On Fox News' Hannity tonight (7/28), Fox Business VP Alexis Glick briefly mentioned the need to "address ERISA", meaning to fix the unintentionally created shield against liability that Congress gave the insurance industry when they tried to provide protection for employee pension plans in the 1970's.
It's about time someone brought this issue to the forefront. Good for you, Alexis! And thank you for confirming my opinion that a fix of ERISA is long overdue.
Tuesday, July 28, 2009
Sunday, July 19, 2009
Rationing Debate or Debating Rationing
I found an editorial in The New York Times today that was published in the July 15 edition. (To think that I would ever be quoting from The New York Times, of all places!) The editorial is entitled Why We Must Ration Health Care, and I actually found it an interesting read, despite the fact that is somewhat long. (Yeah, me complaining that something is long; pot, meet kettle.)
What I found interesting about this article is that the majority of it is actually a reasoned discussion of the factors that need to be and usually are considered in any kind of consideration of rationing. Since these concepts are going to be brought up again and again in the future as we head into the brave new world of "health care reform", I think it is important that everyone be up to speed on the terminology.
The editorial is written by a bioethicist, Peter Singer. Like most discussions that I have read by other ethicists, I can take issue with a few of his points. But I will also acknowledge that some of his points are unquestionably valid, and I have already broached some of these, such as when I said, "for the reality really is we cannot afford to continue doing things the way we have been"; this was just another way of stating that, at some point, rationing of some kind would eventually come into play -- the only issue is whether it is going to be controlled rationing under established rules or rationing controlled by the twisting winds of random fate.
Mr. Singer starts out by outlining that 'health care' resources are "scarce"; I'll dispute that word, but they are finite, and that eventually leads to the same thing. Such scarce resources end up being rationed in one way or another, and the debate is about trying to use these resources in the most beneficial way.
This is the first point where I take issue with Mr. Singer. I don't think that there are too many thinking persons in this country who believe that we can provide unlimited medical care to all comers. Most people accept (if only subconsciously and reluctantly) that rationing is "inescapable". I will argue that most people do not feel it is desirable. And that is because most people start with the premise that okay, there's going to be rationing, but who's going to be making the decisions and how can I make sure I'm not going to get shafted?
Mr. Singer then spends a few paragraphs beating the dead horse of de facto rationing because of high costs, using drugs such as Sutent and Temodar and Gleevac as examples. Of course the tacit implication is that under rationing some people wouldn't get these drugs. The concept of trying to eliminate some of the factors (such as class-action lawsuits, insurance company formularies, and the glacially slow FDA drug approval process) that might make these drugs cheaper doesn't occur to him, as it doesn't support his argument.
He then tries to claim that lack of insurance coverage itself is killing people:
I would love to see this study to see how they reached this conclusion. Most people brought in from major trauma events don't even stop at the registration desk. Medical care begins immediately, and the medical team working on the patient has no idea what kind of coverage or lack of coverage any patient has. Since the advent of EMTALA, most of the hospitals I've worked at don't even let the info on a patient's coverage or lack thereof onto the ER chart until after emergency stabilization has been completed. So how is lack of insurance causing this higher death rate? Could there be some other reason?
Aha! One of the young invincibles! Young, not sick, refuses insurance even when offered by his employer -- a risk taker. And that risk taking likely extends to how he drives. Could it be that the higher death rate has something to do with more severe trauma? Was this even considered in the study? We aren't told. And were the insured trauma victims age and gender matched to the non-insured? Again we aren't told. Since this study was an economics study and not a medical one, I have my doubts.
While discussing years of life saved and Quality-Adjusted Life Years, (see the editorial!) Mr. Singer also covers the fact that human beings are not very good at intuitively comprehending the dimensions of risk reductions from taking certain actions. For example, consider the patient who is excessively worried about his borderline elevated triglyceride level (a minor risk factor for coronary artery disease) while refusing to even consider stopping smoking (probably the biggest risk factor for cardiovascular disease there is). He also discusses, in the concept of QALY, the perceived cost of disabilities by those not disabled and by those that are. And here things get interesting and we get to the heart of the rationing debate -- who's making the decision and how am I going to make sure I don't get shafted?
The real problem here is that Mr. Singer thinks it is a paradox that persons with disabilities want both their disabled lives prolonged and their disabilities cured. The man off the street wouldn't see this as contradictory. This would only occur to ivory tower eggheads. And maybe to eugenicists. Everyone else recognizes that people with disabilities are first and foremost people.
Mr. Singer himself nails the real sticking point in this rationing debate when he says:
The point is that there is no social consensus on this idea of rationing. That's why it's so contentious. And that's why trying to do it should wait until there is a consensus, or at least the beginnings of one. That will require a debate that we haven't had yet and that we may not even be ready for. The current crisis it that the Obama administration is full of people who want to force their views on everyone, because they think they know better.
Well, Mr. President, know this: How you and your people want to ration medical care is NOT how I would do it. And how I would want to do it is NOT how you, my good reader, would want to do it. How do I know without asking you?
Simple. We are nowhere near a consensus on this.
What I found interesting about this article is that the majority of it is actually a reasoned discussion of the factors that need to be and usually are considered in any kind of consideration of rationing. Since these concepts are going to be brought up again and again in the future as we head into the brave new world of "health care reform", I think it is important that everyone be up to speed on the terminology.
The editorial is written by a bioethicist, Peter Singer. Like most discussions that I have read by other ethicists, I can take issue with a few of his points. But I will also acknowledge that some of his points are unquestionably valid, and I have already broached some of these, such as when I said, "for the reality really is we cannot afford to continue doing things the way we have been"; this was just another way of stating that, at some point, rationing of some kind would eventually come into play -- the only issue is whether it is going to be controlled rationing under established rules or rationing controlled by the twisting winds of random fate.
Mr. Singer starts out by outlining that 'health care' resources are "scarce"; I'll dispute that word, but they are finite, and that eventually leads to the same thing. Such scarce resources end up being rationed in one way or another, and the debate is about trying to use these resources in the most beneficial way.
The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?
This is the first point where I take issue with Mr. Singer. I don't think that there are too many thinking persons in this country who believe that we can provide unlimited medical care to all comers. Most people accept (if only subconsciously and reluctantly) that rationing is "inescapable". I will argue that most people do not feel it is desirable. And that is because most people start with the premise that okay, there's going to be rationing, but who's going to be making the decisions and how can I make sure I'm not going to get shafted?
Mr. Singer then spends a few paragraphs beating the dead horse of de facto rationing because of high costs, using drugs such as Sutent and Temodar and Gleevac as examples. Of course the tacit implication is that under rationing some people wouldn't get these drugs. The concept of trying to eliminate some of the factors (such as class-action lawsuits, insurance company formularies, and the glacially slow FDA drug approval process) that might make these drugs cheaper doesn't occur to him, as it doesn't support his argument.
He then tries to claim that lack of insurance coverage itself is killing people:
But even in emergency rooms, people without health insurance may receive less health care than those with insurance. Joseph Doyle, a professor of economics at the Sloan School of Management at M.I.T., studied the records of people in Wisconsin who were injured in severe automobile accidents and had no choice but to go to the hospital. He estimated that those who had no health insurance received 20 percent less care and had a death rate 37 percent higher than those with health insurance. This difference held up even when those without health insurance were compared with those without automobile insurance, and with those on Medicaid — groups with whom they share some characteristics that might affect treatment. The lack of insurance seems to be what caused the greater number of deaths.
I would love to see this study to see how they reached this conclusion. Most people brought in from major trauma events don't even stop at the registration desk. Medical care begins immediately, and the medical team working on the patient has no idea what kind of coverage or lack of coverage any patient has. Since the advent of EMTALA, most of the hospitals I've worked at don't even let the info on a patient's coverage or lack thereof onto the ER chart until after emergency stabilization has been completed. So how is lack of insurance causing this higher death rate? Could there be some other reason?
Those who died were on average around 30 years old ......
Aha! One of the young invincibles! Young, not sick, refuses insurance even when offered by his employer -- a risk taker. And that risk taking likely extends to how he drives. Could it be that the higher death rate has something to do with more severe trauma? Was this even considered in the study? We aren't told. And were the insured trauma victims age and gender matched to the non-insured? Again we aren't told. Since this study was an economics study and not a medical one, I have my doubts.
While discussing years of life saved and Quality-Adjusted Life Years, (see the editorial!) Mr. Singer also covers the fact that human beings are not very good at intuitively comprehending the dimensions of risk reductions from taking certain actions. For example, consider the patient who is excessively worried about his borderline elevated triglyceride level (a minor risk factor for coronary artery disease) while refusing to even consider stopping smoking (probably the biggest risk factor for cardiovascular disease there is). He also discusses, in the concept of QALY, the perceived cost of disabilities by those not disabled and by those that are. And here things get interesting and we get to the heart of the rationing debate -- who's making the decision and how am I going to make sure I don't get shafted?
If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics. That clashes with the idea that all human lives are of equal value. The problem... [lies]...with the judgment that, if faced with 10 years as a quadriplegic, one would prefer a shorter lifespan without a disability..... If [we ask quadriplegics themselves to evaluate life with quadriplegia,] and we find that quadriplegics would not give up even one year of life as a quadriplegic in order to have their disability cured, then the QALY method does not justify giving preference to procedures that extend the lives of people without disabilities over... the lives of people with disabilities....... This method of preserving our belief that everyone has an equal right to life is... a double-edged sword. If life with quadriplegia is as good as life without it, there is no health benefit to be gained by curing it. That implication ... would have been vigorously rejected by someone like Christopher Reeve, who, after being paralyzed in an accident, campaigned for more research into ways of overcoming spinal-cord injuries. Disability advocates, it seems, are forced to choose between insisting that extending their lives is just as important as extending the lives of people without disabilities, and seeking public support for research into a cure for their condition.
The real problem here is that Mr. Singer thinks it is a paradox that persons with disabilities want both their disabled lives prolonged and their disabilities cured. The man off the street wouldn't see this as contradictory. This would only occur to ivory tower eggheads. And maybe to eugenicists. Everyone else recognizes that people with disabilities are first and foremost people.
Mr. Singer himself nails the real sticking point in this rationing debate when he says:
...but if there is a social consensus that we should give priority to those....
The point is that there is no social consensus on this idea of rationing. That's why it's so contentious. And that's why trying to do it should wait until there is a consensus, or at least the beginnings of one. That will require a debate that we haven't had yet and that we may not even be ready for. The current crisis it that the Obama administration is full of people who want to force their views on everyone, because they think they know better.
Well, Mr. President, know this: How you and your people want to ration medical care is NOT how I would do it. And how I would want to do it is NOT how you, my good reader, would want to do it. How do I know without asking you?
Simple. We are nowhere near a consensus on this.
My Response to the AMA
The AMA, after previously stating that they were not in favor of any health care reform plan that included a public option, has recently and surprisingly done a 180 degree reverse course and effectively endorsed the House of Representatives (Democrat) health care reform bill, H.R. 3200, "America's Affordable Health Choices Act of 2009". I am flabbergasted; I am sick; I am angry; I am more postal than I have ever been before. Good thing I don't own a gun.
I have expressed my displeasure in an email to James Rohack, M.D., the current president of the AMA. Following is the text of that letter:
I am completely aghast at the AMA’s endorsement of H.R. 3200, “America's (so-called) Affordable Health Choices Act of 2009". I cannot believe that the leaders of the AMA could have been led so astray by this misbegotten piece of legislation that they could endorse a plan that is tantamount to the premeditated murder of the greatest medical care system in the world.
I am not opposed to the concept of reform of what we call our ‘healthcare’ system, even though it is not now and never has been a healthcare system -- we have a medical care system, the best in the world, and this is significantly different from a system to promote health, a distinction that is crucially important but is being completely ignored. However, increasing government control of the medical care system (which H.R. 3200 does) will make matters worse rather than better. This is reform only if you consider tightening the garrote around one’s neck to be reform. Even cursory examination of the bill reveals that it calls for the creation of at least 31 new federal programs, agencies, and commissions (and the necessary bureaucracies to support each one) all to increase the regulation of medical care. These new programs and agencies include such horrors as a new Health Choice Administration (sitting alongside the Centers for Medicare and Medicaid Services and the Department of Health and Human Services) and a new National Health Care Workforce Commission, whose task will be to decide when and where medical care workforces can and will be altered (and likely decreased as the need for rationing becomes ever more necessary under this plan). Complying with the new regulations to be promulgated by all these bureaucracies will increase both the cost and the hassle of operating a medical practice at a time when practice revenues will be going down. And yes, I said down.
In an editorial posted on the Heritage Foundation website, John O’Shea M.D. discusses testimony presented before the House Energy and Commerce Committee by The Lewin Group. In this testimony, they estimated that “if the public plan is open to individuals and all employers using Medicare payment levels plus 5 percent, as planned, physician net income would fall by 5.4 percent. The loss of net-income would average about $16,207 per physician.” Furthermore, this decrease is probably underestimated, since The Lewin Group predicts that 113.5 million people would be shifted by their employers from private insurance to the public plan, with the concurrent decrease in revenue that would subsequently entail. With the fines to employers set at no more than 8% of payroll if employers do not provide insurance (and even lower for small businesses with smaller payrolls), I feel that the estimate of only 113.5 million people being moved to the public option is decidedly too low. H.R. 3200 will therefore serve as the back door into a de facto government-controlled, single-payer system to which AMA policy is supposedly opposed.
H.R. 3200 does not provide for any improvement in the runaway costs of the medical care system. The Congressional Budget Office’s initial estimate of the cost of this program is set at over $1 trillion dollars over the first ten years. The CBO also specifically notes, “It is important to note that the figures presented here do not represent a complete cost estimate for the coverage provisions of the legislation. They reflect specifications provided by the committee staff rather than detailed analysis of the legislative language.” In other words, it is based on an analysis of only part of the proposed legislation; if all of it were analyzed, the costs would likely be higher. This will add at least $219 billion more to the federal deficit at a time when it is already at unprecedented highs. The CBO also states in their analysis that nothing in H.R. 3200 will reduce the rate of growth of medical costs, despite that being its sole reason for being proposed.
The CBO estimate also covers only the first ten years, with most of the expenditures in the second half of that ten year period. The cost of the second ten years (and so on) is not addressed. Recall that the first-ten-year estimates for Medicare Part D were only $400 billion, but the estimates for the second ten years are at least $1 trillion for Medicare Part D alone. Also remember that the AMA opposed the creation of Medicare and Medicaid in the first place, back in the 1960’s, with one of the objections being that the cost estimates were woefully low. The AMA was correct then: in its first year Medicare cost $64 million, while it has now ballooned to a $500 billion/yr program, while Medicaid has expanded from $770 million in its first year to $264 billion/yr today. Government predictions of the cost of programs are always inaccurate to the low side. If the rate of growth of the cost of H.R. 3200 is the 6% stated by the CBO, then within 25 years this program will be costing the USA as much more again as Medicare costs now. The CBO is right -- it is unsustainable.
This does not even consider the fact that the Virginia-based Council for Affordable Health Insurance has estimated that the administrative expenses of both Medicare and Medicaid over the last decade were 66% higher than those of private sector health insurance companies. There is no reason to suspect that the administrative expenses of H.R. 3200 will be any less and every reason to expect that they will be greater.
True reform is not the expansion of governmental regulation and control of the medical care system. True reform is the reduction if not elimination of unnecessary governmental regulation and control of the medical care system. True reform is a return to a situation in which patient care is delivered and decided upon by a patient and his or here physician without the intrusion of the government or an insurance company. True reform is a system in which the financial aspects of medical care are also between the patient and the physician, with the insurance company only dealing financially with the patient. True reform is a system in which insurance is permanently and irrevocably detached from employment, with the tax incentives for buying insurance granted to the individual, and the employer giving the employee the funds to pay for that insurance through higher wages. True reform allows the power of the free market, which has been kept in chains for the last 70 or more years by ever-increasing governmental regulations, to be turned loose and increase efficiency and quality. True reform requires the government to step in only to eliminate predatory practices and to help out those few individuals who truly cannot provide for themselves. (And this last only because the USA is a Christian and charitable society, and not because there is some bogus universal “right” to medical care.)
H.R. 3200 does none of these things. It in fact does the exact opposite of every one of them.
Since I entered medical school 24 years ago, I have been a member of the AMA. I joined because I thought it was important for physicians to have an organization to speak for them collectively, to fight for what we need and what our patients need -- to fight against primarily the government as I recognized even then that it was the government from which we physicians have the most to fear. Repeatedly I have been let down by the AMA as I watched the organization walk away from contest after contest with the government, not bloodied and beaten, but whimpering and skulking away without even engaging in the battle. For ten years or more I have waited for the AMA to bring the issue of the SGR to a crisis point by walking away from the negotiating table and saying ‘call us back when you’re willing to talk seriously -- and by the way, we’ll enjoy watching you try to provide medical care without any physicians’, only to be disappointed year after year with temporary fixes which provided little relief from the increasing inflation affecting the cost of running a practice and no resolution to the problem with the SGR. We have always had the power to fix the SGR, but you -- the AMA -- refused to use it. And now to get a fix for the SGR, the AMA is swallowing a poisoned pill that will kill everything that is great about the American medical care system. It was my belief that the AMA was supposed to stand behind me. I didn't expect it was so they could stab me in the back with a dagger, not just once, but dozens or hundreds of times.
I insist that the AMA reverse this decision on supporting H.R. 3200 and that the AMA go on the offensive opposing this abomination before it is too late -- too late for the medical profession, too late for our patients, and too late for the greatest medical care system ever created by mankind.
If the AMA will not change course on this issue, I will have no other recourse but to cancel my membership and demand that all money that I have ever donated to AMPAC be returned to me. I do not wish for any of the funding that has led to this looming catastrophe to have come from me. And I will urgently encourage all of my colleagues to do the same.
I have expressed my displeasure in an email to James Rohack, M.D., the current president of the AMA. Following is the text of that letter:
I am completely aghast at the AMA’s endorsement of H.R. 3200, “America's (so-called) Affordable Health Choices Act of 2009". I cannot believe that the leaders of the AMA could have been led so astray by this misbegotten piece of legislation that they could endorse a plan that is tantamount to the premeditated murder of the greatest medical care system in the world.
I am not opposed to the concept of reform of what we call our ‘healthcare’ system, even though it is not now and never has been a healthcare system -- we have a medical care system, the best in the world, and this is significantly different from a system to promote health, a distinction that is crucially important but is being completely ignored. However, increasing government control of the medical care system (which H.R. 3200 does) will make matters worse rather than better. This is reform only if you consider tightening the garrote around one’s neck to be reform. Even cursory examination of the bill reveals that it calls for the creation of at least 31 new federal programs, agencies, and commissions (and the necessary bureaucracies to support each one) all to increase the regulation of medical care. These new programs and agencies include such horrors as a new Health Choice Administration (sitting alongside the Centers for Medicare and Medicaid Services and the Department of Health and Human Services) and a new National Health Care Workforce Commission, whose task will be to decide when and where medical care workforces can and will be altered (and likely decreased as the need for rationing becomes ever more necessary under this plan). Complying with the new regulations to be promulgated by all these bureaucracies will increase both the cost and the hassle of operating a medical practice at a time when practice revenues will be going down. And yes, I said down.
In an editorial posted on the Heritage Foundation website, John O’Shea M.D. discusses testimony presented before the House Energy and Commerce Committee by The Lewin Group. In this testimony, they estimated that “if the public plan is open to individuals and all employers using Medicare payment levels plus 5 percent, as planned, physician net income would fall by 5.4 percent. The loss of net-income would average about $16,207 per physician.” Furthermore, this decrease is probably underestimated, since The Lewin Group predicts that 113.5 million people would be shifted by their employers from private insurance to the public plan, with the concurrent decrease in revenue that would subsequently entail. With the fines to employers set at no more than 8% of payroll if employers do not provide insurance (and even lower for small businesses with smaller payrolls), I feel that the estimate of only 113.5 million people being moved to the public option is decidedly too low. H.R. 3200 will therefore serve as the back door into a de facto government-controlled, single-payer system to which AMA policy is supposedly opposed.
H.R. 3200 does not provide for any improvement in the runaway costs of the medical care system. The Congressional Budget Office’s initial estimate of the cost of this program is set at over $1 trillion dollars over the first ten years. The CBO also specifically notes, “It is important to note that the figures presented here do not represent a complete cost estimate for the coverage provisions of the legislation. They reflect specifications provided by the committee staff rather than detailed analysis of the legislative language.” In other words, it is based on an analysis of only part of the proposed legislation; if all of it were analyzed, the costs would likely be higher. This will add at least $219 billion more to the federal deficit at a time when it is already at unprecedented highs. The CBO also states in their analysis that nothing in H.R. 3200 will reduce the rate of growth of medical costs, despite that being its sole reason for being proposed.
The CBO estimate also covers only the first ten years, with most of the expenditures in the second half of that ten year period. The cost of the second ten years (and so on) is not addressed. Recall that the first-ten-year estimates for Medicare Part D were only $400 billion, but the estimates for the second ten years are at least $1 trillion for Medicare Part D alone. Also remember that the AMA opposed the creation of Medicare and Medicaid in the first place, back in the 1960’s, with one of the objections being that the cost estimates were woefully low. The AMA was correct then: in its first year Medicare cost $64 million, while it has now ballooned to a $500 billion/yr program, while Medicaid has expanded from $770 million in its first year to $264 billion/yr today. Government predictions of the cost of programs are always inaccurate to the low side. If the rate of growth of the cost of H.R. 3200 is the 6% stated by the CBO, then within 25 years this program will be costing the USA as much more again as Medicare costs now. The CBO is right -- it is unsustainable.
This does not even consider the fact that the Virginia-based Council for Affordable Health Insurance has estimated that the administrative expenses of both Medicare and Medicaid over the last decade were 66% higher than those of private sector health insurance companies. There is no reason to suspect that the administrative expenses of H.R. 3200 will be any less and every reason to expect that they will be greater.
True reform is not the expansion of governmental regulation and control of the medical care system. True reform is the reduction if not elimination of unnecessary governmental regulation and control of the medical care system. True reform is a return to a situation in which patient care is delivered and decided upon by a patient and his or here physician without the intrusion of the government or an insurance company. True reform is a system in which the financial aspects of medical care are also between the patient and the physician, with the insurance company only dealing financially with the patient. True reform is a system in which insurance is permanently and irrevocably detached from employment, with the tax incentives for buying insurance granted to the individual, and the employer giving the employee the funds to pay for that insurance through higher wages. True reform allows the power of the free market, which has been kept in chains for the last 70 or more years by ever-increasing governmental regulations, to be turned loose and increase efficiency and quality. True reform requires the government to step in only to eliminate predatory practices and to help out those few individuals who truly cannot provide for themselves. (And this last only because the USA is a Christian and charitable society, and not because there is some bogus universal “right” to medical care.)
H.R. 3200 does none of these things. It in fact does the exact opposite of every one of them.
Since I entered medical school 24 years ago, I have been a member of the AMA. I joined because I thought it was important for physicians to have an organization to speak for them collectively, to fight for what we need and what our patients need -- to fight against primarily the government as I recognized even then that it was the government from which we physicians have the most to fear. Repeatedly I have been let down by the AMA as I watched the organization walk away from contest after contest with the government, not bloodied and beaten, but whimpering and skulking away without even engaging in the battle. For ten years or more I have waited for the AMA to bring the issue of the SGR to a crisis point by walking away from the negotiating table and saying ‘call us back when you’re willing to talk seriously -- and by the way, we’ll enjoy watching you try to provide medical care without any physicians’, only to be disappointed year after year with temporary fixes which provided little relief from the increasing inflation affecting the cost of running a practice and no resolution to the problem with the SGR. We have always had the power to fix the SGR, but you -- the AMA -- refused to use it. And now to get a fix for the SGR, the AMA is swallowing a poisoned pill that will kill everything that is great about the American medical care system. It was my belief that the AMA was supposed to stand behind me. I didn't expect it was so they could stab me in the back with a dagger, not just once, but dozens or hundreds of times.
I insist that the AMA reverse this decision on supporting H.R. 3200 and that the AMA go on the offensive opposing this abomination before it is too late -- too late for the medical profession, too late for our patients, and too late for the greatest medical care system ever created by mankind.
If the AMA will not change course on this issue, I will have no other recourse but to cancel my membership and demand that all money that I have ever donated to AMPAC be returned to me. I do not wish for any of the funding that has led to this looming catastrophe to have come from me. And I will urgently encourage all of my colleagues to do the same.
Wednesday, July 08, 2009
One Last Parting Shot at Jack
I can't resist taking one last shot at you, Jacksmith.
From your blog:
Obviously, you are not covered by Medicare and you do not receive your care from the VA Medical System. Otherwise you would not have made such an incredibly foolish statement as this one.
The only payer without a conflict of interest in patient care is the PATIENT. Any third party payer will always have a conflict of interest in paying for a patient's care, and that conflict is always monetary. Any third party payer, including the government, has the desire to spend as little as possible for a patient's care. For an insurance company, this is motivated by the desire for corporate profit. For a governmental agency, the motivation is to try to minimize the "waste" of tax dollars, for the agency will always be operating within a limited budget given it by the legislative body creating the agency. See the first few pages of Chapter 20 of Newt Gingrich's Real Change for a very good description of this topic.
If you think that the corporate world is more ruthlessly brutal in its mission than a governmental agency, then you must live in an alternate reality from the rest of us. If you think a governmental agency will ever have your best interests at heart, you must be certifiably insane.
Corporations can only go so far before they run off their customers and the physicians and other health care providers that they must have working with them in order to be able to sell their product. A governmental agency need not cajole cooperation -- it can mandate it through the power of bureaucratic or legislative action. A governmental agency need care only about what it wants, not what anybody else needs. And a governmental agency created as the single provider of "health care" will quickly become supremely ruthless in this endeavor.
After all, isn't this supposedly why we're entertaining this foolishness -- because "we're spending too much of our GDP on health care"? If this is the true motivation, then the created bureaucracy's only goal, and only interest, will be reducing the total outlay of dollars, patient care be damned.
That is the difference between you and me, Jack. You see government as a savior, as a benevolent parent which will always do what is best for its children. I see government as a bureaucratic version of kudzu, choking the life out of every aspect of our society that it intrudes itself upon.
As we know here in the South, kudzu must be fought against constantly to keep it from taking over. The same goes for government. But I forget -- you are a Communist. You are kudzu.
From your blog:
You see, one of the most important aspects of a universal healthcare system is easy access, and patient protection. This is accomplished by having a single payer without a conflict of interest in patient care. And by having a payer who has the power to enforce minimum standards of excellence in healthcare delivery for everyone in the plan.
Obviously, you are not covered by Medicare and you do not receive your care from the VA Medical System. Otherwise you would not have made such an incredibly foolish statement as this one.
The only payer without a conflict of interest in patient care is the PATIENT. Any third party payer will always have a conflict of interest in paying for a patient's care, and that conflict is always monetary. Any third party payer, including the government, has the desire to spend as little as possible for a patient's care. For an insurance company, this is motivated by the desire for corporate profit. For a governmental agency, the motivation is to try to minimize the "waste" of tax dollars, for the agency will always be operating within a limited budget given it by the legislative body creating the agency. See the first few pages of Chapter 20 of Newt Gingrich's Real Change for a very good description of this topic.
If you think that the corporate world is more ruthlessly brutal in its mission than a governmental agency, then you must live in an alternate reality from the rest of us. If you think a governmental agency will ever have your best interests at heart, you must be certifiably insane.
Corporations can only go so far before they run off their customers and the physicians and other health care providers that they must have working with them in order to be able to sell their product. A governmental agency need not cajole cooperation -- it can mandate it through the power of bureaucratic or legislative action. A governmental agency need care only about what it wants, not what anybody else needs. And a governmental agency created as the single provider of "health care" will quickly become supremely ruthless in this endeavor.
After all, isn't this supposedly why we're entertaining this foolishness -- because "we're spending too much of our GDP on health care"? If this is the true motivation, then the created bureaucracy's only goal, and only interest, will be reducing the total outlay of dollars, patient care be damned.
That is the difference between you and me, Jack. You see government as a savior, as a benevolent parent which will always do what is best for its children. I see government as a bureaucratic version of kudzu, choking the life out of every aspect of our society that it intrudes itself upon.
As we know here in the South, kudzu must be fought against constantly to keep it from taking over. The same goes for government. But I forget -- you are a Communist. You are kudzu.
Sunday, July 05, 2009
Jacksmith, Here is My Response
In my last post, I linked to a very concise and powerful critique of the Obama "health care" reform plan. I got a response to this posting, which you can see at the link, but which I will repeat here for posterity:
"AMERICA’S NATIONAL HEALTHCARE EMERGENCY!
It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.
STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.
We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.
And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.
Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and request that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).
Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.
In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!
If President Obama has to declare a NATIONAL STATE OF EMERGENCY to rescue the American people from our healthcare crisis, he will need all the sustained support you can give him. STICK WITH HIM! He’s doing a brilliant job.
THIS IS THE BIG ONE!
THE BATTLE OF GOOD Vs EVIL!
Join the fight.Contact congress and your representatives NOW! AND SPREAD THE WORD!
God Bless You
Jacksmith – WORKING CLASS"
I have not altered this in anyway, though copying it here did cause it to lose most of its formatting which is unfortunate. Please, go to the link above and look at this comment in its glorious original. I replied briefly, saying that I would respond in detail to this comment later. This post is my response. I also said that the writer, Jacksmith, had won a special prize.
Your prize, Jacksmith, is the formal recognition that you have contributed the first idiot comment in the history of Rantings of a Medical Mind.
Now, I have received a tiny number of spam comments. Those did not see the light of day. But your comment, Jacksmith, is the first comment that I have received (and I have received precious few comments) that violates the rule that I set out at the very outset of my blog. In my very first post I stated that "I will welcome your comments and critiques of my thoughts. I enjoy a spirited debate on the issues." Your comment, Jacksmith -- may I call you Jack? -- provides neither a critique of my thoughts nor is it a spirited debate on the issues.
Jack, your comment is merely a regurgitation of talking points designed to fear-monger and create distress amongst those unfortunate enough to read it. It also contains so much garbage in terms of what passes for "information" that it cannot be taken seriously.
BTW, Jack, I did find you. With your oh-so-common nom de plume, I wasn't sure that I'd be able to run you down, but find you I did. Let's take a look at this posting on Slate -- same stupid arguments, same violation of netiquette by SCREAMING ALL THE TIME, same signature (Jack Smith -- Working Class) -- yep, that's gotta be you. And you have your own blog! But come on, you've only put up one post? I'm well up into the sixties. I will say though, at least it's good to get confirmation that other people are reading my writings, even if it is someone whose brain cells no longer function properly.
Let's begin the autopsy of your comment.
First, we'll cover what you inadvertently happened to get right. Since my post regarded President Obama's public option, and your diatribe did cover that, it was on topic. You mentioned the global H1N1 pandemic -- okay, I'll accept the WHO proclamation on this (even though if the current Mexican flu outbreak defines a pandemic, we need a new word for something like the Spanish flu or the Medieval Black Death). And by the quoted numbers, we do spend something like two times as much of our GDP on "health care" as many other nations, though that number is always in flux. That's about it. Everything else is wrong. Or a lie. And really, what's the difference, except in intent? If you're just mistaken, it means you're an idiot. If you're lying, it means you're a tool of people who are using you to push their agenda, even though you, and everyone else right along with you, will ultimately pay for it in the end (literally and figuratively). I'll choose to be kind and call you an idiot, for in my book, being a tool is far worse.
On second thought, after reading your single blog post, I will have to retract my assessment of you. You are both an idiot and a tool.
Your concern about the Mexican flu is not totally warranted. As of July 3, 2009 (2 days ago), WHO has confirmed worldwide 89,921 cases of H1N1 with 382 deaths. This is a case fatality rate of 0.43%, much lower than that of the regular seasonal flu. The CDC reports, as of July 2, 2009, that in the US there have been 33,902 cases with 170 deaths, for a case fatality rate of 0.50%, again lower than that of the regular seasonal flu. So, currently, this flu is not something to get all hot and bothered about. It is true that the first cases of Tamiflu-resistant H1N1 have just now been reported, but you couldn't have known that when you posted your comment, so you get no points for that. Besides, we have medicines we can use other than Tamiflu.
In regards to your discussion of the H1N1 cases in Mexico, I don't know where you are getting your information, since the Mexican health authorities have been incredibly tight-lipped about what has been going on there. WHO reports only 10,262 confirmed cases in Mexico with 119 deaths, for a case fatality rate of 1.16%, higher than elsewhere, but still not terribly high (the Third World nature of the Mexican health care system may have something to do with this). Also, as reported in this article from Reuters, the higher case fatality rate in the area of origin of the epidemic is consistent with what has been seen with other epidemics in the past. This article also mentions that the majority of deaths in Mexico are among people under the age of 59, which is unusual for influenza and is NOT the pattern being seen elsewhere in the world. Investigators think this may be because people above age 52 may have some residual partial immunity from the last H1N1 strain that circulated before 1957.
[Yes, I am calling it the Mexican flu. Naming convention for influenza epidemics in the past have named the outbreak with the name of the country in which the outbreak was first publicly identified. In this case, Mexico drew the short straw. There is nothing racist about it. I'm sure that Spain doesn't like that the Spanish flu was named thusly, since the virus most likely originated in the American and European soldiers fighting World War I, but since the first public information about the outbreak came from Spain, the name became Spanish flu. By the same token, this flu is the Mexican flu.]
In your comment, Jack, you strongly push for the adoption of President Obama's health reform plan. Have you even read the plan? "Coverage can begin immediately through our current medicare system" -- Obama's plan doesn't change Medicare and does not involve enrolling anyone into Medicare. "Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan" -- Obama's plan doesn't call for the institution of direct payroll deductions for the public option, but rather the payment by the employer into the public pool, from which non-covered workers will receive funds to buy insurance from the Exchange. "With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry" -- Obama's plan doesn't call for the cancellation of the private insurance industry......
But I see from your blog post that what you are really after is a single payer, government controlled system. And you are too stupid to see that Obama's plan doesn't call for that -- oh, now I see. You are shilling for Obama's plan, a plan you favor, because you want a single payer system, and you also see Obama's plan as a way into a single payer system. Thank you for making that point crystal clear. (This was supposed to be a secret! For a tool, you really aren't very sharp, you know that?)
Furthermore, you want President Obama to declare a national health emergency if your precious plan doesn't pass, during which he is to seize all the insurance companies and impose the single payer system that the American people, through Congress, have just rejected. Now I know that certain laws were passed after 9/11 that allow the President (and even the state governors) to declare such emergencies and impose things like quarantines, forced vaccinations, forced redistribution of medical supplies, and the like, but these bills do not give the President the power to seize industries and impose radical system change. But you want him to have these powers. Because you are a "progressive Democrat". You are a "World Citizen" (from your blog). You are a member of the "Working Class". (Shouldn't that last one really be "Proletariat"?)
You really hate privately run "health care" systems, don't you, Jack? Look at the way you just shriek those hateful words -- "GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE". Is it just the profit driven "health care" system you hate, or is it any for-profit endeavor? How about taking over the computer industry, or the auto industry -- wait, bad example. President Obama has already done that. Bet that made you feel really good inside, didn't it? While the rest of America had to fight to keep from retching. And then there's this, from your blog:
Health care is a public service?? Not even electricity and water are public services. Regulated utilites, yes, but not public services. Just try not paying your electric or water bills for a while and see what happens. Making health care a public service puts me and all other health care workers at your disposal -- making us your servants, or worse. And I will repeat once more -- Healthcare is Not a Right!
It's time to pull back the curtains and let the purifying light of truth shine upon you, Jack. You are a Communist (and yes, I meant that to be with a capital 'C'). You are a relic of an outmoded political ideology that was completely discredited with the collapse of the Berlin Wall and the disintegration of the Soviet Union. Even China is slowly moving away from the true Communist structure. You are so blinded by your ideology that you do not realize that you are being used by other people to advance their agendas, not yours, and that when you finally realize this and you protest, you will be discarded like the used, empty and crushed beer can that you are.
I pray that God blesses you, Jack. I pray that He gives you the ability to clearly see the truth and the wisdom to be able to correct the errors of your ways.
As always, I welcome critiques of my thoughts and rants, and I eagerly look forward to a spirited discussion of the issues.
But Jack, if you come back at me with another regurgitation of talking points or a pile of useless drivel with no thought behind it and no evidence to back it up, I will be forced to wipe it from my blog and throw it away, just like I wipe up and throw away the hairballs that my cat spits up. Spitting up the hairballs at least serves a useful purpose, if only for the cat. Your droppings don't even make good manure.
"AMERICA’S NATIONAL HEALTHCARE EMERGENCY!
It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.
STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.
We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.
And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.
Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and request that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).
Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.
In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!
If President Obama has to declare a NATIONAL STATE OF EMERGENCY to rescue the American people from our healthcare crisis, he will need all the sustained support you can give him. STICK WITH HIM! He’s doing a brilliant job.
THIS IS THE BIG ONE!
THE BATTLE OF GOOD Vs EVIL!
Join the fight.Contact congress and your representatives NOW! AND SPREAD THE WORD!
God Bless You
Jacksmith – WORKING CLASS"
I have not altered this in anyway, though copying it here did cause it to lose most of its formatting which is unfortunate. Please, go to the link above and look at this comment in its glorious original. I replied briefly, saying that I would respond in detail to this comment later. This post is my response. I also said that the writer, Jacksmith, had won a special prize.
Your prize, Jacksmith, is the formal recognition that you have contributed the first idiot comment in the history of Rantings of a Medical Mind.
Now, I have received a tiny number of spam comments. Those did not see the light of day. But your comment, Jacksmith, is the first comment that I have received (and I have received precious few comments) that violates the rule that I set out at the very outset of my blog. In my very first post I stated that "I will welcome your comments and critiques of my thoughts. I enjoy a spirited debate on the issues." Your comment, Jacksmith -- may I call you Jack? -- provides neither a critique of my thoughts nor is it a spirited debate on the issues.
Jack, your comment is merely a regurgitation of talking points designed to fear-monger and create distress amongst those unfortunate enough to read it. It also contains so much garbage in terms of what passes for "information" that it cannot be taken seriously.
BTW, Jack, I did find you. With your oh-so-common nom de plume, I wasn't sure that I'd be able to run you down, but find you I did. Let's take a look at this posting on Slate -- same stupid arguments, same violation of netiquette by SCREAMING ALL THE TIME, same signature (Jack Smith -- Working Class) -- yep, that's gotta be you. And you have your own blog! But come on, you've only put up one post? I'm well up into the sixties. I will say though, at least it's good to get confirmation that other people are reading my writings, even if it is someone whose brain cells no longer function properly.
Let's begin the autopsy of your comment.
First, we'll cover what you inadvertently happened to get right. Since my post regarded President Obama's public option, and your diatribe did cover that, it was on topic. You mentioned the global H1N1 pandemic -- okay, I'll accept the WHO proclamation on this (even though if the current Mexican flu outbreak defines a pandemic, we need a new word for something like the Spanish flu or the Medieval Black Death). And by the quoted numbers, we do spend something like two times as much of our GDP on "health care" as many other nations, though that number is always in flux. That's about it. Everything else is wrong. Or a lie. And really, what's the difference, except in intent? If you're just mistaken, it means you're an idiot. If you're lying, it means you're a tool of people who are using you to push their agenda, even though you, and everyone else right along with you, will ultimately pay for it in the end (literally and figuratively). I'll choose to be kind and call you an idiot, for in my book, being a tool is far worse.
On second thought, after reading your single blog post, I will have to retract my assessment of you. You are both an idiot and a tool.
Your concern about the Mexican flu is not totally warranted. As of July 3, 2009 (2 days ago), WHO has confirmed worldwide 89,921 cases of H1N1 with 382 deaths. This is a case fatality rate of 0.43%, much lower than that of the regular seasonal flu. The CDC reports, as of July 2, 2009, that in the US there have been 33,902 cases with 170 deaths, for a case fatality rate of 0.50%, again lower than that of the regular seasonal flu. So, currently, this flu is not something to get all hot and bothered about. It is true that the first cases of Tamiflu-resistant H1N1 have just now been reported, but you couldn't have known that when you posted your comment, so you get no points for that. Besides, we have medicines we can use other than Tamiflu.
In regards to your discussion of the H1N1 cases in Mexico, I don't know where you are getting your information, since the Mexican health authorities have been incredibly tight-lipped about what has been going on there. WHO reports only 10,262 confirmed cases in Mexico with 119 deaths, for a case fatality rate of 1.16%, higher than elsewhere, but still not terribly high (the Third World nature of the Mexican health care system may have something to do with this). Also, as reported in this article from Reuters, the higher case fatality rate in the area of origin of the epidemic is consistent with what has been seen with other epidemics in the past. This article also mentions that the majority of deaths in Mexico are among people under the age of 59, which is unusual for influenza and is NOT the pattern being seen elsewhere in the world. Investigators think this may be because people above age 52 may have some residual partial immunity from the last H1N1 strain that circulated before 1957.
[Yes, I am calling it the Mexican flu. Naming convention for influenza epidemics in the past have named the outbreak with the name of the country in which the outbreak was first publicly identified. In this case, Mexico drew the short straw. There is nothing racist about it. I'm sure that Spain doesn't like that the Spanish flu was named thusly, since the virus most likely originated in the American and European soldiers fighting World War I, but since the first public information about the outbreak came from Spain, the name became Spanish flu. By the same token, this flu is the Mexican flu.]
In your comment, Jack, you strongly push for the adoption of President Obama's health reform plan. Have you even read the plan? "Coverage can begin immediately through our current medicare system" -- Obama's plan doesn't change Medicare and does not involve enrolling anyone into Medicare. "Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan" -- Obama's plan doesn't call for the institution of direct payroll deductions for the public option, but rather the payment by the employer into the public pool, from which non-covered workers will receive funds to buy insurance from the Exchange. "With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry" -- Obama's plan doesn't call for the cancellation of the private insurance industry......
But I see from your blog post that what you are really after is a single payer, government controlled system. And you are too stupid to see that Obama's plan doesn't call for that -- oh, now I see. You are shilling for Obama's plan, a plan you favor, because you want a single payer system, and you also see Obama's plan as a way into a single payer system. Thank you for making that point crystal clear. (This was supposed to be a secret! For a tool, you really aren't very sharp, you know that?)
Furthermore, you want President Obama to declare a national health emergency if your precious plan doesn't pass, during which he is to seize all the insurance companies and impose the single payer system that the American people, through Congress, have just rejected. Now I know that certain laws were passed after 9/11 that allow the President (and even the state governors) to declare such emergencies and impose things like quarantines, forced vaccinations, forced redistribution of medical supplies, and the like, but these bills do not give the President the power to seize industries and impose radical system change. But you want him to have these powers. Because you are a "progressive Democrat". You are a "World Citizen" (from your blog). You are a member of the "Working Class". (Shouldn't that last one really be "Proletariat"?)
You really hate privately run "health care" systems, don't you, Jack? Look at the way you just shriek those hateful words -- "GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE". Is it just the profit driven "health care" system you hate, or is it any for-profit endeavor? How about taking over the computer industry, or the auto industry -- wait, bad example. President Obama has already done that. Bet that made you feel really good inside, didn't it? While the rest of America had to fight to keep from retching. And then there's this, from your blog:
"Health care is NOT! a private for profit business. Healthcare is an essential public service. Like police, and fire. And healthcare is also a human right! PRIVATE FOR PROFIT HEALTHCARE IS AN OXYMORON, AND AN IMMORAL AND UNETHICAL PERVERSION OF HEALTHCARE AND HUMAN RIGHTS."
Health care is a public service?? Not even electricity and water are public services. Regulated utilites, yes, but not public services. Just try not paying your electric or water bills for a while and see what happens. Making health care a public service puts me and all other health care workers at your disposal -- making us your servants, or worse. And I will repeat once more -- Healthcare is Not a Right!
It's time to pull back the curtains and let the purifying light of truth shine upon you, Jack. You are a Communist (and yes, I meant that to be with a capital 'C'). You are a relic of an outmoded political ideology that was completely discredited with the collapse of the Berlin Wall and the disintegration of the Soviet Union. Even China is slowly moving away from the true Communist structure. You are so blinded by your ideology that you do not realize that you are being used by other people to advance their agendas, not yours, and that when you finally realize this and you protest, you will be discarded like the used, empty and crushed beer can that you are.
I pray that God blesses you, Jack. I pray that He gives you the ability to clearly see the truth and the wisdom to be able to correct the errors of your ways.
As always, I welcome critiques of my thoughts and rants, and I eagerly look forward to a spirited discussion of the issues.
But Jack, if you come back at me with another regurgitation of talking points or a pile of useless drivel with no thought behind it and no evidence to back it up, I will be forced to wipe it from my blog and throw it away, just like I wipe up and throw away the hairballs that my cat spits up. Spitting up the hairballs at least serves a useful purpose, if only for the cat. Your droppings don't even make good manure.
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