Testimony for PA Senate Democratic Appropriations Committee Public Hearing on Medicaid Expansion, March 8, 2013

Good morning. Thank you for conducting this session and for inviting me to speak. I am Dr. Chris Hughes, state director for Doctors for America, a nation-wide group of physicians advocating for high quality, affordable health care for all. I have been an intensive care physician for my entire career, now approaching 25 years, and within the past year I have also begun practicing hospice and palliative medicine. I am a former Trustee of the Pennsylvania Medical Society and Chair of the Patient Safety Committee. I have completed graduate studies in health policy at Thomas Jefferson University, and I am now teaching there, in the Graduate School of Population Health.

I tell you this to let you know that I can get down in the weeds with you about the nuts and bolts of implementation of the Affordable Care Act, and I know a fair amount about health care financing, access, cost shifting, and all the rest. But you have fine panelists assembled here today who have been doing this for you, and I know you all know your way around these topics as well. That’s why you’re here.

I am here as a physician and a representative of my profession. Every doctor you know, and every nurse and pharmacist and social worker and everyone in the front lines of health care, for that matter, can tell you stories of how our health care system has failed someone. Our system fails people regularly, and often spectacularly, and often cruelly, day in, day out.

I've had patients who work full time in jobs that fall far short of the American dream. They get by, but they can't afford health insurance.

I'll give you a few of my patients’ stories here, not just to point out the obvious- that we are mistreating our fellow human beings – but that we are misspending countless dollars on the wrong end of the system.

There's the cabbie who recognizes his diabetes and determines to work harder and longer so he can buy insurance before he is stricken with the label even worse than diabetes: preexisting condition! He doesn't make it and ends up in the ICU with diabetic ketoacidosis.

There's the construction worker who has a controllable seizure disorder that goes uncontrolled because he can’t afford to go to the doctor. He ends up in the ICU, on a ventilator – life support - multiple times.

There's the woman who stays home to care for her dying mother and loses her insurance along with her job. When her mother is gone and she finally gets to a doctor for herself, her own cancer is far advanced. She goes on hospice herself.

The laid-off engineer whose cough turns bloody for months and months before he “accesses” the health care system – through the Emergency room and my ICU with already far advanced cancer.

Shona’s attendant, of course. [Shona Eakin, Executive Director of Voices for Independence, in her earlier testimony.]

These are people who are doing the right thing – working, caring for family members – and still have to go begging for health care. How many hours does an American have to work to “deserve” health care? 40? 50? 60? We, as a society, are telling these people that their work, their lives, are not valuable enough to deserve access to health care until they meet some standard of employment in a job that has health insurance.

While doing some research on Medicare cost savings, I ran across a paper from US Sen. Tom Coburn with this quote: "Medicaid is a particular burden on states, consuming on average 22 percent of state budgets." I don’t quibble with the number, I quibble with the mindset that leads one to think that the suffering of millions is a non-factor in the decision making. And the fate of patients is not mentioned in his paper.

Not long ago, expanding access to health care was a nonpartisan goal. As recently as 2007, a bipartisan group of U.S. senators, including Republicans Jim DeMint and Trent Lott, ( let me repeat that, “Jim DeMint and Trent Lott” ) wrote a letter to then-President George W. Bush pointing out that our health care system was in urgent need of repair. "Further delay is unacceptable as costs continue to skyrocket, our population ages and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for 'free.' "

Their No. 1 priority? It was to "Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage."

Medicaid expansion and the Affordable Care Act will get us closer to this than at any time in our history.

You will hear some physicians speak out against all of this. But what you generally will not hear is their leadership and organizations speaking out against it, except perhaps in the deep south. There is a reason for this. As leaders of our profession, we have to come to terms with the idea that we are not just in it for ourselves. We are in it for our profession as well, and that means we have to put our patients’ interests above our own, and that means we have to do our best to ensure that everyone has access to high quality, affordable health care. Don’t just take my word for it. The American Board of Internal Medicine Foundation and other organizations put together a Charter on Medical Professionalism about ten years ago, specifically making this, fair distribution of health care resources, a part of our professional responsibility. If you go to their website, you will find that virtually every physician organization you can think of has endorsed it. That means the anesthesiologists and orthopedic surgeons as well as the pediatricians and the family practitioners.

For Medicaid expansion specifically, we should note here that the major national physician organizations, including the AMA, and the organizations representing internists, family practice, pediatricians, psychiatry and more, all endorse Medicaid expansion. On the state level, all of these organizations state chapters endorse it as well, with the exception of the Pennsylvania Medical Society, which I am chagrined to say, has endorsed general terms of expansion only.

But this concept is really not controversial among physicians and health care providers. We see everything from the catastrophes to the small indignities. They are tragic, unnecessary, and we are on the road to ending them.

Some in the provider community have expressed concerns about Medicaid in particular as the way we are providing access, so I would like to take a moment to address the concerns we hear most often.

First, that Medicaid is “bad” insurance. What is bad about Medicaid is largely fixed in the ACA. Namely, it is very poorly reimbursed for providers. You’ve already heard from others why hospitals want it, why advocates want it, but for providers in primary care, the frontlines of health care, they get a major boost in reimbursement under the new law. Pennsylvania has historically had awful reimbursement in the Medicaid program, among the worst in the nation. Now, reimbursement will go to par with Medicare reimbursement, a huge incentive for providers to take on Medicaid patients whom they may have been reluctant to see previously. There are other new innovations such as Patient Centered Medical Homes, the new Medicaid Health Homes (which, by the way, we have also not begun implementing in PA – maybe another panel?), and other innovations, coming down the pike, that should really give people who previously had no chance at excellent care, a chance to avoid complications, avoid the ER and avoid the hospital. To live in good health.

I’ve also heard the strange claim that having Medicaid is worse than having no insurance. I suppose that in a vacuum where there is no good data, and where one sees, like I do, patients with no insurance or Medicaid, who don’t know how or aren’t able to access a doctor, you could look at patients who get very sick and mistake that association and attribute that to Medicaid, but we do have data now. In Oregon, due to a fairly bizarre set of circumstances a few years ago, Medicaid eligibility was determined by lottery, creating a natural experiment of haves and have-nots. In the first year, those who were enrolled were 70 percent more likely to have a usual source of care, were 55 percent more likely to see the same doctor over time, received 30 percent more hospital care and received 35 percent more outpatient care, and much more. Incidentally, I heard a cable talking head complain about the Oregon data because it didn’t examine outcomes, such as deaths and such. A fair point if we had more than a year’s worth of data! I, and most other health professionals, would argue that the results they have seen already are impressive and worthwhile in and of themselves.

People often ask me why I am so passionate about this, and I always tell them, “I blame the nuns.” Growing up Catholic, there was nothing so drilled into me as Matthew 25. We used to sing a hymn based on it, “Whatsoever you do to the least of my brothers,” on a regular basis at Mass. And we went to Mass before school every day!

It turns out this is a pretty universal sentiment. I checked. Go to the websites of every mainstream religious denomination – Anglican, Methodist, Mormon, you name it - and it will be in there somewhere: The Social Gospel and Social Justice. Dignity of the individual. Our duties to the less fortunate. It is part of our national Judeo-Christian heritage, and a component of every major religion and philosophy in the world, with one notable exception – Ayn Rand’s. And I mention Ayn Rand and her most famous book, Atlas Shrugged, because it is perennially listed as the second most influential book in America, after the Bible. A damning fact for us.

In spite of that, I am glad that social justice and a commitment to the fair distribution of our health care resources is integral to the sense of duty of my profession, the nursing profession and all health professions.

I often say that I encourage debate about how we get to universal health care, but I refuse to accept that America, alone among all modern nations, and Pennsylvania in particular, will reject the idea that we need to get there.

A final thought from health care economist Uwe Reinhardt, regarding all of the reasons given about why we cannot achieve universal health care; he says, “Go tell God why you cannot do this. He will laugh at you,”

Right now, Medicaid expansion, the Health Insurance Exchanges and many other components of the Affordable Care Act are our best hope. Let’s not squander it.

Thank You.

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Remarks on Medicaid Expansion

I had the privilege of testifying in favor of Medicaid expansion for Pennsylvania at a hearing of the PA House Democratic Policy Committee, chaired by Rep. Dan Frankel of Allegheny County. (Follow the link for the agenda and other speakers.)

Good morning. I am Dr. Chris Hughes, state director for Doctors for America, a nation-wide group of physicians advocating for high quality, affordable health care. I have been an intensive care physician for my entire career, now approaching 25 years, and within the past year I have also begun practicing hospice and palliative medicine. I am a former Trustee of the Pennsylvania Medical Society and Chair of the Patient Safety Committee. I have completed graduate studies in health policy at Thomas Jefferson University, and I am now teaching there as well in the Graduate School of Population Health.

I tell you this to let you know that I can get down in the weeds with you about the nuts and bolts of implementation of the Affordable Care Act, and I know a fair amount about health care financing, access, cost shifting, and all the rest. But you have a fine panel assembled here today who can do that for you, and I know you all know your way around these topics as well.

I am here as a physician and a representative of my profession. Every doctor you know, and every nurse and pharmacist and social worker and everyone in the front lines of health care, for that matter, can tell you stories of how our health care system has failed someone. Our system fails people regularly, and often spectacularly, and often cruelly, day in, day out.

I've had patients who work full time in jobs that fall far short of the American dream. They get by, but they can't afford health insurance.

I'll give you a few of my patients’ stories here, not just to point out the obvious- that we are mistreating our fellow human beings – but that we are misspending countless dollars on the wrong end of the system.

There's the cabbie who recognizes his diabetes and determines to work harder and longer so he can buy insurance before he is stricken with the label even worse than diabetes: preexisting condition! He doesn't make it and ends up in the ICU with diabetic ketoacidosis.

There's the construction worker who has a controllable seizure disorder that goes uncontrolled because he can’t afford to go to the doctor. He ends up in the ICU multiple times.

There's the woman who stays home to care for her dying mother and loses her insurance along with her job. When she finally gets to a doctor for herself, her own cancer is far advanced.

The laid-off engineer whose cough turns bloody for months and months before he “accesses” the health care system – through the ED and my ICU with already far advanced cancer.

These are people who are doing the right thing – working, caring for family members – and still have to go begging for health care. How many hours does an American have to work to “deserve” health care? 40? 50? 60? I’ve seen all of these.

Not long ago, expanding access to health care was a nonpartisan goal. As recently as 2007, a bipartisan group of U.S. senators, including Republicans Jim DeMint and Trent Lott, ( let me repeat that, “Jim DeMint and Trent Lott” ) wrote a letter to then-President George W. Bush pointing out that our health care system was in urgent need of repair. "Further delay is unacceptable as costs continue to skyrocket, our population ages and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for 'free.' "

Their No. 1 priority? It was to "Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage."

Medicaid expansion and the Affordable Care Act will get us closer to this than at any time in our history.

You will hear some physicians speak out against all of this. But what you generally will not hear is their leadership and organizations speaking out against it, except perhaps in the deep south. There is a reason for this. As leaders of our profession, we have to come to terms that we are not just in it for ourselves. We are in it for our profession as well, and that means we have to put our patients’ interests above our own, and that means we have to do our best to ensure that everyone has access to high quality, affordable health care. Don’t just take my word for it. The American Board of Internal Medicine Foundation and other organizations put together a Charter on Medical Professionalism about ten years ago, specifically making this part of our professional responsibility. If you go to their website, you will find that virtually every physician organization you can think of has endorsed it. That means the anesthesiologists and orthopedic surgeons as well as the pediatricians and the family practitioners.

For Medicaid expansion specifically, we should note here that the major national physician organizations, including the AMA, and the organizations representing internists, family practice, pediatricians, psychiatry and more, all endorse Medicaid expansion. On the state level, all of these organizations state chapters endorse it as well, with the exception of the Pennsylvania Medical Society, who have endorsed general terms of expansion only.

But this concept is really not controversial among physicians and health care providers. We see everything from the catastrophes to the small indignities. They are tragic, unnecessary, and we are on the road to ending them.

Some in the provider community have expressed concerns about Medicaid in particular as the way we are providing access, so I would like to take a moment to address the concerns we hear most often.

First, that Medicaid is “bad” insurance. What is bad about Medicaid is largely fixed in the ACA. Namely, it is very poorly reimbursed for providers. You’ve already heard [I assume] from HCWP why hospitals want it, but for providers in primary care, the frontlines of health care, they get a massive boost in reimbursement under the new law. Pennsylvania has historically had awful reimbursement in the Medicaid program, among the worst in the nation. Now, reimbursement will go to par with Medicare reimbursement, a huge incentive for providers to take on Medicaid patients whom they may have been reluctant to see previously. There are other new innovations such as Patient Centered Medical Homes and others, coming down the pike, that should really give people who previously had no chance at excellent care, a chance to avoid complications, avoid the ER and avoid the hospital.

I’ve also heard the strange claim that having Medicaid is worse than having no insurance. I suppose that in a vacuum where there is no good data, and where one sees, like I do, patients with no insurance or Medicaid, who don’t know how or aren’t able to access a doctor – you’d be amazed at how often this happens – you could look at patients who get very sick and attribute that to Medicaid, but we do have data now. In Oregon, due to a fairly bizarre set of circumstances a few years ago, Medicaid eligibility was determined by lottery, creating a natural experiment of haves and have-nots. In the first year, those who were enrolled were 70 percent more likely to have a usual source of care, were 55 percent more likely to see the same doctor over time, received 30 percent more hospital care and received 35 percent more outpatient care, and much more.

People often ask me why I am so passionate about this, and I always tell them, “I blame the nuns.” Growing up Catholic, there was nothing so drilled into me as Matthew 25. We used to sing a hymn based on it, “Whatsoever you do to the least of my brothers,” on a regular basis at Mass. And we went to Mass before school every day!

It turns out this is a pretty universal sentiment. I checked. Go to the websites of every mainstream Christian denomination in America and it will be in there somewhere: The Social Gospel and Social Justice. Dignity of the individual. Our duties to the less fortunate. It is a component of every major religion and philosophy in the world, with one notable exception – Ayn Rand’s. And I mention Ayn Rand and her most famous book, Atlas Shrugged, because it is perennially listed as the second most influential book in America after the Bible. A damning fact for us.

In spite of that, I am glad that social justice and a commitment to the fair distribution of our health care resources is integral to the sense of duty of my profession, the nursing profession and all health professions.

I encourage debate about how we get to universal health care, but I refuse to accept that America, alone among all modern nations, and Pennsylvania in particular, will reject the idea that we need to get there. And right now, Medicaid expansion, the Health Insurance Exchanges and many other components of the Affordable Care Act are our best hope. Let’s not squander it.

Thank You.

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I am a job creator: A manifesto for the entitled - The Washington Post

I am a job creator: A manifesto for the entitled - The Washington Post

I am the misunderstood superhero of American capitalism, single-handedly creating wealth and prosperity despite all the obstacles put in my way by employees, government and the media.
I am a job creator and I am entitled.
I am entitled to complain about the economy even when my stock price, my portfolio and my profits are at record levels.
I am entitled to a healthy and well-educated workforce, a modern and efficient transportation system and protection for my person and property, just as I am entitled to demonize the government workers who provide them.
I am entitled to complain bitterly about taxes that are always too high, even when they are at record lows.
I am entitled to a judicial system that efficiently enforces contracts and legal obligations on customers, suppliers and employees but does not afford them the same right in return.
I am entitled to complain about the poor quality of service provided by government agencies even as I leave my own customers on hold for 35 minutes while repeatedly telling them how important their call is.
I am entitled to a compensation package that is above average for my company’s size and industry, reflecting the company’s aspirations if not its performance.
I am entitled to have the company pay for breakfasts and lunches, a luxury car and private jet travel, my country club dues and home security systems, box seats to all major sporting events, a pension equal to my current salary and a full package of insurance — life, health, dental, disability and long-term care — through retirement.

 There's lots more and it is all dead on!

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Romney’s theory of the “taker class,” and why it matters

Romney’s theory of the “taker class,” and why it matters

For what it’s worth, this division of “makers” and “takers” isn’t true. Among the Americans who paid no federal income taxes in 2011, 61 percent paid payroll taxes — which means they have jobs and, when you account for both sides of the payroll tax, they paid 15.3 percent of their income in taxes, which is higher than the 13.9 percent that Romney paid. Another 22 percent were elderly.

So 83 percent of those not paying federal income taxes are either working and paying payroll taxes or they’re elderly and Romney is promising to protect their benefits because they’ve earned them. The remainder, by and large, aren’t paying federal income or payroll taxes because they’re unemployed. But that’s a small fraction of the country.

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Money or Your Life - NYTimes.com

Money or Your Life - NYTimes.com

Critics of the Affordable Care Act argue that many Americans neither want nor need health insurance, and that it forces them to pay for coverage against their will. But just as the government collects taxes to pay police officers and firefighters, the individual mandate compels Americans to pay for a service they may not immediately want but could at any time desperately require.

Much of the debate has focused on the role of government in everyday life. I don’t discount the value of that question, but my focus is on real needs. I treat patients with $20,000 chemotherapy injections or monthly doses of IV immunotherapy that cost $10,000 a bag. If they don’t receive these drugs my patients will die, so to me, the most pressing issue here is compassion. Without change, the patients will resemble the man with leukemia, human beings without insurance terrified that their lives aren’t worth what it will cost to save them, all because of a broken but fixable system.

Crowds at conservative rallies have, astoundingly, cheered the idea that uninsured people should, if they become ill or badly hurt, be left for dead. It’s easy to imagine such a thing in the heat of a rhetorical moment. But the reality is, I hope, harder to embrace. Because reality means a real person — you, me, someone we know — condemned to a possibly preventable death because, for whatever reason, they don’t have insurance.

My patient with leukemia is dead. He got the best care money could buy, but his disease only briefly went into remission and he went home on hospice care. Should he, because he did not buy insurance, have been denied this chance for a cure?

The Affordable Care Act is not the health care solution everyone wants, but when patients wish for death panels as a response to leukemia, something needs to be done, and soon. This plan would help any patient facing a tough diagnosis not view treatment as a choice between his money or his life.

Theresa Brown is an oncology nurse and the author of “Critical Care: A New Nurse Faces Death, Life, and Everything in Between.”

I have had similar discussions with those who are not in healthcare as their profession.  They cannot seem to see the distinction between cutting people off who did not buy insurance, for whatever reason, and actually carrying out this virtual death sentence. We, as medical professionals, just cannot do this. Therefore, we need to figure out how to have universal access to care and universal insurance coverage. ObamaCare is a very good start.

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Subsidiarity (Catholicism) - Wikipedia, the free encyclopedia

Subsidiarity (Catholicism) - Wikipedia, the free encyclopedia:

Paul Ryan has referred to his philosophical bent as having more to do with subsidiarity than Ayn Rand.  I consider myself well read, especially about theology, Catholic or other, but I was not familiar with this term, so here is the Wikipedia section on the Catholic take on it:

The principle of subsidiarity was developed by German theologian Oswald von Nell-Breuning.[2] His work influenced the social teaching of Pope Pius XI in Quadragesimo Anno and holds that government should undertake only those initiatives which exceed the capacity of individuals or private groups acting independently. Functions of government, business, and other secular activities should be as local as possible. If a complex function is carried out at a local level just as effectively as on the national level, the local level should be the one to carry out the specified function. The principle is based upon the autonomy and dignity of the human individual, and holds that all other forms of society, from the family to the state and the international order, should be in the service of the human person. Subsidiarity assumes that these human persons are by their nature social beings, and emphasizes the importance of small and intermediate-sized communities or institutions, like the family, the church, labor unions and other voluntary associations, as mediating structures which empower individual action and link the individual to society as a whole. "Positive subsidiarity", which is the ethical imperative for communal, institutional or governmental action to create the social conditions necessary to the full development of the individual, such as the right to work, decent housing, health care, etc., is another important aspect of the subsidiarity principle.

The principle of subsidiarity was first formally developed in the encyclical Rerum Novarum of 1891 by Pope Leo XIII, as an attempt to articulate a middle course between laissez-faire capitalism on the one hand and the various forms of communism, which subordinate the individual to the state, on the other. The principle was further developed in Pope Pius XI's encyclical Quadragesimo Anno of 1931, and Economic Justice for All by the United States Conference of Catholic Bishops.
“ It is a fundamental principle of social philosophy, fixed and unchangeable, that one should not withdraw from individuals and commit to the community what they can accomplish by their own enterprise and industry. (Pope Pius XI, Quadragesimo Anno, 79) ”

Since its founding by Hilaire Belloc and Gilbert Keith Chesterton, Distributism, a third way economic philosophy based on Catholic Social teaching, upholds the importance of subsidiarity.

The Church's belief in subsidiarity is found in the programs of the Catholic Campaign for Human Development, where grassroots community organizing projects are supported to promote economic justice and end the cycle of poverty. These projects directly involve the people they serve in their leadership and decision-making

So, as Inigo Montoya would say, "You keep using that word. I do not think it means what you think it means." I think we have centuries worth of ample evidence that charity cannot provide health care to nations, that economic justice and ending poverty are not possible through devolved local or institutional efforts. Some things require government, and Paul Ryan and so many others like to pretend that if we just "get out of the way," all of this will take care of itself. Never has, never will.
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Budget battle pits atheist Ayn Rand vs. Jesus, say liberals - USATODAY.com

Budget battle pits atheist Ayn Rand vs. Jesus, say liberals - USATODAY.com:

"I am no fan of big government, but there are far better ways to critique it than Rand's godless nonsense, especially for Christians"

Colson says in the video.

More than 6,000 people have signed a petition asking Ryan to put down Rand and pick up a Bible, according to Kristin Ford of Faithful America, a left-leaning online group.

"Ayn Rand's philosophy of radical selfishness and disdain for the poor and struggling is antithetical to our faith values of justice, compassion and the common good," the petition reads.

The American Values Network video, which Sapp said will be emailed to 1.2 million Christians in Wisconsin, opens with anti-religious remarks from Rand and segues into Republican leaders, including Ryan and Sen. Rand Paul, R-Ky., offering high praise of the Russian novelist.

"Rand, more than anyone else, did a fantastic job of explaining the morality of capitalism, the morality of individualism," Ryan says in a

2009 Facebook video excerpted in the ad. "It's that kind of thinking, that kind of writing that is sorely needed right now."

Ryan's spokesman, Kevin Seifert, said the congressman "does not find his Catholic faith to be incompatible with his feelings for Ayn Rand's literary works. ... Rand is one of many figures and authors that Congressman Ryan has cited as influencing his thinking during his formative years."

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An immoral budget that shuns social justice - JSOnline

An immoral budget that shuns social justice - JSOnline:

In response to Ryan's Republican budget last year, the U.S. Conference of Catholic Bishops warned House leaders that "a just framework for future budgets cannot rely on disproportionate cuts in essential services to poor persons." Just recently, the bishops' conference called on Congress to protect the safety net from harmful budget cuts. Ryan has ignored their wise counsel.

Ryan takes his Catholic faith seriously and has defended his policy approach in strong moral terms. But it seems he needs a refresher course in basic Catholic teaching. The Catholic justice tradition - as defined by bishops and popes over the centuries - holds a positive role for government, advocates a "preferential option for the poor" and recognizes that those with greater means should contribute a fair share in taxes to serve the common good.

Ryan and other conservatives hold tax cuts for hedge fund managers on Wall Street sacred even as they dismiss concern about rising income inequality as "class warfare." In contrast, Pope Benedict XVI denounces the "scandal of glaring inequalities." This is an accurate description when the 400 wealthiest Americans now have a greater combined net worth than the bottom 150 million Americans.

It seems that Ryan's budget is more indebted to his hero Ayn Rand than to the message of Jesus. Rand, a libertarian icon who mocked all religion and rejected the Gospel's ethic of compassion, has been praised by Ryan for explaining "the morality of individualism." Catholic values reject such radical individualism and the social callousness that it breeds.

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Budget battle pits atheist Ayn Rand vs. Jesus, say liberals - USATODAY.com

Budget battle pits atheist Ayn Rand vs. Jesus, say liberals - USATODAY.com:

More than 6,000 people have signed a petition asking {Budget Chair Paul] Ryan to put down Rand and pick up a Bible, according to Kristin Ford of Faithful America, a left-leaning online group.

"Ayn Rand's philosophy of radical selfishness and disdain for the poor and struggling is antithetical to our faith values of justice, compassion and the common good," the petition reads.

...

"Rand, more than anyone else, did a fantastic job of explaining the morality of capitalism, the morality of individualism," Ryan says in a 2009 Facebook video excerpted in the ad. "It's that kind of thinking, that kind of writing that is sorely needed right now."

Ryan's spokesman, Kevin Seifert, said the congressman "does not find his Catholic faith to be incompatible with his feelings for Ayn Rand's literary works. ... Rand is one of many figures and authors that Congressman Ryan has cited as influencing his thinking during his formative years."

 If one can not find the incompatibility between Catholicism (or any major religious tradition, for that matter or even secular humanism) then one is clearly actively refusing to look!

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How Ayn Rand Seduced Generations of Young Men and Helped Make the U.S. Into a Selfish, Greedy Nation | | AlterNet

How Ayn Rand Seduced Generations of Young Men and Helped Make the U.S. Into a Selfish, Greedy Nation | | AlterNet:

Only rarely in U.S. history do writers transform us to become a more caring or less caring nation. In the 1850s, Harriet Beecher Stowe (1811-1896) was a strong force in making the United States a more humane nation, one that would abolish slavery of African Americans. A century later, Ayn Rand (1905-1982) helped make the United States into one of the most uncaring nations in the industrialized world, a neo-Dickensian society where healthcare is only for those who can afford it, and where young people are coerced into huge student-loan debt that cannot be discharged in bankruptcy.

..............................

Ayn Rand’s personal life was consistent with her philosophy of not giving a shit about anybody but herself. Rand was an ardent two-pack-a-day smoker, and when questioned about the dangers of smoking, she loved to light up with a defiant flourish and then scold her young questioners on the “unscientific and irrational nature of the statistical evidence.” After an x-ray showed that she had lung cancer, Rand quit smoking and had surgery for her cancer. Collective members explained to her that many people still smoked because they respected her and her assessment of the evidence; and that since she no longer smoked, she ought to tell them. They told her that she needn’t mention her lung cancer, that she could simply say she had reconsidered the evidence. Rand refused.

So, I guess that explains why the anti-science crowd is so confident in its ignorance - Ayn Rand has their back!

Rand said, “Capitalism and altruism are incompatible....The choice is clear-cut: either a new morality of rational self-interest, with its consequences of freedom, justice, progress and man’s happiness on earth—or the primordial morality of altruism, with its consequences of slavery, brute force, stagnant terror and sacrificial furnaces.” For many young people, hearing that it is “moral” to care only about oneself can be intoxicating, and some get addicted to this idea for life.

Explains most of the Conservative "thought" on economics, doesn't it? Rand Paul, Paul Ryan, I'm looking at you.

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Daily Kos: An indecent proposal

Daily Kos: An indecent proposal:

That cut-up Grover Norquist suggest wealthy Americans like Warren Buffet contribute to the Federal government on an optional basis, and Hunter at DailyKos offers to accept the offer...

My proposal is that we make taxes for wealthy Americans and corporations entirely optional. That's it. If a corporation wants to pay zero percent in taxes, they should be allowed to, and if they want to pay the full tax rate, that is also allowed. The same for wealthy Americans.

The only caveat is that non-contributing corporations and individuals will be barred from taking advantage of any government services. It is the perfect free-market-based opt-out: If you do not want to support the American infrastructure and population to the same extent that your fellow citizens do, you can simply decline to, and live your life as the libertarian god you have always longed to be. You will be free! You will be allowed to go Galt, or not go Galt, to whatever degree you wish; as a special bonus, we shall prevent you from becoming that most dreaded of figures, the parasite, since if you are not contributing to the benefit of society it only stands to reason you should not gain profit from it either.

For starters, companies that do not pay the going tax rate will be barred from shipping their products on American roads. They will be prevented from connecting to the American electric grid, or from using municipal water or sewer systems. Instead, they will have to provide these services on-site. The good news: They can feel free to pollute as much as they like, as long as no pollution crosses the boundaries of their property (above, below or horizontally) into the rest of America. That would be considered an act of war.

Wealthy Americans that opted out of paying the going tax rate would also, of course, be prohibited from using American roads. This would not be a problem for them, as they generally can afford airplanes or helicopters, which would be similarly fine so long as they did not use American airspace (sorry, but the FAA costs money too, you know). But they could certainly fly around the property, which might be a pleasant experience.

Then we must consider the issue of security. Fire and police protection would be right out, so there would be no particular incentive for poorer Americans not to loot their properties (wealthy Americans tend to have nicer things than the rest of us). The American elite might consider the approach taken by wealthy Mexican families, which is to install a high perimeter fence around the property with a heavily armed private guard service. This would be expensive and unsightly, but it would be up to each individual to decide, for themselves, what the appropriate free-market level of protection for their own property might be. My one tip would be to spend a good deal of time on that decision.

It goes without saying that non-contributing Americans, corporate or otherwise, would not have access to the courts. This should be fine with them, since we know that meddlesome lawsuits are the biggest non-tax-related threat to America today. There is the minor issue of no recourse, if armed mercenaries do manage to overpower your guards and make off with your antique commodes or whatever it is you rich people hoard these days: Again, though, think of the tax savings.

This is a nice echo of Elizabeth Warren's comments on the arrogance of the John Galt wannabees.

UPDATE: I posted this to the comments section:

Don't forget the socialism of WWII 

Let me add another item to your great piece, Hunter, and to Elizabeth Warren's recent speech: Did the fathers of any of these captains of industry go to college on the GI Bill?
See here:

Within the following 7 years, approximately 8 million veterans received educational benefits. Of that number, approximately 2,300,000 attended colleges and universities, 3,500,000 received school training, and 3,400,000 received on-the-job training. By 1951, this act had cost the government a total cost of approximately $14 billion.
The effects of increased enrollment to higher education were significant. Higher educational opportunities opened enrollment to a varied socioeconomic group than in the years past. Engineers and technicians needed for the technological economy were prepared from the ranks of returning veterans. Also, education served as a social safety valve that eased the traumas and tensions of adjustment from wartime to peace. For the American colleges and universities, the effects were transforming. In almost all institutions, classes were overcrowded. Institutions required more classrooms, laboratories, greater numbers of faculties, and more resources. House facilities became inadequate and new building programs were established. New vocational courses were also added. This new student population called for differential courses in advanced training in education, commerce, agriculture, mining, fisheries, and other vocational fields that were previously taught informally. Teaching staffs enlarged and summer and extension courses thrived. Further, the student population was no longer limited to those between 18-23. The veterans were eager to learn and had a greater sense of maturity, in comparison to the usual student stereotype. Finally, the idea that higher education was the privilege of a well-born elite was finally shattered.

And of course, it was continued after WW II: Continuation of the Bill

The original G.I. Bill of 1944 expired in 1956, but the concept of veteran compensation continued, with all subsequent legislation still referred to as G.I. bills. In 1952 Congress passed the Veterans’ Adjustment Act to compensate veterans of the Korean War (1950-1953). There were some minor differences between the World War II and Korean G.I. Bills, but the outcome was broadly similar. More than two million Korean War veterans used the G.I. Bill to go to college, and 1.5 million financed new homes. The G.I. Bill underwent a significant change in 1966, when Congress passed the Veterans Readjustment Benefits Act (VRBA) as part of President Lyndon B. Johnson’s Great Society slate of social programs. The VRBA removed the requirement of serving in combat to receive government benefits, and instead made G.I. Bill benefits available to anyone who served in the military, whether in wartime or peacetime. Since 1966 the G.I. Bill has undergone a series of modifications and adjustments, but the fundamental benefits subsidizing education and home ownership remain the same. The Montgomery G.I. Bill (MGIB), enacted by Congress in 1985, provides educational stipends to former members of the military who contribute a small portion of their pay during their time in the service. The Post 9/11 Veterans Assistance Act of 2008 (effective date August, 2009) substantially increased the amount of tuition and housing assistance, allows veterans to transfer benefits to their spouses and children, and provides tuition benefits for National Guard and Reserve members.

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The rich are different — and not in a good way, studies suggest - Health - Behavior - msnbc.com

The rich are different — and not in a good way, studies suggest - Health - Behavior - msnbc.com:

"In other words, rich people are more likely to think about themselves. “They think that economic success and political outcomes, and personal outcomes, have to do with individual behavior, a good work ethic,” said Keltner, a professor of psychology at the University of California, Berkeley.

Because the rich gloss over the ways family connections, money and education helped, they come to denigrate the role of government and vigorously oppose taxes to fund it.

“I will quote from the Tea Party hero Ayn Rand: “‘It is the morality of altruism that men have to reject,’” he said.

- Sent using Google Toolbar"

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Some more on Ayn Rand

DownWithTyranny!: The Inspiration For Paul Ryan's Profoundly And Explicitly Anti-Christian Budget

An overview of Ayn Rand and the un-Christian worldview she and her followers, like the hard core conservatives in Congress, represent.

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Why We Fight

Forgive the World War II reference, but as I write this, I am reminded of the estimate of 45,000 deaths attributable to lack of access to health care, not even counting the countless maimings, wounding, and psychological hurt inflicted on the uninsured and under-insured in America, it seems appropriate. It is not an existential threat to our democracy, but this is, make no mistake, a battle for the soul of our country. As Michael Moore put it in “Sicko,” is America about “we”or “me?”

As physicians, we are obliged to be about “we.” In the Charter on Medical Professionalism, we are enjoined to seek social justice in the delivery of medical care, to be good stewards of our health care resources. Specifically, physicians “should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.”

We are also our patients fiercest advocates, and that includes those who can afford to see us and those who cannot. We all have our favorite collection of horror stories of the American healthcare system leaving individuals to fend for themselves with no hope of accessing the system until it is too late. Part of my anecdote collection is here, and I always trot it out when I am told a third hand anecdote about how bad health care is in “other countries.” For most Americans, health care is pretty good, but for the uninsured or under-insured, America is a third world country: access to care is completely dependent upon ability to pay.

Remember that, only in America of all advanced nations, have we answered “No!” (or perhaps “Hell, no!” from some) to the question of whether, as Uwe Reinhardt has put it, “As a matter of national policy, and to the extent that a nation's health system can make it possible, should the child of a poor American family have the same chance of avoiding preventable illness or of being cured from a given illness as does the child of a rich American family?” Medical ethicist Arthur Caplan argues that lack of access to health care is a fundamental road block to equality of opportunity in America, that placing the additional hurdle of untreated illness on a large segment of society is inherently unjust.

It has been pointed out that Americans are singular in the world in our Christian religiosity, but this religiosity is characterized by public policy consistent with ruthless Social Darwinism in many respects, while Europeans are pointedly irreligious, yet have structured their societies to function along a very progressive commitment to social safety nets, social justice and equality of opportunity, as well as a very Teddy-Rooseveltian distrust of great accumulated wealth.

I, as do many, take pride in my religion's unwavering commitment to Social Justice, Glenn Beck's disapproval notwithstanding. It is what keeps me a Catholic, and I am sure it is what keeps many in other traditional churches. It is, in fact, fundamental to every religion, Christian, Jewish, Muslim, Hindu, Buddhist and more, and most non-religious philosophical paradigms as well. I am well aware, however, that the most influential book outside of the Bible in America, “Atlas Shrugged,” and its author, vehemently reject all such sentiment as counter-productive nonsense. And this book is widely commended by conservatives who consider themselves deeply religious Christians.

So, this basic ethical commitment to fairness, tending to the sick, the poor, the treating of others as we would wish treated, is pervasive among every population in the world, except for those who follow the Ayn Rand school. I cannot fathom this, as I think the cognitive dissonance of holding both Christianity and Rand dear would be incapacitating, but there it is, and it is rampant in our political and clerical classes.

The argument is frequently made to me that their Christianity only allows for individual charity, not state sponsored programs. That is nice in theory, but as even Mike Huckabee acknowledged:

“If there are a certain number of kids from single-parent homes who aren’t going to school and don’t have health care, you can say that’s not government’s job,” Huckabee told me. “Well, sweet and fine! But you know what? If the kid’s sitting outside the door of the hospital choking with asthma, do I sit there and say, ‘Oh, I’m sorry, I don’t think, philosophically, government should get involved’? I’d much rather the kid get help than I sit around and say I’m so pure in my ideology.”

And, frankly, the milk of human kindness has not flowed freely enough anywhere in the world to provide health care to a population, and I don't expect it to do so now. I don't think giving it another century to work itself out is a reasonable strategy.

We fight because of the fundamental unfairness of the system to so many. One in six Americans is uninsured, another one in six under-insured; the deaths, injuries, bankruptcies, anguish and degradation of basic human dignity are why we fight. The America I grew up in was working on being better than this. The Great Society programs of LBJ took us a long way forward, and we have been painfully stuck in place until the passage of the Patient Protection and Affordable Health Care Act in 2010.

PPACA represents our rejection of treating so many of our brothers and sisters and our patients as lesser human beings, less deserving, less worthy of our help. Let's keep fighting for “We the People,” and fight those only concerned about “me.” Ayn Rand and Glen Beck notwithstanding.

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Wealthcare

Wealthcare

An analysis by Jonathan Chait of the philosophy of Ayn Rand and its influence on modern conservative thought. It is based upon 2 books about Rand Published in 2009.

Well worth reading, especially with the rise of Randian thought amongst the Tea Party crowd.

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What If Summers and Romer Are Wrong Again?

I hope this gets passed around the White House like an Atul Gawande article!

Watching PBS NOVA last night, I am still amazed that there are still defenders of the efficient market hypothesis in a pure form. I am 50 years old and remember stagfaltion, the crash of 87, the S&L debacle, the internet boom/bust and our current fiasco. Who is so out of touch that they do not recognize these events for what they were and are: disastrous macroeconomic and microeconomic events casued by oh so 'inefficient' humans?

I an still dumbfounded to hear that conservatives still think that the business leeches will act in the best interests of their companies. They will act in their own best interests, period. And if that means earning $100 million as they ride their company into the ground? Hey, they still have their $100 million.

Greenspan, still such an Ayn Rand dupe, that he still seems to think, exclusive of his mea culpa last year, that we can count on people to act in the ultimate interest of themselves and all will be well. Voltaire's "Best of all possible worlds," for the uber-capitalist set.

Read the Article at HuffingtonPost

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AlterNet: Ayn Rand, Hugely Popular Author and Inspiration to Right-Wing Leaders, Was a Big Admirer of Serial Killer

AlterNet: Ayn Rand, Hugely Popular Author and Inspiration to Right-Wing Leaders, Was a Big Admirer of Serial Killer

If you knew Ayn Rand was a bit whacked, you had no idea...

So what, and who, was Ayn Rand for and against? The best way to get to the bottom of it is to take a look at how she developed the superhero of her novel, Atlas Shrugged, John Galt. Back in the late 1920s, as Ayn Rand was working out her philosophy, she became enthralled by a real-life American serial killer, William Edward Hickman, whose gruesome, sadistic dismemberment of 12-year-old girl named Marion Parker in 1927 shocked the nation. Rand filled her early notebooks with worshipful praise of Hickman.

According to biographer Jennifer Burns, author of Goddess of the Market, Rand was so smitten by Hickman that she modeled her first literary creation -- Danny Renahan, the protagonist of her unfinished first novel, The Little Street -- on him.What did Rand admire so much about Hickman?

His sociopathic qualities: "Other people do not exist for him, and he does not see why they should," she wrote, gushing that Hickman had "no regard whatsoever for all that society holds sacred, and with a consciousness all his own. He has the true, innate psychology of a Superman. He can never realize and feel 'other people.'"This echoes almost word for word Rand's later description of her character Howard Roark, the hero of her novel The Fountainhead: "He was born without the ability to consider others."

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Tea Partiers as Christians - Big Fail

Non-negotiable Core Beliefs from TeaParty.org's Dale Robertson
(Founder/President) and my comments in italics.

Illegal Aliens are illegal.
Pro-Domestic Employment is indispensable.
Stronger Military is essential.
Gun ownership is sacred.
Government must be downsized.
National Budget must be balanced.
Deficit Spending will end.
Bail-out and Stimulus Plans are illegal.
Reduce Personal Income Taxes a must.
Reduce Business Income Taxes is mandatory.
Intrusive Government Stopped.
English only is required.
Traditional Family Values are encouraged.
Common Sense Constitutional Conservative
Self-Governance is our mode of operation.

....and Yes, we are a Christian Nation!

So, let's start with the hilarious first, "Yes, we are a Christian Nation!" Well, not hilarious, just sad. Look through all of those and tell me which items would get Jesus all fired up? Nothing about universal access to health care ("when I was sick"), nothing about the unprecedented dependence on Food Stamps, not only to buy food ("when I was hungry"), but for subsistence needs ("when I was naked"), nor anything about our embarrassingly high incarceration rates for Americans ("when I was a prisoner").

But these "Christians" did include those damn illegal aliens!! The Bible is terribly draconian on aliens:
Exodus 22: Do no wrong to a man from a strange country, and do not be hard on him; for you yourselves were living in a strange country, in the land of Egypt
And Leviticus is even worse: The alien living with you must be treated as one of your native-born. Love him as yourself, for you were aliens in Egypt. I am the LORD your God.
Anyway, may as well go through the rest of his list, briefly.
Pro-domestic employment. OK, we can agree on this one. However, I expect their view is very anti-union, which the Pope, at least (he's Christian, right?) opposes.

Thus, the encyclical rises strongly to the defense of labor unions, which are still vehemently opposed by large numbers of politically conservative Catholics. The pope notes that unions "have always been encouraged and supported by the Church.

Stronger Military. How about smarter military? How abut defunding "Star Wars," and preparing for the wars we are fighting and will fight in the future: "wars" against terrorist organizations. Oh, wait, that's law enforcement and intelligence. Then how about focusing the Pentagon on human resources instead of lining the pockets of Haliburton, Blackwater, Northrup and the rest of the Military industrial complex. Eisenhower was so prescient and wise:

Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities. It is two electric power plants, each serving a town of 60,000 population. It is two fine, fully equipped hospitals. It is some fifty miles of concrete pavement. We pay for a single fighter plane with a half million bushels of wheat. We pay for a single destroyer with new homes that could have housed more than 8,000 people. This is, I repeat, the best way of life to be found on the road the world has been taking. This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron. ... Is there no other way the world may live?

Gun Ownership is sacred. Fine, this is way low on my list of issues to get exorcised about but gun rights are not unlimited. Again, I don't see this as being near the top of Jesus' list for important aspects of national governance. Also, why is it that the most heinous crimes always seem to be done with legally purchased guns?
Government must be downsized, National Budget must be balanced, Deficit Spending will end. Reduce Personal Income Taxes a must. Reduce Business Income Taxes is mandatory.
Typical right wing BS. Run up the most massive deficits in the history of the country, first under Reagan and again under Bush, then bitch about it as Democrats try to clean up the mess (Clinton for Reagan, and Obama for Bush). I'll let you all in on a little secret: Tax cuts never have, never will pay for themselves. "Supply side" economics, wherein lightening the tax burden on the wealthy so that they will supply more products and thus stimulate demand is as S-T-U-P-I-D as it sounds. Besides, investment income is taxed at such low rates already, the wealthiest in America have far lower tax rates than the rest of us! Patriots like Teddy Roosevelt would be out there railing against this injustice.
Bail-out and Stimulus Plans are illegal. Very stupid, poorly thought out, way too generous to Wall Street with not nearly enough regulatory "burden" injected in return for the favors. Did anybody else notice that the same stupid Ayn Rand- Milton Friedman stupidity that led to the S&L Bailout under Reagan-Bush I led Phil Gramm to believe they could do even more damage to the tenuous regulatory environment in place in the 90's and everything would turn out just swell - for the "Fortunate 400", and the pretty fortunate 40,000.
Intrusive Government Stopped. This is just so funny because of where I expect they see the government is being too intrusive and where I think it is too intrusive. I am one of those silly Bill of Rights types, and so I reject pretty much every intrusion into the lives of Americans that the chickens in the Bush administration thought were so vital to national security. And yet, I have been paying attention enough to realize that intrusions into the affairs of Corporate America in general, and Wall Street gambling, in particular, are vital to the stability and prosperity of the country.
English only is required. I guess this goes up above with how we treat each other and the strangers among us. I think Jesus, who spoke Aramaic, while living under Roman rule, might have a touch of sympathy for the non-English speaking.
Traditional Family Values are encouraged. This is a little tricky, in that Jesus and Christian tradition is so clearly liberal in matters of economics, social justice, immigration, etc., and yet Jesus was pretty darn tough on sexual issues. So, I'll make an offer to the Tea Partiers: You make Jesus' rule against divorce into law, help us with the big social justice issues like universal health care, reforming prisons, strengthening workers rights, and more, and then we'll go after gay marriage. Deal?
Common Sense Constitutional Conservative Self-Governance is our mode of operation. I really don't know what the heck this means, but I did find it amusing that there is another organization called "We the People" (From the Constitution - get it?) that is an ANTI-government, Tea Party type organization.
But I do think this last bit is critical: I think progressives view government as "us" (as in "We the People") and conservatives view government - when they are not in power - as them. Even when my party was not in power, I still believed government was us, but that we had failed our country by allowing the Siths to win so many elections.
So, in summary, these people who constantly complain that we are not acting as a Christian Nation, seem to completely miss the point of Christianity, the social justice mission, the generosity of heart, the embracing of the weak, the poor, the hungry the sick, the loving of those NOT like us :

If you love those who love you, what credit is that to you? Even 'sinners' love those who love them. And if you do good to those who are good to you, what credit is that to you? Even 'sinners' do that. (Luke 6)

Cheers,
---------
Update just to add this from
"...How terrible it will be for those who make unfair laws, and those who write laws that make life hard for people. They are not fair to the poor, and they rob my people of their rights. They allow people to steal from widows and to take from orphans what really belongs to them. (Is 10:1-2 NCV)"

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My notes for Testimony for GOP doctors caucus January 21, 2010

[I know, I know,State of the Union! I did want to get this up, however, for the record. My opening statement is here.]

As I do not have a transcript, and the video posted by the Caucus only contains the opening statements of the Congressman and not the panel (imagine that!), these comments reflect what I recall based on my note taking on the fly during the hearing.

The committee was co-chaired by Congressman Tim Murphy and Rep. Phil Gingrey.
Rep. Murphy started hearings and made some comments about the congressional process, the election in Massachusetts, and then outlined his specific ideas for healthcare reform: these included purchasing insurance across state lines; focus on cost, outcomes and transparency;health insurance should be personal portable and should not lose insurance with job. He also in passing mentioned that Medicare has not been overhauled since it was passed.

Gingrey also opened with observations about Massachusetts election. He then quoted Jefferson, "Whenever the people are well-informed, they can be trusted with their own government;... whenever things get so far wrong as to attract their notice, they may be relied on to set them to rights." He postulated that people don't like the House or Senate bills, and that deals or cut behind closed doors were bad, and finally that the GOP stands opposition to health care reform is currently constituted

Congressman Roe stated that the process should be open and transparent and that simple ideas will increase access. He is opposed to special interests deals that were made, and quoted a survey that said that 91% of people surveyed like what they had in regards to health insurance, and something along the lines of "when you take this much money out of the system..." bad things will happen.

Congressman Broun had a very simple message that can be summed up as the market will fix all. He has introduced HR 3889 along these lines . He referenced the original intent of the Constitution. He spent a few minutes complaining about CLIA regulations that shutdown labs and he thought this was inappropriate and was bad for healthcare.

Congressman Fleming said that we agree on the need for increased access and decrease costs.

Congressman Boozman: transparency is critical.

Before I move on to the testimony, I do want to say a few words about the opening statements. I do not doubt that all of the Congressman would like to achieve universal access to health care in some sense of the word. I do not believe that their sense of universal access to health care comes anywhere near my concept of universal access to health care. They are perfectly comfortable, I believe, with a multitiered system, with poor receiving charity care when it is available, the less poor receiving Medicaid rationed as it is by its fee structure, and then others with very poor insurance policies which limits their access to care, and so on. It is fairly striking to me, that Medicare really is the Cadillac plan in the United States. Private health insurers may pay more for procedures or office visits or what have you, but Medicare provides care to everyone in the level that ensures the basic dignity of every patient. Is dignity important? To some, it is not. But I think, as someone who advocates for a traditional view of social justice and basic dignity of human beings, that the ability to seek medical care and not beg for it is important not only to the individual, but to us as a society.

All of the Congressman at some point during the day reference how important they felt it was to have the ability to purchase insurance across state lines. My view, and the view of many economists and health policy experts, is that this will lead to a race to the bottom. In one of my meetings with Congressman Murphy, he expressed great skepticism in the ability of a government program to do anything properly. He argued that he'd seen some government programs go so wrong as to make him supremely cautious about allowing any new government programs to be enacted. I understand the skepticism. But my skepticism of the ability of state governments to avoid the corrupting influences of money and corporate power far, far outweigh any concern that I have about a federal government program going out of control. And I say this as someone who believes that the privatization of our defense efforts in the forms of Blackwater and other extra governmental agencies has become extremely dangerous for this country. But, looking out across states, and seeing how easy it is for corporations to drastically influence state elections including those for judges and Supreme Court justices, the ability to pressure insurance commissioners, the ability to influence elections for state representatives, and also seeing how poorly some states manage and fund their Medicaid programs, I worry about the states.

I certainly think all the sentiments expressed about transparency in the process and the avoidance of sweetheart deals and backroom deals are very true. However, to hear this from the party of Medicare Part D, and Billy Tauzin, energy policy by Exxon and Enron, the party that by and large believes the BS of Ayn Rand, I find this concern, well, inconsistent. But, I will echo all of those sentiments.. FDR would have gone out and challenged all those special interests that the Democrats made deals with. I, too, am disappointed in my party's leadership.

Regarding the comment about Medicare not been changed since its inception, I guess one could argue that the general concept of Medicare hasn't changed since its inception, but obviously, many parts of the program have changed. Some of the biggest changes included the massive increases in spending in the 60s and 70s allow for growth hospitals expansions of a residency programs in medical schools and so on. Other big changes have come in the forms of DRGs in order to contain costs, this remains a mainstay of financing of health care by both public and private insurers around the world. Payments to physicians and the structure of these payments has changed drastically since the inception of Medicare. Another interesting one is, the addition of the end-stage renal disease benefit program. Because of the sympathy engendered by patients who cannot afford dialysis and were driven to destitution and death, a benefit was added to pay for people with end-stage renal disease. This is now also an untouchable program. But consider that even this program with such good intentions has the same fatal flaw as much of the rest of American medicine, in that it focuses on taking care of the patient after the disease has progressed beyond retrieval. Very telling, indeed.

I was quite surprised by Congressman Roe's comment about the ill effects of taking large amounts of money out of the system. If American medicine were anything close to lean mean machine, there might be some validity to that comment. But the massive amounts of bureaucratic waste, the massive amounts of over testing, under testing, over treating, under treating, the perverse incentive system of rewarding procedures over prevention and high-tech healthcare often with marginal benefit, over coordinating the care of complex patients, the abysmal end-of-life care, the "sweetheart deal" of Medicare part D., the excess subsidies in Medicare advantage plans, and on and on make this comment ludicrous.

Briefly, regarding the Thomas Jefferson quote, all I could think at the time was, that's why the Democrats have overwhelming majorities in both houses and the White House. They'd finally had enough. I do not claim to be an expert in the Massachusetts election, but the only sound clip I saw of the victor was a short sound bite in which he made proclamations about health care reform that were, to be kind, misleading. This dovetails with Congressman Roe's notation that most Americans are happy with the insurance they have, if they have it. I think doctors and nurses will back me up on this: most of them are only happy because they haven't had to try using their insurance. It's that sticky part about when you actually have to use your benefits and become sick and miss work and possibly lose your job and so on and so on so many become unhappy with their insurance and stunned to find out how poorly it sometimes functions. Monty Python said it best with their "never pay" insurance companies sketch.
Panel testimony then followed. Besides myself, the panel concluded Paul Fronstin, Ph.D. of the Employee Benefit Research Institute testified on how the excise tax in the Senate bill will force companies to limit employee coverage, and The Lewin Group’s John Sheils told the Caucus that if these bills passed, wages will decrease as employers pay more in healthcare benefits. Other witnesses included Jim Martin of 60 Plus Association and Dr. Karen Nichols with the American Osteopathic Association.

Fronstin of the EBRI: I will admit that my mind wandered here and I did not critically analyze his testimony on excise tax. A couple of points he did make were that 20% of the population accounts for 80% of the cost of health care, and that chronic conditions are the bulk of the cost.

Jim Martin of the 60+ organization, the conservative alternative to the AARP and, he did not disappoint. It was, unfortunately, like listening to a mash up of Limbaugh/Hannity/Beck/Coulter/Malkin quotes. They believe in healthcare reform but incremental and he emphasized first do no harm. He argued to not take a wrecking ball to the current system, that cuts to Medicare will hurt seniors "whether you're for Medicare or against it" (an interesting quote, eh?), that seniors are scared, that they "paid their due" and expect their due, and he also perseverated on the size of the bill in pages, and also that that "bureaucrats are asking seniors to sacrifice more." You know, I'm not even going to bother.

Dr. Nichols of the AOA: one of five medical students is osteopathic; there is a physician work force shortage; graduate medical education funding needs to be expanded not just reapportioned; Medicare pays for graduate medical education the hospitals and so training incentivize to stay within the hospital and out of community areas and underserved outpatient settings; international medical graduates-the US imports doctors and this creates an international brain drain; primary care physicians are disincentive on by income; only 55% of the work of a primary care physician is actually taking care of patients; payment system values procedures and not coordination of care or cognitive services; emphasized the need to repeal the SGR; threefold difference in income in primary versus specialist; national health service Corps deferments need reinstated.

Shiels of the Lewin Group (he had lots of charts and graphs but we did not get copies, so I missed a lot): the House bill creates a $372 billion increase in employer costs; talked about the change in after-tax income which I didn't follow; changes in average family health spending; if under 50,000 they get a net savings, if over 100,000 there was a modest increase in cost and if greater than 150,000 there is a $443 increase in the House bill and hundred $47 and the Senate bill.

Question-and-answer period. I'm going to have to free flow this because i don't have many notes because - can you believe it- I was paying attention.

Medicare advantage, why is it being cut?
Mr. Martin said it's because the AARP wants market share
We disagree, as does the AMA, and other organizations, and the White House explanation is here.

Gingrey Massachusetts hates the Massachusetts health care reform plan. Except that 68% like their own plan. And 70% of physicians like it, too. And among Obama voters who voted for Brown, only 23% thought Health Reform went too far, with 41% not knowing why they opposed it and 36% didn't think it went far enough! He is worried about the work force adequacy
Nichols reiterated the need to fix the SGR.

Mr. Martin voiced his disgust at people at the Townhall meetings August being called un-American clearly did not get the point. I almost grabbed the microphone next to me to shout him down so he would get the point. Really. I almost did it.

Martin also mentioned that we should scrap all the bills and the Medicare is going bankrupt. I find this magical thinking by the Right about medicare truly amazing. Medicare is going bankrupt, but taking money out of Medicare, even overspending on Medicare Advantage, reducing practice variation, increasing preventive care and improving care coordination and all the things we talk about to improve quality and decrease cost, are off the table. It reflects the schizophrenia of having a popular government program that they would love to vilify and gut if they could, but they can't because seniors will have their heads. And seniors like Martin want it all and more in terms of spending on them, the rest of the economy and the country be damned.

Mr. Broun tried to get us all agree that market reforms that solve the system's problems
I was wondering if Medicare was unsustainable for Part D, as it is now...I will try to find out.

Broun reiterated his idea of four things he considered "critical:" 1. being able sell insurance across state lines is critical, 2. association pools were critical, 3. high risk pools were critical, and 4. health insurance costs be 100% deductible. Dr. Brown also made the amazing statement that he went to Canada and only found one Canadian happy with Canadian healthcare. Just one table for now, because this is just so terminally stupid: 34% of Americans think we need to completely rebuild our system compared to only 12% of Canadians. And only 28% of Republicans still believe that we have the best system in the world.

There was more, but this is enough for now.

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Southern Baptist Convention: Politics trump morality

Unbelievably (or not), considering Richard Land's history, this position on health reform:

In his August 18, 209 press release, Dr. Land states that he opposes the current House bill, H.R. 3200, but does believe that health care reform is needed.
According to Land, he "recognize[s] the need to rework certain elements of the health care equation in America. While the health care industry in the U.S. is relatively robust, it is not without flaws. And there is a segment of the American population, either because of their income level or their medical condition, that needs responsible and well-regulated government assistance."
Dr. Land doesn't believe that greater government involvement is the answer. Dr. Land believes that tort reform is one of the biggest avenues of savings in the health care industry. He states, "If we had tort reform, just tort reform, getting the stinking, rotten lawyers out of the business of ambulance chasing, we would eliminate about $50 billion of medical costs every year that doctors have to pay for malpractice insurance which is then passed on to you in the form of bills."
Dr. Land does believe that in a country as prosperous as the United States, every one should have guaranteed access to some level of health care, though he rejects government involvement. According to Land, the "answer is to provide alternatives and incentives for most people to be in health care that they provide for themselves, and then the government can focus like a laser on those who aren't able to provide it for themselves and you give them a basic level of health care. If I could use the car analogy, everybody should have a Chevrolet. Those who can afford it can get Cadillacs or even Mercedes."

It is amazing that Mr. Land's SBC seems to have more in common philisophically with Ayn Rand than Jesus Christ. Or the Pope.

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