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  • Senate Committee Blocks Anti-Rationing Amendments

    What has been going on in the Senate Health, Education, Labor, and Pensions (HELP) Committee for the past three weeks? Unless you’ve been carefully watching the mark-up of the Kennedy health bill, you wouldn’t be aware that Senators have been battling over many of the 398 amendments proposed to the legislation. You also wouldn’t know that all attempts to protect patients from health care rationing were defeated.

    Comparative effectiveness research (CER), which is research that compares the clinical and/or cost-effectiveness of two health care treatments for the same condition, has been a contentious topic since the giant stimulus bill provided government agencies with $1.1 billion to conduct it. The Kennedy bill includes an increased role for CER. How this language is to be interpreted is crucial.

    There is nothing wrong, of course, with finding out what works and what doesn’t. The key issue is the consequence of the research findings for patient care, and whether those findings come with any regulatory or reimbursement strings attached to them. If CER can be used by the government to make payment, treatment, and coverage decisions, it could also be used as a rationing tool. Recently, the Senate Committee considered and rejected three amendments that were designed to prevent CER from becoming any such thing:

    Sen. Pat Roberts (R-KS) amendment.
    Sen. Tom Coburn (R-OK) amendment.
    Sen. Mike Enzi (R-NV) amendment.

    These three amendments would all have prevented the use of CER to ration or deny care or mandate coverage. All three were defeated on straight party-line votes. This is a serious development, and it has gotten little public attention in the general media.

    As The Washington Post pointed out on June 8th, one of the key issues emerging in the national health care debate is whether or not there will be official limits on the kinds of care, medical treatments, or procedures that Americans can get. As The Post reporter noted, when asked a specific question on this issue, the President failed to respond.

    The bad news is that a majority of Senators on the HELP Committee have responded in a way that most ordinary Americans would not expect. The truth is that with legislation authorizing the federal government to make key decisions on medical benefits and medical procedures, dictating the kinds of health benefits Americans will and will not have in the government-approved health insurance plans, federal officials would retain enormous power over the kind of care Americans would get.

    The President has stated, repeatedly, that if you enjoy your relationship with your doctor, his proposals would not interfere with that relationship. However, if CER becomes a pretext for rationing, government policy would, in effect, destroy the doctor-patient relationship. It would not only devalue a physician’s professional judgment in a particular case, it would also amount to a violation of the traditional Hippocratic Oath. The traditional Oath, after all, holds that the doctor is a servant of the patient.

    Americans should now realize that one of the most contentious issues of the national health care debate has already been joined. They should know that in this initial skirmish, Senate amendments to protect patients were lost with little fanfare. This isn’t the first and certainly won’t be the last time that such a battle will be joined. But it should be a wake- up call to taxpayers who think that the health care debate is merely a battle over the uninsured, over rules governing insurance markets, or over costs of these expensive House and Senate health care bills.

    This post was co-authored by Julius Chen.

    Posted in Obamacare [slideshow_deploy]

    21 Responses to Senate Committee Blocks Anti-Rationing Amendments

    1. Roxanne, Colorado says:

      I would like to see congress and the White House try all this out first before we commit any more money.

    2. Pingback: » Financial News Update - 07/10/09 NoisyRoom.net: “Extremism in the defense of liberty is no vice. Moderation in the face of tyranny is no virtue.” Barry Goldwater

    3. Ange Lobue, MD, MPH, says:

      CALL FOR CONGRESSIONAL WARRIOR ANGELS

      I am a 71 year-old American citizen, a psychiatric physician, a pharmacist, a small business owner, a tax payer and a voter. I was a medical director for a multinational pharmaceutical corporation, who sometimes accompanied lobbyists colleagues on visits to the offices of your predecessors and colleagues in State Legislatures and Congress some decades ago. In addition I served as an assistant in governmental health care administration, one step removed from the White House, and as a visiting scholar studying the health systems of other countries. I served on the faculties of a leading medical school and a leading university cinema/tv school.

      Moreover, as a practicing senior psychiatrist, I sometimes had occasion to counsel and treat members of your profession when they found the stress of the conflicting impulses created by the demands in their lives overwhelming.

      So, in addition to a broad and deep life history, I have some understanding of your position when it come to the kind of major war that is currently underway between the American people and the insurance and pharmaceutical industries.

      Although almost 70% of American are shocked and perplexed by the aggressive resistance to their voices recently exhibited, for example, by your Blue Dog Congressional colleagues, I know that you are unable to tell them the real story because it contradicts so dramatically the fantasy narrative upon which they have so desperately come to depend.

      And of course, you and your colleagues are seriously concerned about what effect knowing the real truth about Congress and its relationship with corporate power might have on national morale and consequently national security.

      So, I am hoping that, unlike with most letters, faxes and calls you are receiving, which demand, challenge and even berate you, you will find in this one a sense of empathy, perhaps even sympathy.

      What I want you to know, is that I understand why you CAN'T want a single payer, Medicare for All, national health care system for America, in spite of the overwhelming support such a plan has from its citizens.

      I understand that it is not your choice but the choice of your political, financial, marketing, public relations and emotional support sources, something you may have been receiving, in the past, from your family, friends and the American voter. But because of the way Congress has devolved, you have had to make the supreme sacrifice of shifting your source of sustenance from family, friends and individual constituent voters to the big corporate families who are now responsible for your sense of satisfaction with your life.

      I know that before you entered politics, unless you were born into it, you probably had little understanding of how beholden to big money you would eventually become during your career.

      I know that you thought you would be different, more courageous, more resistant to temptation and the power of the subtle and not-so-subtle threats and bribes of lobbyists.

      But over the years you learned that it is not the American people who put you in office, it is big corporate money which put you in and keeps you in office.

      You are a smart person. You know that before you can help your country you must first feed, clothe, educate and maintain the health and welfare of your own family. And in order to do that, you must do what is "necessary" to stay in office.

      Of course, you vowed you would do as much as you could for your constituents, after you had ensured the safety of your tenure. But you soon came to realize that your real constituents are big corporate money, constituents upon whom you can depend. Not the average, fickle American who offers you mainly complaints, demands, very little financial support and even less emotional and political support. There is a distinct difference between the relative ineffectiveness of the loud and voluminous few letter-writing, faxing or calling individual voters, and that of the quiet-spoken, casual and amiable, but enormously powerful lobbyist.

      Your doctor knows that Congress should be ashamed of the way it has permitted predatory profiteers to destroy American medicine. If s/he hasn't told you, there may be some protocol obstacles in the way of an honest relationship that keep the subject from coming up. Try talking to a rural doctor who sees average and uninsured people.

      You also know that putting "the PURSUIT of happiness," on a list of civil rights that does not contain the right to health implies that health is a privilege, rather than a right. I know you cannot be proud of that oversight in our Constitution.

      You also must know that some of your colleagues have become more afraid lately and while some are reacting with typical fight or flight reactions, some are reacting with the alternative freeze reaction.

      And here is something that many of you may not know: the decisions facing you now are of Biblical proportions.

      For as you do know, nothing will change until you become courageous enough to call your colleagues aside, begin to meet quietly, and create a group of Congressional states-people, whose mascot name should be closer to "Warrior Angels," than "Blue Dogs," with the mission of major changes to the lobbying laws: THE REMOVAL OF THE MONEY TABLES FROM THE HALLS OF CONGRESS.

      It appears to me that you don't have much time left on this issue, becauseof a number of rapidly developing factors: the level of awareness among middle-class Americans, their developing cohesiveness because of the internet, their determination resulting from an increased sense of empowerment of like-minded individuals and the increasing tension produced by the arrogance of the Blue Dogs. All of this appears to be ripening toward an explosive eruption of feelings from Americans who, although they may disagree about many other things, seem to agree that the time has come to make health an American Civil Right.

      You shouldn't be surprised when you see us on the streets, again.

      I know many of you are waiting patiently for the development of sufficient citizen momentum that will permit you to feel more comfortable when you begin to prepare to confront the insurance industry. I know that without the strength on the streets, you will have difficulty mustering appropriate courage in the halls of Congress.

      However, I wonder if you have yet begun to imagine the pleasure of being among the first line to be hailed by the citizenry as a Congressional Hero of the American Civil Health Rights Movement of the 21st Century?

      I'd certainly be willing to send you money and praise for that.

      And if the millions of Americans who currently are raising their voices, now are joined by the millions of angry others we intend to mobilize, your perception of your own personal political risk may be reduced to the comfortable levels you require to speak out and take action.

      So, as a good strategic planner, you might want to begin to consider a contingency plan as you keep you eye on the numbers and your ear to the ground.

      Read this one right, and you'll be a hero.

      Read it wrong, and choose to stay behind the money tables in the halls of Congress, and I can assure you we will not forget you when we start turning them over.

      Respectfully for now,

      Ange Lobue, MD, MPH, BSPharm

      American Board of Psychiatry & Neurology

      Academy of Television Arts & Sciences

      trinidadca@gmail.com

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    7. Michael Friedman, M. says:

      As a physician in practice for forty years, I would like to express my agreement with the reasoning and conclusions of Dr. Ange Lobue, posted above.

      I would also like to point out that the rationing of medical care is already taking place through the denial of coverage to people with "preexisting" conditions, the inability of so many people to pay for health insurance and the various limitations of coverage that are included in the policies of people who have health insurance.This rationing is based on the financial advantage of health insurance companies. A rationing based on comparative effectiveness research would be more patient-centered.

      Michael Friedman, M.D.

      Berkeley, California

    8. Chantal Lobue BSN, F says:

      I am disappointed that Congress is trying to distract the American people with the absurd non-issue of "rationing."

      As a family nurse practitioner and physician assistant with over 39 years of health care experience, currently working in a rural area where I see many patients with and without insurance, I am quite familiar with rationing of care. I and my medical colleagues see it every day as 1200 profit-driven health insurance companies fight with us to maintain their expectations of an ever-increasing bottom line.

      However, we also see many Medicare patients whose care is funded by a single payer, the United States government.

      Just ask me and my patients who, before qualifying for Medicare received payment for their care via the predatory health insurance industry, which "system" we think works better for them, The answer is an unqualified, "Medicare works better!"

      So while Congress, with its obligations to the industry which insures its members with luxury policies and keeps them in office with corporate contributions and campaign support, betrays the American people with distractions like threats of rationing, business continues as usual here in the hinterland.

      Are there no courageous Congresspeople who are willing to take the risk of representing the will of the American people for a change?

      Over 70% of Americans want a single payer health care system.

      Only the insurance industry and Congress want the status quo.

      What's wrong with this equation?

      Sincerely,

      A Very Disapointed Health Care Provider and Voter,

      Chantal Madeleine Lobue, BSN, FNP, PAC

      McKinleyville Family Practice

      Stanford School of Medicine Primary Care Associate Program

      chantalobue@gmail.com

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    17. Ken, AL says:

      Please, no more government control. Tne government has gotten control of the Banks, The Auto Industry and now they want control of the Health Care Industry. More government control erodes freedom. Do you really trust a bunch of partisan idealogues to take care of you?

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    20. DF, Orlando says:

      Ange Lobue and Chantal Madeleine Lobue are completely wrong. Rasmussen Reports August 10, 2009 that only 32% of Americans Support a Single-Payer System. 57% are completely against such system.

    21. Ange Lobue, MD, MPH, says:

      National Security and Compassion

      Anyone who knows anything about statistics, especially public opinion polls knows that there are many factors, visible and hidden, which affect the results, not the least of which is their intended use. Just compare Rasmussen Reports with those produced by pollsters affiliated with MoveOn.com.

      We would like to avoid the usual distracting focus on the popularity of the measures which is, either overtly or subtly, based upon a cost/benefit analysis in the mind of the observer, an analysis not unlike that which is applied to the costs of maintaining national security.

      The maintenance of each citizen's right to life, liberty and the pursuit of happiness is the reason for the maintenance of our national security. And the omission of the right to HEALTH in the Constitution, implies that health is a privilege, rather than a right, and has permitted an every-man-for-himself, profit-driven approach to health care that has been responsible for much unnecessary suffering and death in this country.

      We believe America can and should do better than that and should demonstrate its concern for the health of its citizens as the honorable and necessary thing to do, just as maintaining its national security is the honorable and necessary thing to do.

      We hope you will agree with us on this so that a meaningful conversation can begin about what really is important.

      Respectfully submitted,

      Ange Lobue, MD, MPH, BSPharm

      American Board of Psychiatry and Neurology

      Academy of Television Arts and Sciences

      Chantal Lobue, FNP, PAC, RN, BSN

      Academy of Family Nurse Practitioners

      Stanford University School of Medicine

      Primary Care Associate Program

      McKinleyville Family Practice

      trinidadca@gmail.com

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