STORY #1—-DELAY IS PREFERABLE TO ERROR
Public support for the law has waned and opposition has held steady. July 47% thought the laws was bad. Dems continued control of the senate, so comprehensive repeal isn’t in the cards now. The right course for the moment is delay. The delayed parts of obamacare is the employer mandate, the income and health status verification requirements for individual in state-based exchanges, and the requirements that employer health insurance plans cap employees out of pocket deductible costs. The adm affinities for crony capitalism that the part of the law obama has chosen to delay have been those that big business most wanted to have delayed-and prudent. What is the case against delaying the exchanges as a whole? They lack adequate privacy and security measure, and they plagued by broader implementation problems that are becoming increasingly obvious across the nation, implementation looks to be a real mess. The obama adm. Has come up with a bureaucratic dispensation to provide special treatment for senators and congressmen in the exchanges.
This is no longer a political debate; this is what we call the law. It was passed and signed 3 years ago. The SC upheld it a year ago. The president was reelected. This is the law of the land. Peter Suderman writes: obama has chosen to ignore the law of the land by selectively enforcing provisions encouraging government agencies and ignoring clear legislative language that conflicts with the adm goals. The delay of the employer mandate is not supported by statue. Authority to enact the delay obama has not even tried to claim that it is : instead he has simply asserted the authority to delay the provision and then returned to criticizing republican opposition. As Thomas Jefferson wrote to Washington in 1792, “delay is preferable to error”. Obamacare is to adopt a phrase used by Jefferson in a more famous place, “unfit to be the law of the free people”.
Source-weekly standard, William kristol, wsj,
STORY #2:—HOW MANY EXPERTS TO ADVISE A DYING PATIENT
Called death panel—obamacare many cost/benefit bureaucratic boards would lead to explicit health care rationing; and that doctors paid to “counsel” elderly and dying patients about end-of –life treatment would actually pressure them to refuse expensive treatments. Lack of popular trust, the end-of-life counseling provision was dropped to grease the way fro obamacare final passage. Now the proposal is back in both the house and senate with bipartisan support. The Care Planning Act of 2013 is the most far-reaching of the bills. Supported by the AARP and sponsored by senator Warner and Isakson the bill ostensibly aims to compensate medical providers who accept Medicare and Medicaid for participating in end-of –life treatment discussions with patients. Once the federal government sets the pay, it will make the rules. If they want to be reimbursed, doctors will have to structure the conservations in the way the government instructs. This bill is 46 pages long. It would create a Care Planning Advisory Board an expert panel of 15 members, 3 appointed by the president and the remainder by the four partisan leaders of the house and senate. Imagine the patronage opportunities. the board will advise how to “a assure that individuals with advanced illness receive person and family centered care”. The board will also investigate and recommend way the government can ensure that qualified patients” develop a treatment plan that is formed around their goals values and preferences that is informed by research on disease trajectory”. To ensure that care plans are “realistic, actionable and concrete. The board will help the government “develop and promote best practices in communications about advanced illness between providers, individual and family caregivers in different settings, including acute care hospitals. Since patients can only receive paid counseling-“once in each 12 month period. Still more regulations will needed. Patients are to receive the services of a multi-disciplinary “core team” made up of a “physician or an advanced practice registered nurse, a social nurse, a nurse and a minister or the individuals personal religious or spiritual adviser”. The team can be expanded when necessary to include a pharmacist. A licensed clinical social worker and a psychologist,” along with anyone also who meets the :”requirements that may be established by the ‘secretary”.
Isn’t helping patients decide on appropriate treatment already part of a doctor job? Hospices-covered by Medicare and Medicaid now use the multidisciplinary approach without having been told to by Washington. The bill also requires “culturally and educationally appropriate training for individual and family care givers to support their ability to carry out the plan. The bill facilitates the creation of advance directives and care planning consistent with patient values. The bill specifically permits doctors to refuse to provide wanted end of life care based on their own conscience, if such refusals are allowed by state law. Problems exist in ensuring that all patients receive optimal care.
Sources-weekly standard, Wesley smith,