicing Physician

Vecchio Policy Paper on Healthcare Reform Ideas for Colorado

62. Karl Marx vs. Samuel Adams

We’ve talked about how Medicare and Medicaid reimbursements don’t cover our costs as physicians for seeing patients, and how the Independent Payment Advisory Board will be decreasing these payments even more.  That means that it will COST doctors to keep seeing these patients.  And when states increase the number of Medicaid patients thru Obamacare,  that means that doctors will be paying more and more money to care for people.  Now that Obamacare truly is the law of the land, it’s time to discuss what this administration is saying to physicians.  They are saying that patients have a RIGHT to make us PAY to take care of them.  They are saying that it’s OK to force doctors to practice against their free will.


Karl Marx, in his Communist Manifesto, proposed a system wherein resources would be distributed “from each according to his ability, to each according to his need”.  In other words, those who have the ability to make goods or money should have it taken from them and given to those who need it.  Contrast this with the words of one of our founding fathers, Samuel Adams (and I’ll paraphrase):  “If ye love government handouts more than liberty, the tranquility of servitude better than the animating contest of freedom, go home from us in peace. We ask not your counsels or arms. Crouch down and lick the hands which feed you. May your chains set lightly upon you, and may posterity forget that you were our countrymen.”  Which quote do you think represents what America should be?


Obamacare is also saying to taxpayers that it is OK for the government to force us to pay for the healthcare of others.  We will have no choice but to pay additional money that we have worked hard to earn, so that people who choose not to work can have the same healthcare choices that we have.  I’m not talking about those who are truly needy here.  I’m talking about those who have chosen to be dependent on others.  From each according to his ability, to each according to his need.  I don’t know about you, but no one has a RIGHT to my skill, knowledge or money.  Not my patients, not my neighbors, and not you, Mr. President.


Come Jan. 1, 2014, when the healthcare law goes into full effect, I as a physician will have a very difficult decision to make.  Do I bow down to the Obamacare Manifesto, or do I stand with Samuel Adams and the “animating contest of freedom”?  Which will YOU choose? 

61. Legislation I’d Like to Propose

Even though Republicans lost the Senate and White House, I believe that they could score some major points with the 2014 and 2016 voters if they’d propose some much needed legislation.  Of course, it will never go further than the House, but it’d put Democrats in the Senate on the record for refusing to take it to a vote.


First, pass a bill that prohibits Congress from passing any law that does not apply to all members of Congress.  Actually, I think this should be a Constitutional Amendment.


Next, pass a true Balanced Budget Amendment.


Next, pass a bill requiring Term Limits.  This is what the founding fathers envisioned:  that citizens would serve in office for a few years, then step aside for others to do so.  No more career politicians holding Congressional seats for 40 years.  I think this should also be a Constitutional Amendment.


Next, pass a bill that prohibits Congress from using its taxing authority to force Americans to do or purchase something.  I’m not sure if this can be done, but give it a try.


Now, pass a bill that prohibits the United Nations from imposing laws on Americans that violate our Constitution.  Just for the record. 


Now, pass a bill prohibiting earmarks.  How about a bill that requires new legislation to focus on only one issue at a time instead of bills containing completely unrelated provisions.


There should also be a bill that requires 30 days of review and analysis for every 50 pages of legislation.  No more “let’s pass it so we can see what’s in it”.  The Congressional Research Service should post an explanation of proposed legislation in lay terms so Americans can understand what their representatives are getting them into.


I think all of these bills would be enthusiastically supported by the American people.  And when these bills are passed by the House, stage a massive marketing campaign so the American people can see who’s really on their side…and who isn’t.

60. What Republicans Need to Do for the Next Four Years

Now that the 2012 election is over, there are a few things I’d like to see the Republicans do over the next four years.


First, stop compromising with socialism!  “Reaching across the aisle sounds magnanimous”, but all it does is allow the progressives to move closer and closer to a socialized America.  You are in office to protect our Constitution—so do it.


Next, start defending capitalism instead of apologizing for it.  You have allowed the Democrats to stigmatize those of us who have achieved the American Dream thru hard work for far too long. 


Next, GET LOUD!  The progressives control the media, the White House, the Senate, and perhaps soon, the Supreme Court.  The voice of taxpaying Americans will never be heard without your participation.  We carried the message for you to get elected, now it’s your turn.  Republicans reaped the benefits of the Grassroots movements, now stand up and join with us in the ongoing battle for freedom.


Next, EXPOSE the Democrats and the mainstream media for what they are and for what they really want:  they want to destroy the very essence of what America stands for—Freedom, personal responsibility and property rights.  Use the social media.  Hire a bunch of third graders if you don’t know how to do it, but get it done.


Next, DEFINE YOURSELVES for a change!  Republicans have been on the defensive for every election.  You’ve been so preoccupied with attacking the Tea Party and each other that you’ve lost sight of the real issues:  our Constitution and national security.


One more thing:  stop talking to each other and the pundits and try talking to the PEOPLE for a change!


Lastly, try putting your country ahead of yourselves.  We did not send you to Washington or the state capital so you could become wealthy and powerful, or have a lifetime career in politics.  You say you love America—it’s time to prove it.

59. The Demise of “Thanks”

Friends of ours in South Dakota had a son who was severely injured in a rodeo accident.  The family had to go to a different state for surgery and rehabilitation treatment for several weeks.  When it was time to harvest their crops farmers throughout their community drove their combines and tractors to the family’s farm and worked thru the night to see that their friend’s crop was brought in.  Our friends didn’t demand that their neighbors help them and the government didn’t force anyone to do all that extra work.  Our friends were touched and grateful, and they personally thanked their neighbors for their generosity.


There are several groups of healthcare workers from the US that travel to other countries to perform procedures on children and adults that aren’t otherwise available to them.  These workers donate their time and money to these patients, no one is forcing them to do it; there are no government mandates. 


Why do people donate their precious time and hard-earned money?  Because there is a certain sense of fulfillment, of self-worth, of accomplishment when we are able to help someone in need.  One of the unique blessings of being a physician is the warm connection that comes from helping a patient during a difficult time; and having them sincerely thank you.  It is the interplay of giving and showing thanks that makes charity such a symbiotic experience.

 Think about this when you hear about increasing welfare programs, Obamaphones, advertisements for food stamps, and the class warfare of the haves and have-nots.  When the government acts as the middleman between giver and recipient, there is no charity, no volunteering, no connection, no sense of fulfillment, and there is definitely no “thank you”.  Instead, there is manipulation, entitlement and fraud; taxes instead of donations; coercion replaces empathy; government replaces humanity.  I wonder how our country would be if everyone receiving a government check had to stand face-to-face with a taxpayer and say “Thank You”.

58. My Brother’s Keeper

The Progressive Movement loves to quote the Bible when they are promoting socialized healthcare:  “we are our brother’s keeper”.  Well, it’s not surprising that they wanted to eliminate “God” from their Democrat platform, when they don’t seem to be able to quote the Bible accurately.  For clarification:  In Genesis, Cain kills his brother Abel out of jealousy.  When God asks Cain where his brother is, Cain replies, “How should I know?  Am I my brother’s keeper?”  


So from this smartalec comment, we now have an entire political movement meant to hold Americans hostage to the notion that we are responsible for the welfare of our fellow human beings.  And somehow, the government is supposed to be the great  arbiter of “fairness”, the modern-day Robin Hood, who justifiably takes from the greedy, self-serving workers, and gives to the poor, less fortunate, non-workers.  Let’s say it out loud for once—most of the “fortunate” in our country, got there, not by Luck, but by education and hard work.  And many, if not most, of the “less fortunate” in our country, have made poor choices that have rendered them “in need”.  They are not so much “less fortunate” as they are less motivated to be responsible for themselves.  Wow—not a politically correct thing to say, huh?  Who do I think I am?  Well, I’m someone who has spent the last 27 years working with the “less fortunate” in the healthcare system.  I’ve seen patients claiming to be unable to work, on “disability”, that drive to the clinic in a nice car, walk in wearing nice leather boots and coats, with acrylic nails, hair extensions, even breast implants.  We see patients in the ER with expensive gold chains, tattoos, multiple body piercings, and diamonds imbedded in their gold teeth, but who won’t pay their bill.  Some patients are “disabled” only because they are morbidly obese, so much so that they are unable to walk. 


The notion of Personal Responsibility is not politically profitable, but it is what the Bible really teaches:  that reward will come from hard work.  What are not commonly quoted are the many passages of the Bible that tell us not to be careless by lending or giving money to irresponsible and lazy people!  Unless we recognize the need for personal responsibility in our society, we will be destroyed by the demands of those who claim our property in the name of a God that they themselves don’t believe in.

It is beyond time to stand up for what the Bible really teaches.


57. American Dreams

Did you know that there almost wasn’t a first Thanksgiving?  The Pilgrims that we celebrate in our schools every year, actually nearly starved to death—because of socialism.  I wasn’t taught that in grade school—I’ll bet you weren’t either.  Apparently, the Pilgrims set up a collective farming system in 1620 after arriving in the New World.  No one owned their own land, all worked common ground, and no one was allowed to own their own crops.  As a result, individuals were not motivated to work harder than anyone else when they would receive no more for their efforts than anyone else; and so all worked according to the laziest of them, and they nearly died of starvation as a result. 


In 1623, the Pilgrims decided to try allotting parcels of land to individuals to farm.  Whatever they grew themselves, they got to keep.  Not surprisingly, the people were more motivated, all family members participated in the farming, and the harvest was bountiful.  The threat of starvation was alleviated by the institution of what our children are now taught is greedy and self-serving---private property rights.  It’s unbelievable to me that the Progressive Movement (that is, Obama and the Democrats) still, 400 years later, try to convince us that socialism can actually work.


America has been the land of opportunity for the oppressed throughout the world.  People don’t risk their lives to come here because of the welfare system, or nationalized healthcare—they come because here, in America, they have the chance to own their acheivements, to control their destinies, to make goals for themselves and their children.  The Progressive Movement represents the oppression that these immigrants fled.  They see what is happening in our country and they know exactly what it means and who is behind it.  They’ve watched as their own countries fell under the spell of the Utopian Ideal; only to find that, very quickly, that ideal was only beneficial to the elite ruling class—the Barack Obama’s, Nancy Pelosi’s and Harry Reid’s.  They saw their relatives die prematurely because of socialized medicine, they watched as the government took over industries and private lands.  They endured crippling taxes and food shortages.  And then they risked all they had to escape it, because there was actually a country to escape to.  Where will WE go when America becomes a socialist country?  Today, please vote Barack Obama and the Progressive Democrats out of office!  Let’s keep our American Dream alive—for America…and the world.

56. The American Way

Hurricane Sandy lived up to its predictions.  New York, New Jersey, and areas throughout the mid-Atlantic have been devastated by the combination of northeastern snow and hurricane.  My heart goes out to all those affected and their families.  One of the greatest aspects of American society is her ability to respond to disaster.  Remember the tsunami in Thailand?  The earthquake in Haiti?  9/11?  Americans donated millions of dollars in private aid, their own money.  Hundreds of Americans travelled to help with relief efforts.  These were individuals who donated their time and money to make a difference in the lives of those in need.  As a people, we Americans have an amazing capacity for love and charity, a capacity that Democrats somehow think can only come from government.  They believe that only government, through taxation and bureaucracy, can distribute charity—like some great Robin Hood…taking from the greedy rich and giving to the downtrodden of the earth.  Unfortunately, whatever goes to the government first gets filtered through layers of agencies, to distribute as best benefits their agenda.  What this storm, and other natural disasters, should teach us is how much more efficient and meaningful it is to us a people to be able to give of our own free will, to those who will use the money to directly help those in need, in ways that will be most effective.  98% or so of what the Salvation Army takes in in private donations is used to directly help those in need.  It’s impossible to even calculate what tiny amount of what government takes in from taxes will ever go to really help individuals.   Imagine how much more good could be done if private charities like the Salvation Army had the billions of dollars we give to the government each year!  Milton Freidman said it well:  individuals spend their money more efficiently than other people spending their money; the least efficient is when government spends our money.  What if we paid 10% less in taxes to our wasteful government, and instead gave that 10% to private charities, or churches,  hospitals, or needy individuals directly?  That’s billions of dollars!  Imagine what could be accomplished!


We don’t need government to take care of our citizens in need.  They’ve been taking our money for decades and our needy are no better off.  We need government to let us keep more of our money so WE can take care of our citizens in need.  On Tuesday, let’s vote Obama and his corrupt Democrats out of office.  Then let’s get to work really solving the problems of our country… the American way. 

55. The Tao of Yogi

When I was a kid I remember seeing TV specials of Yosemite National Park.  They’d show pictures of bears walking up to visitors in their cars, and the visitors would be feeding the bears Cheetos and pork rinds and everyone was smiling and excited to be interacting with nature.  Isn’t that nice, helping all those bears get fattened up for the winter?  Well, Guess what happened over the next several years:  the bears got pretty fond of Cheetos and pork rinds, so they stopped foraging for berries in the woods.  They’d hang around campsites and cars, hotels and dumpsters looking for food.  Then the park rangers started telling people not to feed the bears anymore because it was interrupting their natural diet, and the bears weren’t supposed to live on Cheetos and pork rinds.  So the park put bear-proof locks on the dumpsters and had campers put their food in lockers at the campsites.  Well, the bears by then must have figured they were entitled to Cheetos and pork rinds, so they started ripping cars and tents open and breaking into houses, even attacking people, looking for Cheetos and pork rinds.  Good heavens, what’s happened to those cute, fuzzy bears??  So now, park rangers are  killing bears that intrude into areas where there are Cheetos and pork rinds.  On a recent trip to Yosemite, there were flyers and signs posted all over saying “Don’t feed the bears!  Feeding kills bears!”  The flyers went on to extoll the virtues of the bears foraging for themselves in the wild, and how humans shouldn’t interfere in their ecosystem. 


So, I have a question—If the park rangers can figure out that it’s bad for humans to interfere with the bears’ ecosystem by getting them hooked on Cheetos and pork rinds, why can’t our government understand that they are destroying the natural instinct for humans to interact in our free-enterprise system by putting them on welfare and endless unemployment benefits.  If bears learn that begging for handouts from tourists is easier than foraging for berries in the woods, why can’t society see that welfare and unemployment only serve to prevent Americans from providing for themselves.  Locking our citizens into lives of dependency on government destroys their opportunity to succeed. 


So next time you see riots in Greece by citizens protesting government austerity measures, think about Yogi the bear and what my husband calls the Occupy Jellystone Movement.


54. It’s One or the Other

Like it or not, we have a 2-party political system in this country.  Some countries divide up votes and representation among several competing political parties, and occasionally we’ll have Independents or Libertarians in the Congress, but it’s time to face the fact:  it’s either Republican or Democrat when it comes to control in our government.  I really like many Libertarian ideas, and there are parts of the Republican platform that I wish weren’t there.  Too bad.  Boo Hoo.  Get over it.


The issue this election can be, in my opinion, defined very simply:  either we vote to continue the path of government control over our lives through the Progressive Movement that President Obama and the Democrats represent; or we choose to take back responsibility for our lives and governance.  Gov. Romney was not my first choice for President, but I know in my heart that the way to freedom in America is NOT thru Obama and the Democrats.  I am willing to risk voting for Mitt Romney, and trust that he and Paul Ryan will work to stop America’s decline into socialism.  Over time, we should work to identify more citizens with integrity that will lead based on this country’s founding principles.  But if we are going to change the course of our country it must begin with this election and we have got to get the Democrats out of power to do it.  In order for them to be out of power, Republicans must take over the majority of the seats in the House of Representatives and the Senate, and they have to win the Presidency. That is the only way that legislation can be passed to stop Obamacare, Agenda 21, and the indoctrination of our country into socialism.  And the ONLY way to do that, like it or not, is to vote for Republicans.


If you think that it’s more virtuous to hold to your principles as a Libertarian and cast your vote for Gary Johnson, well guess what—you just voted for Barack Obama and the Democrats.  If you just can’t bring yourself to vote for Mitt Romney or your Republican candidate and choose to not vote at all, guess what—you just voted for Barack Obama and the Democrats.  So unless you WANT to vote for Barack Obama and the Democrats, just this once at least, vote for Mitt Romney and the Republicans.  That’s it, that’s the way it is, ain’t no other way, hold your nose if you must… get over it… I’m just sayin’…

52. Review of Real Reform Ideas

Obamacare needs to be completely repealed.  Period.  Just because someone likes the idea of a 26 year old kid being included on the parents’ healthcare plan—at the cost of other Americans by the way—is NOT justification for imposing the rest of this heinous law on the entire country.  Get rid of it—ALL of it.  Start over.


First, respect the 10th Amendment and let states decide what reforms will work best for them.  It is silly to think that a bunch of bureaucrats at the federal level can come up with a plan that will work for everyone.  Any government program works best for the people when it is closest to those people, as local as possible.  Next, get government out of the way and let the market system operate through competition and consumer choice.  Put decisions back in the hands of the patients and their doctors. 


Post prices for healthcare services so patients can compare and choose for themselves what they will and won’t have.  Allow patients to save money tax free for medical expenses and encourage employers to help them, like with a 401k.  Separate insurance plans from the workplace so patients can keep their plans when they change employers or quit working.  This will alleviate most of the problems with pre-existing conditions. If patients have continuous insurance and only change carriers, they shouldn’t be penalized for pre-existing conditions.


Eliminate state health insurance mandates and let patients choose what coverages they want to pay for.  Change the organization of risk pools, so people can share risk with larger groups, maybe even nationally.  Keep premium costs low for young, healthy people so they will be able to afford the premiums. 


Get the government out of the health insurance business by privatizing Medicare, Medicaid and the Veterans Administration healthcare systems.  Get rid of all of the ridiculous unnecessary government regulations and coding requirements that only serve to increase healthcare costs for everyone.  Some regulation is needed, but only a small fraction of what we now have.  And finally…Reform our medical malpractice system so that patients get compensated for real damage due to negligence, but doctors aren’t held hostage by greedy lawyers filing frivolous lawsuits that cost everyone.  WE CAN DO THIS FOLKS!!  JUST GET THE GOVERNMENT OUT OF OUR WAY!!

51. Review of Obamacare

So now we know that under Obamacare everyone will NOT have health insurance, in fact, even more folks may be left without insurance.  Healthcare costs will NOT be lower; they will actually be higher.  We will ALL be paying more taxes, many of which will fall on the low and middle classes.  Employers will face new taxes and regulations, and their healthcare costs will be much higher.  This will cost thousands, if not millions of jobs.  Doctors and other healthcare providers will face higher costs due to skyrocketing regulations, and doctors will either sell their practices to hospital groups, or they will close their doors entirely.  Patients will have fewer choices and less control over their own health and lives due to rationing of care and government control over their healthcare decisions.  Insurance premiums will go up and access to quality healthcare will go down.  Medicare patients will have a harder time finding a provider to take care of them, and they will lose the option of Medicare Advantage.  The number of Medicaid patients will skyrocket and they will have very long wait times to see a physician.  The cost of medical devices and pharmaceuticals will increase, and the costs of many other goods will increase as well due to new taxes on these businesses.


The Obama administration is violating our Freedom of Religion by requiring everyone to pay for abortion and contraception coverage.  This is NOT about freedom of choice—this is about our Constitutional freedoms being ignored by a Progressive Movement that believes that they should have the authority to change our Constitution as they see fit—“a living Constitution” they call it.


And now, If the government wants us to buy something, the Supreme Court has  declared that they can force us to buy it just by taxing us until we comply.  Justice Roberts and the liberal court justices decided this was OK.  Another example of their idea of a “living Constitution”.


We are at a precipice, my fellow Americans.  Either we stop the Progressives in the Democrat Party now, or we free-fall into socialism.  It has been 100 years in the making, and it will not stop with Obamacare—but that IS, I believe, the point of no return. Remember, when the government controls your healthcare, it controls YOU.


53. Our Last Chance

The Progressive movement has been working diligently and in stealth for over 100 years in this country to turn America away from its Constitution, and toward a socialist “New World Order”.  Think about it:  The United Nations—a group of countries that mostly hate us, meeting in a building that we pay for, preventing us from protecting ourselves from our enemies;  trying to take over our Bill of Rights and our sovereignty as a nation through Agenda 21.  And Barack Obama and the Progressive Movement love it.


Our schools, through liberal government agencies and union influence, are indoctrinating our children by teaching “social justice” rather than true American History; “fairness” rather than founding Constitutional principles and property rights. Our medical students are taught to make healthcare decisions based on “the good of society as a whole” rather than on the good of the individual patient. Our President takes pride in “the life of Julia”—a fictitious, but only too real, woman who lives by the grace of government handouts thru every stage of her dependent life.  We’ve watched the staged “Occupy Movement”, wherein Americans who work hard to achieve success through great ideas and capitalism, who provide millions of jobs for other Americans, are vilified as greedy and evil. Our children are taught that anything “green” is good—except money. That something given by the government is better than something earned by the individual.  And guess what—they are believing it. 


Over the years, Americans have been talked into letting the government plan for their retirement through Social Security and Medicare.  And now that these programs are failing, senior citizens are frightened about their futures. If there are problems, we don’t look to ourselves to solve them, we look to government.  We have a capital full of politicians that are swollen with power, no longer servants of the people.   Make no mistake folks—we have allowed all of this to happen.  And only WE have the power to make it stop.   But we may only have one more chance.  If Barack Obama is re-elected, we may never be able to control our  government--ever again.


The generation of Americans that lived through the Great Depression and 2 World Wars has been called “The Greatest Generation”.  I agreed with that label…until now.  I believe that THIS generation of adults has the potential to stop the Progressive Democrat Movement and save the very essence of what America stands for.  If we can do that, starting with this election, WE will, in my opinion, be… “The Greatest Generation”.