Everything Obama Thought He Knew About Health Cost Control Is Wrong

The Gardiner Harris of the NY Times describes a rebuttal to an influential Dartmouth study:

For much of the past year, President Obama lavished praise on a few select hospitals like the Mayo Clinic for delivering high-quality care at low costs, but a pointed analysis published Wednesday in an influential medical journal suggests that the president’s praise may be unwarranted.

Mr. Obama received his information about the hospitals from a widely cited analysis called the Dartmouth Atlas of Health Care, produced by the Dartmouth Institute for Health Policy and Clinical Practice. An article in The New Yorker magazine last year written by Dr. Atul Gawande that used the Dartmouth Atlas as its organizing principle became required reading in the White House last year.

But an analysis written in The New England Journal of Medicine by Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center in Manhattan, suggests that much of the Dartmouth Atlas is flawed and that it should not be used to compare the relative efficiency of hospitals.

Good job by Mr. Harris including a link to the article.  I am ready to tell you their secret - they only studied dead people:

Atlas researchers might correctly argue that costs correlate poorly with outcomes. But poor correlation does not imply that outcomes are homogeneous, but rather that there are high-spending hospitals that use resources in a manner that improves outcomes and others that squander resources, failing to improve health. The same goes for low-spending hospitals. Figuring out which is which is the purpose of efficiency assessment, which therefore requires consideration of both costs and outcomes.

Say Hospital A and Hospital B each has a group of patients with a fatal disease. Hospital A gives each patient a $1 pill and cures half of them; Hospital B provides no treatment. An Atlas analysis would conclude that Hospital B was more efficient, since it spent less per decedent. But all the patients die at Hospital B, whereas only half of the patients do at Hospital A, where the cost per life saved is a bargain at $2. Although $1 cures are rare, changing the price or efficacy of the pill does not alter the fundamental problem with examining costs alone when cost differences are sometimes associated with outcome differences.

There is another problem:

The conceptual problem lies in the fact that in Atlas analyses all health care costs that are incurred by patients over the 2 years before their death are attributed to the hospital where they were admitted most frequently during that period. This method assumes that the hospital controls all, or at least most, patient care, even if it occurs outside the hospital or in another hospital. It thus seems to presuppose a system in which hospitals are accountable for all care — perhaps a noble long-term objective, but not a current reality.

Do read the Dartmouth reply, which includes this non-answer:

We agree with Dr. Bach that fragmentation of care — resulting in the admission of patients to multiple hospitals and nursing homes — can explain why some hospitals appear so expensive in the Dartmouth data. But patients need to know about such fragmentation. Do they really want to be cared for in a hospital–physician network where patients are bounced from one hospital to another? Furthermore, accountable care organizations are a promising approach to discouraging such poorly coordinated care.

Regardless of whether people want to be "bounced around" (I see empowered patients availing themselves of their free choice of multiple providers, but whatever), it still doesn't make sense to ding one hospital for all the costs incurred by that patient.

As to the reliance on dead people:

The Atlas sample comprises Medicare enrollees with at least one life-threatening chronic disease in their last 2 years of life. It further adjusts for the type of chronic disease and the presence of multiple diseases. As we show, appropriately risk-adjusted “look-forward” and “look-back” measures are very highly correlated.

I have to score that dispute as "beyond my pay grade".  But it is not above the pay grade of the critic who just got his paper published in a prestigious journal.

Comments

[steve sturm]

GIGO... Obama's health care proposals are influenced by flawed research... his environmental proposals influenced by flawed research... his remarks about the Cambridge cop based on flawed assumptions (that white cops dealing with blacks are racist), his foreign policy influenced by flawed assumptions (that apologizing to the world would make them all fall in line)...

[Slaves; all of 'em.]

Who cares? It's free.
============

[narciso]

It's a bug, not a feature, as Instapundit is wont to say

[Old Lurker]

WaPo Lead Editorial 22 Feb 10:

"THE EARTH is warming. A chief cause is the increase in greenhouse gases accumulating in the atmosphere. Humans are at least in part responsible, because the oil, gas and coal that we burn releases these gases. If current trends persist, it's likely that in coming decades the globe's climate will change with potentially devastating effects for billions of people.

Contrary to what you may have read lately, there are few reputable scientists who would disagree with anything in that first paragraph."

Please compare that view with the four simple points posted at JOM last week.

[drjohn]

Being wrong will not deter Obama one iota. Witness the Obama's bitter clingitude to the AGW fraud.

[It's getting even more egregious than usual.]

The longer the US media go in denial of the AGW hoax, the worse they will look. Worldwide press is eating AGW alive, and for the WaPo and the NYT to think that their readers don't know this is unexplicable.

George Will has a nice column about ignoring the boulders.
===============================

[Rick Ballard]

OL,

It's the same process that used in the Dartmouth study:

1. Determine conclusion
2. Manipulate data to support conclusion
3. Find data which are relatively simple to manipulate.

The (D)irty socialists need to control the health care unions and they need Air Taxes (rather desperately) to provide unicorn feed and keep rainbows in good repair. The UN had to step in on the climate nonsense because of the worldwide need for Air Taxes to support socialist idiocy around the globe.

It really is sort of scientistic and inevitable - if you just shut up, plug your ears and close your eyes.

[Old Lurker]

4. Task friends to diseminate the phony logic to the people.

[Old Lurker]

Kim, Will seems to be making ammends for hosting the Conservatives Come to Jesus Dinner at his house a year ago.

[Neo]

Damn. It's just like Global Warming, the report is flawed, so the program based on the report is a POS.

[I pity Naomi Oreskes her paranoia.]

Jeffrey Sachs, with the help of his pal George Soros, trashed the skeptics in the Guardian today. Check it out Chaco. I'm beginning to hope Ol' George might get nailed in this mess. There's a lot of anger internationally starting to be directed at the architects of this fraud.
===============================

[brahma]

Climategate has caused me to have an icky feeling about the last phrase "who just got his paper published in a prestigious journal." I no longer believe that being published in a scientific journal is other than an editor/agenda driven result. I no longer have "class level" (such as scientific journals) trusted sources. Does anybody now believe this health insurance funding debate is about other than politicians skimming from the cash flow to pay back donors and lobbyists with regulation, deals, and influence?

[Neo]

As for the example, I bet that bullets are probably cheaper than those $1 pills. So if you put a raving lunatic like Dr. Amy Bishop on your staff, you can further lower costs.

[Buck Smith]

"If current trends persist, it's likely that in coming decades the globe's climate will change with potentially devastating effects for billions of people. "

This is the claim which is pure BS and speculation. CO2 does cause the earth to warm. The fraud is around magnitude of warming and the effects.

[Cecil Turner]

. . . it still doesn't make sense to ding one hospital for all the costs incurred by that patient.

No, it doesn't. And the "fragmentation is bad, too" response was a complete non sequitur. This is the weakest point of the study, and the non-defense suggests to me it's indefensible.

The looking back two years from death postulate is also troubling, but enables the statistician to group cases appropriately, and may be a necessary evil for comparing end-of-life care costs.

[narciso]

Seeing how they hid the trend of cooling or stagnant temperatures for up to 15 years, and
trashed the rest, one cannot consider anything
they say as legitimate

[Alexander D. Mitchell IV]

It occurs to me that Obama's election itself could be said to have been based on flawed research... of the candidate by the voters, that is.

[RahmEmanuel]

(5) Find a believable liar in a position of power to spread the message.
(6) Propagandize the goal at NYT.
(7) Bribe liberal Democrats to pass laws forcing the goal.
(8) Ignore the democratic process.
(9) Ignore voters’ views.
(10)Ignore "real" science.

(Adding comments to Rick Ballard 8:32 AM and Old Lurker 8:35 AM)

[narciso]

Victor Davis Hanson, observes on this phenomena, in the LUN

[Jack is Back!]

RAS PAI = 19% - Wow!!

The Won has us where he wants us. Mean, mad, angry, reticent, crazed, foaming at the mouth, deranged and energized. We are going to lay down and take it whether we want it or not. The Way. The Power. The Glory of it all.

[MrPete]

"THE EARTH is warming. A chief cause is the increase in greenhouse gases accumulating in the atmosphere. Humans are at least in part responsible..., because the oil, gas and coal that we burn releases these gases. If current trends persist, it's likely that in coming decades the globe's climate will change with potentially devastating effects for billions of people."

THE EARTH is cooling, after a period of warming. A chief cause is variation in solar activity. Humans are not responsible for this, because we do not control the sun. If current trends persist, it's likely that in coming decades the globe's climate will change with potentially devastating effects for billions of people.

Contrary to what you may have read for a number of years, there are few reputable scientists who would disagree with anything in that second paragraph.

[daddy]

From what I've seen in Climate Gate the last year I have zero faith whatever in these Climate Scientists. That's why I'm bummed that Congress just announced the creation of 6 new NOAA Climate Science Centers and ">http://www.adn.com/2010/02/11/1135066/anchorage-to-get-regional-climate.html"> 1 of them is going to be located in Anchorage.

"...climate changes like decreases in duration of sea ice and increases in land surface temperature are impacting Alaska earlier and with more intensity than anywhere in the United States," NOAA Administrator Jane Lubchenco wrote in a letter to Sen. Mark Begich."

A prediction: Their conclusions about Climate Change are already made up and they will do research designed to buttress their conclusions and further lock up the State from development by its citizens. And they will completely ignore this Watts Up story ">http://wattsupwiththat.com/2010/02/21/fudged-fevers-in-the-frozen-north/"> of bogus Alaska Temperature Warming Adjustments because it fits their template.

I hate these guys.

[Rob Crawford]

As for the example, I bet that bullets are probably cheaper than those $1 pills.

LUN; .45 ACP FMJ as low as 31 cents a round, hollow points 57 cents a round. Hollow point .22 LR as cheap as 4 cents a round.

[Rick Ballard]

Cecil,

I disagree re "weakest point of the study". I would submit that

Resources that are consumed in the care of fee-for-service Medicare patients who died are also a poor surrogate for costs of care for other patients at the same hospital. If resource consumption is measured by the number of hospital days, the correlations are only 0.40 with patients in Medicare Advantage plans and 0.34 with patients covered by commercial insurance. If most care and resources went to dying fee-for-service Medicare patients, then maybe these weak correlations wouldn’t matter. But I estimate that these patients account for less than $3 of every $100 spent on health care.

better encapsulates the absurdity of the conclusions drawn in the initial study. They went a few extrapolations too far in their attempt wring meaning from inadequate data.

[daddy]

"Obama's health care proposals are influenced by flawed research... his environmental proposals influenced by flawed research... his remarks about the Cambridge cop based on flawed assumptions... his foreign policy influenced by flawed assumptions..."

All of which makes the WaPo think he'd be perfect ">http://www.washingtonpost.com/wp-dyn/content/article/2010/02/18/AR2010021803275.html"> as a Supreme Court Justice because he's so "detached and cerebral."

[Porchlight]

Worldwide press is eating AGW alive, and for the WaPo and the NYT to think that their readers don't know this is unexplicable.

Sadly, I think the explanation is that the WaPo and the NYT are probably right. Their readers by and large don't know this. The MSM lock on gullible/uninformed/willing dupe liberals is still pretty strong despite encroaching rust.

[Rob Crawford]

Off Topic: Amy Bishop's colleagues suspected she had planted a "herpes bomb" in their building. LUN

(Also a new detail in the shooting of her brother -- she refused to drop the shotgun when first approached by police.)

[Mr. Pete is one of my heroes.]

Welcome Mr. Pete, the best. Mojib Latif, hardly a skeptic, has just called the IPCC's work a 'betrug', a fraud on the public and his colleagues.
==================================

[Rob Crawford]

All of which makes the WaPo think he'd be perfect as a Supreme Court Justice because he's so "detached and cerebral."

Detached cerebrum seems like a reasonable diagnosis.

[Porchlight]

Do they really want to be cared for in a hospital–physician network where patients are bounced from one hospital to another?

If being "bounced" means moving from an average mid-sized busy urban hospital to a top notch, "high spending" facility like the Mayo Clinic, yes.

The chief thing wrong with the Dartmouth analysis as I see it is that by the time a patient makes it to the Mayo, he/she has likely already 1) become quite ill and 2) already seen a couple of specialists and had many expensive tests performed. So I don't see how you can easily compare the spending between hospitals and outcomes at that point.

[Rob Crawford]

OH, GOOD LORD!

The NYT, in the story LUN and mentioned above, says the following about the coverup of Bishops murdering her brother:

Did someone intervene to save Amy Bishop from prosecution? Her mother served on the town committee, an elected legislative panel of 240 members that set the town’s spending. Or was Amy’s release merely a town’s way of caring for its own, the way small towns do?

Yeah, those small towns. They cover up so many murders. Uh-huh. That's just as likely as a political favor in the state that gave us Chappaquiddick.

[I just came back to change my underpants.]

Mebbe so Porchlight, but there is a disconnect. Not all of the NYT and WaPo readers read nothing else, and this news is widespread internationally and on blogs. Even alarmist blogs are under siege from skeptics.
==========================

[But he's a true believer like Chris Mooney, who poured my last effort down the memory hole.]

I've been trying to convince Phil Plait at Bad Astronomy to take another look at the evidence.
============================

[narciso]

I did notice that about him, some compared him to Spock, but I'd say Data; the nonchalant
way he discussed whether to replace his grandmother's hip, the way he answered that fellow that asked about whether 'spirit' was
a consideration for continued health care. That bit about 'bitter clingers and their faith and their guns'

[Old Lurker]

Only a genuine loon could imagine Obama has the brains, thought process, temperment, work ethic or attention span to succeed on the Supreme Court.

[Porchlight]

I hope so, kim. It seemed like the dike was crumbling after Climategate broke, but a comfortable counter-narrative seems to be settling in ("these denier cranks are more persistent than we thought, and unfortunately are able to seize on minor errors by our guys"). It's going to take a while before the whole structure disintegrates.

[narciso]

It's interesting the comparison to Thomas, who really did have a tough climb to the top,
but was savaged for challenging too many liberal shibboleths, is criticized for not speaking out in conference, yet whose opinions
event dissents like that in Boumedienne will stand the test of time

[Pagar]

"the report is flawed, so the program based on the report is a POS."

currently on Memoramdum//////from the Guardian.

"Scientists have been forced to withdraw a study on projected sea level rise due to global warming after finding mistakes that undermined the findings."

"The study, published in 2009 in Nature Geoscience, one of the top journals in its field,"

LUN

how many billions have already be wasted on this manufactured crisis?

Is every thing the leftists publish/read garbage?

[We are cooling, folks; for how long even kim doesn't know.]

Well, porchlight, it ain't gettin' any warmer, and the blues will get the clues eventually.
====================

[Old Lurker]

"Is every thing the leftists publish/read garbage?"

One would make fewer mistakes assuming that than the opposite.

[Jim Brown]

To Neo and Rob Crawford:

Ammo cartridges (not "bullets" BTW) aren't the only costs of the scheme you suggest. One also should factor in a number of other items, as per the following:

1. Amortized cost of the firearm(s) used

2. Costs of cleaning supplies for firearm(s)

3. Costs for EPA-approved disposal of spent lead and brass

4. Wages of executioner(s) and firearm cleaning technician(s)

5. Pension, SS, unemployment taxes and health insurance for above employees

6. Apportioned overhead cost for entire hospital per recognized accounting principles, including amortization of building, salaries of administrators, property taxes, etc.

So you see, it ain't necessarily so simple as one might at first blush imagine.

[narciso]

Apparently a similar calculation to Bishop seems to have operated in the Hassan case, you can't make this up, and who would want to

[Clarice]

OT (sort of)
Two Obama voters on an escalator:
The Obami

[Cecil Turner]

They went a few extrapolations too far in their attempt wring meaning from inadequate data.

I agree, but wouldn't blame that on the study. It's clearly labelled:

Tracking the Care of Patients with Severe Chronic Illness: The Dartmouth Atlas of Health Care 2008 is available! [emphasis added]

Extrapolating that to generic healthcare spending is obviously inapt, but it appears to me that's primarily the responsibility of the Administration spinmeisters.

So you see, it ain't necessarily so simple as one might at first blush imagine.

Heh. Definitely wrong (in the "hey, that ain't right" sense), but funny. I feel guilty laughing, though.

[Old Lurker]

The WaPo editorial quoted above was so much fun, see how many matters in the quote below (Newsmax) cause heartburn:

"WASHINGTON - A last-ditch attempt at passing a climate change bill begins in the Senate this week with senators mindful that time is running short and that approaches to the legislation still vary widely, according to sources.

"We will present senators with a number of options when they get back from recess," said one Senate aide knowledgeable of the compromise legislation that is being developed. The goal is to reduce emissions of carbon dioxide and other greenhouse gases that scientists say threaten Earth.

The options will be presented to three senators -- Democrat John Kerry, independent Joseph Lieberman and Republican Lindsey Graham -- who are leading the fight for a bill to battle global warming domestically.

The aide said the Senate's drive for a bill got a boost last week with President Barack Obama's announcement of an $8.3 billion government loan guarantee to help start expanding the nuclear power industry, a top Republican priority. "The administration is really putting their money where their mouth is," the aide said."

[centralcal]

LOL, Clarice! Great little video comment on the Obami.

[narciso]

Yes, but they are still keeping Yucca Mt closed right, do words have any relation to reality for these people. Just facilitate the
regulations on construction, and you won't need the loan guarantees

The climate change control bill, A solution to a problem that does not exist, maybe they should read a certain Facebook page once in a while

[Sue]

http://spectator.org/archives/2010/02/22/specter-race-scandal-sestak-ac/1>Bribery?

This is the stuff of congressional investigations and cable news alerts, as an array of questions will inevitably start being asked of the Obama White House.

Don't expect anything to come of this, but you can't bet money if it was a republican, it would be an issue.

[Sue]

Or maybe you could bet money.

[Captain Hate]

I just got this from the WSJ:

President Obama unveiled a proposal to address health-care costs, hoping to bridge the gaps between separate health plans already passed by the House and Senate.

The latest proposal, which would cost $950 billion over 10 years, comes ahead of Thursday's bipartisan summit. The plan delays taxes on high-end health-insurance plans until 2018, and suggests new taxes to make up for lost revenue. It sets up a new insurance market and includes rules to prevent insurers from barring coverage based on pre-existing conditions.

[Ralph]

As a health insurance actuary, I can tell you that there is no way I would rely on these data to compare the cost effectiveness of particular hospitals. While it is true that on average people consume 90% of their health care cost in their final six months of life, such data have nothing to do with the current "health care" (really health insurance - not the same thing) debate in Congress. Congress is debating changing the way health insurance for people under age 65 (in general with a few exceptions) is regulated. End-stage costs for Medicare recipients have little or nothing to do with such a debate. They may be useful for Medicare to improve its efficiency; outside the Medicare Select program, Medicare utilizes no real provider network. They may also help Medicare improve its inpatient hospital reimbursement scheme (essentially a fixed fee per stay based on diagnosis plus an outlier adjustment for unusually long stays) efficiency.

Only roughly fifty percent of ongoing medical cost is funded through Medicare, and very little of that cost is related to end-of-life costs. Thus, such data do not belong in the current legislative debate, which relates largely to non-Medicare recipients.

[Jim Ryan]

Asked whether he had heard of the so-called Climategate scandal, Senator Lindsey Kerry said, "No, I hadn't heard about that. Well, it just goes to show we need to pass Cap and Trade now, before global warming is completely disproved. There's no time to waste."

[Ignatz]

--The Gardiner Harris of the NY Times--

TM's forming a habit. Hope the The Allahpundit guardian doesn't see it.

[cathyf]

Do they really want to be cared for in a hospital–physician network where patients are bounced from one hospital to another?

By "bounced" do they mean where the dying Mr. Smith stabilizes for a few weeks or months several times in the course of his decline, and gets to return to the nursing home room that he shares with Mrs. Smith? Are they counting patients who go home to their own beds and have home-health care nurses take care of them as having "bounced" from one institution to another?

[Old Lurker]

"House Republican Leader John Boehner (R-OH) issued the following statement in response to the partisan health care proposal posted online by the White House for discussion at the upcoming bipartisan health care summit:

“The President has crippled the credibility of this week’s summit by proposing the same massive government takeover of health care based on a partisan bill the American people have already rejected. This new Democrats-only backroom deal doubles down on the same failed approach that will drive up premiums, destroy jobs, raise taxes, and slash Medicare benefits.

“This week’s summit clearly has all the makings of a Democratic infomercial for continuing on a partisan course that relies on more backroom deals and parliamentary tricks to circumvent the will of the American people and jam through a massive government takeover of health care.

“The best way to protect families and small businesses in this time of economic uncertainty is to start over with a step-by-step approach to health care reform focused on lowering costs, and that’s exactly what Republicans are fighting for. The non-partisan Congressional Budget Office has confirmed that the Republican bill reduces premiums for families and small businesses by up to 10 percent. The Republican bill reduces premiums by implementing common-sense reforms such as allowing Americans to purchase insurance across state lines. Despite their rhetoric to the contrary, none of the Democrats’ proposals – including the President’s – provides this much-needed reform in a manner that can actually be effective.

“Republicans are also standing with the American people by calling for health care reform to protect human life and not use taxpayer money to fund abortion. The Republican bill would codify the Hyde Amendment and prohibit all authorized and appropriated federal funds from being used to pay for abortion, which the President’s proposal would allow. Pro-life Democrats in the House have already pledged to vote against this provision. Health care reform should be an opportunity to protect human life – not end it – and the American people agree.”

[daddy]

Concerning the myth of "The Cerebral President Obama", who consistently gets his numbers wrong but is treated as a genius by a fawning, ignorant press.

Surveyor George Washington was a big fan of Mathematics:

"The investigation of mathematical truths accustoms the mind to method and correctness in reasoning, and is an employment peculiarly worthy of rational beings .... From the high ground of mathematical and philosophical demonstration, we are insensibly led to far nobler speculations and sublime meditations."

Republican President Lincoln was a huge devotee of Euclid:

"I said to myself, "Lincoln, you can never make a lawyer if you do not understand what demonstrate means"; and I left my situation in Springfield, went home to my father's house, and stayed there till I could give any proposition in the six books of Euclid at sight. I then found out what "demonstrate" means, and went back to my law studies.'"

Republican President James Garfield">http://www.members.tripod.com/american_almanac/garfield.htm"> invented a proof for the Pythagorean Theorem while a member of the House of Representatives, just 5 years before becoming President.

Yet it is in general the Republican's who are considered stupid, ill-educated hicks, unlike the vastly more intelligent Woodrow Wilson's and Jimmy Carter's and Al Gore's and Obama's who are touted and worshipped as geniuses.

Simply appalling.

And since I'm still in France, hope you won't mind me throwing another theorem in from a leader you'd never expert, Napoleon Bonaparte. Had no idea that he had come up with a Theorem of Equilateral Triangles, which you can find here.">http://en.wikipedia.org/wiki/Napoleon's_theorem">here.

I recall how he spared destroying the house and family of Mathematician Gauss in Gottingen because of admiration of Gauss's mathematical brilliance, and also the story that French Mathematician LaPlace had dedicated his great Math book to Napoleon, but that when Bonaparte read it and noted there was no mention of God in the manuscript, LaPlace replied "Sire, I found I had no need of that hypothesis." Reading that it made me wonder if I saw LaPlace's bones yesterday, crudely cemented in some macabre artwork in the Paris Catacombs.

Anyhow, the overall point, is that Republican Presidents have been some pretty smart cookies, and easily able in my opinion to hold themselves at least equal and probably better thinkers than their Dem counterparts who the Media always likes to promote as geniuses of the first order. Simply compare Bush's to Kerry's Yale Transcripts to tell that tell. And if Obama, or, you know, his wife, you know, could, you know, balance his, you know, checkbook I'd be, you know stunned.

[Patrick R. Sullivan]

Okay, it's official, Mr and Mrs Paul Krugman are total loons:

Once Obama won the primary, Krugman supported him. Obviously, any Democrat was better than John McCain. “I was nervous until they finally called it on Election Night,” Krugman says. “We had an Election Night party at our house, thirty or forty people.”

“The econ department, the finance department, the Woodrow Wilson school,” [his wife Robin] Wells says. “They were all very nervous, so they were grateful we were having the party, because they didn’t want to be alone. We had two or three TVs set up and we had a little portable outside fire pit and we let people throw in an effigy or whatever they wanted to get rid of for the past eight years.”

“One of our Italian colleagues threw in an effigy of Berlusconi.”

“I put out some coloring paper and markers so that people could write stuff on it and throw it into the fire. People really felt like there was stuff they wanted to shed! I had little hats and party whistles.”

[Captain Hate]

Well that confirms everything I was wondering about Drugman and his wife. I think My Weekly Reader in grade school was written and read by more intelligent and mature adults than the inmates of Pinch's Asylum.

[Cowboy Steve]

Good news!

Massachusetts legislators are beginning the process of introducing a "Death with Dignity" bill.

The logical next step in the absurd tale of our experiment in State run healthcare here in the workers paradise.

[PDinDetroit]

7 Inches of Global Warming in the Detroit Area today...

[NK]

TM--

OT, but worthwhile, perhaps. Our friends on the Left are announcing new FOIA docs, which purportedly show greater disclosure to Congress of enhanced techniques than has been admitted to by Congress. Gear up your old threads about Cheney vs. Pelosi truth or dare about briefings. Looks like Mme. Speaker is a lying POS (but we knew that already); I'm sure the Left will spin this as being proof of EVIL REPUBLICANS, but we may be in for some hilarious DEEP BLUE LEFT vs. Light Blue Dems. Always entertaining.

[Jack is Back!]

daddy,

While in Paris, try Man Ray on Avenue Marbeuf near the Champs. Funky but good world food - lots of leggy models and a hip crowd. Last time I was there, the coquille st. jacques (scallops) were the best I ever had.

And Patrick Sullivan - it takes an article in the New Yorker to convince you the Krugman's are loons:) I am surprised the article didn't have pictures of them in the buff at the party.

[PDinDetroit]

Test for new avatar

[aafan]

It gets worse. Patients do not always take meds or treatment as prescribed. There are so many factors that are beyond the control of the doctors and hospitals. Patients continue to drink, smoke, take meds erratically, forget or lose their pills, and miss doctors appointments. How were these factors addressed in the study? Would people be more likely to comply if the prestigious Mayo Clinic were giving them advice?

[Captain Hate]

Since this is the health care thread of the day, yesterday Mrs Hate hit me with what I considered a ridiculous statement she got from the MSM drones: The US ranks in the 30s compared to all other countries as far as quality of health care. I think that's very erroneous but was unable to counter it with anything. Any idea what the "real" rank is?

[sammy small]

Don't worry, the "Nuclear Winter" caused by Iran will offset any AGW we experience.

[Cowboy Steve]

Captain Hate,

The studies the media cites on healthcare are usually done by advocacy groups masking themselves as NGO's and the like.

They are advocates for socialized medicine, and their scoring strongly factors in the absecence of socialized medicene here as a huge negative number, dragging our "score" down.

It's pure prophaganda, best to ignore it.

[Cowboy Steve]

Here's just one Fisking of these reports, it's old but gives you the general idea how these studies are rigged.

I found it after a quick google search of "Us healthcare ranking false."

There are more out there of a similar nature.

LUN.

[Jane]

Steve, where is that info on the MA death panels?

[RichatUF]

cathyf-

Isn't that hospice care?

narciso-

I'm unsurprised that Goober Graham would be suckered into supporting "comprehensive" energy and climate legistlation with the bait of an 8 billion or so loan guarantee for a Georgia nuclear plant. Obama is making that a pool of money for his lawyer friends to sue over since the same lawyers won't have anymore Yucca lawsiuts to file. I really wish the voters of SC would send him to pasture. Play a sucker to catch a sucker, seem dumber than your mark. Lindsey must be really, really dumb to be looking for a "bipartisian" "solution" on energy.

Porchlight-

It's going to take a while before the whole structure disintegrates.

Probably, but then again, not many people believed that the Berlin Wall would come down a few weeks after Hungary pulled down their boarder fences. And fwiw, Fukuyama wrote "The End of History" during that time, though it has been criticized well by historians on the right and less so by those on the left, he understood that any sort of revolutionary socialist program was doomed to failure. The criticisms from the left usually brought up environmentalism as the next revolutionary idea which will bring about the socialist utopia. I'm waiting for Charlie to write the definitive article that lays out the case for "the last men and the end of environmentalism".

And sorry I got a bit long winded and off topic. I've got nothing to add about healthcare.

[Cowboy Steve]

Jane,

No link yet, heard it on WRKO newsbreak during Rush.

Nothing up yet on the Herald or Boston.com.

[Captain Hate]

Cowboy Steve, your thoughts pretty well echo mine of the uselessness of agenda-driven ratings like that.

[Cowboy Steve]

Jane

Spoke to soon, Herald has it now.

It's supposed to be elective, for now.

LUN.

[Cowboy Steve]

Captain Hate,

They are nonsense pure and simple.

[Army of Davids]

This meeting on the 25th is a trap.

In the fullness of time Republicans are better off walking away from it unless the current conditions are met.

Paul Ryan and Tom Coburn are invited.

5 R governors are invited.

Reconciliation is off the table.

The old bill is completely scraped.

[Army of Davids]

The reconciliation push clearly shows that Democrats have no true interest in bi-partisanship.

Republicans are better off walking away from the meeting on the 25th.

[Charlie (Colorado)]

I've been trying to convince Phil Plait at Bad Astronomy to take another look at the evidence.

Good luck. Met his at the NASA conference last weekend and he was, um, less than open.

[DebinNC]

WSJ: The latest proposal, which would cost $950 billion over 10 years

Says who?...the WH? The WSJ should at least have thrown in a "would supposedly cost" or "Obama claims would cost".

[Janet]

Charlie, I wish you were the climate writer for the Washington Post. Anyone that just reads the Post is clueless as to what all is happening.

If nothing else, the AGW promoters should tell us what their ideal global climate is. What is the target? Is there a point where they would think we "fixed" everything? or does this scam just go on forever?

[Charlie (Colorado)]

Folks, keep your eyes on PJ tomorrow. We should be breaking something pretty big.

[There's a reason I call the Real Climate boys 'The Knights of White Satan'.]

Omigod, be still my beating heart.
=====================

[Fresh Air]

Janet--

No, there is no "target." As humans, we are perpetually harmful to the planet. We can never do enough until we become extinct. Of course, the liberals never volunteer to extinguish themselves first.

[Jane]

Steve,

That death bill doesn't bother me unless they make someone besides the patient the decider or have any mandatory part in it, which I guess is the risk. But frankly I'd like the option of putting myself out of my misery if it came to that.

[Fresh Air]

I'm all for the Massachusetts legislature dying with dignity.

[Charlie (Colorado)]

Might be too late for the "dignity" part, Fresh.

[Captain Hate]

The WSJ should at least have thrown in a "would supposedly cost" or "Obama claims would cost".

The WSJ news reporters shouldn't be confused with the editorial page writers.

[Old Lurker]

Janet, I read the WaPo and WSJ each morning while caffinating.

Most days I think they are describing different planets.

[I Won]

The American people elected me by an unprecedented majority to deliver to them health care reform that would bend the cost curve down and insure 50 million people who for eight years had been ignored by the previous administration.

Nevertheless, I am nothing if not a bipartisan outsider, not of Washington, and welcome any good input from average, bitter people of this peaceful, fair, and promising land. That is why I am announcing that I am presenting you with the opportunity to present your good ideas on fighting greedy insurance companies and malpracticing doctors while providing a safety net so that your life savings cannot be wiped out--like that--and given to Wall Street and Halliburton. See ya'll on TV.

[DebinNC]

Surprise, Surprise...CBO can't score Obama's hc proposal as written.

[Janet]

OL, I like how Clarice calls the WaPo "thin gruel". Ha

[Jim Ryan]

It is good that the buffoons will delay their acknowledgment of the evidence undermining AGW. The longer they wait, the harder they fall.

The deserved decline in subscriptions to an AGW-shilling newspaper will be greater the longer the paper lies to its readers. The damage to an AGW-shilling scientist's career will be greater the longer he perpetrates his scam.

[Fresh Air]

The WSJ is the most lefty-biased paper in the country. No joke--even worse than the Slimes.

[bgates]

CBO can't score Obama's hc proposal

Obama has said what it will do. What are you, some kind of denier who denies things?

Denier!

[cathyf]

Of course, the liberals never volunteer to extinguish themselves first.

Remember that Star Trek episode where the people had to report to the machine that would kill them? I always have this vision: we agree to all line up to be killed, but the "humans are an evil pox on gaia" folks have to get in line first. Then after they are all gone, the rest of us just get out of line and go peaceably about our lives.

Everyone gets what they want, problem solved!

[Clarice]

cathy, what a beautiful idea.

[Ignatz]

--but the "humans are an evil pox on gaia" folks have to get in line first--

Since you graciously corrected my market mistake this morning, cathy let me similarly remind you that the gaia folks always have the rest of us in mind for the Soylent Green meow mix, not themselves.
It ain't the priests of Baal who get sacrificed, just the unlucky schlubs within arms reach.

[Janet]

I'm gonna have to get a pin with DENIER printed on it. Embrace the truth and be proud of it.

[cathyf]

This is related to the organic food schtick, too -- if we eliminated all genetically engineered crops, then the earth would support 2 billion people. So -- if you think that genetically-engineered food is bad, then we'll promise to eliminate them as long as you line up for the abattoirs first. Honest, cross our hearts.

(Again, as soon as they're gone, the rest of us can go back to eating junk food made from star-link corn.)

[Ignatz]

--This is related to the organic food schtick, too--.

It's related to darn near everything these mountebanks advocate, cf.
I have a similar, and similarly unlikely, vision to yours where our taxes are low because all of Joe Biden's patriots who think America is undetaxed voluntarily do the virtuous thing and overpay theirs.

[Greens especially.]

Local food has historically meant early Spring malnutrition.
==================================