Wednesday, December 14, 2011

We Have a New Executioner

On July 8, 2010, I wrote on the recess appointment of Dr. Donald Berwick to the head of Medicare/Medicaid Services, "Meet Your Executioner". I still think there's a lot of important information on the mindset of the administration and their plans for Obamacare in that piece.  For one thing, Dr. Berwick voiced opinions that seem to express that supply and demand doesn't function in health care, claiming that the UK's National Health Service was better than ours.
You see, Dr. Berwick is a big fan of the British National Health System.  That's novel because most of the British people are not fans of the NHS, and you have to go a long way (apparently, all the way to Harvard) to find someone who is in favor of it.  In a speech marking the 60th birthday of the NHS, he praised the it for deliberately creating scarcity: "You [the NHS] plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much and then you search for care bottlenecks and try to relieve them."  In a time when the largest wave of retirees in US history hits the Medicare system, the has cut the budget for the system by half a trillion dollars ($525 Billion).  The only conclusion is that life will be worse for us than for those who were in the system before us.  This is in complete agreement with the trend of this administration, which (as far as I can tell) is completely dedicated to making all of our lives more miserable. 
Dr. Berwick has left his position - I can't truthfully tell you how much damage he has done, but this gentleman claiming to be Neurosurgeon called into Mark Levin's radio program, saying that under the new care guidelines, if a 70 year old presents in the ER with a bleeding brain, surgeons will not be "allowed" to try to save that person's life.  In Berwick's place, the Obama administration has appointed Marilyn Tavenner, former head of the Hospital Corporation of America.  Mrs. Tavenner is extremely unusual for an Obama appointee: she has worked in industry for most of her life - her background was as an ICU RN, not an academic like Berwick - and she actually appears competent.  As you well know, such attributes are unheard of in this administration. 
It is worth mentioning that part of her job is to clean up Medicare fraud, and she worked for HCA when it was under investigation for the largest Medicare fraud in US history.  HCA ultimately paid a $1.5 billion fraud.  As that American Spectator piece (previous link) says,
There is no indication that Tavenner was directly involved in HCA's billing skullduggery. However, after the Berwick controversy, it's surprising that even the famously tone deaf Obama would nominate someone with such problematic ties to the industry she will regulate. These ties have also been ignored by most major media outlets, whose coverage of Tavenner has consisted primarily of puff pieces focusing on her early years as a nurse. This contrasts sharply with the coverage received by Republican Rick Scott, who was the CEO of HCA during the investigations. Scott was never implicated in the fraud scheme either. But it did happen on his watch, and every "news" story written about him while he was running for Governor of Florida insinuated that he was somehow involved in the fraud.
 The important question is whether or not she's an upgrade from Donald Berwick,
There is no sign, however, that she holds different views than her controversial predecessor. She spoke to the National Association of Medicaid Directors last month and echoed refrains often heard from Berwick. Her position on giving the states control of their own Medicaid programs, which are funded by state as well as federal funds, is virtually identical to that of the good doctor: "That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above." In reality it won't necessarily force them to do any of these things. It would, however, allow the states to develop creative ways of covering the poor, reduce administrative costs, and reduce the coercive power of Washington over the states. One suspects that the last is Tavenner's primary concern.
Tavenner wrote an op-ed for the Washington Examiner, full of the glib, hard to decode statements that bureaucrats make.  I keep hearing from Washington how wonderful things are while every doctor I know says the cuts to Medicare patients are so great they are refusing new patients. 

Is she an improvement over Donald Berwick?  It would be hard not to be, but I don't see as much written by her and about her.  It will take more research. 

In the meantime, Mrs. Tavenner, folks would appreciate if you don't piss on us and tell us it's raining. 


  1. Prohibiting doctors from healing patients is no different than Action T4.

    This is how Nazis are made.

  2. Our generation will be the example caught in the middle. Too young to be allowed to die of old age; too old to take advantage of those young enough to SEE what's going on and do something about it.

  3. That is something I am unclear about: will it actually prohibit doctors from providing care, or simply prohibit their being paid by any insurance program for providing that care? I'd like to get something for the thousands my insurance costs every year, but if I can pay for something out of pocket and still get it, perhaps it isn't as bad as I feared. As long as I can make payments, rather than having to come up with the full price up front. Then I'm truly screwed, for anything major.

    I pay over $430 a month for my plan and barely use it (preventative medicine - a few yearly tests, an exam, and some meds for a couple of chronic conditions, all of which require co-pays, along with a yearly $600 cost up front before the insurance kicks in for any of it). So I guess it actually costs me about $6000+ including my co-pays.

    As far as this woman is concerned, her having been a nurse is no recommendation. I've worked with many during my time as an RN, and earlier as an EMT in the ERs of two different hospitals. I have seen a number of them who had as much compassion as Josef Mengele, especially the ones who trained us in nursing school. Something tells me this lady isn't channeling Florence Nightingale.

  4. Tough one, Reg. As I understand it you are still allowed to buy insurance. The reality of socialized medicine seems to be that the will price everyone else out of the market and eventually no one will sell policies besides them. You're much closer to Canada than I am - isn't it the case that it's illegal for them to buy healthcare on their own? They're not even supposed to come here for care? (Although I understand they do...)

    As for being merciful - not what I was thinking. I was thinking she has worked in the industry and might understand the caregiver's side better than a Donald Berwick or the other sadists that wrote the Whole Lives plan, or the guy who wrote the original version of Obamacare while he was in prison for federal white collar crimes.

  5. My info is probably out of date, but at one time in Britain, the wealthy could buy better care than from the NHS. (Wasn't that what Harley Street was all about?)
    Since Canadians can - and do - come down here for medical care they cannot get - or at least not in a timely fashion, like before they die of their cancer or other disease - I'm guessing it isn't against the law.

    I seem to recall seeing something on a TV show while sitting in a motel somewhere wherein it was said Canadians _could_ go to private clinics if they had the money.

    As far as Tavenner is concerned, as a former RN, you might expect her to lean toward caregivers (anyone would probably be better than Berwick, who _is_ channeling Mengele), but I suspect she is so impressed by the attention and contact with the Obama administration that she will wag her tail like a puppy and do exactly what they want her to do. But that's just my cynicism showing. Chances of her being as bad or worse than Berwick are infinitesimal.