Today's News & Views
November 23, 2009

The Day After the Day After the Senate Health Care Restructuring Vote
Part One of Three

By Dave Andrusko

Part Two looks at a man who was misdiagnosed for 23 years as being in a PVS. Part Three walks you through another rationing and euthanasia threat in the proposed Senate health care restructuring bill. Please send your comments on any part to daveandrusko@gmail.com. If you'd like, follow me on http://twitter.com/daveha.

Let me begin Monday's TN&V with three illuminating quotes. The first two are from today's Rasmussen Reports.

"Just 38% of voters now favor the health care plan proposed by President Obama and congressional Democrats. That's the lowest level of support measured for the plan in nearly two dozen tracking polls conducted since June."

"The Rasmussen Reports daily Presidential Tracking Poll for Monday shows that 28% of the nation's voters Strongly Approve of the way that Barack Obama is performing his role as President. Forty-one percent (41%) Strongly Disapprove giving Obama a Presidential Approval Index rating of -13. For the first time in the Obama Administration, the Approval Index has been in negative double digits for nine straight days." [The Presidential Approval Index measures the difference between the percentage which strongly approve and those strongly disapprove of the President.]

"[President] Obama and [Senate Majority Leader] Reid wanted debate – so now they'll get debate, on their cloaked provisions that would cover abortion on demand in proposed new government-run and government-subsidized insurance plans."
-- From National Right to Life's Statement, following the Saturday vote. The statement is reproduced in its entirety at the end of this blog.

So, what do we know that we didn't know last Friday? Maybe I should phrase it differently, or at least begin by discussing what was confirmed when Harry Reid secured just enough votes to clear a procedural hurdle.

Pro-Abortion President Barack Obama

First, as the NRLC statement makes crystal clear, Obama and Reid and the rest of the pro-abortion Democratic leadership went to the mat to preserve what matters most to their pro-abortion allies: payment for any and all abortions through a huge new federal health insurance program, the "public option," and also to subsidize purchase of private plans that cover abortion on demand.

Second, as is par for the course for the entire 2,074-page bill, the public is supposed to willfully suspend disbelief and accept what is patently not true: that the bill is somehow "neutral" on abortion. The Stupak-Pitts language, adopted by the House, genuinely extends the principles of the Hyde Amendment that governs all of the current federal health programs. When Reid refused to include this language in his bill, it unmistakably signaling his real intent.

So why are all the smoke and mirrors necessary? Because Obama and Reid know (as the NRLC statement points out) that the "substance of these abortion-promoting policies is deeply unpopular, so they seek to conceal the reality with layers of contorted definitions and money-laundering schemes."

So, what else do we know? We heard some Democrats say they merely voted to go ahead with a debate over the bill--that their affirmative vote doesn't necessarily mean they will go along with the final measure.

What we do know for sure that there is a band of pro-life Democrats in the House who have minced no words: if the Stupak-Pitts Amendment is gutted or removed, they will oppose final approval of health care legislation.

Please read NRLC' s statement below and make sure that you use your social networks to forward this edition of TN&V to all your pro-life friends.

We know that Reid has said the debate on the substance of his bill begins next week. To keep up to date on how you can help NRLC stop inclusion of the Reid pro-abortion language, please go to http://nrlactioncenter.com.

National Right to Life to Obama and Reid: You wanted debate? Now you'll get debate – on government-funded abortion.

As National Right to Life has previously noted, Senator Reid's bill [on page 118] would authorize the federal government to pay for any and all abortions through a huge new federal health insurance program, the "public option," and also to subsidize purchase of private plans that cover abortion on demand. President Obama and Reid know that the substance of these abortion-promoting policies is deeply unpopular, so they seek to conceal the reality with layers of contorted definitions and money-laundering schemes.

Obama and Reid wanted debate – so now they'll get debate, on their cloaked provisions that would cover abortion on demand in proposed new government-run and government-subsidized insurance plans.

Obama and Reid are seeking to block enactment of the bipartisan Stupak-Pitts compromise, adopted by the U.S. House of Representatives on November 7 by a vote of 240-194. This amendment would prevent government funding of elective abortion through the proposed "public option," and would also prevent federal subsidies from paying for private insurance plans that cover elective abortion.

During the weeks ahead, National Right to Life will continue to fight the efforts of President Obama and congressional Democratic leaders to cover abortion on demand in two huge new federal health programs. The Senate bill faces additional 60-vote hurdles in the future. Moreover, a courageous group of pro-life Democrats in the House of Representatives will oppose final approval of health care legislation if the Stupak-Pitts Amendment is gutted or removed.

http://www.nrlc.org/News_and_Views/Nov09/nv112309.html

Today's News & Views
November 23, 2009

Debate On Reid Senate Health Care Restructuring Bill to Begin After Thanksgiving
Part Three of Three

Editor’s note. Last week NRLC’s invaluable Robert Powell Center for Medical Ethics blog began a series of posts to explain various concerns in the Reid Senate health care restructuring bill related to rationing and euthanasia. The measure cleared its first hurdle Saturday with a 60-39 cloture vote to begin debate. The party-line vote (Sen. Voinovich, R-Ohio, did not vote) allows the full Senate to begin debating the bill. The bill, with its numerous rationing concerns, will be debated after this week's Thanksgiving recess.

Price Controls (Medicare)

The Reid bill includes the House provision that would effectively allow the Centers for Medicaid and Medicare Services to bar senior citizens from adding their own money, if they choose, to the government contribution in order to get private-fee-for-service Medicare Advantage plans that are less likely to ration life-saving treatment.

Medicare—the government program that provides health insurance to older people in the United States—faces grave fiscal problems as the baby boom generation ages. Medicare is financed by payroll taxes, which means that those now working are paying for the health care of those now retired. As the baby boom generation moves from middle into old age, the proportion of the retired population will increase, while the proportion of the working population will decrease. The consequence is that the amount of money available for each Medicare beneficiary, when adjusted for health care inflation, will shrink.

Three alternatives exist.

In theory, taxes could be increased dramatically to make up the shortfall – an unlikely and politically difficult proposition. The second alternative—to put it bluntly but accurately—is rationing. Less money available per senior citizen would mean less treatment, including less of the treatments necessary to prevent death. For want of treatment, many people whose lives could have been saved by medical treatment will perish against their will.

The third alternative is that, as the government contribution decreases, the shortfall could be made up by payments from older people themselves, so that their Medicare health insurance premium could voluntarily be financed partly by the government and partly from their own income and savings.

What most people do not realize is that, as a result of legislative changes in 1997 and 2003, supported by the National Right to Life Committee, this third alternative is now law. Under the title of “private fee-for-service plans,” there is an option in Medicare under which senior citizens can choose health insurance whose value is not limited by what the government may pay toward it. These plans can set premiums and reimbursement rates for providers without upward limits set by government regulation.

This means that such plans will not be forced to ration treatment, as long as senior citizens are allowed to choose to pay more for them. This option means that Medicare can operate in such a way that whatever the government provides will serve as the floor, not the ceiling, for what health care senior citizens can get. As government contributions sink, private fee-for-service plans can provide a way to escape rationing. (More on the background of this program can be found at www.nrlc.org/news/2007/NRL03/Rationing.html)

Medicare covers everyone of retirement age, regardless of income or assets. Yet, because of budget constraints, the Medicare reimbursement rates for health care providers tend to be below the cost of giving the care. This deficit that can only accelerate as cost pressures on Medicare increase with the retirement of the baby boomers.

This means that providers engage in “cost shifting” by using funds they receive in payment for treating insured working people to help make up for what the providers lose when treating retirees under Medicare. Thus, comparatively low-income workers often effectively subsidize higher-income retirees.

However, when middle-income retirees are free voluntarily to add their own money on top of the government contribution (through a private fee-for-service plan), they stop being the beneficiaries of cost-shifting and become contributors to it. However, this program faces elimination in the Reid bill.

Section 3209 indirectly amends the section in existing law that allows private fee-for-service plans to set their premiums without approval by Centers for Medicaid and Medicare Services [CMS] by saying, “Nothing in this section shall be construed as requiring the Secretary to accept any or every bid submitted by an MA [Medicare Advantage] organization under this subsection.” [1]

This allows CMS to refuse to allow private-fee-for-service plans that charge what CMS regards as premiums that are too high – or, literally, allows CMS to refuse to allow private-fee-for-service plans (or any other Medicare Advantage plans) altogether, for any reason or no reason.

This dangerous provision in the Reid bill will eliminate the only way that seniors have to escape rationing--by taking away their right to spend their own money to save their own lives.

http://www.nrlc.org/News_and_Views/Nov09/nv112309Part3.html

Today's News & Views
November 23, 2009

Man Misdiagnosed as Being in a "Persistent Vegetative State" for 23 Years
Part Two of Three

By Dave Andrusko

Earlier this morning I read about Rom Houben, misdiagnosed as being in a so-called "persistent vegetative state" for 23 years. Doctors discovered three years ago Houben, who was severely injured in a car crash in 1983, had been mentally alert all along, but unable to communicate. Only today did the news reach a wider audience.

But I was unable to post a TN&V until later because of a number of other things I had to get done. This is fortunate, because as the day progressed many very important details and clarifications came out.

Rom Houben

A lot of distinctions had been blurred in the accounts. For example, four very different conditions--coma, comatose, vegetative state, and persistent vegetative state--were used almost interchangeably. Even after reading a number of stories, it's difficult to know who thought what when. One of the later stories suggested doctors first thought Houben was in a coma and then lapsed into a "persistent vegetative state."

But whatever the diagnosis, it was wrong. Fortunately for Houben, a former martial arts enthusiast and engineering student, he was not starved to death.

"Mr Houben recalled the terrifying realisation after he came round from his accident when he knew that he had lost complete control of his body – but no one knew that he was fully conscious," The Times of London reported. Although he could hear every word his doctors were saying, Houben could not communicate with them. "I screamed, but there was nothing to hear," he told the German magazine Der Spiegel.

Initially, all the credit for the correct diagnosis seemed to belong to the medical team headed by Dr. Steven Laureys, a neurological researcher at the Liege University Hospital in Belgium, a man who clearly is on a mission. While they deserve plenty of kudos, there is a "rest of the story," as we shall see momentarily.

Dr. Steven Laureys

"Laureys, who is head of the coma science group and neurology department at Liège University hospital, concluded coma patients are diagnosed falsely 'on a disturbingly regular basis," The Guardian reported. "In around 40% of cases diagnosed as vegetative, more careful examination shows there is still some level of consciousness. He examined 44 patients believed to be in a vegetative state, and found that 18 of them responded to communication. 'Once someone is labelled as being without consciousness, it is very hard to get rid of that,' he told Spiegel magazine, calling for a systematic overhaul of the methods of diagnosis."

He told the Guardian that "patients who are not fully unconscious can often be treated and are capable of making considerable progress." Houben now communicates through a computer, and a special device above his bed makes it possible for him to read books

But how did Dr. Laurey even learn about Houben? His parents, who did not believe he was comatose or vegetative, according to the Associated Press. His mother, Fina Houben, talked with the AP by phone and said they had taken Rom to the United States five times for tests.

"More searching finally got her in touch with Laureys, who put Houben through a PET scan that indicated he was conscious," reports Raf Casert of the AP. "The family and doctors then began trying to establish communication. A breakthrough came when he was able to indicate yes or no by slightly moving his foot to push a computer device placed there by Laureys' team. Then came the spelling of words using his finger and a touch-screen attached to his wheelchair." It is not entirely clear why the case came to light at this particular moment; Laureys published his study in the journal BMC earlier this year, showing that some 40% of patients diagnosed as being in a vegetative state were not.

Be that as it may, Houben is a very happy man. "I'll never forget the day that they discovered me, it was my second birth," he said. Now he says, "'I want to read, talk with my friends via the computer and enjoy my life now that people know I am not dead," according to the Daily Mail.

http://www.nrlc.org/News_and_Views/Nov09/nv112309part2.html