The “Health Care” Bill:

Power to the People Bureaucrats!

David C. Stolinsky, MD
Nov. 5, 2009

When those who used to shout “Power to the people!” now vote power to the bureaucrats, you know something is wrong. When they vote the bureaucrats power of life and death over the people, you know something is very wrong.

However you feel about government-run health care, what is your opinion of the 1990-page version that Speaker Nancy Pelosi unveiled? I ask this question rhetorically, knowing it has no answer. How can anyone have a rational opinion of what he cannot understand? Worse, how can anyone have an opinion of what nobody can understand?

No, this is not hyperbole. I believe that no one is capable of understanding 1990 pages of dense legalese − not the lawmakers who will vote on it, not the president who will sign it, not the judges who will rule on it, and most certainly, not the citizens who will have to live or die under it. That is the bad news.

The worse news is that the law also cannot be understood by the horde of bureaucrats in 111 new bureaucracies, which will be empowered to interpret and enforce it. But because neither they nor anyone else can say what the law really means, the bureaucrats will be able to rule according to their whims. In short, they will be able to rule.

When this power involves life-and-death decisions regarding the health care of 307 million Americans, it is frightening. When many citizens do not know enough to be frightened, it is even more frightening.

If you think I am exaggerating, read the bill − that is, if you are a serious masochist and are searching for an intensely painful experience lasting many days. But in the unlikely event that you actually succeed in reading all 1990 pages, you still will not understand the bill.

In you are interested in health care, try to chew on this mouthful:

(ii) QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAM.—referred to as the ‘QAPI program’) for skilled nursing facilities, including multi-unit chains of such facilities. 2 Under the QAPI program, the Secretary shall establish standards relating to such facilities and provide technical assistance to such facilities on the development of best practices in order to meet such standards. Not later than 1 year after the date on which the regulations are promulgated under subclause (II), a skilled nursing facility must submit to the Secretary a plan for the facility to meet such standards and implement such best practices, including how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under clause (i).

With rationing of care, you will probably not live long enough to reach a nursing home. But if you do, you will receive QAPI care. Higher taxes, mountainous debt, less choice of doctors or treatments, decisions made by remote bureaucrats, but at least you’ll get QAPI care. There, don’t you feel reassured?

Or if you are interested in law, try to swallow this indigestible lump:

SEC. 1189. STATE CERTIFICATION PRIOR TO WAIVER OF LICENSURE REQUIREMENTS UNDER MEDICARE PRESCRIPTION DRUG PROGRAM.
(a) IN GENERAL.—Section 1860D–12(c) of the Social Security Act (42 U.S.C. 1395w–112(c)) is amended—(1) in paragraph (1)(A), by striking ‘‘In the case’’ and inserting ‘‘Subject to paragraph (5), in the case’’; and (2) by adding at the end the following new paragraph: ‘‘(5) STATE CERTIFICATION REQUIRED.—‘‘(A) IN GENERAL.—Except as provided in section 1860D–21(f)(4), the Secretary may only grant a waiver under paragraph (1)(A) if the Secretary has received a certification from the State insurance commissioner that the prescription drug plan has a substantially complete application pending in the State.

This goes on for 1990 pages. And then there will be amendments, perhaps hundreds of pages of amendments, as there were for the “cap-and-tax” bill. But Speaker Pelosi plans to allow only three days of debate before a vote is scheduled.

You might conclude that this monstrous caricature of law is a blunder, concocted by frenzied, agenda-driven staffers and drunken, incompetent legislators. You might conclude that it is the product of well-intentioned but bumbling politicians. I believe you would be mistaken − in fact, optimistic.

I believe that the health-care bill, like the “cap-and-tax” bill, is intentionally written to be undecipherable − hugely long, diabolically complex, filled with acronyms and obscure references, and as ambiguous and confusing as possible. Then, once it has been passed with minimal debate and no real reflection, how will it be enforced?

Since no one can say what the law means, it will mean whatever bureaucrats say it means. Goodbye government of laws, hello government of bureaucrats. If your mother is denied a cardiac pacemaker or a hip replacement, you probably will have neither time nor money to take the case through the courts. But even if you could, how will judges be able to discern the intent of the legislators − who didn’t understand the law themselves?

The fact that much of the law is unconstitutional does not seem to concern our elected representatives. One can hope that it will concern judges. One can also hope to win the lottery, but one cannot depend on it.

America used to have almost as many lawyers as doctors. But about 1970 the lines crossed, and the number of lawyers increasingly exceeds the number of doctors. Why are we more concerned with suing our neighbor than with our own health?

The “Health-Care Bill” could better be titled the “Trial Lawyers Full-Employment Bill.” It penalizes states for capping malpractice awards, while it forbids suing bureaucrats for denying care (page 1452), but allows suing doctors for not providing the care the bureaucrats denied (page 149). Heads lawyers win, tails doctors lose. Will top students want to go through medical school and prolonged training in order to join such a losing proposition? Many will go to law or business schools instead. And many older doctors will retire early.

The bill purports to give access to health care to millions now denied it. But the bill provides not one penny to train more doctors. More patients plus no more (or fewer) doctors equals long waiting lists and rationing. This is not complex.

Trial lawyers are the Democrats’ biggest contributors. Think of the bonanza this enormously complex law will provide for them. But what does this say about the priorities of the “elite”? What does this say about the ethical values of the politicians and academics who want to take medical decision-making away from patients and their doctors, and empower paper-shufflers and bean-counters to decide whether Mom gets the pacemaker or hip replacement?

Then what, precisely, will prevent ObamaCare from slipping into SchiavoCare?

Life-and-death decisions for ourselves and our loved ones will be left to the tender mercies − that is, the whims − of a swarm of remote, unelected, unaccountable bureaucrats. But this isn’t the first time such a thing has happened:

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public records, for the sole purpose of fatiguing them into compliance with his measures.

He has erected a multitude of new offices, and sent hither swarms of officers to harass our people and eat out their substance.

− Declaration of Independence, July 4, 1776. [Emphasis added.]

We used to know what to do when our elected representatives are pressured into complying with the whims of others. We used to know what to do when swarms of bureaucrats are sent to harass and control us. It is time we remembered.

Dr. Stolinsky writes on political and social issues. He can be contacted at dstol@prodigy.net.

www.stolinsky.com