Joe Cobb

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By Betsy McCaughey

Since Medicare was established in 1965, access to care has enabled older Americans to avoid becoming disabled and to travel and live independently instead of languishing in nursing homes. But legislation now being rushed through Congress—H.R. 3200 and the Senate Health Committee Bill—will reduce access to care, pressure the elderly to end their lives prematurely, and doom baby boomers to painful later years.

The Congressional majority wants to pay for its $1 trillion to $1.6 trillion health bills with new taxes and a $500 billion cut to Medicare. This cut will come just as baby boomers turn 65 and increase Medicare enrollment by 30%. Less money and more patients will necessitate rationing. The Congressional Budget Office estimates that only 1% of Medicare cuts will come from eliminating fraud, waste and abuse.

The assault against seniors began with the stimulus package in February. Slipped into the bill was substantial funding for comparative effectiveness research, which is generally code for limiting care based on the patient’s age. Economists are familiar with the formula, where the cost of a treatment is divided by the number of years (called QALYs, or quality-adjusted life years) that the patient is likely to benefit. In Britain, the formula leads to denying treatments for older patients who have fewer years to benefit from care than younger patients.

When comparative effectiveness research appeared in the stimulus bill, Rep. Charles Boustany Jr. R-LA), heart surgeon, warned that it would lead to “denying seniors and the disabled lifesaving care.” He and Sen. Jon Kyl (R-AZ) proposed amendments to no avail that would have barred the federal government from using the research to eliminate treatments for the elderly or deny care based on age.

In a letter this week to House Speaker Nancy Pelosi, White House budget chief Peter Orszag urged Congress to delegate its authority over Medicare to a newly created body within the executive branch. This measure is designed to circumvent the democratic process and avoid accountability to the public for cuts in benefits.

Driving these cuts is the misconception that preventative care can eliminate sickness. As President Obama said in a speech to the American Medical Association: “We have to avoid illness and disease in the first place.” That would make sense if most diseases were preventable. But the two most prevalent diseases of aging—cancer and heart disease—are largely caused by genetics and their occurrence increases with age. Your risk of being diagnosed with cancer doubles from age 50 to 60, according to the National Cancer Institute.

The House bill shifts resources from specialty medicine to primary care based on the misconception that Americans overuse specialist care and drive up costs in the process (pp. 660-686). In fact, heart-disease patients treated by generalists instead of specialists are often misdiagnosed and treated incorrectly. They are readmitted to the hospital more frequently, and die sooner.

“Study after study shows that cardiologists adhere to guidelines better than primary care doctors,” according to Jeffrey Moses, a heart specialist at New York Presbyterian Hospital. Adds Jeffrey Borer, chairman of medicine at SUNY Downstate Medical Center: “Seldom do generalists have the knowledge to identify the symptoms of aortic valve disease, even though more than 10% of people over 75 have it. After valve surgery, patients who were too short of breath to walk can resume a normal life into their 80s or 90s.”

While the House bill being pushed by the president reduces access to such cures and specialists, it ensures that seniors are counseled on end-of-life options, including refusing nutrition where state law allows it (pp. 425-446). In Oregon, some cancer patients are being denied care by the state that could extend their lives and instead are afforded the benefit of physician-assisted suicide instead.

The harshest misconception underlying the legislation is that living longer burdens society. Medicare data prove this is untrue. A patient who dies at 67 spends three times as much on health care at the end of life as a patient who lives to 90, according to Dr. Herbert Pardes, CEO of New York Presbyterian Medical Center.

What is costly is when seniors become disabled. In a 2007 Health Affairs article, researchers reported that surgeries to unclog arteries and replace worn out hips and knees have had a major impact on steadily reducing disability rates. And nondisabled seniors use only one-seventh as much health care as disabled seniors. As a result, the annual increase in per capita health spending on the elderly is less than for the rest of the population.

Nevertheless, Medicare is running out of money. The problem is the number of seniors compared with the smaller number of workers supporting the system with payroll taxes. To remedy the problem, the Congressional Budget Office has suggested inching up the eligibility age one month per year until it reaches age 70 in 2043, or asking wealthy seniors to pay more.

These are reasonable solutions—reducing access to treatments and counseling seniors about cutting life short are not. Medicare has made living to a ripe old age a good value. ObamaCare will undo that.

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York state. This article is reprinted from The Wall Street Journal, July 23, 2009

by Michael Shermer

In a nutshell, I am a libertarian because conservatives are a bunch of gun-totting, Hummer-driving, hard-drinking, Bible-thumping, black-and-white-thinking, fist-pounding, shoe-stomping, morally-hypocritical blowhards, and liberals are a bunch of tree-hugging, whale-saving, hybrid-driving, sandle-wearing, bottled-water-drinking, ACLU-supporting, flip-flopping, wishy-washy, Namby Pamby bedwetters. There’s a better way. Libertarianism.

Michael Shermer’s recent Skepticblog posts about libertarianism have drawn an enormous volume of commentary. To better assess the tone of the comments, Junior Skeptic editor Daniel Loxton sat down with Skepticblog webmaster William Bull to undertake an informal content analysis for internal review.

This was a lengthy, brute-force task. All of Michael Shermer’s posts were parceled out to a team of volunteers (one reviewer per thread) who read every single comment — and assigned each of those thousands of comments a positive, neutral, or negative rating based on simple guidelines (“NEUTRAL: Too close to call, a non-sequitur, or expresses something not directly related to the topic of the author’s post”).

Individual commenters were allowed only one unique “vote” per thread.

The results of this back-of-the-envelope analysis (current to May 8, 2009) are presented below, along with Dr. Shermer’s thanks for the constructive comments.

Okay, now that I have your attention, let me address the constructive comments posted in response to last week’s blog post on how I became a libertarian, and this week explain why. But first, what is a libertarian? I hate labels, and as you can see from the comments people make certain assumptions based on the label instead of the person and particular beliefs. Nevertheless, labels are cognitive shortcuts, so the shortest thumbnail is this: a libertarian is socially liberal and fiscally conservative. It’s an alternative to the standard left-right linear spectrum, and it allows one to nuance positions on different issues. For example, I am pro-choice, pro gay marriage, and pro separation of church and state, which makes me a card-carrying liberal, right? Well, I am also in favor of lower taxes, cutting welfare programs, privatizing social security, and replacing the income tax with either a flat tax or abolishing it altogether and replacing it with a national income tax, which makes me a card-carrying conservative, right? So what am I?

(Parenthetically, I find it troubling that most atheists, agnostics, skeptics, free thinkers, humanists and secular humanists are liberal. The reason I find this troubling is not because I am not a liberal (although as noted above, I agree with liberals on many issues), but because most people think that the skeptical/humanist movement is (or should be) politically neutral. If it were, there would be roughly a 50/50 split of liberals and conservatives. But it isn’t, and I think that’s a problem. Humanists, for example, are supposed to be in favor of all humans, but when virtually our entire constituency votes Democratic, that means we are missing half the human population! There’s something wrong with this picture. I’m not saying that we should all be libertarians; only that a more politically diversified membership would indicate that our movement is more politically balanced. When I point out this discrepancy to my liberal friends and colleagues, they predictably explain the left-leaning bias as due to the fact that liberals are right! Of course… My conservative friends say the same thing when I note the conservative bias in businesses and commerce related organizations.)

Basically, libertarians are for freedom and liberty for individuals, and we prefer not to have the state involved in either our bedrooms or our boardrooms. This is not a simple hedonistic “I want to move to Idaho and smoke pot and watch porn and the rest of you all be damned” (although I’m sure there are libertarians who want precisely this). Rather, libertarianism is based on the principle that individuals should be free to choose for themselves. Libertarianism is grounded in the Principle of Freedom: All people are free to think, believe, and act as they choose, as long as they do not infringe on the equal freedom of others.

There is a very simple reason why libertarians do not like government: it is not just that government is so inefficient (although it is), or that it elevates graft and corruption to new levels of bureaucratic efficiency (although it does), or that it treats its citizens like we’re a bunch of juvenile helpless pinhead morons in need of a nanny to take care of us from womb to tomb (we aren’t and we don’t); it is because it infringes on our freedoms to choose.

Of course, the devil is in the details of what constitutes “infringement,” but as I outlined in The Mind of the Market, there are at least a dozen essentials to freedom:

The rule of law.
Property rights.
Economic stability through a secure and trustworthy banking and monetary system.
A reliable infrastructure and the freedom to move about the country.
Freedom of speech and the press.
Freedom of association.
Mass education.
Protection of civil liberties.
A robust military for protection of our liberties from attacks by other states.
A potent police force for protection of our freedoms from attacks by other people within the state.
A viable legislative system for establishing fair and just laws.
An effective judicial system for the equitable enforcement of those fair and just laws.
Under our current system of politics government clearly has a role in most (but not all) of these 12, but only in the capacity of what we might call Preventative Rights: preventing others from infringing on our freedoms (taking my property, preventing me from speaking or writing or associating, inhibiting my freedom to exchange with others on a voluntary basis, etc.). By contrast, government should not be in the business of Providing Rights: providing goods and services that require the infringement of our freedoms (e.g., taking my property through taxes to pay for someone else’s education, health care, vacations, paternity leaves, etc.).

Basically I believe in individual choice and responsibility. You make your choices and you are responsible for the consequences of those choices. Of course, we are not just individuals living in isolation; we are spouses and significant others, we are members of families and extended families, we are constituents of social communities, and we are citizens of societies. As such, we have a moral obligation to take care of those who cannot take care of themselves (children, the elderly, the infirm), to help those who cannot help themselves (the mentally ill, severely handicapped), and to give aid and comfort to victims of natural disasters and totalitarian regimes, but through private choice and charity.

It is none of the government’s business who I choose to help and give aid and charity to, and I find it deeply morally repugnant that bureaucratic agencies have the legal right to confiscate my wealth through force or the threat of force (taxes), launder my money and waste most of it to run the government organizations that process my money (with dollops allocated for paying for bridges to nowhere and prostitutes for politicians), and redistribute it to people who I do not know. Libertarians are not uncharitable selfish hedonists; we just want the freedom to choose.

May 12 2009

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