NYT: O-Care is really No-Care

posted at 12:55 pm on April 7, 2010 by Ed Morrissey

For months, media outlets like the New York Times scolded conservatives over their concerns about rationed medical care.  Sarah Palin outraged them by referring to “death panels” when the ObamaCare bill wound up containing language enabling “comparative effectiveness” boards as guiding lights for medical care decisions.  Last July I wrote about comparative effectiveness, a medical-care rationing system, by asking the question of who says “no” in a government-run medical system.  Today, the New York Times gives the same answer I did, conveniently after the passage of ObamaCare:

How can we learn to say no?

The federal government is now starting to build the institutions that will try to reduce the soaring growth of health care costs. There will be a group to compare the effectiveness of different treatments, a so-called Medicare innovation center and a Medicare oversight board that can set payment rates.

But all these groups will face the same basic problem. Deep down, Americans tend to believe that more care is better care. We recoil from efforts to restrict care. …

From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing, and Medicare’s long-term budget deficit will grow.

So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform. “Being able to say no,” Dr. Alan Garber of Stanford says, “is the heart of the issue.”

David Leonhardt goes on to praise ObamaCare as the start of saying “no” to people who want more health care.  That’s an interesting tack for the Times to take, especially after its screeching over the use of “death panels” by critics, which meant exactly the same thing.  Now they admit that the “most important task” of the people running the ObamaCare reform is to deny people medical care — under circumstances where a group of elites decide it’s not worth it.

Once again, we have people looking at this from the notion of a shortage, crisis market.  If we want to solve the problem of overutilization, which is what ObamaCare purports to do, we’re going about it in exactly the wrong manner.  We need to restore pricing signals in order to make consumers aware of the consequences of their decisions, not shield those costs even further by having taxpayers subsidize even more of those costs.  That would require getting insurance out of the way of normal, routine medical care and using it only for catastrophic issues, and providing tax-free shelters for medical-care funds controlled by individual consumers.

Instead, we’re slowly turning the entire medical system into an HMO, only this time with Congress and the executive branch running it.  It will suck so many resources out of the middle class that only the wealthy will have any real options outside of the government-controlled network in a few years as insurers go broke under Obama’s regime of price-fixing.  Once that medical care becomes an entitlement for everyone, no one will have any reason to exercise cost controls, and the comparative effectiveness policies created will wind up becoming the Dr. No of ObamaCare.


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Badger40 on April 7, 2010 at 1:56 PM

Translation: I don’t know the difference between reduced incentive and no incentive, so let me call you names

You’re usually better than that.

ernesto on April 7, 2010 at 1:58 PM

Somebody help me out. I’ve misplaced my troll scorecard. Is ernesto a troll or just clueless?

Aviator on April 7, 2010 at 1:58 PM

The entire medical R&D sector is not going to simply disappear. To believe it would simply vanish is delusional.

ernesto on April 7, 2010 at 1:45 PM

Well you are right. They will cater to the rich who will be the only ones able to afford such luxuries.
The rest of us poor ba$!ard$ are going to doing without, or lying cheating & stealing to get enough to get the treatment they need.
And of course those who cannot will die.
So yes ernesto-you’re right.
R&D won’t entirely disappear.
Genius.

Badger40 on April 7, 2010 at 1:58 PM

I believe the well-document government progression is from republic to democracy to tyranny. Guess where we are in that progression.

docdave on April 7, 2010 at 1:59 PM

Well you are right. They will cater to the rich who will be the only ones able to afford such luxuries…

Badger40 on April 7, 2010 at 1:58 PM

You know, that’s a frightening thought, that medical care could one day be considered a ‘luxury’.

Liam on April 7, 2010 at 2:01 PM

ernesto on April 7, 2010 at 1:58 PM

LOL!
Reduced incentive, you are OK with?
And where is the name calling?
Your skull is senselss & thick bcs no one in their right mind would find reduced incentive to create (and it just isn’t ‘reduced’ it’s severely reduced-strangled is more like it)a product as acceptable.
Bcs that’s what is sounds like to me. You sound accepting of this.
It is outrageous and unacceptable.

Badger40 on April 7, 2010 at 2:01 PM

This is what bho meant by giving grandma a pain pill. No care. No hope of getting better. Just a pain pill until she dies so we can use that bed for someone else.

He’s sick!

UnderstandingisPower on April 7, 2010 at 2:03 PM

So there will be groups of bureaucrats that decide how to cut care for the poor and elderly, some of which will cause them to die.

Sounds nothing at all like a death panel.

Chuck Schick on April 7, 2010 at 2:03 PM

All the news that’s fit to kill.

EMD on April 7, 2010 at 2:03 PM

Newsweek’s notorious feature article, “The Case for Killing Granny” by Evan Thomas in September 2009.

The ultimate liberal method of saving money in health care has always been to find a way for more of us to die more quickly.

They just don’t like to be called out on it. They squeal like stuck pigs when you say they favor death panels or some kind of back-door de-facto euthanasia.

But these things are exactly what we get in ObamaCare. “If there’s a way for you to die sooner when you are seriously ill, who are we to stand in your way?” is the liberal subtext that they want you to understand, but don’t want you to make a stink about.

Every now and then the mask slips and you get an article like “The Case for Killing Granny” which indicates what the Party of Death really thinks about human life — people die every day, so why not save a buck and help them leave the stage more quickly.

Edouard on April 7, 2010 at 2:05 PM

You know, that’s a frightening thought, that medical care could one day be considered a ‘luxury’.

Liam on April 7, 2010 at 2:01 PM

It pretty much is already.
I almost considered my mammogram a luxury & almost didn’t have it.
But I went ahead & had it anyway & it took me a year to pay off.
If I need treatment for something, I have learned to research the hell out of it 1st & try to make my own decision about going forward or not.
Since I teach anatomy, I try to keep up with the basic knowledge.
So I guess I’m more proactive than others about their medical care & more of an advocate for myself since I can determine sometimes whether I really need a certain test or not.
I have demanded certain tests before knowing I needed them.
In this day & age this will get worse for people, which is why I keep up with this crap.
I will not undergo a medical test if I think I do not need it.

Badger40 on April 7, 2010 at 2:05 PM

No, but I never said they would. The entire medical R&D sector is not going to simply disappear. To believe it would simply vanish is delusional.
 
ernesto on April 7, 2010 at 1:45 PM

 
Old men with combovers have hair, but they’re still bald.

rogerb on April 7, 2010 at 2:06 PM

But these things are exactly what we get in ObamaCare. “If there’s a way for you to die sooner when you are seriously ill, who are we to stand in your way?” is the liberal subtext that they want you to understand, but don’t want you to make a stink about.

Every now and then the mask slips and you get an article like “The Case for Killing Granny” which indicates what the Party of Death really thinks about human life — people die every day, so why not save a buck and help them leave the stage more quickly.

Edouard on April 7, 2010 at 2:05 PM

This is what those in favor of assisted suicides agree with.
Ghoulish, sick, twisted people.

Badger40 on April 7, 2010 at 2:07 PM

Old men with combovers have hair, but they’re still bald.

rogerb on April 7, 2010 at 2:06 PM

+100
But I’m sure this analogy’s point will be missed.

Badger40 on April 7, 2010 at 2:09 PM

Badger40 on April 7, 2010 at 2:05 PM

At least you have the choices, and the brains to act on them as you need.

What I fear is people needing tests or treatment won’t be allowed to get those things because of some cost-analysis done by a third party.

That is just plain wrong, if not an outright evil.

Liam on April 7, 2010 at 2:10 PM

This guy Leonhardt may be the best liar I’ve ever read. His opening paragraph, “How can we learn to say no?” condenses a huge lie into six innocent words, including the embracing “we.”

Nowhere in his piece does he actually say “we” means “they” will say “no” to “you.” And nowhere does he explain why humdrum market practices that maximize product/serve choice and availability across numerous quotidian markets can no longer serve in health care. Leonhardt is a first-class snake.

BTW, HALF of medical practitioners left the country during WWII to join the other 5% stationed overseas, yet medical-care metrics shifted not a tittle. The growth of third-party payers has only increased that tendency to grossly overconsume medical services. Add to that the lawsuit-prevention tests ordered up, and we could probably whack medical care back by four-fifths in this country without the loss of a single man-day overall.

But when you say the govt is going to be the arbiter of who gets what care, you’re on the fighting side of me. If nothing else, Roe v. Wade determined that not to be Constitutional.

Chaz on April 7, 2010 at 2:15 PM

I know. But remember, a lot of ‘New Yorkers’ are transplants [not me], and they come from where all of you guys live.

Urban Infidel on April 7, 2010 at 1:41 PM

everyone comes from somewhere….

upinak on April 7, 2010 at 2:16 PM

You sound accepting of this.
It is outrageous and unacceptable.

Badger40 on April 7, 2010 at 2:01 PM

Im not. My first comment said as much. But there are realistic effects and concerns, and then there are exaggerated, speculative effects and concerns. The latter are pretty useless, or at least serve little purpose in a legitimate discussion.

ernesto on April 7, 2010 at 2:16 PM

Badger40 on April 7, 2010 at 2:01 PM

when you are in your early twenties (and sometimes 30′s) and have never had any medical issues. How are you suppose to know if you have never been there to begin with anyway?

upinak on April 7, 2010 at 2:18 PM

What I fear is people needing tests or treatment won’t be allowed to get those things because of some cost-analysis done by a third party.
Liam on April 7, 2010 at 2:10 PM/blockquote>

MediCare patients already face such situations. This is the liberal medical dream now coming true for you, me and the whole country.

Now that ObamaCare is law there is nothing stopping American medicine from racing full steam ahead toward universally enforced care-rationing.

Edouard on April 7, 2010 at 2:20 PM

there are realistic effects and concerns, and then there are exaggerated, speculative effects and concerns. The latter are pretty useless, or at least serve little purpose in a legitimate discussion.

ernesto on April 7, 2010 at 2:16 PM

You remind me of Barney Frank during the years before the housing bust.

Medicare and Social Security are trillions and trillions and trillions and trillions of dollars in the red. You somehow, someway think that Obamacare will fare better?

visions on April 7, 2010 at 2:21 PM

Now that ObamaCare is law there is nothing stopping American medicine from racing full steam ahead toward universally enforced care-rationing.

Edouard on April 7, 2010 at 2:20 PM

The liberals’ definition of a ‘level playing killing field’.

Liam on April 7, 2010 at 2:23 PM

The British newspapers of all persuasions have been cover the problems with the NHS for years. You’d think anyone who has ever been to the Times Online (Times of London), Telegraph, or even the uber-liberal Guardian would have an idea how bad rationing can get.

Laura in Maryland on April 7, 2010 at 2:23 PM

At least you have the choices, and the brains to act on them as you need.

What I fear is people needing tests or treatment won’t be allowed to get those things because of some cost-analysis done by a third party.

That is just plain wrong, if not an outright evil.

Liam on April 7, 2010 at 2:10 PM

–It’s being done now by insured plans.

Jimbo3 on April 7, 2010 at 2:33 PM

How are the doctors going to dodge the lawyers when the government tells them they can’t order the battery of tests to cover their arses.

keebs on April 7, 2010 at 1:28 PM
They’ll move to the few states that do have tort reform or give up medicine entirely. I think there have been articles already on the coming shortage of general practitioners.

It is possible that the standard of acceptable medical care would be revised downward so the doctors would use the “effectiveness panels” criteria for what is considered acceptable medical procedure as a defense.

Wethal on April 7, 2010 at 1:31 PM

–Well over thirty states now have some type of tort reform, so that allows people to move to most of the US.

Jimbo3 on April 7, 2010 at 2:36 PM

From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct.

What the hell is medicine if we’re not doing exactly this? We’re talking about trying anything to save, preserve and prolong life. How else are we to interpret this BUT death panels and rationing?

I’m so sick of liberals recklessly mucking up everything and then, in hindsight, when it’s entirely too late, deciding to speak truthfully…while stroking their egos for their lucidity, as if we haven’t been saying this forEVER. Mind-melting stupidity and criminal arrogance.

Diane on April 7, 2010 at 2:36 PM

They were outraged at what Palin said just because it was Palin who said it. Many of them knew that end-of-life rationing would become a fact of life; remember “The Case for Killing Granny” in Newsweek?

Bill Ramey on April 7, 2010 at 2:43 PM

It’s going to be interesting when the libs who pushed so hard for this are faced with the results of their efforts. When their loved ones are left in the lurch because the needed care is ‘too expensive’, what will they do? To whom will they cry?

Liam on April 7, 2010 at 1:54 PM

To make a sweeping, but fairly accurate generalization, libs tend to be less rational and more neurotic, particularly regarding health care issues.
They are going to suffer much mental anguish by what is really coming down the pike with this fiasco.

justltl on April 7, 2010 at 2:46 PM

–Well over thirty states now have some type of tort reform, so that allows people to move to most of the US.

Jimbo3 on April 7, 2010 at 2:36 PM

Yeah, that some form of tort reform consists of just enough to be able to call it that. In the meantime, Obamacare will be taxing the Doctors, their Malpractice insurance rates will continue to rise, because in spite of the fact there is tort reform doesn’t mean they won’t be sued and then will be hit with reduced Medicare and Medicaid payments and still have to pay their office staff. If you don’t think doctors who are anywhere close to retirement won’t retire enmass, then you haven’t talked to any lately.

flytier on April 7, 2010 at 2:52 PM

It’s going to be interesting when the libs who pushed so hard for this are faced with the results of their efforts. When their loved ones are left in the lurch because the needed care is ‘too expensive’, what will they do? To whom will they cry?

Liam on April 7, 2010 at 1:54 PM

To make a sweeping, but fairly accurate generalization, libs tend to be less rational and more neurotic, particularly regarding health care issues.
They are going to suffer much mental anguish by what is really coming down the pike with this fiasco.

justltl on April 7, 2010 at 2:46 PM

With all of these mandates and whatnot it will be interesting in a very morbid way to see what happens. I mean if an insurance company won’t pay for a procedure now because of cost the people still have the right to pay for it out of pocket.

When the government is in charge of the decision it will be much worse because more than likely the price of the procedure will be SO high that even if people wanted to, they wouldn’t be able to afford paying for it out of pocket.

Next the government will prevent doctors from doing a specific procedure at all. You can have an abortion at will and it will be free, but forget that life saving brain surgery, unless there will be back alley brain surgeons like the libs said there would be back alley abortionists if we stopped funding abortions.

MobileVideoEngineer on April 7, 2010 at 2:56 PM

–Well over thirty states now have some type of tort reform, so that allows people to move to most of the US.

Jimbo3 on April 7, 2010 at 2:36 PM

Yeah, that some form of tort reform consists of just enough to be able to call it that. In the meantime, Obamacare will be taxing the Doctors, their Malpractice insurance rates will continue to rise, because in spite of the fact there is tort reform doesn’t mean they won’t be sued and then will be hit with reduced Medicare and Medicaid payments and still have to pay their office staff. If you don’t think doctors who are anywhere close to retirement won’t retire enmass, then you haven’t talked to any lately.

flytier on April 7, 2010 at 2:52 PM

–People always say “bold” things when they’re ticked off. What matters is how many take real action. And that’s alot fewer (historically) than those that complain.

Jimbo3 on April 7, 2010 at 2:56 PM

Rest easy everyone. Just make sure you don’t eat the Soylent Green.

cyclown on April 7, 2010 at 3:08 PM

The sad thing about all of this is that the cost problem could be rectified simply and instantly. Here’s how:

Tell docs to practice cost effective yet high quality medicine. Enable them to do that by allaying the massive and ever present fear of malpractice suits.

It really is that simple.
And it really is never going to happen.

Thank the Democrat party.

justltl on April 7, 2010 at 3:10 PM

It will be neat to tell our grandchildren about how we once had a choice on which products we spent our money on.

rogerb on April 7, 2010 at 3:14 PM

Before this, we were getting harangued about how everyone deserves healthcare and anybody who voiced opposition to ObamaCare was a monster gung-ho on denying care to people who needed it. Now we’re hearing “we who make all the decisions need to tell people NO when they start begging us for medical care.”

Aitch748 on April 7, 2010 at 1:19 PM

If the government intends to limit everyone’s actual medical care, what was the big rush to make sure everyone had healthcare insurance?

katiejane on April 7, 2010 at 3:17 PM

–People always say “bold” things when they’re ticked off. What matters is how many take real action. And that’s alot fewer (historically) than those that complain.

Jimbo3 on April 7, 2010 at 2:56 PM

Liberals who think they can say “I dare you to retire”, and laugh at physicians who are angry about this thing, are going to get their bluff called.

ObamaCare is regarded as an act of hostility by every doctor I have talked to about it and I do know a few.

The early retirements are coming and you would be well advised to count on it.

Edouard on April 7, 2010 at 3:22 PM

This is shameful!

The main argument for Obamacare was that “healthcare” should be a basic “right”.

Well, controlling your own healthcare is one of those unalienable “rights” that everyone used to posses. Now, with Obamacare, that “right” has been ceded to the Federal government and nameless, faceless bureaucrats with no accountability. That is one of the reasons why there is a principled reason for conservatives and the GOP FIGHT FOR REPEAL!!!

Michael K. on April 7, 2010 at 3:45 PM

She turned white when she realized that I may be right. I think she is coming around.. slowly.

upinak on April 7, 2010 at 1:29 PM

Your mom was black?
Yeah, this is going to be a shocker to many, when they find out that the “death panels” are real.
And it is going to be interesting as the people find out that the clever libs, putting this in place after the 2012 elections think they are immune.
People will be expecting free service, and the Republicans should fuel that discontent…yes, give out dis-information, and show how the libs have deceived people into believing “free” is coming.

right2bright on April 7, 2010 at 3:46 PM

If the medical establishment remained as is and assumed an influx of 30M more patients, as OCare purports to do, we face shortages and rationing.

When many medical professionals say ‘adios’ to OCare because they don’t want to be tools of the government, those shortages will be even more pronounced.

What will be utterly unbearable are all of the people NOT entering the medical profession to replace those departing and to backfill where we need more doctors and healthcare providers. Then we’ll see shortages, rationing and chaos on a scale we can barely imagine.

redfoxbluestate on April 7, 2010 at 4:00 PM

Medicare growth rate is out of control. It’s true we can’t pay for it. Something has to be done. But what’s the one thing you don’t do? Add another federal entitlement for 32 million people. That is senseless and counterproductive, and anyone with a room temperature IQ knows it. Grandpa, you lose, unless you’re very rich or politically connected.

chris999 on April 7, 2010 at 4:01 PM

The entire medical R&D sector is not going to simply disappear. To believe it would simply vanish is delusional.

ernesto on April 7, 2010 at 1:45 PM

Last year, the Mayo Clinic performed more medical research initiatives than Canada and the UK combined. Just the Mayo Clinic.

Your right it won’t vanish, it will become miniscule.

barnone on April 7, 2010 at 4:04 PM

We (anyone old enough) have already seen the result of federal price controls, 30 years ago. They were called gas lines.

A creative statist will find a way to blame big oil for the fact that you will have to wait 24 months for an MRI.

percysunshine on April 7, 2010 at 4:38 PM

Can we start with saying no to illegal immigrants?

That would require getting insurance out of the way of normal, routine medical care and using it only for catastrophic issues, and providing tax-free shelters for medical-care funds controlled by individual consumers.

Grrrr. How about we have a choice in the matter? There should be a menu of options available to everyone to purchase, including routine care if that’s what the consumer wants. As for the tax free shelters, okay, but what if we move to a flat tax or fair tax (as we should) where all shelters are eliminated?

Buy Danish on April 7, 2010 at 4:43 PM

Dems: Party of No

No freedom, No liberty, No healthcare, No unicorns, No choices, No individuality.

Yep, that’s them Dems. Wear it punks.

ted c on April 7, 2010 at 5:00 PM

If we want to solve the problem of overutilization, which is what ObamaCare purports to do, we’re going about it in exactly the wrong manner. We need to restore pricing signals in order to make consumers aware of the consequences of their decisions, not shield those costs even further by having taxpayers subsidize even more of those costs.

I don’t know that you’re accurately capturing the intent of many policymakers. The goal isn’t to create a giant government HMO, but to change the way providers are compensated- by results instead of by procedure. Ideally, doctors won’t need to follow anything more than high level guidelines from above (government, insurers, or exchanges)- and provide care dictated by their decisions as to what’s best for the patient.

I agree that pricing signals would be effective, although you can’t ‘restore’ pricing signals that essentially have never existed. Patients should have to make more co-payments that reflect underlying costs, but even this is inadequate. It’s the major end-of-life Hail Mary procedures that drain the system and lead to the most extraordinary costs. My brother is a kidney specialist who sees this almost every day (by the time your kidneys fail, you typically are on your last legs). Families will order any operation or life support option that has even a 2% chance of extending life, regardless of the cost. When confronted by death in the family, people have trouble making rational decisions and need help beyond a 2 minute conversation with docs in the hospital lounge. Before the health care bill, ‘death panels’ were universally seen as a good thing.

That would require getting insurance out of the way of normal, routine medical care and using it only for catastrophic issues

Ed, you’re calling for radical changes in the current, private system when you refer to getting “insurance companies out of the way”. If you want to keep the private system involved, you may want to re-think that statement.

bayam on April 7, 2010 at 5:06 PM

Ed, you’re calling for radical changes in the current, private system when you refer to getting “insurance companies out of the way”. If you want to keep the private system involved, you may want to re-think that statement.

bayam on April 7, 2010 at 5:06 PM

+1

Buy Danish on April 7, 2010 at 5:13 PM

–It’s being done now by insured plans.

Jimbo3 on April 7, 2010 at 2:33 PM

And medicare denies coverage at twice the rate of private plans. What’s your point?

We heard screaming and crying about how insurance companies denied care and coverage. But now that the government is running/regulating it, it’s somehow okay and “we” need to “find ways to say no”.

The difference being that with the government, you have less recourse than with a private company. Where else are you going to go if you don’t like the service? What board or panel can you appeal an adverse decision to? the same one who issued it?

This whole thing is not about “health” or “care”. It’s about power and control, and trust (or lack thereof). It’s also about some people feeling better about themselves because “they ensured everyone has health care” when 1 – I don’t work to make you feel better about yourself, and 2 – it ensures nothing, as this NYT article shows.

JeffWeimer on April 7, 2010 at 5:20 PM

I don’t think Ed means that insurance companies have to be totally taken out of the health care business. What we need is insurance deregulation.

chris999 on April 7, 2010 at 5:21 PM

–It’s being done now by insured plans.

Jimbo3 on April 7, 2010 at 2:33 PM

Yes. Insurance plans that are by choice. Plans that must compete with other plans.

JusDreamin on April 7, 2010 at 5:22 PM

It’s very clear that the current legislation – a crazy quilt of taxes, subsidies, mandates – is not the intended plan. Insurance companies will not survive these regulations. All sophisticated people know this. Obama and Waxman and company know it. They just won’t say it. When insurance companies start limiting care and/or leave the health care business, the government will ride in on its white horse, blame big insurance and put us all on single payer. And we’ll be relieved because it will be preferable to the chaos they created. That’s their theory, anyway.

chris999 on April 7, 2010 at 5:31 PM

Trying to prepare us for the inevitable. Doing it with the added pleasure of telling Americans once again how horribly greedy they are, especially in their desire for health care with the “try anything” and screw the costs attitude. We all need to just line up outside the hut with the outhouse and get our shots quietly. Besides, it’s better for the environment.

/sarc

Sultry Beauty on April 7, 2010 at 5:32 PM

–It’s being done now by insured plans.

Jimbo3 on April 7, 2010 at 2:33 PM

Jimbo, please try to get this through your head once and for all:

An insurance company refusing to pay for a procedure does not deny you that procedure. You have other options: Pay for it yourself, get a loan, look for a different insurance company, or sue your insurance company. They cannot stop you from having the procedure.

When the government controls health care, they can stop you from having the procedure. You will have nowhere else to go.

See the difference?

Mary in LA on April 7, 2010 at 5:57 PM

So the NYT tells us (conveniently only after the bill was passed) what we knew all along (because some former governor from Alaska had the cojones to do so).

Gee thanks NYT. All the fishwrap that’s fit to use…. and I wouldn’t even use you for that nowadays.

Chaz706 on April 7, 2010 at 6:25 PM

a so-called Medicare innovation center and a Medicare oversight board that can set payment rates.

Sounds like death panels to me how about you, Sarah? Doggone she was right AGAIN!

Herb on April 7, 2010 at 6:29 PM

This can be fixed in November…………….

ultracon on April 7, 2010 at 6:42 PM

The real outrage will be when folks who pay full price for Obamacare for 15 years get the “NO” from the Death Panel so underemployed “artist” hacks whose premiums have been subsidized by said folks can get sex-change operations so they can feel better about themselves.

The U.S. has gone mad. Truly. Mad.

ROCnPhilly on April 7, 2010 at 7:03 PM

You know that ever increasing life expectancy Americans used to be able to enjoy? Its over.

The oldest among us right now will be the longest lived generation in American history as those who are aging will find the Medical Care necessary for them to reach those “life expectancy” numbers are now denied to all but the most wealthy among us.

Libs – lying to insure that the best is reserved for the rich/elites

Fatal on April 7, 2010 at 7:51 PM

I think I’ll start calling it Auschwitzcare.

Everybody gets the same government mandated course of treatment at standardized facilities, delivered by high-speed rail and nobody survives it. Plenty of eyeglasses and dentures to recycle so the enviro-national-socialists will probably call it “green.”

viking01 on April 7, 2010 at 8:50 PM

Families will order any operation or life support option that has even a 2% chance of extending life, regardless of the cost.
bayam on April 7, 2010 at 5:06 PM

And that’s what makes all the difference. Private insurers factor those costs into their premiums and still manage to make money, even offering patients those expensive choices. Government programs ration the limited dollars they have, limiting patient choice, and suck ever more and more tax dollars into the debt-laden black hole of “free” health care. (Sorry, was that racist?)

It is amazing to me how libs are so willing to put on the sackcloth and ashes for healthcare and global warming in their ersatz pietous yearnings for social justice and environmental purity and yet sneer at Christians who think being faithful to your spouse and protecting the life you create are moral aspirations. In the case of healthcare, we will all be sacrificing just so the progs can feel righteous and holy.

inmypajamas on April 7, 2010 at 8:50 PM

–It’s being done now by insured plans.

Jimbo3 on April 7, 2010 at 2:33 PM

And medicare denies coverage at twice the rate of private plans. What’s your point?

JeffWeimer on April 7, 2010 at 5:20 PM

Jimbo is useful.

CWforFreedom on April 7, 2010 at 9:13 PM

Instead, we’re slowly turning the entire medical system into an HMO, only this time with Congress and the executive branch running it.

Yes, but it’s an HMO with only one specialty: Proctology.

PoodleSkirt on April 7, 2010 at 9:22 PM

Families will order any operation or life support option that has even a 2% chance of extending life, regardless of the cost.
bayam on April 7, 2010 at 5:06 PM

And that’s what makes all the difference. Private insurers factor those costs into their premiums and still manage to make money, even offering patients those expensive choices.

That’s not the way it plays out. Doctors often give families confusing medical descriptions of their dying family member’s conditions along with a set of equally confusing medical options, typically in a few short minutes without any real context. These decisions are difficult and painful. Medical procedures that were designed to save the life of a 30 or 40 year old can also be performed on a 90 year old, even when doctors think that it won’t result in more than a few days or weeks of ongoing, but very painful life for the patient. Personally, I hope that my life doesn’t end this way.

The kind of ‘panel’ supported by people like Palin and Gingrich in the past consists of health advisors, clergy, and doctors. It’s about helping families cope with the most difficult end of life decisions in a rational way. Approving any and every possible way to freakishly extend the life of an elderly person who’s in the process of a natural death is usually not in anyone’s best interest, especially not for the patient.

bayam on April 7, 2010 at 9:24 PM

Option 1: I have private insurance which refuses to pay for my treatment. I get a loan, get a second job, sell my car, sell my house. I pay for treatment myself. I get better and live. I pay back loan.

Option 2: I have govt run health care. The govt refuses to treat me. I die.

It’s that simple.

angryed on April 7, 2010 at 9:39 PM

The kind of ‘panel’ supported by people like Palin and Gingrich in the past consists of health advisors, clergy, and doctors. It’s about helping families cope with the most difficult end of life decisions in a rational way. Approving any and every possible way to freakishly extend the life of an elderly person who’s in the process of a natural death is usually not in anyone’s best interest, especially not for the patient.

bayam on April 7, 2010 at 9:24 PM

Exactly. One of the hardest facts to swallow in this whole debate is that sometimes it really is best to pull the plug…but the federal government should not be directly involved in the process.

Dark-Star on April 7, 2010 at 9:44 PM

Yet be careful about cheering what the Dutch decided to do which was to facilitate putting Granny out of her young-’un’ses misery.

Potentially horse track medicine where every patient eventually appears to be a thoroughbred with a broken leg.

viking01 on April 7, 2010 at 9:50 PM

Just a little levity apropos of the topic: The Zimmers belt out “My Generation.” http://www.youtube.com/watch?v=zqfFrCUrEbY

(Zimmers are what the Brits call walking frames.)

onlineanalyst on April 7, 2010 at 9:53 PM

Basically, they think they know better than doctors.

They think there is no art in medicine.

They think it’s all in tables they produce.

They will tell doctors what will be covered, and say no to what they think isn’t cost-effective.

Just as we always said. Exactly as we said.

However, now that will be a *good* thing, leftists will insist, because they, too, believe government knows best in all things, including medicine.

Liars, prevaricators, evil people. “There’s rationing in this, specifically” we say. “No there’s not, and stop lying,” they say.

Then, when the time is right, they announce that there is a rationing in this. But since they said it, now that’s a good thing.

I hate these people.

Alana on April 8, 2010 at 2:02 AM

I suspect this is some deep seated plot to take over Canada.

With OsamaCare all the Canadians who come here to get health care have no place to go except to the to the big maple leaf in the sky, leaving the vast frozen tundra up north free for the taking. This assumes there are still some of us around.

Bubba Redneck on April 8, 2010 at 2:54 AM

Alana on April 8, 2010 at 2:02 AM

Always remember that for Libtards to lie all they have to do is open their mouth.

Bubba Redneck on April 8, 2010 at 3:06 AM

More evidence that the Progressives are guided by the principles of Satan.

2 Thessalonians 3:10 “For even when we were with you, this we commanded you, that if any would not work, neither should he eat.”

Or have health care.

csdeven on April 8, 2010 at 7:02 AM

What is the greatness of ‘limited incentive’?

Compare how many new medications, procedures, therapies, and durable medical equipment discoveries have been made in US labs… as compared to European labs. That is why European medical companies have US labs: they would like to innovate and create new ways to treat diseases and come to the place where that can be done.

Remember Europe has ‘limited incentives’ via health care systems run by governments, and yet if you want new medications, treatments, therapies, and methodologies to treat diseases and disorders, from the simple to the leading edge, which part of the globe do you look at?

The ones that have ‘limited incentive’?

Or the one where you can make a good profit by finding a new treatment, creating a new market, helping people to live longer and more active lives, and increase company and overall economic growth?

Just like in the physical sciences, the torch got passed from Europe to America for these things decades ago. And some of those lovely Nations in Europe won’t allow their citizens to get medications and equipment from the US as it… yes… costs too much. It seems that ‘limited incentive’ with ‘limited markets’ with ‘limited care’ does not get you innovation in not only medical care but in more economical medical care over time. You can get cheap medical care if you restrict yourself to the drugs and procedures of the early 1970′s, and have the life expectancy that we had in the early 1970′s. When you limit the rate of change, you stagnate the market and the incentive TO change. Thus not only is change reduced, the rate of change is reduced… and you pay more for getting less from the system because bureaucrats decide what innovation should be supported and which just left unfunded.

Hard to make a choice between a better, but more expensive therapy, and one that has known but limited results when you don’t have a newer one around to compare it to. I will trust the drug companies on what to research far easier than a government bureaucrat looking to ‘cut cost’ via reducing treatment and stifling innnovation. They know how to balance things far better than any bureaucrat ever found in any era, anywhere.

My life hangs in the balance.

So does yours.

ajacksonian on April 8, 2010 at 7:22 AM

But there are realistic effects and concerns, and then there are exaggerated, speculative effects and concerns. The latter are pretty useless, or at least serve little purpose in a legitimate discussion.

ernesto on April 7, 2010 at 2:16 PM

I’m not into fear mongering here. And I think it’s pretty fair to speculate when we already have experience w/ govt intervention in healthcare right now: Medicare/caid.
This is why our health care is uber expensive, i.e. $8 for a Tylenol pill.
It does serve a purpose. People need to get on the move about stopping this horrendous experiment that will not just fail, but has the high potential to further ruin us.
The discussion of reduced options, care, & access to doctors is very legitimate.

Badger40 on April 8, 2010 at 8:14 AM

It will suck so many resources out of the middle class that only the wealthy will have any real options outside of the government-controlled network

So now I have a strategy- get rich!!!

xax on April 8, 2010 at 8:32 AM

And all must remember that it’s not just Obama . . . every politician that supports him is equally culpable for this fiscal, moral and social disaster.

rplat on April 8, 2010 at 9:16 AM

edicare is abused by doctors. Witnessed it myself. The doc walked in to the room says good morning to everyone,leaves and cha ching 300.00. Thats a bit much. Worst part is he says he did this every day for 2 weeks. I saw him maybe 3 times. Some bills came in 4 months after showing he did other things. The hospital billed $30,000. Medicare covered it of course. The talk radio guy are right on this one. O care will not do a darn thing. The hidden things are really the killer.

johnnyU on April 8, 2010 at 9:17 AM

“Being able to say no,” Dr. Alan Garber of Stanford says, “is the heart of the issue.”

So did he take the hypocratic oath or the hypocritical oath?

jeffn21 on April 8, 2010 at 9:37 AM

I am surprised there are so few comments on this topic, all considered.
Pretty much a verification of the death panel meme.

FireBlogger on April 8, 2010 at 9:51 AM

Of course care is rationed under private insurance. Nobody denies that. However, private insurers have many reasons to expand coverage that the gov’t will never face once they take over completely (which Obamacare is designed to do). First, gov’t will not face competition. Currently, different insurers cover things that they think will get them more clients. So coverage expands based on the market.

Second, insurers are subject to lawsuits. The gov’t will be subject to a “due process” hearing, but that is almost always a sham. they will set it up so you present your case and the hearing officer will 98% of the time agree with the agency. That is what such due process hearings accomplish b/c the agency “has the expertise”. The Courts will only overturn such decisions if arbitrary and capricious and that is a rare thing.

So, while private insurers do “ration” care, it is much less rationing then the gov’t will ever do. Also, b/c insurers, up to now, have not had to cover people with pre-existing conditions or people who could not pay premiums, they could cover more b/c there was actual money in the risk pool and the insurer could cover treatment.

Those luxuries are gone. So now, more people and more expensive treatments need to be covered with the same or less money. Thus, the gov’t has to ration care more than private insurers ever would.

However, people like Jimbo and Ernesto will always believe that the gov’t will make more “just” or “logical” decisions then private individuals contracting with each other. there is no evidence supporting that in history, but the evidence of history is that socialsim absolutely does not work anywhere it is tried, that socialist gov’ts always eventually turn into totalitarian regimes, and that socialists and leftists have killed more people in the name of “utopia” then anyone on the right ever dreamed about doing. Even if you count the nazis as right (which is absurd, since the nazi’s were socialists), the left still has the title for worst when you count Mao, Pol Pot, Stalin, Castro, and myriad other lesser lights in eastern europe, South america, and Africa.

Somehow though, this time, Obama and the U.S. gov’t will do it right and we will all have wonderful gov’t controlled health care without our taxes increasing.

Monkeytoe on April 8, 2010 at 11:30 AM

It’s being done now by insured plans.

Jimbo3 on April 7, 2010 at 2:33 PM
Jimbo, please try to get this through your head once and for all:

An insurance company refusing to pay for a procedure does not deny you that procedure. You have other options: Pay for it yourself, get a loan, look for a different insurance company, or sue your insurance company. They cannot stop you from having the procedure.

When the government controls health care, they can stop you from having the procedure. You will have nowhere else to go.

See the difference?

Mary in LA on April 7, 2010 at 5:57 PM

–Where does the health care law provide that we can’t get services other than through the exchanges or employer insurance plans? If you have coverage (and so don’t have to pay the fine), I see nothing that says that you can’t pay in cash for additional services.

Jimbo3 on April 8, 2010 at 12:20 PM

–Where does the health care law provide that we can’t get services other than through the exchanges or employer insurance plans? If you have coverage (and so don’t have to pay the fine), I see nothing that says that you can’t pay in cash for additional services.

Jimbo3 on April 8, 2010 at 12:20 PM

So, your response is that the care I now get included with my premium, once that is taken away, I can pay for out of pocket? And I haven’t lost anything in this scenario how exactly?

Monkeytoe on April 8, 2010 at 12:28 PM

Moreover, I would not be surprised to see the gov’t make direct case for services illegal in healthcare. Otherwise, more providers will switch over to a cash only practice which the gov’t will not want b/c they need those providers giving out care in the gov’t service. Many of the socialized single-payer countries have done this, which is why their better-off citizens usually come to the U.S. for serious surgeries and treatments.

Monkeytoe on April 8, 2010 at 12:30 PM

Monkeytoe, am responding to this:

Jimbo, please try to get this through your head once and for all:

An insurance company refusing to pay for a procedure does not deny you that procedure. You have other options: Pay for it yourself, get a loan, look for a different insurance company, or sue your insurance company. They cannot stop you from having the procedure.

When the government controls health care, they can stop you from having the procedure. You will have nowhere else to go.

See the difference?

Mary in LA on April 7, 2010 at 5:57 PM

Jimbo3 on April 8, 2010 at 12:31 PM

Well, in that case you are correct, unless, like in Canada up until recently, the Gov’t makes it illegal for providers to provide care outside of gov’t controlled health care. In other words, no cash for procedure.

Monkeytoe on April 8, 2010 at 12:42 PM

And, again, b/c they will need every provider working for Obamacare to limit the rationing as much as possible, they will likely try to make it illegal, or at least very, very difficult, for providers to work outside of Obamacare. Which means that you would not be able to get a procedure once the gov’t told you no.

Monkeytoe on April 8, 2010 at 12:43 PM

OT: Am I hallucinating that, while I am watching “Contact”, the blind dude is Allan Colmes?

ProudPalinFan on April 8, 2010 at 1:12 PM

Nah…checked the credits but it’s not him…I gotta fetch a YouTube clip, it’ll creep everybody out! Like a living, breathing twin with voice and everything.

ProudPalinFan on April 8, 2010 at 1:28 PM

Black market healthcare. It WILL happen.

psychocyber on April 8, 2010 at 2:20 PM

Dear Diabetes Patients:

We regret to inform you that amputation is too expensive. Take the Blue Pill while your foot continues to rot.

ObamaCare Panel
Washington, DC

TN Mom on April 8, 2010 at 3:47 PM

I wrote this up and I want to post it somewhere, but I don’t have my own blog, so I’ll post it here. Please let me know what you think:

The 2nd Bill of Rights

Our country is currently in a crisis the likes of which it has never seen before. The Federal government has assumed powers which would be inconceiveable to our Founding Fathers. It has done this through a long, slow process of increasingly larger and more expensive socialist programs starting with FDR and currently ending with the Health Care debacle. None of these programs are listed in the Enumerated Powers section of the Constitution:

“Section 8: The Congress shall have power To lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States;

To borrow money on the credit of the United States;

To regulate commerce with foreign nations, and among the several states, and with the Indian tribes;

To establish a uniform rule of naturalization, and uniform laws on the subject of bankruptcies throughout the United States;

To coin money, regulate the value thereof, and of foreign coin, and fix the standard of weights and measures;

To provide for the punishment of counterfeiting the securities and current coin of the United States;

To establish post offices and post roads;

To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries;

To constitute tribunals inferior to the Supreme Court;

To define and punish piracies and felonies committed on the high seas, and offenses against the law of nations;

To declare war, grant letters of marque and reprisal, and make rules concerning captures on land and water;

To raise and support armies, but no appropriation of money to that use shall be for a longer term than two years;

To provide and maintain a navy;

To make rules for the government and regulation of the land and naval forces;

To provide for calling forth the militia to execute the laws of the union, suppress insurrections and repel invasions;

To provide for organizing, arming, and disciplining, the militia, and for governing such part of them as may be employed in the service of the United States, reserving to the states respectively, the appointment of the officers, and the authority of training the militia according to the discipline prescribed by Congress;

To exercise exclusive legislation in all cases whatsoever, over such District (not exceeding ten miles square) as may, by cession of particular states, and the acceptance of Congress, become the seat of the government of the United States, and to exercise like authority over all places purchased by the consent of the legislature of the state in which the same shall be, for the erection of forts, magazines, arsenals, dockyards, and other needful buildings;—And

To make all laws which shall be necessary and proper for carrying into execution the foregoing powers, and all other powers vested by this Constitution in the government of the United States, or in any department or officer thereof.”

I see nothing in there about maintaining a welfare state. I see nothing in there about health care, the redistribution of wealth, Medicare, Medicaid, Social Security, bailouts of companies, bailouts of states, bailouts of industries, loaning money to students, giving money to banks or anything else that the Federal Government is currently doing outside of its jurisdiction.

Unfortunately, the Federal Government has assumed all of these powers through the “Commerce Clause”, the second point above,:

“To regulate commerce with foreign nations, and among the several states, and with the Indian tribes;”

Slowly and creepingly, over the years, this has come to be interpreted to mean, if it involves any type of commerce (or has any effect on commerce whatsoever), that Congress may make a law addressing it. This, unfortunately means that nothing would ever be out of Congress’ purview. This was obviously not the framer’s intent. The entitlement programs created by the government are currently bankrupting our country. We are, at the time of this writing, almost $13 Trillion in debt. Social Security alone is insolvent and would probably bankrupt the country within thirty years. Medicare alone is also insolvent and would probably bankrupt the country within thirty years. Both of them, along with the new health care bill, will probably bankrupt the country within fifteen years.

The entitlement state in which we live is unsustainable, unconstitutional is incompatible with prosperity and liberty.

We must reverse this course. Therefore, I am humbly proposing these Amendments to the Constitution. I will explain the reasoning behind each one after it’s Text. I will Refer to them as Amendment A, Amendment B, etc. for purposes of reference and so that they are not confused with the current actual amendments.

Amendment A

Section 1. Congress shall make no law which directly or indirectly requires citizens to participate in government programs against their will, excepting military conscription during times of war. All such previous laws are declared null and void and all such programs are dissolved. The right to create such programs are reserved for the states.

Section 2. Congress shall create no mandates for the citizens of the United States to purchase and/or use any product or service. All such previous laws are declared null and void and all such programs are dissolved.

Section 3. Congress’ ability to regulate via the commerce clause of Article I, Section 8 shall only be regulation of actual commercial activity. It shall not be construed to allow regulation of inactivity. It shall not be construed to allow regulation of activity which is not actual commerce between states, but which could directly or indirectly affect such activity. It shall not be construed or to allow regulation of personal behavior, consumption or production.

Section 4. The government shall not be involved in providing or guaranteeing non-enumerated services such as, but not limited to, health care, retirement programs, loan services, educational services, grant programs, welfare programs or entitlement programs.

Section 5. Congress shall not give more than 10% of its total annual budget for any year directly back to the states for any reason, and no more than 1% to any individual state.

This amendment should dissolve Social Security, Medicare, the new Health Care Bill, and the department of Education. While these things can still be kept up and done, they should be done on a state by state basis. If Maine wishes to have a universal retirement program or universal health care, then they can. If Texas wants to stay away from such programs, then they can. Such things were left up to the states via the Tenth Amendment. Section 5 is to prevent the federal government from bailing out any individual state (governmental welfare) because of that state’s failed policies. It is also to prevent the federal government from bribing states to do its will in order to get around the 10th Amendment (for example, the withholding of highway funds unless state seat-belt laws are enacted).

The 10th Amendment:

“The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

Welfare programs (welfare, food stamps, etc.) should not be confused with “for the general welfare” programs such as NASA, road building, military, etc.. General Welfare is the making of things for the use of all such as roads, military, etc. Welfare programs are for specific people (i.e. those making less than $50,000 a year, those who are 65 or older, those who have three children and are unmarried, etc.).

Amendment B

Section 1. Congress shall make no law guaranteeing any industry, business or service. Congress shall not bailout any industry, business or service. Congress shall not nationalize any industry, business or service.

Section 2. Congress shall sell off to the highest bidder any stakes that it may currently hold in any bailed out industry or company. Congress shall have seven years from the time of the ratification of this amendment to hold bidding for and finalize such sales.

Section 3. Congress shall make no law whose main purpose is the redistribution of wealth.

This should stop the industry bailouts. It should also end the government’s ownership of General Motors, etc. It would also put a stop to the government takeover of the student loans. It would also end the Fannie Mae/Freddie Mac scenario because it could to place guarantees on any industry. The third section is self-explanatory.

Amendment C

Section 1. The budget of the Federal government for a fiscal year shall not exceed 10% of the GDP for the country for the calender year dated three years before.

Section 2. Any amount taken in by the Federal government in excess of their budget shall be used to pay off the debt until it is retired. After the debt has been retired, any excess shall be set aside to be used as deemed necessary by Congress to pay for future wars. It may be used for no other purpose.

Section 3. The maximum percentage of income allowed to be taken by the income tax under the 16th Amendment shall not exceed 15%. Whatever the percentage taken by the tax (15% or less), it shall be taxed to all persons and entities evenly without exceptions, exemptions or loopholes.

Section 4. Once the debt has been retired, the maximum percentage of income allowed to be taken by the income tax will be reduced to 12%.

This amendment will reign in runaway government spending. For example, the GDP was $14.2 trillion in 2009. Thus, the Budget for the Federal Government could not exceed $1.42 trillion for the 2012 budget year. With the removal of the entitlement programs, this limit should never need to be exceeded. The second section works to retire the debt and builds an actual war chest once the debt is retired. The third and fourth sections reduce the income tax to a level which will promote long term investment and prosperity.

Amendment D

Section 1. No person shall serve more than two full or partial terms in the House. No person shall serve more than two full or partial terms in the Senate.

Section 2. Congress shall make no law for the people which exempts them from equality under that law.

This amendment is very, very straightforward. It would go a long way towards eliminating career politicians and it would keep them from writing bills for the people from which they are exempt (see the new Health Care Bill).

Amendment E

A citizen of the United States shall be somebody who was born abroad of two U.S. Citizen parents, who was born in the United States or any of its territories of at least one parent who is a U.S. Citizen or who has been naturalized as a Citizen through a process as is established by Congress.

This amendment will correct a misreading/misunderstanding of the 14th Amendment and will disallow the “anchor babies”. With the removal of entitlement programs federally, the lure of entitlements would be greatly reduced, but the fact that many states will continue to carry on entitlement programs (which is their right under the 10th Amendment), they would still be a problem without this amendment.

Programs should be tried by states if they wish. The programs that work will be adopted slowly by other states. The programs that fail will be abandoned. People will always vote with their feet by moving from one state to another when things become too bad in the state where they currently live. Thus, some states will always have entitlement programs.

Feel free to debate and add to these if necessary. I believe that these five amendments would greatly correct the course of our country and it would bring back prosperity for all.

We can even propose and amend these state-by state (by-passing Congress if necessary): (emphasis mine)

“The Congress, whenever two thirds of both Houses shall deem it necessary, shall propose Amendments to this Constitution, or, on the Application of the Legislatures of two thirds of the several States, shall call a Convention for proposing Amendments, which, in either Case, shall be valid to all Intents and Purposes, as Part of this Constitution, when ratified by the Legislatures of three fourths of the several States or by Conventions in three fourths thereof, as the one or the other Mode of Ratification may be proposed by the Congress; Provided that no Amendment which may be made prior to the Year One thousand eight hundred and eight shall in any Manner affect the first and fourth Clauses in the Ninth Section of the first Article; and that no State, without its Consent, shall be deprived of its equal Suffrage in the Senate. “

We can do this, and, for the love of the country, I suggest that we start soon.

Theophile N. Guimbelleaux
4/8/2010

Theophile on April 8, 2010 at 4:39 PM

Latest socialized health care success story from Britain:

Mother, 37, forced to sell her home to buy cancer drugs Labour pledged to fund

A dying mother last night became the human face of an election battle over the NHS.

Nikki Phelps, 37, who has a rare glandular cancer, has been refused the only drug that could prolong her life.

Despite pleas from her consultant, her local NHS trust says it will not meet the £100-a-day cost.
Terminally ill: Nikki Phelps with husband Bill and their twins Jack and Harry. The NHS has refused to fund the drugs that could prolong her life

Labour ministers promised more than a year ago to give sufferers of rare cancers easier access to life-extending drugs.

But the rationing body NICE has since refused to approve ten such drugs. Experts say the rulings cut short up to 20,000 lives.

Sharke on April 8, 2010 at 8:49 PM

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