Monday, July 21, 2008
Surprise Meeting, Surprise Attack
You may not be aware of this, but in January 2007, John Conyers (D-MI) introduced legislation (HR 676) which will, for all practical purposes, nationalize the medical sector. Last Friday, after having attended a meeting I had heard nothing about until two nights before it was to occur, I was horrified and angered to learn not only that fact, but that a sizable contingent of Congressmen are working feverishly to build support for this bill among various pressure groups while deliberately keeping the voting public -- supporters and opponents alike -- in the dark about its nature.
According to the OpenCongress web site, the bill has 90 co-sponsors. (The Library of Congress lists 78.) Literature passed out on behalf of Sheila Jackson Lee (D-TX), further claims that HR 676 has the support of 14 "national/international" labor unions, 33 state AFL-CIO federations, 19 "national/state" organizations (ranging from the Hip Hop Caucus to the American Medical Students Association), and thousands of physicians and nurses.
Unofficial Meeting, Official Testimony?
This meeting started an hour and fifteen minutes late and ended after only one question from the audience. It was, in the words of Sheila Jackson-Lee, who ran it, an "unofficial hearing of the House Judiciary Committee". She even complained at the beginning of being "without a gavel" to call it to order. The proceedings were recorded, presumably for future use when the bill is debated in Congress.
Two sets of "witnesses" ("not panelists") were seated and offered their testimony as to why this bill should be passed. (On that, there was no dissent.) The atmosphere was somewhat informal, with lots of back-slapping ("Sheila Jackson-Lee [who was an official in the local Boy Scouts at one time] was a great Boy Scout.") and humor for show among the participants. At one point, Jackson-Lee demanded -- like an emcee at a variety show -- that the audience "give it up" more (i.e., applaud again, more loudly) for one of the witnesses after she finished speaking.
It was very quickly apparent that, contrary to its billing as an "examination" of the medical insurance crisis for all "healthcare stakeholders", this meeting was to be a selective gathering of endorsements for this bill from among prominent locals. All of these were involved in some way with medicine, group medical coverage, or egalitarian activism. The meeting was open to the public, but the lack of publicity and the small seating capacity of the venue indicated that there was no serious interest in obtaining feedback from the supposed beneficiaries of this legislation.
To my knowledge, there was absolutely no local media coverage of this event. (Contrast this to the nine results for Conyers and Jackson-Lee's other meeting here.) If this bill is such a great idea -- if we will all benefit so greatly from it -- would not two experienced professional politicians have managed to attract some publicity for this event? The media silence speaks volumes, all of it about why Conyers and Jackson-Lee would want to fly under the radar about their great plan. What possible harm could enormous gratitude and legions of adoring fans bring to a politician?
The secrecy will begin to make more sense when we consider the bill itself, and the meeting, in which Conyers (if I recall correctly) said he wanted to "frame" this legislation. Indeed it does, but not in the way he intended.
Here are a few highlights taken from my notes on the meeting:
About 50-60 people attended, including about ten witnesses. In addition to Conyers and Jackson-Lee, Donna Christian-Christensen (D-Virgin Islands) attended. She served as a sort of opening act for Conyers and Jackson-Lee, speaking for a few minutes, starting just before they arrived.
Jackson-Lee indicated that we were "blessed" by Christensen's presence due to the fact that she is not just a female physician, but a black physician. Christensen stated one of the main themes of this meeting early on: She sees the medical insurance crisis as a racial issue. ("This system is discriminatory.") This idea, whether explicitly tied to race or implied by associating race with poverty, was frequently echoed during the remainder of the meeting.
(During the testimony, the audience was "blessed" with the sight of Christensen texting -- and not even pretending to try to be discreet about it. To her credit, however, she was awake. Conyers, self-appointed guardian of the public health, dozed off at one point.)
Christensen eventually brought up at least one of the two other bills (HR 6212 and HR 3014) touted as companions to HR 676. I have not yet looked into either of these in any detail, but I gather from various remarks that they are to include various measures to increase the number of minorities in the medical professions, start loan forgiveness programs, institute "health empowerment zones" (whatever that means), and train more American nurses. (Every time that came up, there were words to the Seinfeldian effect of "not that there's anything wrong with" immigration.) Christensen also expressed a desire for "culturally competent" care. I don't know about you, but when I'm sick, I want medically competent care.
Conyers, presiding over the meeting as the Chairman of the House Judiciary Committee, delivered some long-winded opening remarks to the effect that he is interested in "correcting disparities", and wants to "improve healthcare" on the way to its eventual government takeover. (If more government control equals "improvement", we have been doing this for decades already.)
Most notably to me, Conyers attempted to portray his proposal as noncontroversial and practical, saying that this effort is not "theoretical", "philosophical", "idealistic", or "ivory towerish". I disagree with all but the last. The idea that someone else can dictate to me and my physician the terms under which we can do business is the political application (collectivism) of an objectively wrong theory of morality (altruism) that can have very negative practical results when applied.
Conyers also noted that many labor unions, after having initially expressed satisfaction with their medical coverage, have begun defecting to his plan after encountering the prospect of having coverage reduced in the face of the souring economy. In addition, and most notably, I got the impression that he thinks that Hillary Clinton, who made the last serious effort to nationalize medicine, failed tactically in her efforts to take over the medical sector of the economy.
Straight out of Atlas Shrugged
The format of the rest of the meeting was that a panel of witnesses was seated, with each in turn being allowed nominally three minutes to speak. Conyers could then solicit additional remarks after all were finished. After both panels, I think there was to have been a public Q&A, but this was cut short after only one question since Conyers and Jackson-Lee were leaving. Below are some highlights from the rest of the meeting, not all necessarily in order. Some names may not be correct due to the fact that my eyeglasses had broken that morning and for some reason, I hadn't yet been handed a new pair by my state caretakers in time for the meeting.
- One Dr. Hamilton noted that several physicians from his former practice who had specialized in internal medicine quit 5-10 years early. He cited this and the unprofitability of that practice as a good reason for passing HR 676. He was neither asked for nor volunteered whether he thought extensive state interference with the medical sector might have had anything to do with that.
- A young, black, handsome pediatrician, Dr. Raphael, brought up another recurrent theme of the proceedings: the poor or ignorant as "gatekeepers" of medical care, in this case, for their children. (More on that later.) He claimed to "speak for all pediatricians" in wanting greater "access" for children to good medical care. He also claimed that 60% of physicians want a single-payer plan.
- Local AFL-CIO President Dale Wortham, big, blustering, and wearing a Hawaiian shirt, expressed outrage at the medical insurance crisis. He seemed like the only person at the meeting with a clue about how much a national insurance plan would cost. Meaning that money for NASA to send men to the moon was wasteful and could be spent on medicine instead, he said, "We have the rocks." (Even a valid argument against government waste does not constitute a valid argument for the government taking over a sector of the economy.)
- In the first Q&A, Conyers, yanking words out of context to manufacture unintended insults like the best of 'em, called Wortham on the carpet for using the phrase "worst of the worst" to describe some of the people both were allegedly there to help. It was plainly obvious that Wortham meant, "worst off of the worst off", and yet Conyers demanded and got an apology from Wortham.
- Sheila Jackson-Lee again states that, "These are not panelists. They are witnesses." For whose benefit is she saying this?
- The second panel includes (1) a RESULTS.org activist who says she wants "equal opportunity for healthcare" (2) Dr. Jones, whom Jackson-Lee called "Mr. Disparities in Healthcare". He's part of the "Intercultural Cancer Caucus".
- Jones related a story of how a rich, rural man faced a medical facility with its closed emergency room on "drive-by" status -- What might EMTALA have had to do with that? -- had to try to fly his kid to one. His kid died in flight. Jones' point is that "access" "disparities" don't just affect the poor. No mention is made of the state's possible role in causing this needless death or how an even greater state role will not cause other kinds of "access problems" to become much more common.
- Dr. Bob (?) of Physicians for a National Health Program testifies that he is here to "debunk" the "myth" that state control of medicine will end health care as we know it. He is not an economist or a political philosopher, but a clinical psychologist.
- Oddly enough, Dr. Bob sees coverage limits on outpatient visits as evidence that, "The system routinely discriminates against my patients." Even more oddly, although this bill is being called "Medicare for All", he seems not to realize that the government, as the single payer, will have to make similar calls. Even the nation's resources are not unlimited. He also claims that the free market is limited in achieving "socially desirable [by whom? --ed] goals".
- Dr. Bob claims, contrary to Dr. Leonard Peikoff, that, "Health Care is a right."
- Dr. Bob also calls single-payer the "gold standard of administrative efficiency". Much of the rhetoric was focused on the large amount of money being spent to administer payment for medical care, as if the much wiser government could redirect most or all of it towards medical care. It seems like nobody in this room regards money as private property.
- A nurse from a Harris County hospital claims that the average age of a nurse has increased over her career from 32 to 50. This sounds plausible to me. It does not, however, follow that the state should take over the medical sector,.
- She also puts the family as "gatekeeper" this way or something like it:"Do I pay my electric bill or medical?" She fails to notice that Conyers' plan will take this decision out of our hands and put it in the hands of the government. I, for one, do not often agree with how the government spends the money it is already taking from me!
- She complains that only 5% of nurses are bilingual. Note that this bill intends to treat everyone in America. Mighty generous of us. And hell, we're not even going to ask our foreign "guests" to pick up a smattering of English, first!
- Betty Lewis, immediate past president of National Black Nurses Association, is also fixated on training "American" nurses. If this plan can magically fix nurse's compensation, which I believe came up at one point, why not magically declare all of us millionaires and solve the whole "access" problem once and for all?
- The token "capitalist" (TC) on the panel -- of witnesses -- runs a physician-owned facility that takes in a total of 80% of its revenue from Medicare and Medicaid, but that ends up writing off $20 million (per annum?) due to inability of its patients to pay. In my notes, I write, "This guy thinks he'll make out like a bandit."
- TC cites agreement with Milton Friedman as if to establish that he's a capitalist and then says there exist private, as opposed to public goods. He sees medicine as a "public good". Memo to Conyers, who dozed off during this (and I can see why): There's your "theory".
- One non-empaneled person (whose comment is obviously wanted) grovels for money to research various alleged "causes" of poor health among minorities. These generally sounded hokey to me.
The Expanded and Improved Medicare for All Act
As for the bill itself, just covering this meeting has already taken me far longer than I planned this morning. I urge you to read it, though. As just an example, consider that this bill will make it illegal for private insurers to duplicate coverage allegedly provided by the state. This will require patients to either pay for all of their own medical care (unless this is construed as "self-insurance") or accept whatever the government -- as the new "gatekeeper" -- decides you will get.
And, while Conyers et al. claim that single-payer will permit you to choose your physician, recall that he is going to set the rate your physician receives for services. What will free choice even mean when demand skyrockets for "free" medical care and the "gatekeeper" has to decide whether to cut services, raise taxes, or reduce physician compensation? And what if the government disagrees with your physician over whether treating you is "medically necessary"? What criteria will it use? What if you no longer contribute income to the public coffers? Just because the national budget is bigger than a family's budget does not mean that it is limitless. Sooner or later, choices based on money will have to be made. If you -- rather than a government bureaucrat -- want to be the one making such choices, you should fight this plan.
Just this provision -- and it is only the tip of the government-takeover iceberg -- illustrates what is wrong with government interference in the economy in general and this plan in particular: The personal judgement of physician and patient alike can be nullified by government regulation or trampled at the whim of any government functionary entrusted with enforcing those regulations.
Conyers and his supporters are busy telling each other that this proposal will accomplish what Hillary Clinton's set out to do. At the same time, they are getting ready to tell its potential opponents that it differs greatly from Clinton's plan in substantive ways. (It does not. Consider the question of choice more fully. See above.) They are clearly planning to use the worsening insurance crisis as "evidence" that the free market cannot work. I suspect that they want to spring this proposal on a confused public and attempt to pass it rapidly, before it can be examined critically. Notice that much of their focus involves "answering" objections to Clinton's old plan (e.g., physician choice, it won't "end healthcare as we know it", the market has allegedly been tried and failed).
The time is now to get up to speed on this bill, digest the arguments against state control of medicine, and apply those arguments to this new variant. And if you do not have time to do so, or to work against this bill, then I urge you to support the Foundation for Individual Rights in Medicine, the Americans for Free Choice in Medicine, and the Ayn Rand Institute (which recently put out an op-ed debunking the free market facade of Medicare.
Today: (1) Corrected an error. (2) Corrected typos.