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Healthcare ‘Death Panel’ Created 2/17/09 in Stimulus Bill

People are heated up over elements of the Democrat health care bill; metaphorical smoke is rising from townhall meetings everywhere.  But guess what the Stimulus Bill passed in February gave us?

We should scrub the entire health care legislation under consideration and start over.  But health care in America is already changed because of the Stimulus Bill passed in February.  There are two main components you should know about:

  • the Federal Coordinating Council for Comparative Effectiveness Research, and
  • the Office of the National Coordinator for Health Information Technology.

You can read the entire Stimulus Bill enacted February 17th 2009  in PDF, and I will refer to page numbers and lines on the page for each of the points in this post.   

1.  Federal Coordinating Council for Comparative Effectiveness Research

The Stimulus Bill passed in February of this year creates the Federal Coordinating Council for Comparative Effectiveness Research.  (190:6ff) This new bureaucracy composed of 15 members is appointed by the President.  It includes the Secretary of Health and Human Services (HHS) who serves as Chair; and 7 of the 15 must be from FDA, Defense, Veterans Affairs, (the new) Office of the National Coordinator for Health Information Technology, NIH, Medicare, Medicaid, and the Agency for Health Care Research; half must have medical expertise.  (191-192) Health Care in Crisis Cartoon 8.18.09

 Among the purposes of this newly created council:

A.  “…assist the officers and agencies of the federal government…to coordinate the conduct or support of comparative effectiveness and related health services…” (190:14-19)

B.  Advise the President and Congress on “…appropriate organizational expenditures for comparative effectiveness research.”  (191:1, 2)

The Federal Coordinating Council for Comparative Effectiveness Research has already been created, and you can read about the members here.   This Council will direct every officer and agency in the federal government on how they are to engage in and support the comparative effectiveness and related health care services in the United States. 

This group of 15 people will determine what is “effective” and will control what every other department (Medicare, Medicaid, Veterans Affairs, Defense, and Indian Health) finds is “effective” as it relates to health care.  Nowhere does the law state how “effectiveness” is to be determined so it is fungible – what is effective is what these people say is effective.

I need to let you know about one of the members of the Federal Ezekiel Emanuel 2Coordinating Council for Comparative Effectiveness Research.  There has been much discussion about Ezekiel Emanuel, brother of Rahm Emanuel, Obama’s enforcer.  In 2008 in Health affairs: The Policy Journal of the Health Sphere, he wrote:

“Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost controls, more for show and public relations than for true change.”

So all the stuff the Democrats are touting isn’t going to lower the cost of health care.  Also last year in the Journal of the American Medical Association he said that saving money on health care will require doctors to think differently about what they do.  He said that they take their Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others.”  In other words physicians should be concerned more about the effect of their treatments on everyone except the patient!  How do you feel about that Doc? 

In 1996 in the Hasting Center Report, November-December 1996, Emanuel co-authored an article dealing with the “just allocation of health care resources.”  “Services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed.  An obvious example is not guaranteeing health services to patients with dementia.”  (Emphasis mine)

In the British medical journal Lancet in January 31, 2009, he wrote that it is moral to discriminate against older patients; “Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life states rather than being a single age.  Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years.”  So since you were 25 at some point in the past, you need to get over a physician denying you treatment because the government thinks the money should go to someone who is 25 right now.  Death panel anyone?

So we have a man in the inner circle, chosen and appointed by President Obama to a Council, created to determine what medical care can be practiced by any physician who will be paid at least in part by the federal government; this man thinks healthcare should not be provided to – among others – patients with dementia.  He insists that physicians think of their medical practice as a good for society at large, and not for their patients.  Don’t spend too much money on a victim of cerebral palsy, or Parkinson’s, save it for the young and healthy.  This Council, sports fans, was created in the Stimulus Bill passed February of this year.

We know that the president has repeatedly said that “unsustainable cost” is the reason he has made changing health care a top priority for his administration.  So we must assume that lowering cost is the primary reason for the creation of this new and very powerful bureaucracy.  The ‘death panels’ are (or are not) out of the health care legislation, but this Council has the real power to determine what doctors can and cannot do; they control the same for Medicare, Medicaid, Defense, Veterans Affairs, and others; and serves as the advisory arm for the President and Congress.  This group will inform them about what to fund, and what not to fund, deciding indirectly who lives and who dies.  The panel controlling life and death by means of controlling which medical treatments for Medicare patients will be paid for already exists – it was created February 17, 2009.

 C.  Spend money, “to promote the electronic exchange and use of health information for each individual in the United States…”  (194:2, 3)

D.  Provide “integration of health information technology, including electronic medical records into the initial and ongoing training of health professionals and others in the health care industry…”  (194:17-19)

This new Council oversees yet another new bureaucracy responsible for enforcing the decisions of the Council.  This new bureaucracy responsible for carrying out the dictates of the Federal Coordinating Council for Comparative Effectiveness Research is discussed now.

 

2.  Office of the National Coordinator for Health Information Technology 

This part of the Stimulus Bill is referred to as Health Information Technology for Economic and Clinical Health Act - HITECH.  (434:15-20) It creates more new bureaus, and sub-bureaus.  It is designed to create “Enterprise Integration” meaning “the electronic linkage of health care providers, health plans, the government, and other interested parties, to enable the electronic exchange and use of health information among all the components in the health care infrastructure…”  (437:23 – 438:4)  Remember, this set of bureaus is designed to carry out the findings of the Federal Coordinating Council for Comparative Effectiveness Research.

This part of the Stimulus Bill requires the new HITECH department to create “individually identifiable health information” (439:23, 24) and this is required for “each person in the United States by 2014.”  (445:1-3) (Emphasis mine) 

The new Office of the National Coordinator for Health Information Technology David Blumenthal 5is appointed by the HHS Secretary (Kathleen Sebelius), and answers to the HHS Secretary.  (441:12-18)  This appointment has already been made, and as of today, Dr. David Blumenthal is the National Coordinator for Health Information Technology.  So he is now the person in charge of forcing doctors to carry out the dictates of the Federal Coordinating Council for Comparative Effectiveness Research.

Dr. Blumenthal has supported computer-based medical records as well as government health care spending controls.  He wrote in the JAMA March 8, 2001 that spending controls are “associated with longer waits,” and “reduced availability of new and expensive treatments and devices.”  So he is comfortable with waiting lines and the loss of new treatments for American patients.  He thinks it is “debatable” whether getting to the doctor as quickly as we do in America is worth the cost anyway – might as well wait.

Further, he said in the New England Journal of Medicine, April 9, 2009, many doctors would not want to switch to “embedded clinical decision support.”  This means that he expects doctors to resist the computer-based treatment requirements delivered to them by the Office he runs and developed by the Federal Coordinating Council for Comparative Effectiveness Research.  I would guess that is a fair assessment.  Most doctors would resist checking with a computer data base to see which treatment he or she can provide for the patient in the room.  This is the one-size-fits-all medicine the government is implementing.  Not so good if you happen to be an atypical patient; doesn’t matter though – get with the program or you won’t get paid. 

A.  This National Coordinator for Health Information Technology will also establish “the utilization of an electronic health record for each person in the United states by 2014.”  (445:1-3) 

Among the purposes for this office is to coordinate the information gathered from “each person in the United States” and see that it “improves health care quality, reduces medical errors, reduces health disparities…”  (442:4, 5)  That last part (and it is repeated throughout the bill) has to do with racial “disparities” operating on the assumption that health care delivery in the United States has been discriminatory.  So expect to see something similar to affirmative action in health care as a consequence of new U.S. law. 

B.  Another task of the National Coordinator for Health Information Technology is to see that the information gathered “reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care…”  (442:7-9  All the concern about ‘death panels’ being a part of the health care bill under consideration right now is welcome, but the government already has the capacity to accomplish the same thing through the Stimulus Bill. 

Dr. David Blumenthal is tasked with using the personal medical information gathered from every person in the United States to reduce health care costs.  This places the power to decide which services are “efficient” and which are not; which services are appropriate and which are “inappropriate.”  How is this decided?  It is up to these panelists; there are no rules.  They could decide that it is “inappropriate” to provide certain kinds of surgeries or pharmaceuticals for specific conditions because of the age of the patient.  There can be no doubt that they will make this kind of decision. 

Once the federal government has the capacity to control what medical services are available to whom, and accompany that power with medical services items in a budget, expect that they will – indirectly – “pull the plug on grandma.”

C.  “The National Coordinator may provide financial assistance to consumer advocacy groups and not-for-profit entities that work in the public interest for purposes of defraying the cost to such groups and entities to participate under, whether in whole or in part, the National Technology Transfer Act of 1995 (15 U.S.C. 272 note)” (449:21-25 – 450:1, 2)

Oh boy!  Our community organizer president is now the ‘community organizer in chief’ – he is the organizer and he organizes us.  This means that the National Coordinator for Health Information Technology can give money to ACORN and other radical interest groups enabling them to lobby for liberal interests.  Your tax dollars at work.  I wonder how this fits into the idea of saving money? 

The Stimulus Plan passed in February of this year alters the Medicare Program adding new regulations.  (511:9ff)  Some of these regulations have to do with payment for physicians treating those on Medicare, and how they will be forced to participate in the program.

D.  “If the eligible professional (your doctor) is a meaningful EHR user (Electronic Health Record) …for the reporting period with respect…”  A “meaningful EHR user” is defined as a professional demonstrating to the satisfaction of the (HHS) Secretary that the professional is “using certified EHR technology in a meaningful manner.”  (517:2-8)

Thus the Secretary of HHS alone determines who is a “meaningful user” and who is not.  This is critical because only “meaningful users” of the new required electronic health record system will be paid.  So doctors who treat Medicare patients are forced into the new government plan where your entire medical history is located on a government server accessible to authorized personnel in government, health insurance companies, and others. 

E.  If any professional (physician) treating a Medicare patient is a “meaningful user” of the new EHR system the Stimulus Bill creates, they will be paid “75 percent of the Secretary’s estimate…of the allowed charges…”  (512:6, 7)  Thus the government lowers payment to physicians from 80% to 75%.  But note that the government has three control systems: what they choose to cover (what’s “appropriate” and what’s “inappropriate”), the Secretary’s estimate of what the “covered” services should cost; and the percentage of the estimate that they will pay (down from 80% to75%). 

This means that the government now has the means to lower the cost of Medicare by denying or diluting services by means of only paying for the stuff the government panel approves (what’s appropriate and what’s not), and lowering reimbursements to physicians for treating Medicare patients.  Does this constitute a ‘death panel?’  ‘Death Panel’ may be a short and brutal description, but the power the government already has through the Stimulus Bill passed in February of 2009 accomplishes exactly the same thing.  It is indirect.  There is no group you stand in front of to plead your case to live rather than be put to death.  Instead, medical treatments are controlled by the government, doctors are told which treatments to give for each diagnosis based on their statistics not on the patient.  Your prostate, your heart, your skin all belong to the government; they will decide what they want to do with it – not you and your doctor.  The doctor will not be paid for any treatment he or she knows the patient needs to live and be healthy because health care is one-size-fits-all – they will only be paid for the approved, “effective,” “appropriate” treatment.  ‘Death Panel’ is just shorthand. The agencies, councils, electronic health records, efficiencies, and determinations of appropriateness, and coordinators created in the Stimulus Bill accomplish the very same ends. 

F.  Beginning in 2016, the 75% reimbursement will begin to decline for physicians not cooperating with the new EHR system dropping from 100% of the 75% reimbursement to 99% of it and dropping 1percentage point each year through 2018.  (523:15 – 524:14).

If individual physicians don’t cooperate quickly enough with this new plan for government controlled Electronic Health Records, they will be penalized economically, and their Medicare patients will have to pay increased co-pays.

G.  Then there are general “incentives” for all physicians.  Beginning in “2019 and each subsequent year, if the Secretary finds that the proportion of eligible professionals who are EHR users is less than 75%, the applicable percent (of payment of estimates of covered services) shall be decreased by 1 percentage point from the applicable percent in the preceding year.”  This is called an incentive.  (523: 12, 13ff)

This means that if 75% of doctors in general are not “meaningful users” (in the Secretary’s view) complying with regulations for giving the government complete access to all their medical treatments for all their patients through the EHR, all doctors treating Medicare patients will see their 75% of the estimated cost of the covered services go to 74%.  (524:17-24) Thus physicians are in the position of forcing their colleagues into compliance or those who are complying will see reduced reimbursements!  It also means that patients will be called on to pay more than 25% of the cost of the service, and will thus be forced to seek out physicians who are in compliance in order to lower the out of pocket expense. 

H.  No review of reduced payments (as incentives) is permitted under this law; no administrative review, no judicial review – the physician and patient are stuck.  (521:14-23)  The same applies to hospitals forcing compliance with the new EHR system – no review at all.  (54:11-21)

When you attend townhall meetings

1.  Ask your Senator or Representative if they voted for the Stimulus Bill in February, and if so why they would sell out the citizens regarding health care. 

2.  Arm yourself with the information listed here, and confirm it by clicking on the link to the Stimulus Bill itself – make sure you are prepared.

3.  This Bill is a Democrat bill – no Republicans voted in favor of it.  If you have a Republican Congressman, thank him or her for voting against it, and then ask how they plan to overturn the elements of this legislation that requires physicians to follow the treatments the government prescribes.  Treatments decisions should be made by physicians and their patients, not unaccountable bureaucrats on the Federal Coordinating Council for Comparative Effectiveness Research

Be sure to share the information in the Stimulus Bill with your doctor when you are next in touch with him or her.  I’m sure they would like to know what’s coming; probably most of them have not read the Stimulus Bill and are not informed about what’s coming – they are busy taking care of patients.

Feel free to forward this post to your friends, or other blogs or send links to the Culture and Freedom blog – we really need to get the word out right now while we have the Congress in our home districts.