Seriously, this guy is doctor?  How?

Puppie sent me this charming little email.

Fuck you asshole.  You can suck your own balls jerkoff.

David Gius, M.D., Ph.D.
Associate Program Director

NIH Oxford/Cambridge Scholars Program

Trans-NIH MD/PhD Partnership Program
Chief, Molecular Radiation Oncology Section
Radiation Oncology Branch
Center for Cancer Research
National Cancer Institute
National Institute of Health
Bldg 10 B3-69
Bethesda, MD 20892-1002301

Office:  (301) 496-5457
Fax:  (301) 301 480-5439
E-mail:  giusd@mail.nih.gov

Hal,
where are these hospitals that deny pain medication to terminally ill patients?

Is dog their doctor?

Puppie,
Under the rules of the Constitution after an “up or down” vote results in a 50-50 tie it is the JOB of the President of the Senate to cast the deciding vote.
Another point: laws are voted on in the House by a majority not a

And it didnt exactly pass the house with an overwhelming majority.

Shouldn’t you be practicing trying to lick your balls or something now? Or your patients balls?

Alex, what I’m saying is this.  When people get to the end of life, they have two choices.  They can sit in a hospital, in pain and misery, fighting it out to the last full measure at great expense.  Or the can be at home, with some pain killers and die cheaper and with more dignity.  When people have the means to make their own choice (i.e, lots of money), they are highly inclined to choose the latter.

The problem is that Medicare creates a perverse incentive.  It makes it cost little for someone to burn up hundreds of thousands of dollars in pointless care.  The incentives need to better aligned, either throw cost sharing or through the voucher system that Congressman Ryan proposes.  You won’t force anyone to forego care.  But you’ll make it much easier for them to make decisions.

Hal,

As i recall the first major Bush tax cut in 2001 used reconciliation and it was 50 to 50 and chaney had to fly in and pass the deciding vote.  And it didnt exactly pass the house with an overwhelming majority.  Just saying?  Am i the only one who sees the similarities?  That doesnt make it right or wrong.  And several of the other much smaller bush tax cuts also used this process since a lot of republicans were not that happy about adding to the debt by cutting taxes.

IMHO it has been used and now it will be used by the dems and my guess is in the future the GOP will use this again as well.  Just like those stupid presidental signing statements that bush used that in my opinion were not constitutional.  But it was done and my guess is BO will use these as well if he fits his agenda?

d

OK, so from what I understand, Mikey thinks the healthcare reform bill sucks, but says it has to be passed to prop up Obama lest he wind up as a one-term wonder. Is that it?

And then for some reason he decides to listen to the police scanner app to become even more depressed and bemoans what 9-11 operators, police officers, and EMTs have to deal with every single day. Which, like the rest of his rant, has nothing to do with his pet raving points but is simply part of life.

Off the deep end? Not really-not for him, anyway.

I want to see a breakdown of how the Republicans used deem and pass.  We heard this talking point on reconciliation.  But, as I blogged, the vast majority of reconciliation votes were for stuff that had overwhelming majorities in both houses or had passed both houses and were reconciling budgets.  it was not use to, for example, start the Iraq War or privatize Social Security.

Maybe people like me that end up owing the IRS taxes every April should also come up with such a nifty rule where we pretend we send in a check to them, but don’t really do it…

What we can do to congress is Vote them out. Which one do you think has more finality and a sure end?

TAX cut?  no it was a increase in the debt limit, to pay for the Wars in Iraq and AFG.
And Nacy Polsi was against it then, working with Citizens united, or some such shit.

Oh BTW Dog, the tax cuts did not bankrupt the United states, decades of Democrat AND republican spending, plus the Housing bubble and well Obama recent Trillion dollar spending, oh and before i get his Trillion dollar Health care plan.....

Hey dog, if you are upset about the US being bankrupted by Republicans, how can you support a massive government ran program of national Health care?

Cite your sources.

And tax cuts never bankrupted anything. Spending does.

And while i am calling you out as a hypocrite i guess you missed the time the GOP passed the very unpopular massive 1.7 trillion dollar tax cut that passed what 50 to 50 in the senate.  But that was fucking OK because it was the GOP so that made it ok.  Did those dumbass tax cuts bankrupt the country?  YES.  But i guess you missed that too. 

d

Alex,

Do you know the definition of hypocrite?  That is your argument.  I am not defending the left i am calling out the fact you are a hypocrite and i am mocking you.  I didn’t know the rules depended on a popularity contest.  Either there are rules or there are not.  Clearly there are rules for the GOP and not the dems.  The only thing i dislike more than a liar is a hypocrite??

d

I dont think thats what they are saying.

So what are they saying then? Because their argument makes no sense otherwise. They surely aren’t advocating for a healthcare system where people are responsible for their own coverage, and those that can’t afford it are SOL. I am certain dog isn’t advocating for that. And I am damned certain Obamacare is doing nothing of the sort. In fact Obamacare is basically creating a two tiered system where the elite that can afford it will have healthcare, and the rest of us will have something that passes for healthcare.

Didnt former Rep. Dennis Hastert R-IL do this when he was the speaker “In the last Congress that Republicans controlled, from 2005 to 2006, Rules Committee Chairman David Dreier used the self-executing rule more than 35 times.  35 times.

Really? And what piece of legislation that was massively unpopular and clearly going to bankrupt the country did he pass this way when his own party held the majority in both houses as well as the presidency? The point isn’t the use of this procedure initself, and I think the procedure is still wrong for the record and do not approve of it when republicans do it, the point is that with a clear majority the leadership still knows that this bill can’t pass because it is crap.

But i am sure there are a ton of really good reasons why is was ok for the GOP to do this but fucking wrong for the dems to do it.

There wasn’t any reason at all: they should not have used it. That there was no uproar was clearly because whatever they did was popular, but that’s still no excuse. I am however not surprised to see that this is the only defense the idiots that are pushing for this bill have left, even if they have to ignore the fact the bill is not just unpopular but angering 70% of the people, to make the case.

You seriously are trying to make the case that people that are not suffering from some horrible terminal pain (and already get exactly the treatment Hal and dog prescribed: pain killers and nothing else) will suddenly say WTF, and opt to end care, are you? You guys watch way too much TV. That scenario is a myth at best.

I dont think thats what they are saying.

and great post, Hal

Really,

Didnt former Rep. Dennis Hastert R-IL do this when he was the speaker “In the last Congress that Republicans controlled, from 2005 to 2006, Rules Committee Chairman David Dreier used the self-executing rule more than 35 times.  35 times.  It is just fucking wrong the the dems do what the GOP did all the time.  Just fucking wrong.  WTF. 

But i am sure there are a ton of really good reasons why is was ok for the GOP to do this but fucking wrong for the dems to do it.  This is called what goes around comes around.  But we can all agree that is wrong.

d

Or maybe you could try to understand that what Hal and dog are saying is that, if people HAD TO CHOOSE whether or not to spend a metric shit-ton of their own money to stay technically alive in a hospital bed for another two weeks, they might CHOOSE not to.

Yeah , sure.. That’s as likely to happen as democrats telling the truth, or Obama keeping his promises other than to fundamentally change this country (and then for the worse). You seriously are trying to make the case that people that are not suffering from some horrible terminal pain (and already get exactly the treatment Hal and dog prescribed: pain killers and nothing else) will suddenly say WTF, and opt to end care, are you? You guys watch way too much TV. That scenario is a myth at best.

Even if we somehow hypothetically got to the point were they would be directly financially responsible for that end-of-life care they got - and only an idiot would make the case that the current abomination that the demcorats are passing is going to do anything close to that - I doubt any significant amount of people when facing the prospect of death will choose to not spend money. What we will get though is government, faceless bureaucrats with political ambitions and personal biases, deciding when people should die. I don’t want that ever.

This is an absolutely outrageous idea, add that it is obviously a political trick to pass a bill that THEY FUCKING KNOW THEY DON’T HAVE THE VOTES TO PASS.  That alone should have people rioting in the streets!  I don’t care what party is doing it.  That is inexcusable and should be grounds to impeach every single one of them that goes along with it.

Maybe you two should have just come out then and advocated to make it law that past a certain age we will just not bother with sick people because it is a bad investement anyway, like the Europeans are starting to do now, and be done with it?

Or maybe you could try to understand that what Hal and dog are saying is that, if people HAD TO CHOOSE whether or not to spend a metric shit-ton of their own money to stay technically alive in a hospital bed for another two weeks, they might CHOOSE not to.  But because the current system allows actual costs to be largely ignored by the end-user of the product, there is no incentive for the end-user to make a rational and considered choice.

Because of the disconnect between the price for the buyer and the actual cost of the product, there is no incentive for the buyer to consider actual cost and therefore no natural market equilibrium.  This is really basic econ-101 type stuff.  It’s called a price ceiling.  If the market cannot set an equilibrium price, and the artificially set price (in the health insurance case it’s a little different because it’s an internally set price ceiling which is a result of the concept of co-payments, etc. rather than an externally set ceiling like rent control) is below the equilibrium price, buyers will demand more than the sellers want to supply.

For example: cars vary greatly in quality, performance, luxury and price.  People have to make rational and considered choices about whether or not they want to incur the opportunity cost of buying a $100,000 Audi S8 luxury sport sedan or pick up a Hyundai Sonata for $30,000.  Part of this price differential has to do with brand cachet and marketing to be sure, but a lot has to do with the Audi being faster, safer, more comfortable, better handling, etc., AND being more costly to actually produce because of more advanced technology incorporated into it.

But right now, the health insurance system in this country says that either the Audi OR the Hyundai can be yours for $30,000.  So any rational actor will look at their choices and say, “Well, if it costs me the same to have either the kick-ass uber sedan or the perfectly functional well built but plain car, why wouldn’t I choose the better vehicle.” Of course, the dealership (read: doctor/insurance company) selling you the car is still on the hook for the invoice price of which ever car you get.  Which of course means that they will eventually stop selling the Audis.  Now imagine that the government steps in and requires the dealership to continue supplying both, in which case the dealership will simply go out of business.  The end result of course being fewer places to buy cars, fewer cars available, and the only one you can get is the less desirable Hyundai.  Your choice has been taken away.

Note that the government DID NOT SAY YOU CAN’T GET THE AUDI.  They actually mandated the exact opposite.  In the context of health care, if the government requires top-notch ultra-expensive care to be provided to everyone during their final years of life regardless of their willingness, ability, or desire to pay; eventually that care will simply not be available.  Which would be the same result if the goverment denied top-notch ultra-expensive care to be provided to everyone during their final years of life.  The only solution is to not let the goverment mandate ANYTHING.

Now you know this of course, but I wanted to try to illustrate the point that neither Hal nor dog suggested requiring people to forego end of life care.  They were actually pointing out that people do not currently make rational choices about end of life care because of systemic problems in the health insurance system as it exists.

I like Jon Stewart’s suggestion that if corporations can have the same rights as people, then people should have the same rights as corporations.

Forget the fact that I think Steward is a moron Sean, I would prefer to have the same right as the politicians. It’s not coincidental that they have excempted themselves from the consequences of this government healthcare takeover. People forget that whatever evils they blame on corprations are made possible by the very politicians that decry those evils the loudest: the democrats.

The health is the unique thing, caring of which you’d better no to safe money, or according to paper writers
it won’t challenge you one time.

I like Jon Stewart’s suggestion that if corporations can have the same rights as people, then people should have the same rights as corporations. You’ll be fine.

This stresses the fact that professional writer of gene-industry will replace God. Hope i won’t see it.

The same all the year round in every political article paper writer have managed to issue

What’s more telling Hal is that with majorities in both houses and control of the executive, demcorats have to resort to a scam like this to pass what is likely the most unpopular bill yet this century. And they keep pretending that they are doing it to help us, when it is obvious to anyone but morons that their idea of reform will destroy our economy and our healthcare system, and basically relegate this nation to a similar future as that now faced by Greece. And the sad thing is that the signs are there for anyone that wants to see, and they are still hell bent on getting it done. Whether it is ego driven or ideology driven doesn’t matter anymore. All Americans should understand that these bastards are pushing for an unsustainable plan that will, sooner than later, bankrupt this great country, end propserity, and relegate us to 19th century living standards.

I like what Stephen Bainbridge said about “deem and pass”

Inevitably, some will say “well, the GOP did it too,” just as they have with reconciliation. But so what? In the first place, two wrongs don’t make a right. What the hell happened to changing the way Washington works?
In the second, whatever the GOP may have done via reconciliation or “deem and pass” in the past, they never used them to (a) pass the biggest entitlement program and most important social legislation in decades or (b) to fundamentally reshape the rules of the game for 1/6th of the entire frakking economy.

Obamacare may yet pass. In my book, however, it will always be the illegitimate offspring of sleaze and procedural sleight of hands. And that leaves me angrier than I can ever remember being about anything in politics during the 30-odd years I’ve been paying attention.

Maybe you have heard of it.  The University of Chicago?

Yeah, sure. More like you went to the Chicago school of politics.

dog got my point exactly Alex.  I’ve seen it a hundred times.  People are near the end of life.  But because Medicare is picking up the bills, teh family wants the last full measure taken to sustain them

Maybe you two should have just come out then and advocated to make it law that past a certain age we will just not bother with sick people because it is a bad investement anyway, like the Europeans are starting to do now, and be done with it? It’s more humane and all. Until you are the one they tell you are to old to bother with..

There could also be battlefield implications, the impact on overburdened ERs, etc. Plus, there’s this to consider.

They use their own money to get a private nurse, go home, get plenty of pain-killers and die with more dignity and less expense.

But it also goes back to the way their minds work: “People really do want this boondoggle! They just don’t know it!” So they’ll go through arcane parliamentary hoops to get their way.

As for cost and personal incentive, personal choice goes a long way towards improving competition for lower prices and better quality of care all around. People who have more control will always have more of an incentive to demand-and get-better care from a service-oriented industry when they have a say in how said industry treats them.