Despite glee over health care woes, 
GOP has no real health reform plan

By Michael J. Pramenko

Compassion is not weakness, and concern for the unfortunate is not socialism. — Hubert H. Humphrey

Last Monday, Denver Broncos head coach John Fox underwent heart valve replacement surgery. Prior to his surgery, his physician had apparently discovered the diseased valve and it was believed that it would likely need to be replaced after the 2014 NFL season. Unfortunately, Coach Fox’s condition worsened earlier than expected and the dysfunctional valve began to significantly affect his health.

This story could happen to any one of us. Our health and well-being are not guaranteed. Fortunately for Fox, he earns a sizable salary and no doubt has wonderful health insurance. Now, without having to wait, his condition is being treated in a timely and efficient fashion.

Without treatment, the diseased valve would begin to affect the heart and would eventually lead to congestive heart failure. Then, after multiple years of disability, premature death would follow.

In addition, left untreated, the congestive heart failure and related illness would be much more expensive to treat, compared to the heart valve replacement at an early stage of disease.

By the way, the “junk” insurance that currently is being “canceled” by Obamacare, often does not cover these serious and unexpected health problems. 

Look beyond the politics. Look beyond the rhetoric regarding socialism. Look beyond deceit and misinformation. You will find human beings. You will find hard-working men and women without the financial means to purchase health insurance. You will find individuals with pre-existing health conditions that once solidified their standing among the uninsured. You will find families facing bankruptcy while attempting to gain access to life-saving procedures and medications.

Now, in 21st century America, we continue the debate on health reform with little regard to the lives the reform seeks to improve. Roger Ailes of Fox News, the billionaire Koch brothers and Sean Hannity must not know a single person who is uninsured with a life-threatening medical problem. Or, maybe they have simply chosen not to care. The glee and excitement regarding the troubling rollout of the website speaks volumes.

Critics act as if there is legitimate counter legislation to Obamacare that would address the issues of pre-existing health conditions and insurance for those who currently can’t afford it. There is not a plan — not even close. A fair analysis of the Republican legislation in the House of Representatives designed to replace Obamacare is just shy of health reform window dressing. 

Simply put, there are resources in America more important than oil. There are resources in America more integral to the success of our country than our forests and farms. America’s human resources surpass all others. How we educate and provide health care for our fellow Americans will define America’s future.

Long after President Barack Obama has served his two terms and long after the website woes of October 2013 have passed, our friends and neighbors will face unexpected life threatening health problems, as Fox has.

Do we really believe that only wealthy Americans deserve access to proper medical intervention? Do we really believe citizens should wait until these health problems become emergencies so that they can access health care via our emergency rooms? Are we really that penny-wise and pound-foolish?

The outcome of health reform efforts will answer these questions. It will also answer the question as to which Golden Rule our society subscribes: “Do unto others as you would have them do unto you” or “The people with the gold make the rules.”

Michael J. Pramenko M.D. is the executive director of Primary Care Partners. He serves on the Club 20 Health Care Reform Committee and is a past president of the Colorado Medical Society.


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Local “conservatives” hectoring the Affordable Care Act (“ACA”) should ponder Dr. Michael Premenko’s column in Sunday’s Sentinel (“Despite glee over health care woes, GOP has no real health reform plan”) – particularly in the absence of any fiscally viable and/or intellectually credible Republican “alternative”.

While it might be tempting to prefer Kathleen Parker’s companion column (“White House can’t spin the fact that it duped American on health plans”), she omits salient facts.  Thus, first, when President Obama announced in 2009 that “you can keep your policy”, that assurance was entirely true – because the ACA “grandfathered” all existing policies, even if non-compliant with its minimum coverage standards.

Second, before March 2010 when the ACA was signed into law, some 60% of individual health insurance policyholders were “churned” – i.e., received annual renewal letters which typically raised premiums by 10+% per year and/or cancelled/modified policy provisions.  Since then, annual premium increases have averaged only 4+% per year.

Third, apparently, the ACA’s authors naively anticipated that reputable insurers would stop issuing non-compliant policies between March 2010 and January 1, 2014 (when the “individual mandate” takes effect), and/or would upgrade those policies into compliance before that deadline.  Unfortunately, some insurers succumbed to a temptation to exploit this windfall “business opportunity” by continuing to market non-compliant policies during that interim, hoping to retain those “baited and switched” customers after 2013.

Fourth, neither Parker nor the Sentinel mentions recently alleged (but still unverified) evidence of efforts to sabotage the ACA’s website using “denial of service” attacks.

Meanwhile, Dr. Pramenko accurately describes the so-called Republican “alternative” to the ACA – most recently touted by 3rd C.D. “Representative” Scott (“Tea Party”) Tipton – as disingenuous “window dressing” (costing $1 trillion more than “ObamaCare”, while failing to eradicate discrimination based on “pre-existing conditions”).

Takeaway:  trust Dr. Pramenko, not GOP politicians and their apologists!

Dear Doctor

I hate to disagree with you, but you forget that the Obama care has a panel to decide it the operation is worth it or not. So being poor with Obama care insurance, you probably would not get the operation anyway. Look a countries like Great Britain, Norway, Canada, etc. etc. At least here if your sick enough they will help you and you don’t have to go somewhere else.

Louise Kendall’s “Dear Doctor” response to Dr. Pramenko’s more-informed opinion perpetuates another familiar myth about the Affordable Care Act (“ACA”).

Cynically disingenuous and/or willfully ignorant (and racist) critics of the ACA first decried a Republican’s provision to compensate doctors under Medicare for providing “end of life counseling” – which Sarah Palin falsely branded as “death panels” and Senator Charles Grassley mindlessly claimed would “pull the plug on Grandma”.

After that meme was thoroughly discredited as ideologically motivated poppycock, similarly minded critics (including Kendall) reverted to mischaracterizations of the Independent Payment Advisory Board (“IPAB”).  Contrary to Kendall’s uninformed assertion, the purpose of the IPAB is not to “determine whether “an operation is worth it or not”.  Rather, the IPAB is charged with analyzing anonymous electronic medical records to determine “best practices” based on actual medical outcomes.

Applying this “evidence based” approach to improving health care and lowering costs to taxpayers, the IPAB can recommend cost-saving changes to Medicare program based on the most cost-effective treatments, thereby achieving savings in administration of the program.
Meanwhile, the IPAB is also prohibited from limiting Medicare eligibility or coverage, or raising the costs on beneficiaries.

Thus, the purpose of the IPAB is not to
“ration” medical care away from those who can least afford it, but to replace quackery and unnecessary profit-driven tests and medically non-therapeutic procedures with evidence-based “best practices” from which every patient will benefit.  That is why the full title of the law is the Patient Protection and Affordable Care Act.

PART 1. Let’s deconstruct some “libspeak”. “Compassion is not weakness.” True. “Concern for the unfortunate is not socialism.” Also true — if you ignore the false premise that using government power (via taxation) to give expression to your personal compassion and concern is a good idea. To the contrary, using government Power to steal money from others to express your personal compassion and concern is evil because it violates the Golden Rule principle of self-ownership. “Tolerance becomes a crime when applied to evil.” ― Thomas Mann. “The world is in greater peril from those who tolerate or encourage evil than from those who actually commit it.” ― Albert Einstein
The question is not whether compassion and concern for the less fortunate is a bad idea. The question is whether collectivism is a sustainable economic paradigm/model. History is replete with tragedies and suffering which prove it isn’t.
Odd as it may seem, Michael Pramenko’s point about the GOP might be well taken as far as it goes. Technically, the GOP isn’t talking about the nitty-gritty things that need to be talked about. If you want to fix the health care system and make it “affordable” overnight, it would actually be quite easy. You just have to talk about things nobody wants to talk about, like the fact Lee Harvey Oswald was not the lone assassin of JFK. (BTW, that’s a metaphor.)
Let’s talk about how the allopathic medical establishment has led inflation for decades just because they have a government granted monopoly on effective pain control and can raise prices at whim, the free market be damned.
Now let’s introduce a little common-sense libertarian free market philosophy: 95% of what docs do in their offices, we could do for ourselves if we were allowed by government to do so. Former libertarian candidate for president, Dr. Mary J Ruwart has said that abolishing the FDA would reduce health care costs by some 80% by opening up competition in the development of new drugs. I would also abolish “unauthorized practice of medicine”. Current fraud statutes should be adequate to prevent a shyster from putting a fraudulent “I graduated from Harvard Medical School summa cum laude” diploma on the wall. If the current fraud statutes are inadequate, they could easily be beefed up. Also, we need a Freedom of Self-Medication Amendment added to the U.S. Constitution giving adults legal right of access —strictly for self-medication, NOT for the treatment of third parties — to buy all the same tools and medicines the allopathic establishment docs use.
These kinds of solutions are easy to understand. The reason the duopoly politicians (yes, that includes many “conservative” Republicans) don’t want to talk about them is because government is where crooks go to develop contacts with “the rich” and put themselves in position to make the really big bucks.

PART 2.  This stuff is not hard to understand, folks. What’s sometimes hard for normal people to understand is Orwellian “libspeak”. To understand that, you have to understand that libs are not unlike Internet trolls. To explain, I will paraphrase a brief article (by Sam Browne) I read titled “Internet Trolls”, except modify the language to fit progressive political rhetoric.
“In face-to-face discussions with friends, coworkers, customers, and sane strangers, people speak with a purpose — to deliver information, make a request, or to express an emotional connection. Civil adults learn to consider the needs of others, respecting their privacy, time constraints, and feelings. So most people are not prepared to understand libspeak, and misunderstand it because it does not occur in normal conversations.”
“One way to understand libs is to think of a toddler, just learning to speak, who had discovered that repeating the question ‘Why?’ over and over again causes an adult to keep talking forever. Another example is a filibuster, in which a legislator read the entire Sears catalog just to give the appearance of engaging in debate. These are denial-of-service attacks. Consuming the time and energy of the target pointlessly is the attacker’s goal.”
“There is a level of good faith in normal conversations — the parties are expected to speak honestly and to have good intentions. So-called ‘progressives’ do not have this good faith; they exploit it to harm others. A ‘lib’ may ask for something, but if their wish is granted, they will not stop asking for things. They may ask a question, but they don’t want an answer. ‘Libs’ are attackers, and the goal of their messages is to harm the recipient.”
Mssrs Pramenko and Hugenberg succeeded in proving Sam Browne’s point by implying that all those who don’t agree with Obamacare, including specifically the GOP, are somehow lacking in Hubert-Humphrey-style “compassion” and “concern” for the less fortunate among us. It just ain’t so. Moreover, it’s provably not so.
I hope most other people are getting as tired as I am of all the wannabe-cutesy little rhetorical manipulations so often found in propagandistic libspeak these days.
Contrary to the implications of Pramenko’s manipulative libspeak, it IS possible for decent, intelligent people of good will to disagree on the real-life solutions to these important problems.
Bottom line: If I am going to die in some health care experiment, I would rather it were MY experiment than that of the likes of Mssrs. Pramenko, Hugenberg, Obama et ilk — thank you very much. I don’t mean to be “uppity” or offensive here, it’s just that I don’t believe collectivists such as Mssrs. Pramenko, Hugenberg and Obama are remotely smart enough to run my life better than I can run it. You see, I “care” a lot more about it than they do.

Bill Hugenberg

Here we go the basic democratic response, I am racist. If anybody is a racist it is you. Why do you think you have the right to tell people what they need to do, I thought we were a land of the free, not the land that we do what the democrats want. As far as the republicans need a response or plan why? What was wrong with people deciding on there own if they need insurance. As far as the death panel or what ever you call them, they decide. Like I stated before about health care in other countries, I know because I have liked and worked in them. So knock off the bull

Here we go again.  Another under-informed critic of the Affordable Care Act (“ACA”) defensively feigns ignorance of the racist undertones embraced by many of her ilk

As Dr. Pramenko previously chronicled, virtually every element of the ACA originated with Republicans.  The Heritage Foundation, our own Club 20, and Colorado’s Blue Ribbon Commission all endorsed the ACA’s market-driven concept, which was then successfully tested in Massachusetts under Republican Governor Romney.  Only after (“half-white”) President Obama embraced their approach did those same Republicans abandon their own ideas and castigate them as “ObamaCare”—joined by those who still insist that he is a Kenyan-born imposter.  Racism?  Of course not!

That history also belies John’s Wilkenson’s paean to “a level of good faith in normal conversation [in which] the parties are expected to speak honestly and to have good intentions”.  Responsible journalists have thoroughly documented the extent to which Republicans have evinced “bad faith” – which they are still exploiting “to harm [millions of] others”.

Kendall claims some expertise based on her alleged experience in countries like “Great Britain, Norway, Canada, etc. etc.”, none of which rely exclusively on a profit-driven health care system and all of which provide virtually universal access to affordable care.

Responding to her presumably rhetorical questions, our Constitution gives Congress “the right to tell people what they need to do”, and—because we are “a land of the free”—we respect the decisions made by duly elected leaders – whether Democrat or Republican.

Republicans don’t need a “response plan” – because the ACA is their plan – but proclaim to have a “better alternative”, which Dr. Pramenko exposed as just another lie.

Kendall pretends not to be unaware that we spend twice as much on health care as do “those other countries” – and get inferior outcomes. “What was wrong with people deciding on their own if they need insurance” was that those who decided for it too-often fell victim to predatory health insurers or were denied coverage when needed most, while those opting not to insure became “free riders”, imposing the cost of their on society.

Before the ACA, our system “rationed” health care based on wealth – denying millions access to affordable health insurance and/or actual care.  “Other countries” ration health care (“decide”) bureaucratically.  The IPAB does neither – but rather “decides” to inform insurers, patients, and providers alike as to evidence-based “best practices”.  There are no “death panels or what ever [Kendall, Palin, or Grassley would] call them” in the ACA.

Notice, also, that Kendall did not in any way dispute my explanation of the IPAB. So, she and Wilkenson should both “knock off the bull”.

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