This'n'That; December 11th[obamaCare;DeathPanels]

"Clown Prince"--The Hypocrite, As Usual!!

[As usual, Fluffy obama is using one of his minions to counter one of his previous positions on legislation. This arschloch will never admit to anything negative; it's all about him!! His handlers cooked up a deal with big pharmaceuticals to ensure they support passage of the obamaCare legislation. As usual, a poliltical payoff-again, with plausible deniability!!

NOTE: Senators Can Block Consideration of a Bill with a “Hold” A “hold” is placed when the Leader’s office is notified that a Senator intends to object to a request for unanimous consent (UC) from the Senate to consider or pass a measure. A hold may be placed for any reason and can be lifted by a Senator at any time. A Senator may place a hold simply to review a bill, to negotiate changes to the bill, or to kill the bill. A bill can be held for as long as the Senator who objects to the bill wishes to block its consideration.]

A deal between the White House and the pharmaceutical industry is holding up a bipartisan amendment to allow the importation of cheaper prescription drugs from abroad.

• Dorgan’s measure, which would permit bulk exports of medicines from countries such as Canada, enjoys broad and bipartisan support and likely has the backing of more than 60 senators, which would guarantee its adoption on the healthcare reform bill.
• Tension between the White House and obamacRATic supporters of the so-called drug reimportation amendment is primarily behind the delay, Senate Majority Moron Whip Dick Turbin (d-Ill.) said Thursday.“There’s a political subtext here,” Turbin said.
• The White House and the Pharmaceutical Research and Manufacturers of America (PhRMA) struck a deal this summer to limit the drug industry’s financial exposure under reform to $80 billion over 10 years, though its terms have never been fully disclosed.
• Fluffy obama himself, was one of the 35 co-sponsors of Dorgan’s drug reimportation legislation when he served in the Senate. In addition, White House Chief of Staff Rahm Emanuel was a leading supporter of the House version of the bill when he served in the lower chamber.
• ”Several obamacRATic senators are objecting to moving ahead with the vote because they believe the amendment has enough support to prevail, said Sen. Olympia Snowe (r-Maine), Dorgan’s lead co-sponsor. “I suspect we haven't had a vote yet because they know it has the votes to pass,” she said.
• obamacRATic senators from states home to pharmaceutical companies, including Tom Carper (Del.), Frank Lautenberg (N.J.) and Robert Menendez (N.J.), object to the amendment, citing concerns about ensuring the safety of medicines entering the U.S. supply chain from foreign sources.
• Congress Daily has reported that Carper (D-Del.) placed a hold on the amendment, but his office refused to comment to The Hill.
• On Thursday evening, Senate Moron Leader harry reid (d-Nev.) said Lautenberg had offered an alternative to the Dorgan amendment; both amendments will come to a vote at the same time, reid said.The obama administration has sent out mixed messages about drug reimportation this week. White House press secretary Robert Gibbs insisted Tuesday that Fluffy has not changed his stance. “The president said during the campaign that he did. [He] said so in his first budget, assuming that safety concerns … could be addressed. And I think that’s the key.”

The same day, however, Food and Drug Administration (FDA) Commissioner Margaret Hamburg, a Fluffy appointee, issued a letter to senators saying her agency believed Dorgan’s amendment would endanger the U.S. medicine supply and be difficult to enforce. “There are significant safety concerns,” Hamburg wrote. The Department of Health and Human Services and the FDA issued similar cautions during the George W. Bush and Clinton administrations.

The message did not seem mixed to McCain, “The fix is in,” he said. This arrangement between the White House, Senate Finance Committee Chairman Max Baucus (d-Mont.) and PhRMA neutralized a powerful potential opponent.

NO Death Panels.......??

Ezekiel Emmanuel MD, Rahm Emmanuel’s brother, who is the "Clown Prince’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.

“Principles for allocation of scarce medical interventions” 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 Lottery First-come, first served Prioritarianism ***Sickest first ***Youngest first ***Utilitarianism
• Saving the most lives ***Saving the most life-years ***Saving the most socially useful ***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
• 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 [graph, above], whereas the youngest and oldest people get chances that are attenuated[=weakened;essentially, they get the shaft!!] … 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. 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 easily 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.

Til Nex'Time....