Tag Archives: Congress

Obama is Failing IV

Obama is Failing

It’s now more that a month past my first post about President Obama’s First two quarters in office,  and the outlook is not any better. Obama is presiding over an economy with accelerating  job losses when he promised job gains with TARP’s passage. The economy is the key thing worrying the country right now, and his entire party and administration seems oblivious to that fact.

Here’s a graphic map that visualizes job losses through time at Slate, please hit the start button, then the green play button. You will see that job losses accelerated dramatically from November when he was elected through to the present.

Even his most ardent supporters cannot step forward in the face of this and say that he is succeeding in his election promise of saving and creating jobs. If he wants success there he’s got several long rows to hoe and with the course that he has set the outcome will be Congress facing elections with the US poorer and unemployment still high in 2010. This will occur even though the economy has turned and our basic economy is sound.

The contentious cap and trade and health care bills in Congress insure economic restraint through uncertainty if they are passed, and if they fail then they must fail dramatically to end the uncertainty. Both will introduce huge new costs to consumers, businesses, state economies, and local economies. These costs are unknowns which keep bean counters at every business in America awake at night because they can’t make forecasts with any hope of reasonable accuracy.

Bottom line:

  • High energy prices created by Cap and trade legislation will turn the economy down, not up, as President Obama promised.
  • Increased taxation from the Health Care bill will retard rather than progress the economy as Obama promised.

Cap and trade has been called “Cap and Tax” for a reason: one outcome will be increased energy costs for consumers and businesses, and high energy prices  drive all other things in the economy.

Indeed there are good arguments to be made that the rest of the world’s countries implementing cap and trade policies in prior years led to the fragility which tipped us over the brink in the banking and mortgage loan industries. Without high energy prices the past several years the system might have been able to sustain with a lower burden of defaults, and mortgage companies might not have so many “toxic assets” on the books. High energy costs stifle economies worldwide, so why would you intentionally make them higher at a time of severe economic malaise?

The other problematic bill in congress is the Health care bill  – the unknowns are more daunting than the knowns since the bill is a nightmare of cut and paste confusion as Pelosi’s staffers and lobbyists crammed like they were writing a term paper they had blown off all semester to get this before Congress in time. The resultant mess in the lower congress from “rushing to woo” the public is a crazy patchwork quilt of conflicting measures that can be interpreted any way opponents want to. This has been a real boon for grenade throwers like Sarah Palin and others.

The outlook for both bills has seriously worsened since I wrote this post, however I still expect pared down versions of both to pass. You can bet that some Republicans in congress do want some of the energy investments in the “energy bill portion” of Cap and Trade, and you can bet there are some health care reforms that Republicans and Blue Dogs could get behind. If Obama wants a cosmetic win in getting both passed then he’s going to have to give up the Pelosi and Waxman versions and cross the aisle to sanity.

To me that’s a failure since the Dems have a big lock on majority and should be able to get pretty much anything through. The struggles they are having now really demonstrates how truly incompetent their legislators are.

UPDATE: Charles hits the nail on the head about the political sideshow of the “DeathPanel” debate, with fact checking on the provisions provided by ABC. Also note that Rick Moran’s been taking a lot of heat over his stance on this, but he’s right.

UPDATE: Slick Willie Preps the diehards for the deal they will have to make if they want a health care bill.

UPDATE: Middle Class and Independent voters would prefer no Bill instead of House Plan by strong majorties.

Health Care Bill:The Advanced Care Planning Section

Health Care Bill:The Advanced Care Planning Section

This particular section of the Health Care bill is causing quite a bit of controversy, the response from the hard religious right is that “Obama wants to euthanize old people!” and the response from the left is that this is merely Advanced Care Planning and not really mandatory. The real answer is that they are probably both wrong.

I’m no lawyer however; the terminus (divisor or departure point, pun intended,) seems to be whether or not this is mandatory for the patient and/or the doctor, and whether it goes far beyond what doctors do for patients already. Is it invasive of liberty, does it expand liberty? Does it proscribe care or services that might be granted, or does it mandate services where they aren’t wanted?

So I’m opening discussion – with a warning: discuss the points of the bill with an eye towards what the language actually demands. Comments advocating political stances on the issue will be deleted, the point here is to determine what this really amounts to.

As a service to the ongoing debaters I’m cutting and pasting the pertinent sections of the bill here. This section starts on page 424 with insertion of the “Advanced Care Consultation” paragraph and ends on page 443, I’ve removed some line formatting & page footers for ease of reading but, here’s a link to the PDF.

5 SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
(a) MEDICARE.—
(1) IN GENERAL.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (A) in subsection (s)(2)—(i) by striking ‘‘and’’ at the end of
subparagraph (DD); (ii) by adding ‘‘and’’ at the end of subparagraph (EE); and (iii) by adding at the end the following new subparagraph:
‘‘(FF) advance care planning consultation (as defined in subsection (hhh)(1)) and (B) by adding at the end the following new
subsection: ‘‘Advance Care Planning Consultation ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

‘‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
‘‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

‘‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

‘‘(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

‘‘(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
‘‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—

‘‘(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

‘‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

‘‘(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy). ‘‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—
‘‘(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and ‘‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii). ‘‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that— ‘‘(I) ensures such orders are standardized and uniquely identifiable throughout the State; ‘‘(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment; ‘‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and ‘‘(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

‘‘(2) A practitioner described in this paragraph is—‘‘(A) a physician (as defined in subsection (r)(1)); and ‘‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.

‘‘(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).‘‘(B) An advance care planning consultation with re18
spect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

“(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

‘‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that— ‘‘(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care; ‘‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual; ‘‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and ‘‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual. ‘‘(B) The level of treatment indicated under subpara
graph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items— ‘‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems; ‘‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting; ‘‘(iii) the use of antibiotics; and ‘‘(iv) the use of artificially administered nutrition and hydration.’’.
(2) PAYMENT.—Section 1848(j)(3) of such Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting‘(2)(FF),’’ after ‘‘(2)(EE),’’. (3) FREQUENCY LIMITATION.—Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended— (A) in paragraph (1)— (i) in subparagraph (N), by striking ‘‘and’’ at the end;  (ii) in subparagraph (O) by striking  the semicolon at the end and inserting ‘‘,  and’’; and  (iii) by adding at the end the following new subparagraph: ‘‘(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;’’; and (B) in paragraph (7), by striking ‘‘or (K)’’ and inserting ‘‘(K), or (P)’’.

(4) EFFECTIVE DATE.—The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011. (b) EXPANSION OF PHYSICIAN QUALITY REPORTING INITIATIVE FOR END OF LIFE CARE.— (1) PHYSICIAN’S QUALITY REPORTING INITIATIVE.—Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w–4(k)(2)) is amended by adding at the end the following new paragraphs: ‘‘(3) PHYSICIAN’S QUALITY REPORTING INITIA
TIVE.—

‘‘(A) IN GENERAL.—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.

‘‘(B) PROPOSED SET OF MEASURES.—The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary.  The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’’

(c) INCLUSION OF INFORMATION IN MEDICARE & YOU HANDBOOK.— (1) MEDICARE & YOU HANDBOOK.— (A) IN GENERAL.—Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:

(i) An explanation of advance care planning and advance directives, including— (I) living wills; (II) durable power of attorney; (III) orders of life-sustaining treatment; and (IV) health care proxies.

(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including—

(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.); (II) website links or addresses for State-specific advance directive forms; and (III) any additional information, as determined by the Secretary. (B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS.—The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.

I will post where I stand on these issues later, right now I think the discussion needs to focus on what this section does or does not do. I’m hoping to hear from Volokh, Lawhawk, and others in the legal field on this, as well as from physicians.

A Boat on the Reef With a Broken Back

A Boat on the Reef With a Broken Back

… And I can see it very well.

To follow up on my earlier post about the real story of the collapse of Obama’s mandate and political capital on the reef of realpolitik and Dem infighting in Congress I proffer a few links:

The Hill: July has been a Disaster for Obama, Hill Dems

Ezra Klein: The Ghosts of Clinton Care

MSNBC: Congress Punting on Health Care Floor Vote

Politico: Dems Search for villains on healthcare [ We have met the enemy and he is us…]

RCP: Unreality Based

RCP: 10 Questions for supporters of Obamacare

The Note: Dems vs Dems

To recap: His two signature initiatives, Cap and trade and healthcare, are both stalled and creating animosity in Congress. Maybe with the high tide of return from recess they can effect some repairs and float these off the reef, but it’s not looking positive for the President.

One other note on this: Maybe it’s not Obama’s mandate that’s lying on the reef; maybe it’s Pelosi‘s West state mandate Agenda. Depending on venue it might be that some run against Obama in 2010, and some run against Pelosi.

West State Democrats

West State Democrats

Just an observation: If you look at the power structure of the Democrat party you see that almost their entire leadership is from Western states. Even President Obama comes from West of the Mississippi. Pelosi and Waxman are from California, Reid and Baucus are from Nevada and Montana. There aren’t any eastern democrats with positions that have a scintilla of real power in the congress.

This can’t sit well with East coast democrats nor the blue dogs, and that ignores the midwest Republicans. Effectively 3/4 of the country region-wise is disenfrancised and walled off from effective political power.

Obama & The Real Story

Obama & The Real Story

The real story for Obama is grim right now: unemployment is at new-century record highs, his first six months in office are a failure, his budget is delayed, transparency is delayed, health care reform is on the rocks, and dissension within his caucus is at an all time high as they wind down toward recess.

If the real story were front page and center now everyone would be focused on the house and the splintering over health care going on there. The press would be dissecting the bill and the points of contention for the public with a bit more vigor than the shorthand of triggers and public options. It’s at the point  where there could be a rebellion and coming leadership change in the Democrat caucus if things continue this way. Even though there are outward signs of unity, this is surface only, and with elections looming in 15 months more is on the line than it would seem at the moment.

True to form when faced with real opposition and a bad news cycle,  President Obama has a habit of changing the subject. That’s why the Gates gaffe was made and in my opinion it was intentional. It’s also probably not a coincidence that nirtherism is front and center in the news again, even though left, right, and center are all calling birth certificate conspiracists marginal and crazy.

These things take the focus off of what’s important and change the subject to topical and idiotic irrelevancies. These are very skillful distractions, everyone has an opinion on racism – with the public in overwhelming agreement that it’s bad — and they all want to talk about it. Much more fun than talking about the boring points of a trillion dollar health bill, n’est ce pas?

It’s also always more fun to talk about marginal nutballs on the right than the unemployment picture too.

Obama is very skilled at these smoke and mirror tricks and by making himself the lightning rod he’s managed to take the focus from the real story for a moment: but his first six months are still not sitting well with the public, and his health care reform is a boat on the rocks of a distant shore.

Cap and Tax Under Hot Debate

Cap and Tax Under Hot Debate

Update: The bill passed 219-212

The Waxman-Markey Cap and Tax bill is under hot debate on the house floor right now, the bill will introduce a huge hidden energy tax to middle class americans, and do pretty much nothing to stop emissions. It’s turned into a huge patronage deal with massive pollution credits going to Dems in coal states to gain their votes. Here’s Representative Dave Camp, MI speaking on the effects of the bill:

The quickest way to stall the world economy that I know of is to introduce more draconian regs like this. The diesel regulations in Europe directly contributed to the recession we are trying to come out of now.

With the coming regulation of shipping diesel fuels, the future is looking pretty grim.

More from Representative Ryan:

Pelosi Pimps National Energy Tax and Iowa Congressman Braley in Des Moines

Pelosi Pimps National Energy Tax and Iowa Congressman Braley in Des Moines

Nancy Pelosi was expecting a quiet soiree of Democrat fat-cat insiders as she attends a private fundraiser for the Democrat Congressional Committee and Congressman Bruce Braley. Braley was out speaking last night trying to tamp down the upset over her lies about the CIA, but they just won’t go away.

Meanwhile the NRCC robo-called across the district to let voters know about the National energy tax that’s the likely outcome of the Democrat Cap and Trade scheme.

At inception it was a plan like those imposed upon Europeans the past few years, plans which have totally failed to reach goals and that increased use of fossil fuels in Europe while strangling those economies. Some of the economic malaise we are in can be tracked back to Euro cap and tax schemes.

That’s how it started off, a plan like the Europeans… but since then it’s turned into a patronage scam of perks and pork as Rep. Henry Waxman trades credits to states whose votes he needs to pass the bill. It’s a monstrosity that we don’t need while the economy is recovering.

Here’s the audio from one of the robo-calls: