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From: TimF4/13/2012 12:32:51 PM
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Fact checking the fact checker on Paul Ryan’s Medicare reform plan

By Joseph Antos
April 6, 2012, 2:34 pm

On Tuesday, President Obama attacked what he claimed is the Republican Medicare plan. Jim Pethokoukis points out that Obama criticized a plan that no one has actually proposed. Today, Glenn Kessler (the Washington Post’s “Fact Checker”) takes on Obama’s claim that Paul Ryan’s plan would not protect seniors from the rising cost of health care. Kessler quotes me, and gets it partly right.

There really is no mystery about what the House Budget Committee documents say. Under Ryan’s plan, every senior will be able to afford full Medicare benefits, whether through a private insurer or the traditional program. In many parts of the country, traditional Medicare will be the low bidder. Indeed, the point of the proposal is to give seniors a good deal through competition, not to drive out traditional Medicare and not to dictate what plan seniors must choose.

It is no coincidence that Ryan adopts the same spending target that Obama proposes in his latest budget: GDP plus 0.5 percent. The GDP plus 0.5 percent target is a budget gimmick used to generate savings that CBO can score, whether or not those savings are actually achieved in future years. If seniors are harmed in any way under Ryan’s plan as a result of the spending target, they suffer the same harm under Obama’s.

The debate is over how Ryan would achieve budget savings, and again there is no mystery despite the White House’s best efforts to obfuscate the matter. Contrary to the claim from an unnamed Administration official, the spending target would not be met simply by slapping a cap on the federal subsidy and leaving seniors with unaffordable premiums. Congress would reduce program costs by cutting payments to providers, reducing program overhead, raising premiums to high-income beneficiaries—in other words, all the actions that Congress could take today if it had the will to rein in Medicare’s runaway spending.

In fact, enrollment in traditional Medicare is likely to be so great even a decade from now that any serious effort to reduce program costs would have to rely on such policies. According to the Medicare trustees, about 55 million people will be enrolled in traditional Medicare in 2022. Roughly $900 billion of the trillion dollars that Medicare will spend that year will be through the traditional program.

It is ludicrous to argue, as the White House does, that deficit reduction efforts under the Ryan plan would ignore opportunities to reduce Medicare’s operating costs and simply pass the high costs onto seniors. Although Ryan’s plan does not spell out in great detail all of the mechanisms it would use to slow Medicare spending, it is clear that Congress would have all the policy tools needed to ensure affordable health care for our seniors. But Congress would have to find the political guts to use them. That has been our problem all along.

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To: TimF who wrote (23658)4/14/2012 8:59:11 AM
From: Peter Dierks
   of 42113
Unfortunately the national democrat mindset is that they will grow government or else it is a cut that their liberal media allies will echo for eternity. IMHO, until the mindset of the Tea Party takes hold the best we can hope for this country is gridlock.

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From: TimF4/14/2012 11:24:18 AM
   of 42113
Still Unprecedented: Recycling the Same Two Examples of Supposed Economic Mandates
Randy Barnett • April 13, 2012 3:59 pm

My friend, Harvard law professor Einer Elhauge, has an essay in the New Republic, If Health Insurance Mandates Are Unconstitutional, Why Did the Founding Fathers Back Them?, in which he breathlessly recycles the same two supposed precedents for economic mandates under the Commerce Clause that have been much discussed over the past two years. The first is the requirement that ship owners provide insurance for their sailors. While navigation laws such as this one were an exercise of the commerce power, it is a garden variety regulation of how commerce, in this case the activity of shipping, is to be conducted. To be subjected to this regulation, you first have to engage in the commercial activity of shipping, or what was called, “the carrying trade.” The fact that this particular regulation required ship owners to provide insurance does not distinguish it from, say, regulations providing for life preservers or life boats (which also have to be purchased!).

The second is the well-trod example of the Militia Act that requires persons to provide their own weapons. Of course, this was an exercise of Congress’s militia power, and the militia duty traditionally required members to provide their own weapons. Contrary to Elhauge’s characterization of this as a “purchase mandate,” guns could be gifts or borrowed or inherited. There was no requirement that they be purchased. Challengers to the mandate have never denied that Congress has the power to require persons to do things. I have long listed the draft, jury duty, the filing of a tax return, and service on a posse, as examples of fundamental duties of citizenship that are owed to the government in return to the protection it affords to citizens. This is all explained in my 2010 article, Commandeering the People: Why the Individual Insurance Mandate is Unconstitutional. But just because the federal government has the power to make you fight and die for your country does not entail that it has the totalitarian power to make you do anything less than this.

Every court that has considered the constitutionality of the insurance mandate, including those judges that upheld its constitutionality, have concluded that this mandate is unprecedented. The fact that these two examples have been so well discussed, debunked, and rejected explains why the Solicitor General cited neither in his oral argument when Justice Kennedy characterized this Commerce Clause mandate as unprecedented. Indeed, the fact that, over two years into this debate, these are the only supposed examples of such mandates on offer by defenders of the Affordable Care Act strongly supports, rather than detracts from, the claim that such mandates are unprecedented. One reason why supporters of the mandate were so surprised by the apparent skepticism of some of the Justices towards this claim of Congressional power may simply be that they are not all that familiar with the constitutional arguments that have actually been made by the challengers in their briefs or the analysis presented in the opinions of lower court judges.

[Update with Einer's reply moved to separate post above.]

A 1798 “Federal Law Requiring the Seamen to Buy Hospital Insurance for Themselves”?
Eugene Volokh • April 13, 2012 8:00 pm

I don’t have a lot to add to the exchange between Einer Elhauge and Randy Barnett on the 1790s laws that Prof. Elhauge identifies as “mandates” that are sufficiently akin to the individual health insurance mandate. But I did want to say something about a particular example Prof. Elhauge gives,

in 1798, Congress addressed the problem that the employer mandate to buy medical insurance for seamen covered drugs and physician services but not hospital stays. And you know what this Congress, with five framers serving in it, did? It enacted a federal law requiring the seamen to buy hospital insurance for themselves. That’s right, Congress enacted an individual mandate requiring the purchase of health insurance. And this act was signed by another founder, President John Adams

As David Kopel noted two years ago, this law (which I quote below) actually looks a lot like a payroll tax, earmarked for health care, not a mandate to buy health insurance. Ship owners were required to pay a flat sum to the government for each sailor, which they could deduct from the sailor’s wages, and the money would go to fund a local hospital for injured and disabled sailors. But nothing in the statute suggested — as would be the case with a requirement to buy insurance — that the sailor must present some proof of payment when he shows up at a hospital, or that the sailor would be penalized for refusing to pay. (A ship owner could be fined for refusing to pay the money, but that sounds like a normal fine for nonpayment of a tax.)

So, as David mentioned two years ago, I don’t see this as a precedent for a mandate to buy insurance; it’s just one of a long line of taxes imposed on economic activity (here, the employment of seamen). It taxed all seamen for the benefit of all seamen. It did not require anyone to buy anything; rather, it required a ship owner to pay money to the government, which seems like a tax to me...

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To: TimF who wrote (23665)4/16/2012 12:22:29 PM
From: Peter Dierks
   of 42113
Ouch! Decade of Obamacare Will Cost $1,160 billion
By Michael Barone
April 16, 2012

How much will Obamacare -- call it the Patient Protection and Affordable Care Act if you like -- cost over the next 10 years?

More than you've been led to believe, reports Charles Blahous of George Mason University's Mercatus Center. To be specific, he projects it will add $1,160 billion to net federal spending over the next 10 years and at least $340 billion to federal budget deficits in that time.

Blahous was appointed by Barack Obama as one of two public trustees of the Social Security and Medicare programs. He worked on these issues in George W. Bush's administration and submitted his Mercatus paper for anonymous peer review.

Why does he say Obamacare will increase spending when the Obama administration, citing Congressional Budget Office numbers, promised it will save money?

One reason is that the CBO said Obamacare's "Class Act" provisions would save money, since the government would collect premiums immediately but not pay off policyholders until later.

But Health and Human Services Secretary Kathleen Sebelius has conceded that the Class Act is unworkable, and so Blahous zeroes out those phantom savings.

Another reason Obamacare was supposed to save money is that it raises the Medicare tax 0.9 percent for high earners. It then dedicates those resources both to Medicare and to general revenues, with the CBO counting the savings twice.

That's because under a 1985 internal ruling (not a full-fledged law passed by Congress), the CBO scores the costs of legislation against a hypothetical baseline rather than against current law.

But, as Sebelius conceded to Congress in March 2011, that's double counting. The government can't spend the same money twice. Medicare tax revenues dedicated to current Medicare spending can't be used to reduce the budget deficit. That's true "in practice," Medicare chief actuary Richard Foster wrote last year, despite the CBO's scoring procedure.

And, as Blahous points out, if the funds don't go to Medicare, then under current law, Medicare will go broke faster and be forced to reduce benefits. Since Congress is not likely to let that happen any sooner than it has to, the deficit reduction promised by the CBO score and claimed by the Obama administration simply ain't going to happen, no how, no way.

To all of which the Obama White House says only the CBO numbers should count and that Blahous worked in a Republican administration. This is about as intellectually serious a reply as, "Nyah, nyah, nyah nyah nyah, nyah."

Which is what we are coming to expect from the Obama White House. Consider the president's Supreme Court trash-talking earlier this month.

The supposed constitutional scholar didn't seem to know that the Supreme Court has been overturning laws since Marbury v. Madison in 1803. He suggested the Lochner case was an example of the Supreme Court striking down New Deal legislation. But Lochner was decided in 1905 and overturned a state, not a federal, law.

Similarly, Obama characterized House Budget Chairman Paul Ryan's budget as "social Darwinism" and falsely said it would require zeroing out spending for various wonderful programs. And he has heaped scorn on those who harbor any doubt that renewables will become major energy sources in the 21st century.

His experiences in university neighborhoods and Chicago politics have apparently left Obama ignorant that there are intellectually serious arguments against liberal policies. So when presented with such arguments by Ryan and others, he scowls, calls people names and does the intellectual equivalent of stamping his feet.

Someone needs to tell him that combining arrogant condescension with intellectual shoddiness is not a winning political tactic.

Or a winning governing strategy. Obamacare's architects also combined arrogant condescension with intellectual shoddiness. They shamelessly gamed the CBO scoring process to make Obamacare look like a money-saver. They threw in unworkable programs like the Class Act to make political points.

And so when Charles Blahous totes up the numbers and give us an idea of what Obamacare would really cost, they are left without an intellectually serious reply.

If Obama really knew constitutional law, he might remember that the Supreme Court unanimously overturned the National Recovery Act in 1935, after it became clear that, with its 700-plus industry groups setting wage and prices, it was unworkable and was becoming increasingly unpopular.

The legal arguments are not quite on point, but Obamacare is looking to be as unworkable as the NRA and even more unpopular. Plus, as Charles Blahous has established, hugely more expensive than advertised.

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From: average joe4/16/2012 12:40:51 PM
   of 42113
Mom with seriously sick baby turned away from hospital

CBC News Posted: Apr 14, 2012 3:49 PM CST

Last Updated: Apr 14, 2012 5:26 PM CST Read 96 comments96

A mother with a child needing urgent care for severe dehydration says she was turned away twice at the Royal University Hospital in Saskatoon.

Traci La Freniere says she has filed a formal complaint over what happened when she sought treatment for her son at the hospital's emergency room at the beginning of April.

Traci La Freniere says her seventh-month old son Connor needed urgent medical care, but was turned away twice at the hospital. (CBC)

La Freniere told CBC News her seventh-month-old boy, Connor, had been vomiting and had severe diarrhea for three days.

She said she could not believe her attempt to get medical help for the boy was met with resistance.

"I couldn't believe it was my child that going through this, after me as a parent trying to get him the help that he needed twice and being shut down," La Freniere said.

La Freniere said she finally returned to the hospital a third time, when the boy went into convulsions.

"My son could possibly be dying and nobody would help me," La Freniere said. "So we have to take him back to the hospital."

La Freniere says she has filed a formal complaint with the health region.
(CBC) On the third visit, La Freniere was with her fiancé and her mother and determined to get help.

"I wasn't going to take no for an answer at that point because I knew how bad things were," she said.

The boy was finally admitted and treated for severe dehydration.

An official from the Saskatoon Health Region told CBC News they take all complaints seriously and would review what happened.

The official also said an apology would be made.

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From: average joe4/16/2012 2:43:49 PM
   of 42113
Canada's War on the Weak

Canada's icon of health-care compassion wanted to sterilize mentally and physically disabled canadians and ship them to camps. that's just one of Tommy Douglas's many chilling ideas that his fans are trying to erase from history

John Robson - July 3, 2006

The greatest Canadian of all time said we should sterilize mental defectives. Wait. Before you report this magazine to the human rights commission, or press hate crime charges for attempting to glorify some neo-Nazi or antiquated bigot, you should know this: we're talking about Tommy Douglas. The Tommy Douglas. The New Democrat pioneer. The socialist icon. The father of our vaunted medicare system. The man voted the Greatest Canadian of all time by CBC viewers. His 1933 master's thesis in sociology--"The Problems of the Subnormal Family"--staunchly advocated eugenics in the most merciless terms. And almost nobody dares mention anything about it.

That Tommy Douglas holds a venerated place in Canadian mythology is beyond dispute. He's not just a hero to left-wing nationalists like Mel Hurtig or CBC television viewers. When the Reform party created a portrait gallery of "bridge builders" in their caucus room in 1996, Douglas was there (along with Louis Riel and three of the Famous Five). What's especially disquieting about Douglas's flirtation with eugenics is that, like recent revelations about Pierre Trudeau's youthful anti-Semitism, reactionary clerico-political views and blindness to Nazi aggression, these are not things we did not know. We just chose not to think about them.

The Wikipedia online encyclopedia entry tells us Douglas "is warmly remembered for his folksy wit and oratory with which he expressed his steadfast idealism, exemplified by his fable of Mouseland . . . In 2004, he was voted 'The Greatest Canadian' of all time in a nationally televised contest organized by the Canadian Broadcasting Corporation." Then the entry states baldly that he "completed his Master's degree (MA) in Sociology from McMaster University in 1933. His thesis was on eugenics as a solution for Canada's economic problems." One cannot simply dismiss these views as youthful folly; when he wrote it, he was nearly 30 years old.

From the point of view of the modern left, much is--or should be--profoundly troubling in Douglas's thesis (you can view a PDF of the original document at He flings about terms like "subnormal," "defective" and "moron" and condemns unwed motherhood in harshly judgmental terms. He speaks of women "guilty" of abortion and grouses about tax money as well as morals, noting that one "mental defective" let out of an asylum "lived as a prostitute" and produced two "mentally defective" children who were also institutionalized. His conclusion: "Thus the initial cost to the taxpayer has been tripled in this case." And far from sympathizing with what we're now meant to call "sex-trade workers"--whom we should view as exploited women--Douglas denounces prostitutes for "accosting" men from "fairly good homes" and giving them venereal diseases.

Douglas's attitudes and vocabulary are troubling. But it is his recommendations that are truly alarming. First, he advocates compulsory certificates of "mental and physical fitness" and seven days' public notice before marrying. He goes on that since "Society does not hesitate to segregate criminals, lepers or any others that threaten the well-being of society" it should put defectives "on a state farm, or in a colony where decisions could be made for them by a competent supervisor." He discusses segregating the sexes within such colonies, but says it "would be very difficult to enforce, and would be an unnatural mode of life. It should only be tried if the next suggestion were rejected, namely sterilization."

Thus we come to Douglas's most appalling proposal: "Sterilization of the mentally and physically defective." To meet anticipated criticism he adds, "medical science declares that it is possible to be sterilized and yet have sexual intercourse. In the main this is all the defective asks." He concedes "that sterilization might be abused . . . There are possibilities of abuse in any forward step . . . The matter would have to be handled carefully. Only those mentally defective and those incurably diseased should be sterilized." The subnormal, he suggests, should simply be discreetly given "contraceptive knowledge . . . when the family had reached a set figure." Douglas never defines the difference between a "defective" and someone who's merely "subnormal." (After all this, it is surely a trivial offence against contemporary progressivism that he also advocates special classes for subnormal children rather than what is now called "mainstreaming.")

If all these views do not cause advocates of political correctness to blanch, the Baptist minister also sees a large role for Christian churches in helping subnormal types to imitate conventional middle-class life, to "have teas," "form clubs" and "learn the useful art of housekeeping." He adds, "When education and legislation have failed, there is still One, who can take the broken earthenware from life's garbage heaps and make them vessels of honor in His temple of love." Such religiously inspired rhetoric is rare on the Canadian left today (a lonely exception being NDP MP and ordained minister Bill Blaikie), but for Douglas it was common. In 1954, he told the Saskatchewan legislature he considered public health, like public education, "an inalienable right of being a citizen of a Christian country." He was also known to urge his followers to build the New Jerusalem in Canada--which may be bad theology, but is unmistakably theology, nonetheless. Yet, today, the conventional wisdom is that religion has no place in politics.

Contrary to occasional allegations, Douglas's 38-page master's thesis actually makes no reference to race, direct or indirect. It is even more important that, while he never seems formally to have repudiated those views, he does seem to have abandoned them fairly quickly and very completely. Thomas H. and Ian McLeod's valuable 1987 biography Tommy Douglas : The Road to Jerusalem (published by Hurtig) notes that he repeated them once, publicly, in a 1934 article for the Research Review, a journal put out by the Saskatchewan Co-operative Commonwealth Federation (CCF). But after becoming Saskatchewan premier in 1944 (while the Nazis were implementing their own mass eugenics program in Europe), Douglas rejected proposals for eugenic sterilization legislation of the sort his progressive colleagues in the United Farmers of Alberta had passed in 1928. Professor emeritus Meyer Brownstone of the University of Toronto adds that, while in power, Douglas worked hard to improve conditions in Saskatchewan mental asylums.

Since eugenics was thoroughly discredited by its hideous eruption in Nazi Germany, it is also important to underline that Tommy Douglas never held Pierre Trudeau's idiotic views on war and peace (as Max and Monique Nemni's recently released book, Young Trudeau: Son of Quebec, Father of Canada, 1919-1944, details, Trudeau blamed Britain for the Second World War and didn't support the idea of Canada fighting Nazi aggression). In 1934, Douglas was expressing conventional pacifist views. But in 1936--as the Nazis were working toward purifying the German race through "racial hygiene" laws and the forced sterilization of those deemed physically and mentally "unfit," culminating in forced euthanasia programs and ultimately, the death camps--Douglas paid a personal and apparently eye-opening visit to Nazi Germany. He returned calling Hitler a "mad dog." In 1938, Douglas denounced the Munich Pact--Britain's attempt to appease Hitler by allowing him to annex Czechoslovakia's Sudetenland--telling Parliament that "Yielding to dictators does not buy peace; it merely brings about demands for further concessions."

Arguably, one could both oppose Hitler's military aggression and still be a bigot. But Douglas's horror at the militarized apparatus of repression that he witnessed in Germany might have had something to do with his reconsideration of the idea of interning "defectives" in camps, where coercive eugenic medical procedures were performed (just as the youthful Trudeau's short play about the perfidious Jew swindling the naive French Canadian might bear some relationship to his own rather different approach to the war). For while CCF founder and party leader J. S. Woodsworth was the man who cast the sole vote against war with Hitler in 1939, Tommy Douglas not only helped bring his party around to supporting the declaration of war, but volunteered for active service. In one of history's ironic quirks, only the same childhood leg problem that famously made him a public health care advocate kept him from probably being sent with the Winnipeg Grenadiers to face death in the fall of Hong Kong or slow torment and probable death as a POW. Instead, Douglas returned to Parliament and helped Mackenzie King's government escape its anti-conscription pledge (in part because, he confessed in a 1942 letter to his associate Clarence Fines, "we are so close to losing the war right now that it makes me shudder every time I look at a map.").

There is no particular reason that an otherwise good man cannot have also held some repellent views, especially briefly. What is peculiar is that this part of Douglas's life should so entirely have disappeared from the official Canadian narrative. The CBC biographical film aired in March, Prairie Giant: The Tommy Douglas Story, which admits at the outset to making stuff up ("characters, locations and events have been composited, condensed or fictionalized for dramatic purposes")--and which the CBC pulled in June because it had unfairly treated Douglas's political rival James Gardiner--also omits any reference to the nature of his graduate studies. And while Wikipedia knows about it, the Canadian Encyclopedia (which began its life as yet another Hurtig production) seems not to. Its online entry takes us from Douglas's "further academic studies in Christian ethics" straight to his respectable political activism.

Tim Woods, executive director of Vancouver's health care-oriented Tommy Douglas Institute, says simply "that's not a master's dissertation I've read," though he admits that he hasn't read any other dissertations, either. Nor does the institute's website profile of Douglas's "achievements and his beliefs" mention it. Mel Watkins, professor emeritus of economics and political science at the University of Toronto and co-founder of the federal NDP's renegade "Waffle" faction, says he's aware of Douglas's dissertation, but doesn't know enough about it to discuss it in detail. Still, Watkins argues that eugenics "was very much in the air at the time, which doesn't excuse Douglas, but does explain--goes to sentencing as one of my lawyer friends likes to say." Fair enough. But why, then, was there no trial?

Possibly because Tommy Douglas was not actually the greatest Canadian ever. Actor Michael Therriault, who played him in Prairie Giant, admitted to a reporter in March that he'd never heard of Douglas before auditioning for the film. "Most of my friends didn't know who he was either," he said. Standard histories of Canada, such as Kenneth McNaught's 1982 revised The Pelican History of Canada, mention Douglas only briefly; McNaught gives him three index entries, Desmond Morton's 2001 revised A Short History of Canada, just five. And socialized medicine is not working as well as the CBC hagiography implies, not least because, as Douglas himself admitted in 1982, he and his colleagues got rid of market pricing, but never got around to figuring out how to make central planning work--not exactly a minor oversight.

But such considerations are beside the point; before anointing T. C. Douglas a secular saint, Canadians might have at least been thorough enough to let the devil's advocate mention eugenics. Instead, "The Problems of the Subnormal Family" went down the memory hole and didn't come back up. The McLeods' favourable biography deals with it frankly, and references to it crop up here and there on the web--but you won't even find the actual text on the Internet. And in researching this article, Western Standard discovered that the McMaster University library has, all these years, been sitting on Tommy Douglas's own handwritten notes about the subjects of his dissertation. Were such a personal artifact to emerge about the intellectual development of truly important American historical figures--say, Abraham Lincoln or George Washington--it would attract enormous attention, even if it was in some ways embarrassing.

Since Canadian nationalists reproach Americans for their uncritical tendency to mythologize their past, shouldn't we be willing to examine our own a bit more closely? Americans know--and mention often--that Thomas Jefferson was a slave owner, and historians have publicly aired suspicions that his slave Sally Hemings was also his concubine. Why can't we discuss Douglas's blunder?

Is it because, in the words of then Much Music VJ George Stroumboulopoulos, Tommy Douglas's "advocate" in the CBC's Greatest Canadian contest, "this is what it all boils down to--the 49th parallel. It's the dividing line between our way and their way. And did you know that on that side every 30 seconds somebody declares bankruptcy because of medical bills? What I'm saying is, Americans go broke because of being sick. I just can't tell you how glad I am that we don't live that way. It's all thanks to Tommy." A morality play this simple has no place for subtle shading of character or historical cause and effect.

To discuss such complexity could teach us about youthful folly. For, as we have seen, Douglas was not a child when he wrote his thesis, but his flirtation with eugenics passed--unlike Trudeau's weakness for foreign tyrants. It was one thing for Trudeau to give a fiery anti-war speech in November 1942. It is quite another for him to write in his 1993 memoirs that, "At the time, Canada was in the grip of a real war hysteria. Is it true that the Gulf of St. Lawrence was swarming with enemy submarines? I have no idea." To his credit, Douglas had, by 1983, ceased musing about forced sterilization.

Another potential lesson from Douglas's thesis is that even a great man or woman may have significant flaws. That's something that might teach us forgiveness. Regrettably, the modern temperament is not as given to forgiveness as, say, a Baptist preacher from Weyburn, Sask., might be.

The lesson that everyone is partly a product of their times could teach us humility about contemporary enthusiasms. But it is highly uncongenial to the progressive temperament to consider that posterity might look askance at, say, unlimited abortion--which seems to fall particularly heavy on the handicapped. Especially given the tendency of progressives to see history, like politics, as a necessarily uncomplicated morality play. The appalling racist episodes and beliefs in our societal past are alleged completely and necessarily to discredit every traditional institution from heterosexual marriage to military prowess to good manners. As Stroumboulopoulos also said, "Tommy Douglas led the rebellion against an older, uglier version of Canada . . .

Tommy's values are now Canada's values." To admire him despite failings, especially regarding anything that even reminds us of racism, requires discarding the blanket condemnation of western civilization that drives the modern left. That's why they've elected to go with option four: ignore the question altogether.

Douglas is famous for his Mouseland parable (you can find it at and for such bons mots as, "The trouble with socialists is that they let their bleeding hearts go to their bloody heads," and "The left in Canada is more gauche than sinister." Even his flirtation with eugenics is mostly gauche, especially when we remember that it took place just before the horrors of Nazism, an ideology against which he was literally willing to take up arms. What seems truly sinister is the silence that now reigns on this imperfection in a revered national figure.


Tommy Douglas's

1933 master's thesis

"The subnormal family presents the most appalling of all family problems."

"Because this class tend[s] to intermarry... the second and third generations are nearly always worse than the first. The result is an ever increasing number of morons and imbeciles who continue to be a charge upon society."

"This does not include the generally low tone of morality among these people, which cannot be shown by statistics, but which is very low."

"Surely the continued policy of allowing the subnormal family to bring into the world large numbers of individuals to fill our jails and mental institutions, and to live upon charity, is one of consummate folly."

"The effects of a large indigent class, of which 20% are moral delinquents, and an even larger percentage morons, cannot but be detrimental to the community."

"it will be seen that there are at least twelve women or girls who are living as prostitutes, and who are diseased . . . It is true, of course, that those infected are those of a low moral order, but not always. Sometimes men from fairly good homes, but who are working in the city, are accosted by these women and are in due course infected."

"Of the 34 moral delinquents, at least 28 are guilty of illegal parentage, or abortion."

"The presence in any school or community of a group of sexually immoral girls is bound to make for a lowering of moral standards . . . The boys included in this class often had resort to foolish but potentially fine girls, who thus became contaminated."

"The girls who have given birth to illegitimate offspring have in the main refused to part with them . . ."

"Sterilization of the mentally and physically defective has long been advocated, but only recently has it seeped into the public consciousness. From the day when Plato wrote his Republic to the present, eugenists have advanced various solutions to the problem of the defective, but sterilization seems to meet the requirements of the situation most aptly."


The failure to come to grips with mildly awkward historical truth is not entirely innocent--even if Tommy Douglas himself has little to fear. Consider this warning to Canadians, from another legendary figure: "It sometimes seems as if the white race lacks both the physical and moral stamina to protect itself, and that maybe the black and yellow races may yet obtain the ascendancy."

It sounds at once repulsive and comically stupid. But it comes from Emily Murphy, and we just erected a statue of her on Parliament Hill and put her picture on the $50 bill, even though she spewed delusional racist hatred under her own name and the pen name "Janey Canuck." And even though she, along with fellow Famous Fivers Nellie McClung, Irene Parlby and Louise McKinney, helped push through Alberta's 1928 Sterilization Act, which victimized nearly 3,000 mental patients between 1928 and 1972 (a similar 1933 B.C. law was used far less often). Oh, and Murphy's anti-marijuana screed The Black Candle makes Reefer Madness look like a balanced documentary treatment of drugs, and the Fu Manchu novels look like sensitive multicultural commentary on the place of the Oriental in early 20th-century western society.

What shall we tell our children now about Murphy's statue and those of her eugenicist fellow Fivers? It's an awkward question. Many adulatory articles on the Famous Five omit the topic altogether. Alberta's Heritage Community Foundation actually states on its website that McKinney "was interested in legislation to aid people with disabilities."

The standard Ontario school curriculum--which encourages grade 11 students to role-play Tommy Douglas among other historical figures--offers grade 12 Catholic school board students a set of "possible suggestions" for favourable study as "agents of change": "Sue Rodriguez, Nelson Mandela, Martin Luther King, Rosa Parks, Mahatma Gandhi, Elijah Harper, Tommy Douglas, David Suzuki, Nelly McClung, Emily Murphy, Pierre E. Trudeau, Craig Kielburger, John F. Kennedy, Robert Kennedy." At least it allows students to consider whether they "would have proceeded differently" and if so, to explain why--say, by leaving out the bits about eugenics. Not to mention the diatribes against lascivious Negroes, opium and white slavery.

Leave them out entirely, that is, since there seems little choice at this point but to try to conceal these so-called great Canadians' views on the unsavoury subjects--especially in the case of Murphy. It is a pity Canadians didn't instead allow themselves the intellectual honesty to discuss them sooner and more frankly. Kids are, after all, curious. One day our children may discover this stuff for themselves--and wonder what the heck we adults were honouring these people for.

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To: Lane3 who wrote (23620)4/16/2012 3:41:29 PM
From: Lane3
   of 42113
I see more good news than bad news in this.

How the Government Plans to Lower Cost by Eliminating Doctors and Shifting Costs to Patients

In our world of 24/7 media, where we seem to hear about the next big cure, important dietary change or very dangerous drug virtually every day, it is hard to believe that the news people, tweeters and bloggers could miss anything that is going on in health care today. However, it appears most everyone missed a big one. This might be one of the most important stories in health care today, that no one seems to have picked up on. No mention in the Times, Wall Street Journal, Washington Post, etc. Only US News mentioned this by re purposing material from Health Day. It's how the government, through the FDA, plans cut health care costs by eliminating the need to see a doctor and shift the costs of medications to the patient.

And you should be afraid....very afraid!!!

What I am referring to is a public hearing that was held on March 22 and 23rd; the notice was placed online only a few weeks before on 2/28. The meeting was entitled:

Using Innovative Technologies and Other Conditions of Safe Use To Expand Which Drug Products Can Be Considered Nonprescription

What was the purpose of such a meeting? According to the briefing document:
"The U.S. Food and Drug Administration (FDA or the Agency) is announcing a public hearing to obtain input on a new paradigm we are considering. Under this paradigm, the Agency would approve certain drugs that would otherwise require a prescription for nonprescription use (also known as over-the-counter or OTC) under conditions of safe use. These conditions of safe use would be specific to the drug product
and might require sale in certain pre-defined health care settings, such as a pharmacy."

You have to read between the lines here, but essentially what this is saying is that the FDA is thinking about a completely new way to approve or classify drugs, so that some drugs if dispensed in a pharmacy would be allowed to be purchased over the counter/without a prescription.

Their rationale which I have extracted (the bolding and underlining are mine):
" Undertreatment of many common a well recognized public health problem..... The requirement to obtain a prescription ... may contribute to undertreatment of ...hyperlipidemia (high cholesterol), hypertension (high blood pressure), migraine headaches, and asthma. For instance, some consumers do not
seek necessary medical care...because of the cost and time required to visit a health care practitioner for an initial diagnosis and an initial prescription. Some patients who obtain an initial prescription do not continue on
necessary medication because they would need to make additional visits....Some prescription medications require routine monitoring through the prescribing practitioner such as blood tests..... FDA believes that some of these visits could be eliminated by making certain prescription medications available without a prescription but with certain other conditions of safe use that would ensure they could be used safely and effectively without the initial involvement of a health care practitioner... In addition to improved health outcomes .... Eliminating or reducing the number of routine visits could free up prescribers to spend time with more seriously ill patients, reduce the burdens on the already overburdened health care system, and reduce health care costs.

Now, on the surface, this might sound like a good thing. Wouldn't it be great if we could find easier ways for patients to get their needed medicines? After all, as our nation gets older (and more overweight), chronic diseases are going to be main issue in health care. It all about improving health, right?

Unfortunately, the bottom line here is that instead of finding a real solution to improving access to primary care physicians or finding real ways of reducing health care costs, the government (through the FDA) has come up with a simple plan: take the doc out of the picture and shift costs to the patients.

The fact of the matter is that though medications are expensive, they only represent about 10 cents of every dollar spent. The two biggest costs are doctors and hospitals. Thus, if we are trying to cut costs, the most economical solution would be to eliminate or at least curtail a visit to the doctor. Since prescription medications require a prescription which requires a doctors visit (or at least phone call); the FDA can just make certain medications available over the counter and we no longer need those annoying, inconvenient, and expensive visits to your primary care provider.

Now there are already lots of medications available over the counter. These medications are considered safe enough to use, and a medical degree is not required to figure out that you take cold medicines for your cold and heartburn medicines for your heartburn. However, what the FDA is talking about are medications to treat chronic diseases like asthma, high blood pressure, high cholesterol and though not mentioned, probably diabetes.

It was only back in 2005 when the FDA rejected Merk's bid to make their cholesterol medicine Zocor (simvastatin) OTC. At that time, they knew that even drugs that seemed relatively safe and could benefit many people required expertise to properly diagnose and treat high cholesterol safely and effectively. More recently, Pfizer also tried to get their patent expiring Lipitor to be sold over the counter (see my post Why OTC Lipitor is a Bad Idea).

How can medicines that were only a few years ago considered too dangerous to be taken over the counter, would now be considered safe? According to the briefing document:

"The conditions of use could include requiring pharmacist intervention to ensure appropriate nonprescription use. Additionally, conditions of safe use could involve the use of innovative technologies, such as diagnostics
approved or cleared by FDA for use in the pharmacy or other setting."

In other words, for certain (particularly expensive) chronic diseases such as asthma, high blood pressure and high cholesterol; the FDA would consider these medications safe by allowing the pharmacist, not the doctor, to determine which medication is right for you. And if you needed any blood work, the FDA might clear the way for this to be done in the pharmacy as well.

But my favorite part is about the kiosks:

"For example, kiosks or other technological aids in pharmacies or on the Internet could lead consumers through an algorithm for a particular drug product."

Can you just imagine patients going up to an ATM-like machine, entering their conditions, allergies, blood levels, etc. and having the computer spit out exactly what dose of what medicine that they should be taking for their high blood pressure or high cholesterol? Would there be a soda-like machine right beside it that could dispense the appropriate medication?

When it comes to prescribing, physician is best
I have nothing against pharmacists. I value pharmacists as part of the health care team. In addition, I feel their role is substantially underutilized. Part of the problem with chronic disease is adherence to medication, a large part which has to do with education. Pharmacists are experts when it comes to informing patients about their medications, how to take them properly and why taking them is necessary. They can monitor adherence to medication and can also serve on the front lines to alert physicians if their patients aren't doing well and need closer attention.

However, when it comes to making a diagnosis and determining which therapy is best, pharmacists do not have the depth and breadth of training that physicians receive. As a primary care physician, I can tell you that even the most common conditions like asthma or sinusitis is not always that easy to diagnose, and even determining treatments for these conditions do not do well with cook book like algorithms.

Another concern I have with pharmacist essentially prescribing medications is that they are employed by the pharmacy that dispenses these medications, and thus have a potential direct conflict of interest. Now, I am sure skeptical readers will say that drug reps have been given physicians gifts and samples for years, and this is conflict as well. Though this may be true, a pen or a slice of pizza is a whole different level of conflict then direct money in your paycheck. Also realize that the pharmacy makes a bigger profit on generics, thus the pharmacist may be consciously or unconsciously biased to give you a generic when it may not be the best choice.

Patients Will Pay More
Usually when a drug goes OTC, it usually means the patient has to pay more. This is because most insurances do not cover over the counter medications. Ask any patient who suffers from seasonal allergies. OTC non-sedating antihistamines like Claritin, Zyrtec, and Allegra cost a lot more out of pocket, even when using the store brand, then when they were available by prescription. This is because the out of pocket cost for co-pay for a preferred drug (even when branded) is often less then the out of pocket cost for and entire supply of over the counter medication, even when generic/store brand. The same is true for acid blocking medicines such as Prilosec. Generic OTC Prilosec (Omeprazole) is just over 50 cents a pill, which means a patient requiring a daily dose will pay over $15 for a 30 day supply. This is generally much more than patients pay for a generic prescription of omeprazole, some paying as little as a $5 co-pay. (Some insurers have actually made the co-pays for the generic omeprazole more expensive then the acid blocking medicines that are not yet over the counter, like Nexium, to steer patients to buying the over the counter medication (full out of pocket cost), rather then request a prescription!)

Where is the Outcry?
What's most shocking to me is the lack of dialogue on this topic. My guess is that this may be due to lack of awareness, since the FDA seemed to slip this past the media. Physician representation at the March hearing was pretty poor. Few groups such as The America College of Physicians seem to be interested (or aware). The AMA did testify at the hearing, and according to their website:

"While the increased availability of certain prescription-based antidotes, such as Epi-Pens, appear to have few if any safety concerns, the FDA has not offered evidence that patients with hypertension, hyperlipidemia, asthma, or migraine headaches can self-diagnose and manage these serious chronic medical conditions safely on their own. This sort of self-diagnosis and treatment conflicts with the kind of care coordination and disease management that both the administration and private sector are trying to achieve through the new health care payment and delivery models."

To me the "conflicts health care payment and delivery models," is very interesting. This suggest to me that the government is trying to hedge their bets. In other words, if the new plans for health care reforms don't work, we can still lower cost and increase access simply by making many chronic disease drugs over the counter.

Most commentary that can be found on this issue seems to be coming from the pharmacist groups, who are not surprisingly supportive. However, there is at least one pharmacist that remains skeptical. Pharmacist blogger Eric Durbin at his blog Eric, Pharmacist states:
"I've never known our government or any of its agencies to move quickly on issues, especially when it comes to our profession. But for this issue, the notification for the hearing was filed on February 27, published in the Federal Register on February 28, with a deadline to present oral comments & presentations of March 9. That's less than two weeks. With the hearing being held less than two weeks after the deadline. 3-1/2 weeks from the notice of hearing in the Federal Register until the hearings begin seems to be moving rather quick to me. Which makes me skeptical"

Bottom Line: Though this may seem like an initiative that could improve patient access and chronic disease outcomes, allowing chronic disease medications to be over the counter is a way the government can cut health care costs by eliminating expensive doctor's visits and shift medication costs to patients.

What can you do?
Though the hearing was over weeks ago, the website still allows visitors to submit comments (due May 7, 2012) online ( CLICK HERE- also note the 20 minute lock out, so you may want to type in Word first and then copy/paste). You can also use the address below for regular mail:

Division of Dockets Management
(HFA–305), Food and Drug
Administration, 5630 Fishers Lane, rm. 1061
Rockville, MD 20852

In addition, you can send this post to those who know who might care about this issue and/or write your own post. You can Tweet, post to Facebook, etc. Social media has done wonders recently in getting the word out and making changes. However, time is of the essence.

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To: Lane3 who wrote (23669)4/16/2012 7:44:49 PM
From: i-node
   of 42113
>> I see more good news than bad news in this.

I do, too, so long as they're reasonable about it. In this age of people having access to information it makes sense they can take a little more responsibility.

OTOH, there is probably a downside, too, in that people who get routine screenings as a result of annual physicals might tend toward fewer such visits. Of course, if they decide quit doing the basic screenings like EKGs and chest x-rays, that won't matter either ;)

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From: greatplains_guy4/17/2012 2:25:35 AM
1 Recommendation   of 42113
More Evidence of Fraud in ObamaCare
Washington Examiner, Washington Examiner
April 12, 2012

When House Budget Committee Chairman Paul Ryan met with President Obama at the Blair House in February 2010, he warned that the CLASS Act program in Obamacare was "a Ponzi scheme that would make Bernie Madoff proud." Last October, Health and Human Services Secretary Kathleen Sebelius admitted Ryan was right. She announced there was no "viable path forward" to implement the provision -- and why would there have been, considering that its only real purpose was to make Obamacare's bottom line look better so that it would pass Congress in the first place.

Now, Social Security and Medicare trustee Charles Blahous has come forward with a new report detailing another of Obamacare's accounting frauds. Blahous charges that $470 billion of the law's Medicare cuts are used to both: 1) add money to Medicare's Trust Fund and 2) fund new subsidies for buying health insurance. If this "double-counting" is eliminated, Blahous argues, Obamacare would add, not subtract, at least $346 billion to deficits over the next 10 years.

Blahous' study -- which was peer-reviewed and not merely an ideological think tank product -- must have struck a nerve, because the White House immediately attacked the report, calling it "another brand of new math." They turned to the Congressional Budget Office, who has recently certified that Obamacare will reduce the debt by $143 billion through 2019.

But the CBO has also previously acknowledged the "double counting" problem that Blahous identifies. In a January 2010 letter to Sen. Jeff Sessions, ranking member of the Senate Budget Committee, the CBO wrote, "The act's effects on the rest of the budget -- other than the cash flows of [Medicare] -- would amount to a net increase in federal deficits of $226 billion over the same period."

The Centers for Medicare & Medicaid Services, the government agency that administers Medicare, has also acknowledged the double-counting problem. The CMS wrote in an April 2010 report, "In practice, the improved [Medicare] financing cannot be simultaneously used to finance other Federal outlays (such as the coverage expansions) and to extend the trust fund, despite the appearance of this result from the respective accounting conventions."

Medicare's financing system is complicated, so think of the issue this way: Imagine that you are a family diligently saving $200 every month for college. Someone comes along and tells you that your kids will never get into college unless you also spend $200 on tutoring now. "But won't this cost me $400 total?" you ask. "No," they tell you, "Just write yourself a $200 IOU every month to cover what you were saving before." When it comes time to pay for your child's tuition, no college will to accept your IOUs as legal tender.

This is the problem Obama's accountants hoped no one would notice. The money that Obamacare spends on health insurance subsidies today will only make it necessary to borrow more money to pay for Medicare later. This is why the only "new math" here is being performed by the White House.

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To: Lane3 who wrote (23669)4/17/2012 2:16:30 PM
From: Lane3
   of 42113
"Healthcare is the third leading cause of death in the US"

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