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Aug 12, 2009

Legislative Language

No funds shall be used for pork roasting within any federal facility except in accord with the provisions of 12.14(f)(4).

Notwithstanding the language in 3.7(b)(2), pork roasting is approved in any amount, anywhere.

5.   Restrictions

5.1   The President's authority under this bill is strictly limited to the explicit provisions of this bill, narrowly considered and constructed.

5.2   The sense of this section 5.2 is constructed from combining the language of sections 5.13 through 5.17 after striking out the words "dog", "cat", and "fish" wherever they appear in those sections.
. . .
5.13   The dog cat President fish
5.14   is fish hereby cat cat
5.15   cat dog empowered dog to cat
5.16   dog dog do dog dog anything cat
5.17   fish dog he fish cat wants. dog fish

The Partial Veto In Wisconsin
January 2004 - Wisconsin Legislative Reference Bureau

[edited]:  In 1930, Wisconsin voters approved an amendment to the Wisconsin Constitution giving the governor authority to approve appropriation bills “in whole or in part”. Overrides of such vetoes have been rare, requiring a 2/3rds vote of both the Wisconsin House and Senate.

Governors have steadily increased the number of partial vetoes, and have have become progressively more creative.

In 1931, Governor Philip La Follette vetoed parts of a bill as small as a statutory paragraph. Two vetoes in 1935 affected individual sentences. In 1961, the governor vetoed part of a sentence. In 1965, the chief executive deleted one figure that appeared in a bill. Later governors have vetoed individual digits and letters, have edited the text to change its meaning, reduced appropriation amounts by crossing out one figure and writing in another, and altered the direction of an appropriation.

Digit Veto

Governor Lucey in 1973 reduced a $25 million highway bonding authorization to $5 million by striking the digit “2”. Objections failed, leading to the establishment of this type of veto.

Editing Veto

Governor Lucey in 1975 vetoed the word “not” in the phrase “not less than 50%”, changing a 50% floor on cooperative advertising to a 50% ceiling. The Wisconsin Supreme Court affirmed that the governor can change legislation in this way.

In 1977, Acting Governor Schreiber changed a law in a way that the legislature had expressly rejected. The legislature specified that a taxpayer could add $1 to his taxes to go toward public funding of political campaigns.

Schreiber’s partial veto changed the addon to a checkoff. The $1 would be paid from the state’s general fund rather than collected through individual tax returns. The Wisconsin Supreme Court upheld.

Pick-a-Letter Veto

In 1983, Governor Earl arranged that appeals of Public Service Commission rulings would be handled by the courts rather than the PSC. His veto reduced a paragraph of 121 words into one sentence of 22 words. The legislature overrode this veto in this case.

Reduction Veto

In 1993, Governor Tommy G. Thompson crossed out nine dollar figures and wrote in smaller numbers. The Wisconsin Supreme Court upheld this use of the veto.

In 1995, Thompson reduced a revenue bond limit for transportation projects. The Wisconsin Supreme Court overruled because that amount was not an "appropriation".

This is madness. The ongoing interpretation of the Partial Veto converted a legislative process into an unlimited contest of political interests. The governor was enabled to change any legislation at the stroke of a pen. The only limits on a Wisconsin governor's power are the interests of his cronies and broad public sentiment. Restated, the only limits are those that apply in a tyranny.

The Wisconsin Supreme Court was content to make rulings around the edges, never bothering to limit the Governor's power to something close to the common meaning of a Partial Veto.

We see the same effects in 2012, where the continuing interpretation of the Commerce Clause of the US Constitution allows our federal government to do almost anything short of telling us what color underwear to put on.

Ignorance is bliss! But see (hhh)(1) Subject to paragraphs (3) and (4)
08/11/09 - Classical Values by Eric

[edited] I finally understand why the Congressmen who are pushing the healthcare bill HR3200 have not read it, and have come up with something unreadable. It's quite deliberate.

If people could actually read it, they might learn too much. If they learned that a new cancer drug would not be available, or that their father's heart surgery would not be covered, millions and millions of ordinary people would be outraged and up in arms, and it would be very bitterly personal, like Mike Sola, the guy whose son has cerebral palsy and who learned he wouldn't be covered.

A Few Words About Policy
Would Obama try to legislate from some scribbles on a cocktail napkin? Would he think "give me anything, we'll rearrange it later to do what we want"?

Join me in the demand to "Show me the policy paper!" If any politician refuses or says that it doesn't exist, then mock him with "Show me the cocktail napkin!"

Aug 11, 2009

ObamaCare May Save Social Security

ObamaCare Saves Social Security
08/11/09 - InsureBlog by Henry Stern

[edited] The healthcare bill we reference is "America’s Affordable Health Choices Act of 2009, Revised Standard Edition". It has the potential to save Social Security from bankruptcy:
Page 425. "The term ‘advance care planning consultation’ means a consultation between the individual and a practitioner [doctor] ... if ... the individual involved has not had such a consultation within the last 5 years."

So, seniors are encouraged to have these consultations at least every 5 years. What are they?

Page 432. "For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life sustaining treatment."  (note)Can you imagine 1000 pages of this language?

So, a "consensus based organization"The End of Life Quality Treatment Board will come to order. All in favor of 'Non-Heroic Treatment Plan 103' say Aye. The plan is approved by 8 votes to 1. I declare this a consensus. We are adjourned."" will determine advanced care planning. It will create orders for life sustaining treatment that will be measured for compliance. It could order anything from a pain pill to life saving surgery, depending on whatever utilitarian measures it wants. And, that will be that. Are you reassured?

This implements social justice. Rich and poor will be prescribed the most cost-effective lifesaving or pain-numbing treatment, according to expert guidelines.

If you are a federal politician, federal employee, or approved union member, you are not covered by this act. You have other, nicer choices for your care, provided by private insurance companiesAren't the insurance companies supposed to be the spawn of the Devil? arranged for you by your union or the federal government.

Social Security will save a lot as most people's lives end on a more rational basis.

This prompted my comment (sarcasm warning):

It is shortsighted to bring quality of life issues into discussion only because of explicit costs for healthcare at the end of life.

It is obvious that we cannot support useless members of the tribe who are no longer able to work.

What is less obvious, and much more important, is to factor in carbon use. This is also a cost to society, and to Gaia herself.

We should accept that when our personal carbon footprint goes up past our productivity, then we need a talking to.

When an individual can no longer bicycle to work, it may be better to accept the end rather than be a carbon burden on us all.

It is inescapable. Some must continue on in the cycle of life so that others may live without damaging the Earth.

Aug 10, 2009

Cuban Health and Economic News

Cuba must replace tractors with oxen
07/02/09 PDF Info Bulletins Cuba by Will Weissert (AP)
  (search: oxen)

[edited] President Raul Castro suggested expanding a pilot program, giving private farmers unused government land to cultivate.

"For this program we should forget about tractors and fuel, even if we had enough. The idea is to work basically with oxen. An increasing number of growers have been doing exactly this with excellent results."

The agricultural ministry proposed increasing the use of oxen to save fuel. Factory closings and turning off air conditioners at government offices has saved oil. The ministry said it had more than 265,000 oxen "capable of matching, and in some cases overtaking, machines in labor load and planting."

Cuba is running out of toilet paper
08/10/09 - Reuters by Nelson Acosta and Esteban Israel

[edited] An official with state conglomerate Cimex said: "The corporation has taken all the steps so that at the end of the year there will be an important importation of toilet paper."

The shipment will enable the state-run company "to supply this demand that today is presenting problems." Cuba both imports toilet paper and produces its own, but does not currently have enough raw materials to make it.

- 09/04/10 - Comment by JC DeCardenas at Cafe Hayek

[edited]  Ha, ha. I left Cuba in 1994. It is like time has frozen in the island. They must be talking about toilet paper for the foreign currency shops or the hotels. Cimex is a military run corporation that manages imports and hotels.

When I was a child in the 1960's we got a ration of toilet paper every now and then that was never enough. Most people supplemented it with newspapers. Wiping on Castro's pictures compensated somewhat for the roughness. Even that ration disappeared years later.

Environmentalism and its proposals always remind me of the hardships in Cuba, everything from using rags for personal hygiene, using the same cloth bags for groceries, and bicycles for moving around.

CNN reports Cuba is a model for a U.S. healthcare plan
08/10/09 - American Thinker by Humberto Fontova

[edited] The CNN report included clips from Michael Moore's "Sicko". CNN's Morgan Neill reported on location from a Havana hospital. "Cuba's infant mortality rates are the lowest in the hemisphere, in line with those of Canada!"

According to 2009 UN figures for infant mortality per 1000 live birtihs, Canada ranks 23rd best at 4.8, Cuba ranks 28th at 5.1, and The U.S. is 33rd with 6.3.  [My link and figures -ag]

Other statistics and reports question the truth of Cuba's rank.

  • According to the Association of American Physicians and Surgeons, the mortality rate of children aged one to four years in Cuba is 11.8, 34% higher than the 8.8 U.S. rate.

    This statistic doesn't figure into UN and World Health Organization spotlighted "infant-mortality rates", so there is no pressure to fudge these figures.

  • Dr. Juan Felipe García, MD, of Jacksonville, Fla., in April 2001, interviewed several doctors who recently defected from Cuba:

    "The official Cuban infant-mortality figure is a farce. Cuban pediatricians constantly falsify figures for the regime. If an infant dies during its first year, the doctors often report he was older. Otherwise, such lapses could cost him severe penalties and his job."

  • The maternal mortality rate per 1000 births is Cuba at 33, 3.9 times the U.S. at 8.4 .

The comparison to the U.S. is too strange. Many more Cuban mothers and children aged 1-4 die in Cuba, but the statistic reported to the UN for "infant mortality" (age under 1 year) shows the same health as in much wealthier countries.

- -
The film Sicko depicts a "mythical" Cuban healthcare system
12/17/10 - Guardian UK by Amelia Hill   (via Samizdata)

[edited]:  Sicko is Michael Moore's 2007 documentary. It attempted to discredit the US healthcare system by comparing it to the excellence of the socialist Cuban system.

WikiLeaks has revealed a confidential US embassy cable. Cuban authorities criticized the film for painting a mythically favourable picture of Cuba's healthcare system. They feared it could lead to a popular backlash by showing facilities that are clearly not available to the vast majority of Cubans. A group of Cuban doctors saw the film. Some left the room, disturbed at the blatant misrepresentation of healthcare in Cuba.

Sicko showed the Hermanos Ameijeiras hospital in October 2007. It was built in 1982 and newly renovated. This was prsented as evidence of the high-quality of healthcare available to all Cubans.

But according to the cable, Cubans may only access this hospital by offering bribes or using contacts inside the hospital administration. "Cubans are very resentful that the best hospital in Havana is off-limits to them."

The cable says the Calixto Garcia Hospital gives a more accurate view of the average Cuban's healthcare experience. This dilapidated hospital was built in the 1800s, and reminds one of a scene from some of the poorest countries in the world.

The Cuban ruling elite seeks serious medical care outside of Cuba.

- -
Useful Idiots at PBS
12/28/10 - PowerLine Blog by Scott Johnson

He describes a recent, naive PBS story, and collects accounts of how terrible Cuban healthcare really is.

Jay Nordlinger provides a realistic and shocking account.

[edited]:  Hospitals and clinics are crumbling. Conditions are so unsanitary that patients may be better off at home. If they go to the hospital, they must bring their own bedsheets, soap, towels, food, light bulbs, and toilet paper. In Sicko, even sophisticated medications are plentiful and cheap. In the real Cuba, an antibiotic will fetch a fortune on the black market.

A nurse reported: "We have nothing. I haven't seen aspirin in a Cuban store for more than a year. If you have any pills in your purse, I'll take them. Even if they have passed their expiry date."

Socialist Cuba spends almost nothing on healthcare by American standards. Then, they make up great statistics and convince the true believers that they are achieving more with so much less. The only way to match Cuba is to adopt a socialist system in the US and make up our own statistics.

- -
The truth about Cuba’s healthcare
12/20/10 - Fausta's Blog &emsp (Via Instapundit)

A PBS story by Ray Suarez applauds Cuba for having great healthcare for such a poor country. This has produced detailed criticism of his naive story.

Fausta [edited]:  Suarez forgets to mention that the statistics for these claims are provided by the Cuban government. That government has refused permission to any independent, outside organization to examine the statistics, the criteria for the data, or how the statistics are gathered. Suarez can’t seem to realize that any statistics put out by a totalitarian regime in a closed society are to be questioned.
The Miami Herald reports details from a US foreign service cable describing the healthcare experience for the Cuban populace [edited].
Some medical institutions are reserved for Cuba’s ruling elites and foreigners who pay in hard currencies. These institutions are hygienically qualified and have a wide array of diagnostic equipment, a full complement of laboratories, well-stocked pharmacies, and private patient suites with cable television and bathrooms.

Hospitals and clinics used by average Cubans don’t come close. The Hermanos Ameijeiras Hospital is partly reserved for foreign patients, and was featured in Sicko. There, a “gift” of $22 to the hospital administrator helps average Cubans obtain better treatment.

The exterior of the Ramon Gonzalez Coro OB-Gyn hospital was dilapidated and crumbling, and its Newborn Intensive Care Unit was using a very old `Bird’ infant respirator, a model used in the U.S. in the 1970s.

- -
USA Healthcare is First - Infant Mortality is Low

Health statistics are intentionally misinterpreted to argue for socialized medicine. The major argument is that the US spends more than Europe, but lags behind in health outcomes. So, US healthcare is both expensive and inefficient.

Actually, the USA has better health when you consider sociological differences, such much higher auto accident fatalities in the USA.

Aug 8, 2009

ObamaCare and the Doctor

ObamaCare and Me
08/06/09 - American Thinker By Zane F. Pollard, MD

I quote here this clear and frightening article describing Medicaid, and by extension ObamaCare. Medicaid pays for medical services to the poor, and in this case to poor children who face vision impairment or blindness.

Regardless, Medicaid denies and delays their care.

I have edited for clarity and added subtitles. See also the excellent comments at the original article, many by doctors.

Medicaid in Atlanta

I want to explain many of the problems of nationalized healthcare from my perspective as a doctor. I have practiced for 35 years in Atlanta, Georgia, in the only group there offering pediatric ophthalmology services to Medicaid patients.

The government has involved very few of us physicians in the healthcare debate. The American Medical Association favors Obama's plan, but remember that the AMA represents just 17% of American physicians.

Delay and Denial of Antibiotics

In the past 6 months, I have cared for three young children on Medicaid who had corneal ulcers. Blindness almost surely results if the cornea perforates from the infection. In all three cases, the required antibiotic was not on the Medicaid list.

I was told each time to fax Medicaid for the approval forms. The form came back to me in 48 hours, which I then immediately filled out and faxed back. They told me that I would have my answer in 10 days. By then, each child would have been blind in the affected eye. Each time, I personally provided the antibiotic.

Anyway, each request was denied. This is rationing of care.

Delayed Approval Causes Disability

I have cared for over 1000 children born with congenital cataracts. In older children and in adults, we insert an intra-ocular lens. In newborns, we use very expensive contact lenses. It takes Medicaid over one year to approve a contact lens after cataract surgery. By that time, the child would be close to blind from not focusing his eyes during early development.

Again, this is extreme rationing. I have a foundation supported 100% by private funds which supplies these contact lenses for free to my Medicaid and illegal immigrant patients.

Rationing in Sweden

I saw the child of an American who lives and works in Sweden for a big corporation. The child had developed double vision 3 months before and was unable to function normally. They had money, but would have waited 8 months to see an ophthalmologist in Sweden. Then, if the child needed surgery, they would wait 6 months more.

The mother called me, and I saw her that day. The child had accommodative esotropia (crossing of the eyes) and responded to corrective glasses within 4 days, so no surgery was needed.

Surgery Would Be Denied Due to Age

Last month, I operated on a 70 year old lady with double vision present for 3 years. She responded quite nicely and now is symptom free.

I also operated on a 69 year old judge with vertical double vision. His surgery went very well, and now he is happy as a lark.

I have been told that the current healthcare bill would deny these people surgery because of their age. They would be told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously, cheaper than surgery.

Rationed Care in the Military

I served two years in the US Navy during the Viet Nam war, and I was well treated by the military. But, there was tremendous rationing of care. We were told specifically which things the military personnel and their dependents could have, and which things they could not have.

While I was in Viet Nam, my wife Nancy got sick and received essentially no care at the Naval Hospital in Oakland, California. She went home and went to her family's private internist in Beverly Hills. While it was expensive, she received an immediate workup.

When Stents Are Indicated

This bill in its present form might be lethal for people over 65. People over age 59 in England cannot receive stents for their coronary arteries. The U.S. government wants to mimic the British plan. If you are younger, it will still restrict the care that you and your children receive.

Paying Doctors Less

99% of physicians chose medicine because we love medicine and the challenge of helping our fellow man. But, economics are still important. My rent goes up 2% each year, and the salaries of my employees go up 2% each year. Twenty years ago, ophthalmologists were paid $1800 for cataract surgery. Today it is $500, a 73% decrease in our fees. Few jobs in America have seen this sort of decrease.

There was a well known ophthalmologist in Atlanta who charged $2500 for a cataract surgery. He had a terrific reputation. In fact, he operated on my mother's bilateral cataracts, with a wonderful result. She is now 94 and has 20/20 vision in both eyes. People would pay his $2500 fee.

Then the government said that any doctor that does Medicare work cannot accept more than the government-allowed rate, now $500. The government made it illegal, subject to fines, to accept more. Those of you who are well off will not be able to go to the head of the line under this new healthcare plan, as no physician will be willing to go against the law to treat you.

I trained for 10 years after college to become a pediatric ophthalmologist, plus two years in the Navy to total 12 years. A neurosurgeon spends 14 years after college, and possibly 2 years in the military, to total 16 years.

The new plan calls for all physicians to receive the same fees. I assure you that medical students will not go into neurosurgery, leading to a tremendous shortage.

The top neurosurgeon at my hospital has just quit. He is in good health and only 52 years old. 49% of children under the age of 16 in the state of Georgia are on Medicaid, and he felt he just could not stand it any more, working with the bureaucracy.

Furthermore, how could you trust a physician who works under these draconian conditions controlled by the state? I certainly could not.

Physician Shortages

This new healthcare plan will create a tremendous shortage of physicians. Here are the estimates. About 5% of physicians will quit under this new system, and another 5% shortage will occur because fewer people will want to go into medicine.

For the past 15 years, the government has required gender equity in medical school admissions. 49% to 51% of each entering class are women. This is also true of private schools, because they all receive federal funding.

The average career of a woman in medicine now is only 8-10 years, and her average work week is only 3-4 days. I have trained 35 fellows in pediatric ophthalmology. By far the best was a woman that I trained 4 years ago. She now practices only 3 days a week.

As mostly male physicians retire, it will be difficult to replace their working contribution, given the gender balance and working preferences of new physicians. -ag

Needs and Results

We are being lied to about the uninsured. They are getting care. I operate on at least 2 illegal immigrants each month who pay me nothing. The children's hospital at which I operate also charges them nothing. This is true not only of Atlanta, but of every community in America.

I urge all of you to contact your congressmen/women and senators to defeat this bill. I promise you that you will not like rationing of your own healthcare.

Health-Care Reform: A Better Plan
08/07/09 - Washington Post by Charles Krauthammer

[edited] Today's ruling Democrats propose to fix our extremely high-quality (but inefficient and therefore expensive) health-care system with 1,000 pages of curlicued complexity.

They promise that this massive concoction will lower costs. Their solution is employer mandates, individual mandates, insurance company mandates, allocation formulas, political payoffs, and myriad other regulations and interventions

This is all quite mad. It creates a Rube Goldberg system that multiplies current inefficiencies and arbitrary rules. This will produce staggering deficits, less choice, and lower-quality care. That's why the administration can't sell Obamacare.

The administration accuses critics of being for the status quo. Nonsense. Candidate John McCain and a host of other Republicans have offered alternatives.

Let me offer my plan. Strip away current inefficiencies before remaking one-sixth of the U.S. economy. There are just two parts: radical tort reform, and severing the link between health insurance and employment.

Eight Years of U.S. Military Healthcare
03/13/10 - Comment by LisaM at NeoNeocon

Read the whole thing. Here is an edited summary. All of the rules and attitudes operate to ration care while hiding that policy.

Motto: We care for everyone who calls us. You just have to call at the right time.

I used the U.S. military medical system for 8 years as a family member. The doctors were great and they were only interested in treating patients. However, the infrastructure around them was maddening and dangerous.

You could only call at 7:00 AM on the first Tuesday of the month to schedule an OB/GYN appointment. While trying to call, all appointments were taken by 7:10, and you had to try again the following month.

My sister had ovarian cancer and needed 6 month checkups. She was called selfish when she tried to make more than one appointment per year. She would be dead now if she had not paid personally for extra civilian screenings.

I was at the Portsmouth Naval hospital. They sent me to the lab on the 8th floor. The elevator was broken. They called my name while I was trudging up and down the steps, and I missed my turn. Too bad for me.

I waited 4 hours at the pharmacy for a prescription. I noted that the medication was different than written. They told me I was lucky to get that.

The day I escaped government-run health care was a very happy day indeed.

19 Years of Army Medicine
03/13/10 - Comment by Gray at NeoNeocon

[excerpts] Strep throat. Diagnosed as strep, but only given 7 days of antibiotics: “that is how we do it, soldier.” Violent recurrence with sepsis. Week of IV antibiotics. “Thought we almost lost you there.”

Pneumonia. Incorrectly diagnosed as allergies: “You need plenty of physical training and water. Try some triaminic cough syrup for those allergies.” 103deg fever. Passed out at my desk taken to Army hospital. Days of delerium. IV antibiotics. “Thought we almost lost you there.”

At Kimbrough (nicknamed Killbro) hospital at FT Meade, Maryland, they killed my units’ Sergeant Major following surgery for diverticulitis. He was 40 and passed out during a run, after his ill-sutured bowel leaked into his body. Peritonitis.