Live Mocking the State of the Union Address

I’ll be tweeting the State of the Union address tonight. Please follow along on Twitter and help me mock President Obama’s attempts to win back the public trust by blaming Booooosh!!!!

Oh, and do yourself a favor: don’t play any of the State of the Union drinking games that require you to take a drink every time President AllAboutMe says “I” or “me.” Your liver will thank you.

January 27, 2010 · Filed Under Barack Obama, Liberal Absurdity

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Keep Government Out of Health Care, Say … Liberals?

Want a clear indication that the federal government has no business getting into the health insurance industry? Look no further than the Stupak amendment, the measure that attached tight abortion funding restrictions to the House health care bill.

Democratic consultant Karen Finney called the Stupak amendment “an attack on our personal freedom and liberty as guaranteed by the constitution.” Rep. Barbara Lee (D-CA) said the amendment “attempts to dictate to women how to spend their own money.” And liberal columnist Michelle Goldberg lamented, “Health-insurance reform was supposed to end the sort of hideous cruelties our system inflicts on patients, not create them.”

To call Finney, Lee, and Goldberg tone deaf would be a grand understatement.

The only reason the abortion restrictions in the Stupak amendment are so intrusive is because health care reform is so intrusive. When we increase the role of government in health care, our freedoms and choices become more vulnerable to politics. Period.

Funding for every aspect of the doctor-patient relationship, every medical test and procedure, and every health care guideline becomes susceptible to pressure from special interest groups and moral scrutiny by taxpayers. If guys who can’t get it up have enough money to throw around, erectile dysfunction drugs make the cut. If taxpayers think acupuncturists are predatory quacks, no reimbursement for them. And after the reconciled bill is signed by the president, an unelected body will make these decisions for all of us.

Liberals cheered when President Obama appointed an executive pay czar, reasoning that companies like AIG have no right to determine pay packages if taxpayers are footing the bill. But somehow they missed the obvious lesson. There are always strings attached to government handouts.

Welcome, liberals, to the hazards of government subsidy. Either private insurance is restricted by health care reform, as with the Stupak provisions, or abortion receives some form of federal funding, thus changing the status quo. There’s no in between.

Objectionable restrictions abound when we seek increased state participation in our lives through regulation or subsidy. Just ask members of a United Methodist Church group that refused to make a beachfront pavilion available to a lesbian couple for a civil union ceremony. The group lost its state property tax exemption for failing to make the venue available to everyone on an equal basis. But that’s how it works: if you want state subsidies, you have to play by the state’s rules.

We’ve seen the impact on coverage in states that are experimenting with models of universal health care. In Massachusetts, legal immigrants no longer have state-subsidized coverage for dental, hospice, and skilled nursing care. And if you’re a Medicaid patient, prisoner, or public employee in Washington state, don’t expect your government to cough up the cash for knee arthroscopy for osteoarthritis – it’s one of several treatments no longer covered.

Speaker Nancy Pelosi has said that “the power of Congress to regulate health care is essentially unlimited.” Do liberals really believe that those regulations will exist to make their wildest dreams come true, now and forever?

When you invite the government to become more deeply involved in health care, you’re also inviting greater government interference in personal choice. Medical decisions become political decisions. That’s how it works, and it’s why philosophical opposition to the growth of government isn’t the crazy-eyed wingnuttery progressives make it out to be.

Proponents of liberal health care reform deliberately lured a bloodthirsty vampire over their thresholds, and now they’re shocked – SHOCKED – to find they have fangs buried deep in their necks. I’m not one to blame the victim, but it sounds like they might be getting exactly what they were asking for.

December 4, 2009 · Filed Under Abortion, Barack Obama, Health care, Liberal Absurdity, Nanny State, Women

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South Carolina: The Fox News of States

It’s no secret that President Obama and his administration have attempted to sideline Fox News, openly punishing the highly rated cable news channel for failing to promote the White House agenda. Fox was conspicuously shut out of Obama’s five-network Sunday talk show blitz in September, and the White House has already determined that the president will not grant any interviews to Fox anchors during the remainder of 2009.

Alienating the millions of Americans who watch Fox is strategic buffoonery of the highest degree. But why focus on solid strategy when you can engage in some good ol’ fashioned spite? And why settle for popular news networks when you can make your petty resentments known to an entire state, like say, South Carolina?

U.S. House Majority Whip Jim Clyburn said Friday that a conversation with White House staff left him with the sense that a hostile environment in South Carolina is keeping the first lady from visiting.

The high-ranking South Carolina Democrat said he has received more than 100 invitations for Michelle Obama. But this summer when he brought one of those requests to her staff on behalf of his alma mater, South Carolina State University, Clyburn said her security was an issue.

The conversation came after former Richland County GOP activist Rusty DePass suggested on Facebook in June that an escaped zoo gorilla was not harmful because it was probably one of Mrs. Obama’s ancestors. DePass’ comment was coupled with a remark in July from U.S. Sen. Jim DeMint, a Republican. DeMint said that beating the president’s health care plan would be a ‘Waterloo’ moment for Obama.

Congressman Joe Wilson’s ‘You lie!’ outburst during Obama’s joint address on health care reform last month didn’t help either, Clyburn said.

‘A lot of it has to do with the fact that the climate in South Carolina just is not good, and that’s a shame,’ Clyburn said at a roundtable discussion at his Columbia office.

‘I do believe it is keeping her away from this state,’ he said.

Emphases mine.

Yes, a moronic South Carolina GOP grunt wrote something shameful about the first lady and a couple of politicians made bold statements about the president and his policies. How do those comments indicate a statewide climate hostile enough to jeopardize Mrs. Obama’s security?

Simple answer: they don’t.

The White House isn’t keeping Michelle Obama out of South Carolina to protect her from assassins in white hoods. South Carolina is being kept off her itinerary to send a message: embarrassing the president will not be tolerated. (Are you listening Joe Wilson?) Dissent will be contorted into proof that racist backwater bumpkins in the south are undermining Obama’s presidency and endangering the very life of the first lady with their dangerous coded rhetoric.

Who cares about smearing the people of South Carolina? After all, it’s just a red state.

Update: Michelle Malkin links. Thanks, Michelle!

Update 2: My very first Instalanche. Thanks, Glenn!

October 13, 2009 · Filed Under Barack Obama, South Carolina

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Platitudes and Abstractions? Yes We Can!

President Obama will deliver his Indoctrination Speech™ to the nation’s schoolchildren today. His silver-tongued litany of subversive communist rhetoric is expected to completely annihilate the morals and values of American students. Complicit teachers trained in Saul Alinsky’s tactics will use Obama-approved socialist lesson plans to reinforce the president’s radical Marxist agenda.

Or something.

I know those are the right wing talking points on the president’s planned address, but I’m having trouble raising my conservative ire to the expected levels. Here’s why:

1. The text of President Obama’s speech is innocuous. Released by the White House on Monday, it looks a lot like a commencement address, sans the humorous one-liners and witty anecdotes. And at 2,540 words, this painfully long speech is almost 10 times longer than the Gettysburg Address. Kids’ eyes will glaze over, their lids will grow heavy, and they will absorb nothing substantive from the president’s vapid string of platitudes and abstractions because it contains nothing substantive.

2. Varying degrees of indoctrination are rampant in American schools. If you’re thinking of keeping your kids out of the classroom today, you might as well keep them home everyday.

I attended public elementary school in New York City in the 1980s. My second grade class was taken around the corner from our school to the gates of the USSR Mission compound to protest the incarceration of Soviet dissident Natan Sharansky. This was done without parental permission.

In 1984, after Walter Mondale selected Geraldine Ferraro as his running mate, my teacher excitedly handed students items from campaign headquarters. My classmates and I spent the remainder of the year with Mondale/Ferraro bumper stickers affixed to our canvas loose leaf notebooks.

From what I gather, partisan bias and philosophical indoctrination are just as flagrant in today’s schools. That’s why conservatives are intuitively wary of a liberal president speaking directly to children. So yes, I guarantee that in some classrooms there will be bias evident in the exercises and lessons that follow President Obama’s speech. But I also assure you that there is informal indoctrination taking place in those classrooms all day, every day. Shielding your children from political bias in the classroom is a laudable goal, but unfortunately, keeping your kids home today is like fixing a leaky pipe with a roll of Bounty.

3. President Obama’s address to the nation’s schoolchildren is a distraction. Conservatives need to remain focused on the health care debate and the far more important speech the president will make to a joint session of Congress Wednesday night.

In the interest of moving on from this particular distraction, I propose that President Obama cancel his speech to kids and instead run the following video with the same message trimmed down to a succinct 30 seconds or so:

September 8, 2009 · Filed Under Barack Obama, Conservatism, Education

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Will Health Care Reform Spawn the Next Great Culture War?

When I turn 35 I will have my first mammogram.

In the United States, mammography is recommended for breast cancer screening every one to two years beginning at age 40. The best available evidence suggests that mammography screening among women aged 40 to 74 reduces breast cancer mortality.

But due to a few minor risk factors, three doctors have suggested I undergo a baseline mammogram at 35. I’m not thrilled with the idea of having a technician I’ve never met manipulate my breasts into squishing position, but being felt up and flattened out sounds a lot better than being dead, so I’ll take my chances.

Of women who receive annual screening mammography beginning at age 40, six out of 10,000 over a decade will have their lives saved. Breast cancer will be detected and cured in many more, but regular mammograms will only make a life or death difference for six of every 10,000 women in that group. Mammograms are of extremely high value to those women and their families, but don’t offer much bang for the buck when it comes to the other 9,994 women.

And wringing more bang from every health care buck is reason enough for Canadian and British recommendations that women wait until age 50 to begin receiving screening mammographies. In these countries where cost-effectiveness studies influence health policy and medical practice, six saved lives aren’t worth the substantial costs associated with all those extra mammograms and the false positives they sometimes produce.

Canadian women are offered routine mammograms every two years, but only from age 50-69 because “evidence is not conclusive” that routine mammograms benefit younger and older women. Doctors have some leeway with regard to high risk patients.

In the United Kingdom, mammograms are recommended every three years beginning some time between age 50 and 53. Based on guidelines developed by the Orwellian-named NICE (National Institute for Clinical Excellence), the National Health Service insists that for women under 40, “mammograms should only be used as part of clinical trials into screening and that they shouldn’t be used under age 30 at all.” According to NICE, “Healthcare professionals should respond to women who present with concerns but should not, in most instances, actively seek to identify women with a family history of breast cancer.”

It is hardly shocking that the breast cancer mortality is 9 percent higher in Canada and 88 percent higher in the United Kingdom. Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent). And British and Canadian patients wait for care about twice as long as Americans.

There are indeed valid criticisms American health care, but one area in which we excel is that we don’t base guidelines for care on cost-utility analysis. That’s why the U.S. ranks first in providing the “right care” for a given condition and has the best survival rate for breast cancer.

Obamacare may force Americans to give up those bragging rights.

The “right care” may soon be defined in part by how much that care costs. Health care reformers acknowledge the impossibility of implementing universal health care without introducing cost containment measures, and Democrats are enamored with a method used by the British called “comparative effectiveness research” (CER.)

AARP CEO and CER proponent Bill Novelli describes comparative effectiveness research as “a wonky term that just means giving doctors and patients the ability to compare different kinds of treatments to find out which one works best for which patient.” And at its best, that’s just what CER does. CER is not inherently bad. For example, it can help doctors cut through seductive pharmaceutical advertising to identify older, less commonly prescribed drugs that are just as effective as newer, more expensive ones.

But with CER, the devil is in the details.

CER can lead to one-size-fits-all medicine and encourages a purely analytical approach to care that is not always beneficial to the patient. The mythical average patient overshadows the individual patient, leaving most of us with about as many options as a public school cafeteria at lunchtime.

And in the UK, NICE includes cost as a determining factor in the comparative effectiveness studies that inform clinical guidelines. Determinations about whether citizens will have access to drugs, tests, and procedures are based on cost per quality of life year (QALY.)

The QALY score is a fairly crude metric that takes into account both the number and quality of years a medical intervention is expected to add to a patient’s life. Here’s the upshot of using QALYs to determine cost effectiveness:

On the QALY scale, 0 means you’re dead, 1 means you’re in perfect health, and varying levels of debility fall in between. Imagine two groups of people, one with a QALY of 1 and the other with a score of 0.5. An expensive technology brings a year of life to both groups. But in the second, that technology would be counted as having provided only six months, and thus be twice as expensive. It may be deemed too costly for that patient group.

The older you are, the sicker you are, the more disabled you are, the less cost effective it is to treat you. And if the cost per QALY of a medical intervention you need exceeds £20-30,000 (around $32,000 – 48,000), you’re out of luck. Drugs, particularly end-of-life treatments, are routinely rejected for use due to poor cost-effectiveness. And screening tests, like the mammograms American women take for granted, are severely restricted to ensure expenditures remain under the cost per QALY threshold.

Liberal proponents of health care reform accuse conservatives of paranoia and fear mongering about health care rationing. Critics of CER are demonized as extremist spewers of far right talking points who don’t care about improving clinical effectiveness. Surely a uniquely American flavor of a CER board would never become as proscriptive as NICE.

But it seems conservative anxiety (and perhaps a bit of healthy paranoia) is more than warranted by Washington Democrats singing the praises of cost-cutting comparative effectiveness studies. Bear with me while I review some of the health care rationing talk in CER clothing coming from inside the beltway.

The stage for CER to become a significant component of health care reform was set when President Obama’s stimulus bill passed with a $1.1 billion appropriation for CER. In April, Senate Minority Whip Jon Kyl (R-AZ) introduced a budget amendment to ensure that CER would be used appropriately:

Statement of Purpose:
To protect all patients by prohibiting the use of data obtained from comparative effectiveness research to deny coverage of items or services under Federal health care programs and to ensure that comparative effectiveness research accounts for advancements in genomics and personalized medicine, the unique needs of health disparity populations, and differences in the treatment response and the treatment preferences of patients.

The amendment was defeated 54-44.

Last week, members of the New Democrat Coalition proposed HR 2505, a bill to establish a new government bureaucracy called the Health Care Comparative Effectiveness Research Institute. The Institute would prioritize research based on both clinical and economic factors, including “the effect or potential for an effect on health expenditures associated with a health condition or the use of a particular medical treatment, service, or item.” This would not be a problem if there were safeguards to ensure that best practices are not interpreted to mean the least expensive practices.

Officials at National Institutes of Health (NIH) recently announced a stimulus-funded initiative to integrate cost-effectiveness into clinical research. “Cost-effectiveness research will provide accurate and objective information to guide future policies that support the allocation of health resources for the treatment of acute and chronic diseases across the lifespan,” according to the call for proposals.

Back at the Whitehouse, President Obama has been paying lip service to the clinical benefits of CER. At the same time, he recently lamented that “the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill … there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place.” That, he explained, was part of the need for “some independent group that can give you guidance” on the ethical dilemmas involved with rationing end-of-life care.

During her Senate confirmation process, Secretary of HHS Kathleen Sebelius declined to voice her support for prohibiting the use of comparative effectiveness data to withhold care from patients. Her ideas echo those of Tom Daschle, the tax-dodging health policy wonk who wrote in his book that the U.S. “won’t be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost effective.”

Then there’s Peter Orszag, Obama’s director of the Office of Management and Budget and a major player in crafting health care reform. For the most part, Orszag’s commentary on CER has been limited to lauding its ability to improve patient care while reducing waste. But when asked a few months ago if the Obama administration has a position on empowering the CER board to make reimbursement decisions, Orszag said, “Not at this point.”

But perhaps of greatest concern is a January House report that included the following statement on CER funding:

By knowing what works best and presenting this information more broadly to patients and healthcare professionals, those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and in some cases, more expensive, will no longer be prescribed.

Sound familiar? Cough, NICE, cough, ahem.

And as Jim DeMint explains, “CER is only one step in the Obama administration’s insidious plan to take over American health care … for our own good.”

But would CER really lead to health care rationing in the United States? Of course. That’s pretty much the point. The debate is not about whether or not CER would be used for rationing, but rather, whether rationing is ethical and useful, and how far we’re willing to go to save a buck and level the economic playing field.

If health care reform shapes up as many Democrats anticipate, CER Institute guidelines will initially apply to the public insurance option expected to be the centerpiece of the Democrats’ proposal. But eventually they would slide down the slippery slope into the private sector. A public insurance option would also ride roughshod over the already anemic competition among overregulated private sector insurers, making the survival of private insurance unlikely. As in the United Kingdom, recommendations will become rules and suggestions will become mandates in order to contain the costs of universal coverage.

To what extent will this result in government control of the doctor-patient relationship? Ultimately, a bureaucratic board will determine when, how, and whether or not you and your family receive care.

Comparative effectiveness research will no longer be just a political hot potato; it will be the basis for the next great American culture war. Instead of clashing over God, guns, and gays, we’ll battle over the monetary value of human life, the sanctity of doctor-patient relationships, the right to medical self-determination, and my favorite hot button issue, the duty to die.

Would cases like Terry Schiavo’s be decided based on financial considerations?

Where will fetuses fall on the QALY scale? How about the elderly or people with Down syndrome? Will they automatically receive limited treatment due to limited resources?

Will smokers be eligible for chemotherapy? Will overweight people have restrictions placed on cardiac care? Will we feel differently about those decisions when we’re footing the bill for everyone?

And you thought the abortion debate was contentious.

Obviously these questions address the most extreme examples of what could happen if we continue on our current path toward universal health care. But government efforts at cost containment through CER may push us toward debating these issues sooner than we think. Hopefully we’ll never see the day when questions like these go beyond an academic exercise.

Meanwhile, I’ll be saving up for a date with a mammography machine in one of those thriving medical tourism meccas. I hear Costa Rica is a breathtaking location for a 35th birthday celebration.

May 26, 2009 · Filed Under Barack Obama, Health care

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Using the Poor as a Scapegoat for Gun Violence

Like a lot of kids raised in liberal New York City, I was taught that anyone who wants a gun is probably the last person who should be allowed to own one. I learned to consider the Second Amendment a quaint throwback to less civilized times and had it drilled into my head that only psychos, criminals, and men with small penises carry guns. Most gun violence could be blamed on economic inequalities created by Reaganomics, according to the elementary school teacher who made sure a Mondale/Ferraro sticker was affixed to each student’s binder.

Then I grew up, read the Bill of Rights, and married a gun nut.

Across the country in Phoenix, Meghan McCain was brought up with a more informed view on the right to bear arms. Her brothers were avid hunters and she developed a deep respect for the Second Amendment. Today she’s an NRA member with a lifetime of positive gun experiences under her belt.

I confess I have a soft spot for Meghan McCain. I don’t agree with all of what she writes and I wish she’d add something new to the national political conversation instead of recycling a mishmash of talking points. But I admire her practical decision to milk her campaign fame for all it’s worth, and I think she’s wise to go the contrarian Republican route. Controversy sells, as evidenced by her six figure book deal.

McCain and I agree on the Second Amendment issue. But while her devotion to gun rights confirms her bitter clinger bona fides, she appears to have absorbed a different kind of liberal humbuggery on the issue of gun violence.

The real solution to preventing gun violence is not taking away the tools, but tackling its causes: poverty, inadequate health care, mental illness, joblessness, inadequate housing, and poor education. Desperate people will make anything a weapon. We need to eliminate desperation, not guns.

Translation: guns don’t kill people, people with less money and education than Meghan McCain kill people. (And sometimes the mentally ill do it too.)

Way to scapegoat the impoverished!

I was under the impression that identifying poverty as the root cause of violent crime was no longer in vogue – after all, that would let guns off the hook – but apparently President Obama feels otherwise. Eight days after the 9/11 attacks, Barack Obama attributed the tragedy to the terrorists’ lack of empathy stemming from a “climate of poverty and ignorance, helplessness and despair.” And in a 2007 speech, Obama called poverty “a disease that infects an entire community in the form of unemployment and violence.” Obama’s first pick for Commerce Secretary, Bill Richardson, shared similar thoughts during the 2007 NAACP Presidential Primary Forum when he said, “the key in eliminating gun violence is eliminating poverty, eliminating hate.”

Perhaps Meghan McCain is simply repeating liberal talking points, but it seems to me that even among the political left, violent crime is usually approached as a complex phenomenon caused by a multitude of sociological and psychological factors. Many recognize that it reeks of classism to suggest that poverty creates desperation-fueled violence. It’s also unsupported by evidence. While a correlation exists between certain crimes and poverty, research has not proven a cause and effect relationship. There are simply too many variables.

Even Marxist criminologists don’t attribute crime to poverty, but rather to relative deprivation like income inequality. But both are silly assumptions: if all of the poverty-stricken or people who find life unfair engaged in violent criminal activities, the world would be in chaos. But clearly most of the world’s have-nots eke out their years without erupting into violence.

Instead, couldn’t it be that violent crime perpetuates poverty? We see this on an individual level among both victims and convicted criminals. It is also evident on the community level. Neighborhoods decimated by gun violence fail to attract entrepreneurs who might help the areas prosper. Crime also keeps property values low and drives up insurance premiums.

It may well be that poverty has little to do with being deprived, and everything to do with being depraved. And it isn’t economic poverty, but moral poverty that is to blame for gun violence.

May 19, 2009 · Filed Under Barack Obama, Crime, Liberal Absurdity

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