Under the latest health care bill out of the Congress, will old folks have a duty to die?

Does the bill prescribe end-of-life options and explicitly encourage them?

Is everyone over 65 mandated to receive counseling for “Advanced Care Planning” (a euphemism for “death planning”) every 5 years?

There are those who look at the bill and say, “absolutely.” Obama’s bill will solve health care costs by encouraging older people to decide to pack it in early, perhaps with the assistance of their “health care proxy” (a new decision-making position). Others say no such thing is stated and that those who say so are both cruel and out to destroy any improvement and needed reforms in our health care system.

So, I looked at the relevant section of the bill, and I don’t know what the hell it means. And that is the real problem. It is a splattery Rorschach of word salad and mumbo-jumbo that allows one to reach just about any conclusion. It has to be interpreted to make sense. So anyone can fill in the gaps as they please.

Now, I have no quarrel with encouraging people—of all ages—to find a responsible individual who cares about them and assign a power of attorney in case they are unable to make their own decisions or act according to their previously-stated wishes. Creating a trust or will—at any age—is also a good idea. A Mac Truck could be barreling down your same path tomorrow.

But, truthfully, I have trouble with what I am able to make of the contested section. No matter what else, the government is going to make sure that your pending demise remains at the forefront of your mind when you hit 65. Subtle pulls will likely be created—one may begin to doubt one’s continued worth, to dwell on the grim reaper, to become depressed, instead of enjoying what time is left to its fullest.

OK—see what you think. Here is what everyone is arguing about straight from the text. I’m not asking you to read the whole thing, but get the feel of it. You might want to take a swig of something first…

(1) IN GENERAL.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
(A) in subsection (s)(2)—(i) by striking ‘‘and’’ at the end of subparagraph (DD); (ii) by adding ‘‘and’’ at the end of subparagraph (EE); and (iii) by adding at the end the following new subparagraph:425

Are you with me?

(FF) advance care planning consultation (as defined in subsection (hhh)(1));’’ and (B) by adding at the end the following new subsection: ‘‘Advance Care Planning Consultation ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years.

Is this mandated? I can’t tell. But here’s what it is about:

Such consultation shall include the following:
(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
(B) An explanation by the practitioner of advance directives, including living wills and durable
powers of attorney, and their uses.
(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
(F)(i) Subject to clause (ii), an explanation of
orders regarding life sustaining treatment or similar orders, which shall include—
(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decision maker (also known as a health care proxy).
(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations
furnished in a State—
(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
(II) that has in effect a program for orders for life sustaining treatment described in
clause (iii).
(iii) A program for orders for life sustaining treatment for a States described in this clause is a
program that—
(I) ensures such orders are standardized and uniquely identifiable throughout the State;
(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;
(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
(2) A practitioner described in this paragraph is—
(A) a physician (as defined in subsection (r)(1)); and
(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign
orders for life sustaining treatments.
(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).
(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a
life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, along-term care facility (as defined by the Secretary), or a hospice program.
(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—
(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care
professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—
(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac
or pulmonary problems;
(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care set21
(iii) the use of antibiotics; and
(iv) the use of artificially administered nutrition and hydration

It seems as though there are a lot of strangers and red tape going on for what should be family decisions.

PAYMENT.—Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
(2)(FF),’’ after ‘‘(2)(EE),’’.
(3) FREQUENCY LIMITATION.—Section 1862(a)of such Act (42 U.S.C. 1395y(a)) is amended—
(A) in paragraph (1)—
(i) in subparagraph (N), by striking and’’ at the end;
(ii) in subparagraph (O) by striking the semicolon at the end and inserting “and”; and
(iii) by adding at the end the following
new subparagraph:
(P) in the case of advance care planning consultations (as defined in section1861(hhh)(1)), which are performed more frequently than is covered under such section; and
(B) in paragraph (7), by striking ‘‘or (K)’’and inserting ‘‘(K), or (P)’’.
(4) EFFECTIVE DATE.—The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.

I thought that our ethic was to provide life-sustaining treatment UNLESS there were orders to the contrary. It looks like that has flip-flopped–you now need orders to be kept alive. And how can anyone make these decisions in advance–as in “advance directive planning”?

1 (1) PHYSICIAN’S QUALITY REPORTING INITIATIVE.—Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w–4(k)(2)) is amended by adding at the end the following new paragraphs:
(A) IN GENERAL.—For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life sustaining treatment.
(B) PROPOSED SET OF MEASURES.— The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’’


(A) IN GENERAL.—Not later than 1 year after the date of the enactment of this Act, the
Secretary of Health and Human Services shall update the online version of the Medicare &You Handbook to include the following:
(i) An explanation of advance care planning and advance directives, including—
(I) living wills;
(II) durable power of attorney;
(III) orders of life-sustaining treatment; and
(IV) health care proxies.
(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including—
(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);
(II) website links or addresses for State-specific advance directive forms; and
(III) any additional information, as determined by the Secretary.

OK—you have the picture. Any questions? The correct answer is, “huh?”

  • treadlightly

    I’m an elder (or almost so) and I read what you posted and I’m not the least bit concerned.

    I guess now that the birther movement is running out of steam (except for people like Lou Dobbs, Andrew McCarthy, and Larry Johnson), the people who simply can’t accept that Obama is president (for better or worse) will apparently now latch on to the latest scaremongering crusade.

    Do you have a living will? Have you assigned durable power of attorney to someone who understands your beliefs and preferences for care in the event you are rendered comatose or severely brain damaged? Have you discussed with family members your wishes for care in the event that a catastrophic illness, accident, or other event renders you unable to express your wishes?

    If the answer to any of those is no, you’re being irresponsible and foolish. The alternative is the Terry Schiavo nightmare in which people fight over what each says the patient would have wanted. Had Terry Schiavo made out a living will and assigned durable power of attorney, which would almost certainly have gone to her husband, there would have been no controversy at all over what Terry would have wanted. Everything would have been expressed in black and white for all to see.

    It also seems wise to revisit these documents frequently to ensure that no one can claim that they are out of date at the time of your disability.

    This isn’t about dwelling on death, nor encouraging anyone to die. In truth, it is silly to limit these actions to the elderly. Everyone who is legally an adult owes it to themselves and their loved ones to take these steps now, so no one ever faces the kind of fiasco we witnessed in the Schiavo case.

    No one even has to see an attorney. Relatively inexpensive computer applications can take care of these simple tasks quite nicely. Perhaps someone could produce an open source program to make it available free to those who can’t afford the price of commercial software.

    If you’re 25 and think you’ll live forever, think again (and stop texting in the car, dammit!). Most people live to be elderly, but that doesn’t mean everyone does. If an eighty-five year old suffers a stroke and is on life support, even with the most aggressive life support care, there is likely to be a fairly limited time before death. However, if a 25-year-old has a brain aneurysm, he or she could be on life support for decades. If that is what the victim and his family wants, they are free to follow their own path and the living will will make that clear.

    But if, like me, you deplore the idea of lying in a hospital bed unresponsive while time and money are wasted for no reason, then living wills and durable powers of attorney are clearly called for. If your own personal beliefs lead you to believe that you should be given all the care your family can afford, perhaps in the hope that you will miraculously regain consciousness, then you definitely should have a living will to ensure that wishes are carried out.

    I support writing all legislation in the clearest, simplest terms possible (and I doubt if any is), but this is just another scaremongering diversion by the Obamalarmists. Call for more clearly written legislation and quit pretending anyone wants to off Grannie.

    Note: in case anyone is tempted to pull the usual “oh, you worship Obama and he can’t do anything wrong” routine that is so common, don’t waste your time. At this moment, I favor impeaching Obama and removing him from office for his policies in the areas of state secrets and related human rights cases. (I know that impeachment will never happen because of these policies, and I’d rather he changed the policies than face impeachment.) There is much about the bailouts I don’t support, I think he was a fool for commenting on the Gates case, and I don’t support what he has done so far on health care. Right now it’s almost impossible for me to imagine voting for him in 2012.

  • jangles

    How many members of congress are ready for their consultation on dying—seems to me Mr. Conyers ought to be heading up that list; Byrd, Kennedy—must be a pretty good list of oldsters there.

    I deeply appreciate you putting this together for us Pat. We all ought to read these things for ourselves and try to make an informed judgment. I know that I would not be in favor of a mandatory consultation. I do think it would be appropriate for everyone to receive age appropriate information about health care choices as they age. Information written in plain English would be a good place to start and to receive resources they can go to for more information if they like. I think it is also good that if one wants to have a counseling session about such matters that one can access it at no cost. Personal choice seems to be very important on this issue—even if that is a Republican meme.

    My husband and I have gone through all of this at our choice and at our cost. I think we paid something like $1200 to have all the appropriate documents drawn up. I am sure that many people can not afford this or do not know all the issues that are there. So providing access is important. I think most people when they get to the nitty gritty of things do not want uber heroic life-sustaining measures—they want peace and dignity, pain management etc—and know that spelling out their wishes gives both direction and comfort to those they are leaving behind.

    I would say that (1) such consultation should never be mandatory; (2) in making such access available to all seniors, care should be taken to make sure that the process honors in every way the individual.

    When you step back from this though and reflect upon it, the essence of it is not good—the language is intricately specific. Why? When you look at it you realize that the language itself says that health care professionals and their patients can not decide what is appropriate and needed—some congressman in DC who can’t read and understand what is written by some nameless staffer is the one who gets to vote and decide that the conversation will take place, what will be discussed and how often.

    I am not a Republican and I get tired of their endlessly repeated rants on government intervention is bad but yeah, government making decisions about our personal health and quality of life and death is unsettling at the very least.

  • Pingback: Cutting Health Care Costs: New Plan for Seniors : NO QUARTER()

  • bayareavoter

    Thank you for writing this piece. There’s so much we don’t know.

    I’ll say up front that my husband and I have our living wills and advanced health care directives in place. And I helped my parents –in their late 80s do the same. I don’t want to end up in bed with tubes.

    HOWEVER, as WMCB said–it’s not the government’s business.

    Two salient articles in Salon and the NYT Magazine–this week and week before last. This week is about a woman who had extreme preemie twins at 23 wks old and didn’t want to intervene to save them but was forced to by the docs at her hospital (because California law is unclear and this practice varies by doctor and by hospital) –one baby died within 4 days and one lived a painful, disabled life until he was 8. Besides all the other questions I can’t even imagine the expense.

    The second article was about the questions the British ethics board faces whether to spend $48,000/yr on an old patient who only has one year to live vs how many teenagers that’s worth given their life potential. Who makes that decision? What if the granny is caring for her grandkids? or if she is adding comfort to her own husband or her children? Maybe she volunteers at the local school. What if the so-called “valuable” teens her life is measured against are gangbangers selling dope to screw up more kids’ lives? Who makes these judgments?

    Take Oakland, CA–murder capital of our state. How much do we pay to patch up gangbangers every week from gun shot wounds, traffic accidents and fights? The govt is paying for their care now and helping bankrupt the system.

    Why can’t we figure out a way that the $48,000 drug costs less? We subsidized tobacco farmers for decades; oil companies; corporations all the time– how much do we pay every week for the wars in Iraq and Afghanistan?

    I am totally for health care reform but I just don’t trust these people. And I think everyone should pay for it like social security–employees and employers pay into the system. You can’t fund this on the backs of the rich!

    Nancy Pelosi doesn’t care–she has plenty of money to keep the gold standard in health care for her family and herself.

    Remember, One BIG difference between Canada and the US is 270 MILLION PEOPLE!

    Canadians like their system for the most part, and no one goes bankrupt, but it is underfunded and only needs to treat 33,000,000! They do not cover drugs or dental care and coverage varies a lot by province.

    I’m starting to like the hybrid systems in Germany and Sweden where insurance is subsidized and mandated and insurance companies must take everyone. I need to study them more.

    • Pat Racimora

      Thanks bayareavoter for your comment. I will read those articles. I think what upsets me the most is that decisions appear to be coerced at worst (and pressure put on people at best) rather than made by the people who are directly affected. It’s the outside invasion that is of great care to me.

  • looking for integrity

    Don’t believe your descrption of yourself – have read similar posts by trolls.

    In many families it’s the grandmother who raises the kids – heck, MJ himself selected his mother. Should something happen to them their families will fall apart. My grandfather practiced medicine until he was 88. Mandela was president of SA when 80.

    If Rahm’s brother wants to play Mengele he should do it in a 2nd world and not impose his beleiefs on the rest of of.

    Our problem would be solved if we placed much more emphasis on preventitive care. Doing so would allow us to keep euthanasia at bay.

  • I’m a Linda too

    Oh yeah, the “secretary” will determine terms and conditions for end of life.

    —>“It seems as though there are a lot of strangers and red tape going on for what should be family decisions.”
    Exactly. They are forcing us to turn our life over to them. WTF??? They will council us when we get old, tell us to disclose our finances and give control of our life to another person??? I think not….so they, govt and medical persons…you know…who Obama calls “stakeholders” REALLY? I thought the family were the ones with a stake in this deal.

    My my….65 now too old to live according to Obama, when they are our foundation, instead of the young and selfish, but too young to even collect benefits or be able to retire.

    …those brown shirts are warming up their excercises-BIG TIME!

    • I’m a Linda too

      And wait a second… I thought Barry’s reasoning for Health Care reform, was to cut costs. Why now are they claiming for older citizens to check they have the finances to pay for care?

      I thought this was the purpose of the excercise,or again, Obama will then tell us, ‘it’s working as he intended’. Which then leads to the next obvious question ‘and what was his intentions”?

  • Marvin

    Excellently written piece, Pat! Your is both incisive and stimulating!

    • Marvin

      I meant to say “Your writing is both. . .”

  • reddragon22

    Thanks for writing this, Pat, because it is exactly what I’ve been thinkng as I try to read through some of this gobbledy-gook.

    I’ve seen some extreme interpretations out there on several parts of HR 3200 (the one I’ve been scanning, Rangel introduced). When i go to those pages and lines, I don’t necessarily see the same thing–at least in stark black and white. However, if I were a medical lawyer and read the entire bill so I could understand the context, I might have a better sense of what I was reading.

    And then again, maybe not. This bill, the Holy One’s press conference, and the entire process is a mirror of him—evasive, duplicitous, speaking in tongues, hiding the truth by speaking its opposite. And that tells me that this bill is every bit as bad as we fear it is. We know how much he hates women and whites and has made it clear all along that he has no use for old people. So who lives the longest in this society? White women.

    So even though the precise words could be interpreted in different ways, I have a dreadful feeling that their real intent is as loathsome and dictatorial as we fear. Eugenics and rationing care for the elderly. Govt interference in and control over the most private of decisions. Their having access to all kinds of information that is none of their business. Just like his vetting process for everyone else, but we cant see his college records.

    That dreadful feeling comes from all that those of us who have done our homework have learned about obama, the emmanuels, holdren, et al, as well as all his other racist anti-american buddies.

    Rationing care for the healthy elder is quite different from the situation where someone who is already beginning to die and cannot be cured decides to stop heroic efforts and treatments, and opt for quality of life during the remaining weeks or months of their life. Advance planning is sensible for all of us at any age–having a health care proxy who knows your wishes, having a living will, thinking about what kinds of measures you would or would not want under various conditions. But that should be voluntary, a set of conversations with self, family, friends, and medical professionals.

  • JTomorrow

    Pat, at least it’s not soylent green….not yet….

    • Pat Racimora

      Gotta do a toon on Soylent Green. When the movie came out (Edward G. Robinson’s last film) it scared the shit out of me. Every time I saw a dump truck, I would get the heebie-jeebies.

      I recently rented it again and felt creepy in a different way–like it is what appears to be coming down the pike. For real.

      That Charlton Heston couldn’t stop it was also disconerting since he could do anything (well, in the movies that is).

  • arran

    I’ve never worried much about what the government did until this year and the health insurance reform. I’m one of the first baby-boomers and it appears that my life may truly be on the line.

    Then, Obama is a one-termer!

  • What I find interesting is because of the recession and being laid off, many young people are having to move back in with their parents. Now if we finish off all our old folks who had kids in their late years, where will all these poor kids get to stay. Further 30 years ago at age 53, I had triple bypass surgery and I do not think kindly on those who think I should have checked out a little bit earlier. In addition many of us old people had to help out our kids, by paying some of the bills for the grand kids teeth, college, etc. With out us around they might have missed having these benefits. I know some of you might think I am a little bit selfish, but I would like to stay around a little while longer to see some of my grand kids graduate from college.

    • TexasMirth

      Jessie Britton- My mother had triple bypass 12 years ago and like you, is glad to be here, enjoying her life. But future cardiac patients may just be given some pain medication and told to accept their fate –that it is their time to go. How sad that our country is allowing the Creep and his gang to rob American families of the future joys that could be shared with grandparents.

    • Solara9

      That’s right jessiebritton!!!! Many seniors are STILL helping their adult children in all sorts of ways–financially. emotionally, and even raising their kid’s kids!!!!

      My friend’s son is going through a horrible divorce. Were it not for her (age 71) I believe the young man(age 38) would be suicidal. Parents can be crucial as parents up until they day they die.

  • tzada

    One posters comments are spot on

    The resemblance to the tenements across from the Lorraine Motel in Memphis are purely coincidental, right?

    Of course, Jeff Danziger [the cartoonist – LA Times] intended to make the connection…and the Washington Post knows full well, too.

    coldwarrior on July 25, 2009 at 7:44 PM

  • tzada

    This one is over the line. Tell me if I am wrong.
    It hints at guns, Republicans and it is distastful to me.

    DeMint portrayed as assassin in political cartoon

    Is it okay to portray Sen. Jim DeMint (or anyone else) as a sniper? And what, or whom, is he aiming at?

    Supposedly the target is “healthcare,” but the cartoon obviously refers to DeMint’s remark about breaking Obama. It’s not much of a jump to believe that the cartoonist intends us to imagine that DeMint’s target is Obama.

    Maybe I’m being touchy. It’s just a cartoon and it’s supposed to be edgy. But most Americans are quite sensitive to suggestions of presidential (or other) assassination, and particularly so when it involves a sniper taking aim from a tall building.

    The Post showed terrible judgment when they chose to run this.

  • Don X

    Let’s hurry and get this incomprehensible bill passed before citizenry realizes what a sham/scam confused mess it is!

    • TexasMirth

      At a National Press Club luncheon, the chairman of the House Judiciary Committee, Democratic Congressman John Conyers D-Mich.)smirked and said:
      “I love these members, they get up and say, ‘Read the bill. What good is reading the bill if it’s a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?”

      I am so sick of this kind of arrogant incompetence going on in Wash DC with OUR MONEY.

      • Docelder

        What? we are too stupid to know just how the process works? So, nobody reads these bills anymore? Is that the message? They don’t know what is in them, because nobody possibly could know? Is he serious?

      • TeakWoodKite

        Texas Mirth, Conyers happens to be correct.
        Which leads to the next obvious question.

        If it is SO dam complicated that you can’t even understand it, then common sense would dictate that you make it understandable. To do any less would to admit defeat.

        Why doesn’t Conyers see this as a solution?

        When BO says he is not familar with a section of the bill, I defy ANYONE to retain;

        (i) in subparagraph (N), by striking and’’ at the end;
        (ii) in subparagraph (O) by striking the semicolon at the end and inserting “and”; and
        (iii) by adding at the end the following
        new subparagraph:


        Not that I would defend BO for his overt ignorance on the piticulars of anything he is selling, but the language is written by someone who needs to put the crack pipe down.

  • Wisewoman

    I am responding to Susie Q’s comments (3rd on page). As a recent medicare patient who also retains my private coverage as a former federal employee (I pay for it, the same price although it is now the secondary policy) I can tell you that the reimbursement rates for medicare is pitiful in comparison to private insurance policies. My husband is 66 and medicare is also his primary health insurance. At 65 companies drop you from their health plans. He pays for an additional health plan also. Here are a few examples from recent Medicare doctor statements and reimbursements:
    Service Amount Medicare Medicare
    Charged Approved Paid
    1. Dr. Visit $76.00 $34.04 $27.23
    2. Cardio test $128.00 $15.42 $12.34
    3. tte w/doppler $284.00 $68.07 $54.46
    4. 3-tests total $112.00 $13.48 $13.48
    5. Lab Test $22.00 $3.00 $3.00
    The first four items are bills from my husband’s doctor who is a premier heart specialist who installed his pacemaker. I have had some very serious health issues starting while I was completely on private health insurance. The medical bills were paid in full at the customary rate which was about what was billed in each and every case. Item 5 was paid in full on the private isurance but Medicare paid only $3.00.
    Now lets analyze these cost and put them in another context so that the average individual can truly understand them. Medicare reimburseses a doctor (Item 1) at a lower rate than what I pay a beatician to fix my hair. They pay less for a medical test than ladies pay to get their nails done. That is why I am skepitical of these health reforms Obama is touting. BUYER BEWARE.

    • Wisewoman

      Sorry the numbers make no sense because my “table” did not pull in correctly. Suffice it to say that medicare do not reimburse at even 50% of what private insurances do for the same procedures and tests.

  • Docelder

    The house health bill refers to “retarded” people.

    The proposed health-insurance bill from the House of Representatives refers to mentally disabled people as “retarded”

    • oowawa

      Yep, don’t forget the pitiful Retards . . . or ‘Tards, for short.

      I’m beyond outrage. I’m just getting real tired . . .

  • Gabi Lange

    Ah yes…Wasilla and Nebraska are looking more appealing daily.
    New Mexico has very liberal health care directive options. However, also a “conscience clause,” so that the local CAtholic hospital could override my directives. It is clear that any withdrawal of ventilation or nutrition is considered euthanasia. This is our community’s only option.

    Gee, will bobobamacare rescue me from all this anxiety about death and dying?

    • oowawa

      Gee, will bobobamacare rescue me from all this anxiety about death and dying?

      If He knew how to do it, Thee One would appoint an Afterlife Czar to implement a committee to screen the applicants to Heaven and Hell. Hope you can afford a lobbyist!

  • Holes in the safety net: Medicaid falls short just as some need it most

    This can’t be good for confidence in gov run health care…?

  • JohnnyB

    Good Cartoon Pat, and I know you are the only person to have read that except for the attorneys for the interested parties (Insurance Companies).

    Maybe when you turn 65 (or on your next birthday if you have passed that date) in the National Interest, you really drink the Jim Jones variety of Kool Aid.
    Save everyone from trying to figure out if you are covered or not.

  • Patience

    Thanks for this Pat, and thanks for your continued focus on this pressing issue. I really appreciate it.

    Of course it’s being proposed to somehow ration care for the elderly — one stated justification for this legislation in the first place is that current health care spending is deemed unsustainable. Given that a huge part of health care spending occurs at the end of life, it’s logical and obvious that rationing is a goal.

    Please forgive and indulge me as I offer a personal anecdote:

    My beloved mother died a few years ago. She was 90 and increasingly suffering from vascular dementia as a result of a mild stroke a few years before she passed. Her final illness though was an abscess in her intestine due to a ruptured diverticula. A surgeon and hospitalist recommended that she undergo a colostomy. I hedged for a couple of reasons. First, I feared lengthy surgery and the general anaesthesia it required would worsen her dementia. Secondly, since I was already the care giver for her and my eldest brother who is profoundly handicapped due to cerebral palsy, I feared that even if surgery were successful she’d never be able to live at home again (which would devastate her) because her care would be too much for me to handle. Third, there was some chance that intensive antibiotic treatment could clear up the abscess.

    At this point one could be excused for presuming that the surgeon and hospitalist were pushing surgery due to greed, as the POTUS implied in his tonsillectomy comment during the presser. But this would be wrong. In order to help her calm down, the hospital MOVED A PIANO TO HER FLOOR FOR HER TO PLAY TO HELP HER RELAX. Doctors and staff were charmed by this and grew fond of her. I should mention that even though surgery was recommended, at no time was I pressured or bullied.

    I still hedged though because within a couple of days of being admitted to the hospital she’d accidently pulled out 2 PICC lines while she slept, thinking her hearing aid had fallen out. I feared she’d likewise sabotage an ostomy bag. Antibiotics had to be administered orally (not as effective as IV) as a result and she had another mild stroke. Diagnostics determined more and worse strokes were imminent.

    With the assistance of a wonderful social worker, hospice care was set up in our home in order to assure that we would all be together at the end. And so it was.

    I initially harbored tremendous guilt for my decision to essentially ration her care. After since hearing of friends’ experiences with elderly parents who had colostomies, my guilt has been allayed.

    There’s room for improvement when it comes to professional end-of life recommendations. There’s room for improvement when it comes to families’ and patients’ understanding of options. But improvement doesn’t require the massive restructuring of health care delivery as is being proposed. IMO decisions should remain the primary determination of doctors, families and patients — not an even-more complicated series of distant bureaucrats than already exists.

    I don’t care one bit that end-of-life care accounts for a big chunk of health care spending — this should be a priority accounted for by reductions in other spending. I don’t see a need to go in the direction of euthanasia — hospice care already deals with this. If other countries want and have mandatory rationing, so be it. But I don’t want it and don’t want to live and die in a country that does.

    Simply put (she said after posting a tome) for those of you who want the government to take care of all of your medical needs from cradle to grave, expect government to fashion policy that includes features you will find to be unsavory. There’s no free lunch.

    • Solara9

      Thanks for sharing your story. It was all your decision and you loved your mother–that is what is so critical about your account. She was not some age number, some diagnostic statistic. You knew what was best for her.

      God bless you.

  • tzada

    “I love these members, they get up and say, ‘Read the bill,’” said Conyers.

    “What good is reading the bill if it’s a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?”

  • Rich

    Wonderful cartoon, but you might have to put new born with special needs and premature children also into the category.

    Again, we need a government that we can trust that knows how to run things efficiently if saving money and insuring more people is the goal. Does anyone believe we have that? No-bid contracts and waste is the norm. Giving your friends and supporters the good deal is the norm. Not the public.

    Also we need Tort reform, and since Obama is an attorney this is off the table. We also need to get society to understand that everything is connected. Big settlements intended to send a message, show our compassion, or because we hope that if it happens to us we would receive a big settlement and make a killing causes exorbitant settlements or judgments. Well guess what? Those settlements or judgments cause insurance rates to go up, and that is passed on to us. So we pay. This might even be OK if there was evidence that doing so made our health care better, but it does not. Doctors and hospitals still make mistakes and the only thing that happens is that everyone runs more unnecessary tests trying to cover their behinds which, guess what, raises our medical costs even more.

    Also, if the government ends up the only surviving insurance company, which over time will happen, and you do not like it where do you go? At least now some of us have a choice. Besides where will the Canadians and others go if they want good health care? I guess people with money can still go to Thailand or places like that. That will be good for our economy and will show what a wonderful country we are.


    • Patience

      Ditto Rich. Tort reform is long overdue. It’s disingenuous to strive for reduced healthcare spending yet take this off the negotiating table.

      Only the very wealthy will have any meaningful options when government assumes total control of health care. Those of us in the middle class and who are content with our current healthcare coverage stand to lose the most.

  • Barry 0351

    Bill Ayer’s, Obama’s BFF did say once that to implement the socilist plan 25 million American’s would have to die.
    These folks ain’t just gonna break us, drive us into the third world but they plan on killing us off to save the earth.

  • tzada

    Nebraska legislators seek to assert state sovereignty

    LINCOLN — At least three Nebraska lawmakers want to send a message to the federal government:

    Butt out of state business.

    Next year they will see if a majority of their colleagues agrees.

    The senators are working on resolutions asserting Nebraska’s sovereignty under the 10th Amendment of the Constitution.

    There are at least 36 states that are working on some sort of resolution regarding States Rights. We are not alone. I was encouraged when someone sent me the following.

    Oath Keepers is a non-partisan association of currently serving military, reserves, National Guard, peace officers, and veterans who swore an oath to support and defend the Constitution against all enemies, foreign and domestic … and meant it.

    Our oath is to the Constitution, not to the politicians, and that oath will be kept. We won’t “just follow orders.”

  • helenk,8599,1912920-1,00.html

    This article was interesting.

    Being a person that this bill will target, as I am over 65 and have COPD I guess I should just die now. But I still have things to do , people to see, and places to go and if the new government does not like that tough.
    Since they would like me to die, I decided to stick around and still push for ERA



    • TeakWoodKite

      God Speed helenk.

  • bill

    Just curious, but does anyone know which lobbyist wrote which section of the bill? Committee members say they did not read the bill, so on what basis do they vote? Testimony from lobbyists who did write the bill? Is there any way to trace back to the original writers? It still boggles my mind that reps vote on what they have not read.

    • Solara9

      Problem is, even if you do read it, ir doesn’t make any sense.

      I think the strong power arms just drop by the offices and tell each one how to vote (and that goes for both parties), which is why we are falling apart at the seams.

  • Whose side are you on? Stop it with the scare tactics for God’s sake! We finally have a chance at real health care reform and this is what you guys are up to? Give me a break! This is a battle between the American people and the Health Insurance Industry. Get on the right side of this battle!

    • WMCB

      The health Insurance companies stand to GAIN from this plan, not lose. That’s why they are backing it.

      There is absolutely nothing in Obama’s plan that prevents them from sucking as many profits as they want off the top. All it does it provide them with a steady stream of more victims.

      This plan battles big insurance about the same way that TARP was all about the little homeowners and investors, and battled the banks.

      No one benefits from this plan except the govt and the insurance industry, as they climb into bed with each other as fast as they can. Just as govt and the bankers climbed in bed with each other over TARP.

      YOU need to wake up, not me.

    • Solara9

      Oh, my dear Suzie Q–

      No one disputes the need for massive changes in health care reform–not even the cartoonist here.

      But this one is a total mess! I have read it carefully. I pray we won’t just take whatever comes down the pike because we are in trouble.

      But what we are doing is trading one disater for another.

      Suzie Q–Mark my words. Remember them. If this bill or anything like it passes, remember that I warned you of the train wreck.

    • Obama: Dubya’ 2 Electric Boogaloo

      So what does DailyKooks pay you? $.25 for each post?

  • tfitzaz

    I find the age-rating provisions to be much more onerous for those over 50. One of the bills ranks it 5:1, the others 2:1. Essentially this means based on AGE, you will pay more for whatever kind of health plan is passed. AARP has kept quiet on this issue. Other advocacy groups are weighing in the this issue.

  • TeakWoodKite

    (B) An explanation by the practitioner of advance directives, including living wills and durable
    powers of attorney, and their uses.

    practitioner = Doctor? If so Why is a doctor giving legal advise?

  • whatever they end up doing, I think they need to require ALL government employees to join. All those members in Congress will be required to give up their *great* health insurance that tax payers pay for, and go to the government run health insurance…that tax payers will pay for.

    • blue orchid

      But the great health insurance all those members of Congress is enjoying is run by the government, which is testimony that government can run health insurance far better and more efficiently than for profit private insurance companies.

      • Politicians are part of the Federal Employee Health Benefit Program. They have a choice of between 5 and 10 health plans in each city. Some are HMOs, some are regular insurance with preferred provider programs. They select a plan they like, the federal government pays a large portion of the premium, and they pay the rest. For more expensive plans with a lot of choices of doctors and hospitals and more services, Senators and Congressmen pay more. For the basic plan they pay a little premium. Not every plan offered in a city is included — they are screened by the Office of Personnel Management.

      • does the government actually run the insurance program, and all that it entails, or do they just offer a health care program to the employees, like all businesses do – and you have your choice of plans?

      • Wisewoman

        Blue Orchard. You are wrong. We (a former government employee who still pays into the government private health insurance through retirement payroll deductions) were never in a government run health plan. Most of us get ours through Blue Cross. The employee only takes it out of our paycheck just as any other private company do. Its people like you who let your emotions rule your head and run off at the mouth spreading falsehoods. Did you ever ask a government employee about this before you decided to enlighten us with your knowledge?

        • blue orchid


          YOU ARE WRONG. Go back and read what I wrote carefully. I did NOT say government employees (my husband is a government employee himself), I said members of Congress.

          It is not wise to slander me prematurely without taking a close look at what I actually wrote first.

          Am familiar with all the stuff you chose to enlighten me with, as I said my husband is a governmnent employee himself.

          • armymom

            Your husband is a “top doctor” who also happens to be a “government employee”? What the hell is he, Obama’s doctor?

            I work in health care and I can tell you that we see patients from Canada on a weekly basis. That’s the fact.

            • blue orchid


              My husband is a professor at medical school and is employed by the government. He also works at several hospitals and is training and educating American future doctors. He has over 100 publications. He has been teaching at medical schools and hospitals all over the world, including Germany, Canada and New Zealand. Believe it or not.

    • Wisewoman

      No they won’t. that is the reason for the phrase “If you like your health insurance you can keep it. they plan to keep their private health insurance just the way they currently have it as a private plan mostly run by Blue cross and a few other insurance providers.

      • Dem NO MORE

        Oh, until your copayment or something changes in your contract (which happens yearly, in most cases). At which point, you will be forced into the government health program.

        Congress people who “elected” to join this system they are forcing us into (none of them have agreed to do) would still be rich enough to pay for health care whereas the bourgeoisie will not be so lucky. The socializing of medicine is to guarantee no one gets better health care than the next guy–sort of spreading the wealth by rationing and forcing the middle and lower classes into inferior care. The wealthy “do you know who I am” class will still get their healthcare.

        I propose that all legislators who are over the age of 65 be euthanized with the rest of us if they pass this sludge onto us.

        (Don’t they teach you folks about the class system in HS anymore?)

    • bayareavoter

      exactly–what happened to the campaign talk that we’d all have the same insurance that Congress has?

  • amy1

    As a healthcare professional, I need to tell you that all this plan is about giving government complete control over your life and death.. This has got to be stopped. This is one step away from genocide. There are other ways to reduce medical costs, including health education and prevention. Please write a snail mail (not email) to your representatives and DEMAND they put a stop to this now. We are losing our freedoms rapidly. Our country is in distress.

    • Nonsense! Right now it’s the health insurance industry that makes these decisions and they make them with only one thing in their sight: PROFIT. It’s so disgusting that folks are telling these lies and that people are believing them.

      This is our chance at real health care reform. Don’t listen to the lies! Remember they destroyed Clinton’s health care reform in the 90s with these lies. Don’t listen to them this time!

      Look around the world! Look at reality! Stop listening to the LIES from the Republicans/health insurance industry.

      Public health care works far better than the private health insurance model – it’s proven time and time again all around the world. It’s time to make the change. This is what we voted for. This is what we need. CHANGE! OUR! HEALTH! CARE! SYSTEM!


      • so why do people from all over the world travel to the US for healthcare?

        • They don’t. That’s just another Republican/health insurance industry lie. People travel much more often to other countries for health care.

          In other every other Western country our health care system is looked upon as a sham. They can’t believe we’re even having this debate.

          Did you know that Canadians voted the man who came up with their public health care system as the greatest Canadian of all time?

          Did you know that only 8% of Canadians have the view that the American health care system is better than the Canadian (vs. over 80% who think the Canadian system is better.)

          Did you know that America has a rate of bankruptcy at over 20 times that of the UK almost entirely because of health costs?

          Did you know that America spends more money per person on health care than any other country in the world despite having worse health care results?

          Look into facts of what actually happens. STOP BELIEVING THE LIES.

          • TexasMirth

            Look into facts of what actually happens. STOP BELIEVING THE LIES.

            If only YOU would, Suzie Q…you might learn something.


          • People travel to the US ALL the time seeking better care.

            Some Americans may travel to Canada for healthcare, and those would be the uninsured Americans. People who do not pay for insurance in America, and then try to receive the *free* care in Canada.

            But, people from ALL over the world travel to the US to receive the best care.

            Europeans pay +50% of taxes for the socialized care. It can work efficiently and can be a great system. It can also be a nightmare. It depends on the area, the actual doctors and medical personnel. Socialized medicine is great for caring for massive amounts of lower income people, who just want the bare minimum in care. But, be prepared to supply all of your own comforts in the hospitals (from tvs to maxipads, no private rooms, no frills. yes, it’s cheap, and many don’t care, but it is a no frills system.)
            Including having to carry your miscarriage in a jar to the hospital (from a doctors office), yourself. And porting your x-rays and files everywhere with you. Also, giving yourself your own shots.

            There are no funds for maintaining the hospitals, so expect conditions like we saw at the VA hospital. Those are quite common here. You also have to be very pushy with your healthcare provider. My BIL was suffering from what I thought was an aneurysm due to his symptoms. The doctor wanted to test him for GURD!! Turns out, because my FIL pushed and pushed another doctor, they have him an immediate MIR (once this other Dr. heard the symptoms) and my BIL had a huge brain tumor. Now, the Dr. was awesome, and he got great care. But, had he not pushed, he would be taking Pepto Bismal or something.

            Another strain on the system is people use the emergency room as a doctors office. Doctors visits are *private* but you pay ~150 euro. So, many people prefer to just go to the emergency room, where it is *free* (usually a small fee, on top of your taxes)

            They send you to the hospital for tests, where you take a number, and wait. If you are there before they open, you can get in line, and your wait is only a couple hours. If you are there late, you will wait hours.

            When my brother in law was diagnosed with the CAT scan, he was then transported to another hospital for the MRI (machines are expensive). He was then transferred to another hospital for the surgery, where the surgeon for tumors worked.

            There are advantages and disadvantages. Yes, you do not go in debt when you get ill. but, you have to pay a lot of taxes, and the health industry does suffer. You also have a huge disparity in care depending on location, and the quality of people working. If you have a bunch of lazy schlubs who don’t give a rats ass, your care suffers.

            Well, there was a long reply! I haven’t commented before, because I think this is an issue the voters should decide, and i don’t want to sway one way or the other (not that I could, but, whatever).

            • blue orchid

              American girl in Italy,

              Super rich people from all over the world do not only travel to our country for health care, they travel to other Western countries for health care AS WELL. My husband is a top doctor who has worked on 4 continents.

              And for every one super rich foreigner who travel to our country for health care, there are hundreds of ordinary Americans who travel abroad for medical treatments.

              And while no health care system is perfect,
              I would pick any other health care over ours anytime. Among others we have lived in Germany for a dozen of years and in Canada for several. So am speaking from personal experience. Btw we are not exactly low income people neither.

          • Prove they are lies, Susie Q, and do it before your dear leader required re-indoctrination session.

            We’re waiting…..

            Oh, you mean it’s just today’s Young Democratic Troll Tactics you are spewing?

          • Dem NO MORE

            As a Detroiter who is only a hop, skip and jump from Canada and who is very familiar with Canadians who cross the border for healthcare, I’m calling you out for your lack of knowledge.

            Check your facts before you propagandize for the killing of granny.

            Oh…here’s one right from Prez. Dr. Death:

        • blue orchid

          The more appropriate question to ask is: why do Americans travel all over he world for health care?

        • blue orchid

          The more appropriate question to ask is: why do Americans travel all over the world for health care?

      • WMCB

        The health insurance industry in BACKING Obama’s plan. They are running TV ads right now in FAVOR of it.

        I agree that the insurance companies are intrusive claim-denying pigs as well. And they need to be reigned in.

        But if you think Obama’s plan actually does that, you are sadly mistaken. Put down the Hopium pipe.

        • Nonsense! The health insurance industry is doing everything they can to kill the public option. Without a strong public option health care reform is a sham.

          • WMCB

            So that’s why I am seeing a flood of TV ads in my area, with the original Harry and Louise actors, paid for by the insurance industry, telling me to get behind this plan?

            Gee, that’s a really odd way of trying to kill it, dontcha think?

            • pm317

              Right, WMCB. Even AARP is silent about all this and why? I am surprised at the absence of resistance from different groups. What is going on? There is something for everybody except the ordinary people, is that it? The new version of pay to play.

      • tzada

        From the quality of your posts it appears that you are one of Obama paid “grassroots” apologists for his HS. You would be on the low end of the scale.

        I suppose that you have friends in high places or low places. Maybe you even belong to ACORN?

        I for one would not care for taking my white self into an ACORN studded board to decide my fate and how I was to die.

        Smoke that along with your hope and change ….

      • Wisewoman

        susie Q. The Clinton health care plan was nothing like this stupid thing Obama and his minions are putting together. Please see my comments further down. You have taken a ride on the emotional train the way they want you to and meanwhile you have left your thinking brains at the station.

  • mdmdstork

    We need to demand bullet points of every aspect of the bill in terms that can be understood by most Americans. The info coming from the WH is so vague that people have no idea what is about to happen to them.
    End of life health problems are a significant drain on Medicare but as a physician we often don’t know it is end of life when someone develops a problem.
    I would hate to have stupid bureaucrats making medical decisions.

    • Dem NO MORE

      John Conyers (D)-Detroit
      RE: Why they don’t read the bill

      ( – During his speech at a National Press Club luncheon, the chairman of the House Judiciary Committee, Democratic Congressman John Conyers (D-Mich.), questioned the point of lawmakers reading the health care bill.

      “I love these members, they get up and say, ‘Read the bill,’” said Conyers.

      “What good is reading the bill if it’s a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?”

      Conyers, 80, is married to Former Detroit City Council President, Monica “Shrek” Conyers who pleaded guilty to charges of taking bribes from a contractor to change her vote.

  • tzada

    Pat, Thanks for addressing this problem.

  • HARP

    Since the Dems want to terminate at the beginning and the end of life, they now can truly be called the party of death.

    • Docelder

      The party of death and taxes. 😉

      • HARP

        Right you are… us to death. Oh shit, they already do that.

    • blue orchid

      Are you aware that our current poor health care system is causing twenty thousand unneccessary deaths each year ?

      • Dem NO MORE

        I, for one, would be interested in seeing the link.

    • Dem NO MORE

      Posthumous voters are the most cost effective.

      • tzada

        0 ought to know he had enough dead people on the voting rolls.

  • WMCB

    Help, caught in the spam filter!

  • hokma

    The AMA which Obama refered to represents only a very small fraction of active doctors and most of those members are residents who only belong to get initial employment. Nearly all seasoned physicians do not belong and belong to a range of other more relevant associations.

    You may find your own doctor now telling you without being prompted what Obamacare will mean for you personal health. Like the Tea Parties, doctors feel compelled to explain the obvious to their patients in an effort to stop this rush to kill our healthcare system.

    Obama’s ignorant and inflammatory statement the other day about physicians making their decisions based on fee scale was the final insult to the medical profession. It was also the best example of why we cannot have government clerks making decisions that should be made by doctors and patients.

    • shannon

      you’re exactly right. In fact I know of a couple of physicians who are quitting the AMA because of what’s gone on in the past couple of months.

  • WMCB

    I have no problem whatsoever with advanced care planning, living wills, “do-not-rescusitate” orders, hospice options rather than pointless hospital stays, discussions regarding health proxies or family powers of attorney as one ages, etc.

    All of that is fine, and are things I FULLY SUPPORT doing. In fact, as a nurse who has seen a LOT of lingering death due “heroic measures” I have a living will myself, and NEVER want to be intubated and poked and prodded and tube-fed etc if there is not a reasonable chance for my recovery. I am all about letting me die at home, with some dignity, when my time comes.

    But notice how many times I said “I” and “me” and “my”?

    And all of the above is MY decision, with MY family and MY doctor, and it is up to US to decide when or IF we even want to TALK about that. The govt has no goddamn business deciding that at X age I need to be sat down and FORCED to have an official “consultation” about this. It’s intrusive and insulting.

    And if it’s a benign provision in the bill, as they say, and is not meant to pressure seniors at all, then why is it in there? If the intent is not to cost-cut by getting MORE seniors to do all of the above, then it’s pointless to have the provision in the first place.

    • kenoshamarge

      I agree 110% WMCB. I don’t want the damn government messing in my life any more than is absolutely necessary.

      What ever happened to the fiercely independent-stand-on-your-own-two-feet American?

      Before I get crushed under a zillion posts about people that need help, I quite obviously wasn’t referring to them. If help is needed it should be provided. If not, get the hell out of my life and leave me the hell alone.

      The very idea that the asshats in the house, senate and White House know what’s best for me is an arrogant affront to every thing I believed we stood for. Not to mention that there are damn few of that bunch smart enough to know what’s best for the care of a cocker spaniel let alone another human being!

    • shannon

      Exactly, right.

      Why are these weird provisions in the bill in the first place? I grow more and more weary of this administration trying to calm me down with a smile and telling me I’m imagining things and overreacting. But I look at this part of the bill, “benign” they’d have you believe, being rushed as if it had to be enacted yesterday, and I’m thinking, ‘Why is this bill here? What does this mean?’

      This is a car salesman trying to pull a fast one on me, and in those situations my reaction is to walk off the car lot.

    • bayareavoter

      Exactly my sentiments!

    • Pat Racimora

      Yes, yes, WMCB. I agree completely. It’s about control and choice–I don’t see that in this bill even though supporters say that it is there.

      Well, as I said in my story, I am not sure what I see. I read it 3 times…

      But whenever something is presented in such as ambiguous manner, I smell a rat.

  • FLDemFem

    Not only do they want to kill grandma, they want access to our bank accounts and other private assets. I don’t want the government having control over my health care choices, and I sure as hell will NOT be giving them access to my bank account. Even if Pelosi manages to get this travesty through the House, it still has to be passed by the Senate. The Senate is where we should focus our efforts on killing this bill. It is not only wasteful, but also infringes on the Constitutional rights of the average citizen and grossly expands government power and control. It is very similar to the health care policies of the Soviet Union. If you are a “worthy” citizen, you get health care, if you aren’t, off to the gulag with you. You get to die at your own speed. Unless the government decides you are still using too many resources, in which case you get to have a “heart attack” so your cost is removed from the budget. Any legislator who votes for this bill is breaking his sworn oath to defend and uphold the Constitution of the United States.

    • tzada

      We also need to start at our state levels and encourage States Rights as retained in the 10th Amendment.

      Seems like somewhere in the Constitution it says Congress shall make no laws that infringe our rights …… The reason the USA was founded as a Republic was that the majority could not take away the rights of the minority, as granted by the Constitution.

  • HARP

    Democrats cost savings for the Health Care……It`s cheaper with the Reaper.

    • Pat Racimora

      LOL Harp–that is the best way to put it succinctly!!!!! (May I use that in an future toon?)

      • HARP

        Please do.

  • not a clue in hell what that all means…

    i think they do that on purpose.

    love your toon! poor grannie and gramps!

  • William L. Donlon

    Health Care Has And Will Always Be Rationed!

    The Only Question Is How?

    Under the current system, the “elderly” get the better end of the deal and young children get the worst end.

    A senior Citizen gets an $80,000 heart job so he/she can:
    Live longer than nature intended
    for the purpose of enjoying retirement longer than intended
    bankrupting Social Security faster than intended.

    A young child gets the surgery needed to make him/her a productive member of our tax paying society for 40 years.

    What’s the question??
    Seems a no brainer to me.

    “Logan’s Run” was about rationing a person’s “allowed time” on earth.

    We have been doing that for some time also.

    We will spare no expense to extend a life to 80 — 99 years while denying any time to a Baby through “partial birth abortion”

    95 years for you!
    None for you!

    As a 65 year old grandparent, I cast one vote to ration at the upper end and expend the resources on the younger generation.

    Hey! I’ve had a good run, It’s their turn.

    • bho boo

      Obama”care” eugenics/euthanasia costs 41 times what it would cost to insure every single low income/uninsured American citizen.
      We don’t need to choose between old and young, we need to “THINK” it out and make this about insurance reform not grisly soylent green 1984 policies.

    • TexasMirth

      Hey! I’ve had a good run, It’s their turn.

      Since you are volunteering, we’ll let you go first, William L. Donlon.

      • William L. Donlon

        Texas Mirth

        “Since your volunteering, we’ll let you go first.”

        I’m ready.

        “For them that think death’s honesty won’t fall upon them naturally, life sometimes must get boring.”

        Bob Dylan 1966

        It can happen to any of us at any time, no one gets out alive.

        I do believe this discussion is over due, necessary and healthy for the Nation to be having.

        I wish Hillary had been allowed to continue sixteen years ago.

        Thanks Larry and No Quarter

        • tzada

          Are there any cliffs, maybe the Grand Canyon in your area? Ever heard of the saying “go jump off a cliff?” Just saying….. You have had a good life and you will no longer be, what extremists
          call a “useless eater”

          What a burden you will relieve society of, your SS can then be given to make someone who has never worked a day in their life, more money to smoke that dope or have their nails done.

          Bless you!!!!

        • bho boo

          This is the ultimate in liberal fake-altruism shame-based dysfunctional thoughtless living. If you think it’s altruistic, probably you think it’s green too, so make sure you plant yourself in the garden so the other people over 65 can enjoy some veggies.

    • HARP

      I do believe Obama`s mother in law falls in that category. Say bye bye to granny kids.

    • pm317

      A senior Citizen gets an $80,000 heart job so he/she can:
      Live longer than nature intended
      for the purpose of enjoying retirement longer than intended
      bankrupting Social Security faster than intended.

      I am in my 40s but these lines have a sinister foreboding to me. If you are arguing medicare and SS have become a burden as govt programs, then there must be a more humane way to deal with it and still keep our human dignity in tact. It should never be denial of service and restricting access to medical care to a specific group of people especially by the govt.

      We just had a death in the family (in India, don’t worry, he didn’t drain your coffers here) and he was 80+ and he had heart surgery when he was 60+ and to think he should have gone 20 years ago without any help or medical intervention .. it is all very sick. There are lingering death and futile exercise in bringing back life situations but that should be left to the doctors and their family to decide what to do and not the govt.

      • shannon

        I’m sorry to hear about your loss pm317. Sincerely.

        along those same line….my grandfather, a family physician living in India, had heart problems during the early 1980s. My mother, now living in the U.S., helped him get a pacemaker. He lived 17 more years and he continued, doing what he loved, practicing medicine for the remainder of his days, into his late 80s.

        • pm317

          You’re right. How does anybody put a dollar value on a life, young or old? Oh, heck celebrities like Letterman and King are still procreating in their 60s (well, and what does that say about women in their ripe old age of 65+, useless on all fronts?). 0bama with his politics has unleashed a lot of cynical and sinister dialog for sure.

          (On a side note, I am glad you’re (as a medical professional) participating on this thread. Your comments and insight are valuable).

    • William L. Donion:

      I strongly disagree with you. I don’t see how a young life is worth more than an old one. Maybe the kid will end up being a mass murderer and the old person will make a discovery of some sort that will save many lives. I am not infatuated with youth, sorry. Their lives are not worth more than mine or anyone elses.

      On the other hand, I do not care to live as long as I can because I believe we are spiritual beings having a human experience and when I have accomplished what I came here to accomplish I will happily move on; I believe in reincarnation and the eternal life of the soul.

      However, I also do not think it is the governments job to counsel me on my death…that’s my business and my family’s if I have one.

      • William L. Donlon

        Puma For Life

        Everyone is for life but sometimes there are tough choices.

        When there are not enough seats in the life boats the old have always stepped back.

        “Women and children first” is not just a slogan, it is an underlying principle of a Democracy.

        If? Again — If this winter there are not enough flu shots to go around,

        H1N1 mutates and you are 20 million short.

        What choices should we make.

        I’m 65, I get one vote,

        I vote to start young and go up the age scale until you run out.

        Children are our “seed corn”

        They need mothers and fathers.

        As a grandparent, I’m the most expendable.

        When the ship is going down and there are not enough seats in the life boats The elders have always stepped back.

        What I have read about Barack”s mother in law, the Grandmother?

        She’d step back.

        Hillary? She’d step back.

        And so would most if not all of the bloggers that I have read on No Quarter.


        Good Discussion, 16 years over due.

        Thanks No Quarter.

        • Solara9

          But Willian, what about the 8% of kids who are being raised by their grandparents? Are they expendable? Do we make special considerations for such caregivers? Where is the bright line then that demarcates the “worthy elderly” from the ones to let go?

        • this 72 year old great grandma would step back.for the young ones

    • Docelder

      We will spare no expense to extend a life to 80 — 99 years while denying any time to a Baby through “partial birth abortion”

      That is sadly mostly accurate. But this is because on the one hand we don’t respect life. On the other, we do respect wealth and hospital corporations are big business. We need reform, unfortunately what we are seeing is just more partisan pay to play politics. As far as trading care so that babies might live… most of our elderly would probably do that, but it isn’t an “either or”. Elderly people doing without isn’t going to save one baby. Truth be told if you don’t respect new life, then you don’t respect life at all… and at that point we are all just as much as ants in an ant farm. As we all breathe out CO2 in order to live, and since the government has asserted that it has the right to ration and tax our right to emit carbon… we already in a backhanded way will owe our right to exist at all to the government. If the government grants us a right, it can rescind that right. When we give up the foothold that we are born from a creator already having rights… if that goes then our rights will go with that foothold. We are seeing a shotgun approach to “change”. Nobody knew before what change was… now we do.

    • Pat Racimora

      Ouch, William! Without a huge population of older Americans who are in good health, all sorts of services would have to be replaced by paid staff OR we can watch our religious institutions fail, and watch other organizations fall that depend in experienced, bright volunteers to survive. When I attended a meeting for neighborhood watch training, I was the only person in the room without gray hair.

      AND, working with those who are too old to give back is a huge source of employment that cannot be outsourced.

      Finally, my mom probably has a terminal condition (not symptomatic at this point) but is too old to be operated on safely. She is where she should be in a nice place with family around. She was a teacher for over 40 years, and a damn good one. She gave her life to children–that deserves some respect I would think.

      Anyway, my next toon in progress is about what older people are giving still. We talk about them as “problems,” and fail to see what most of them are doing that is contributing greatly to our society.

      • Ellen D

        Don’t know what other 65 pluses are doing but in this economy I’m still working.

    • RebelCarol

      As a 65 year old grandparent, I cast one vote to ration at the upper end and expend the resources on the younger generation.

      Well you just go ahead and check out. This 68 year old grannie is not about to give you, Obama, or anyone else the authority to tell me that I have to “go gently into that sweet night.” I’m just getting started with living!

  • TexasMirth

    will old folks have a duty to die?

    Obama has just rephrased one of the ideas promoted in
    Ezekiel Emanuel’s book: The Ends of Human Life: Medical Ethics in a Liberal Polity. Cambridge: Harvard University Press, 1991. (Ezekiel is Rahm Emanuel’s brother)
    This book argues for terminating care for the elderly and the equitable allocation of medical resources.

    Obama wants to kill grandma.

    • Docelder

      Obama wants to kill grandma

      But it won’t be sold as that. It will be grandma is already gone and we are keeping her around for our own selfish interests instead of letting her pass on. But anything is possible once you no longer respect life. The slippery slopes are now open for black diamond first time skiers. Strap them up grandma. Let uncle Ezekiel give you a push.

    • shannon

      I was thinking the exact same thing. This whole section has the fingerprints of Dr. Ezekiel ‘Angel of Death’ Mengele, Rahm EmanuelInBangok’s brother. I read one of Ezekiel’s articles the other day where he writes about the equitable allocation (he uses as examples patients with dementia, autism, etc.).

      The odd thing about all this, I’m a medical student, is that in the course of my rotations with family physicians we learn about the need to bring up these issues of power of attorney and, IF APPROPRIATE, end of life care. To initiate the discussion when appropriate. (and reading this stuff has made me even more sensitive to the idea of approaching it in a more HUMANE manner). What is asked for in this part of the bill is something physicians are supposed to do anyway, so the fact that Obama/Emanuel is emphasizing it as almost a mandatory thing, creeps me out. It does seem as if there’s a bigger philosophic shift going on here in how we’re supposed to think of of end of life care.

      • TexasMirth

        Shannon, you are absolutely right that end of life care issues are already discussed by doctors with family members and/or patients. So…what is Obama really promoting? You hit the nail on the head by recognizing the mandatory part of his plan – and it creeped me out, too.

        • shannon

          yes. I want to be clear on what I wrote above. At this point, as family physicians the guideline is that over the course of so many years we develop a relationship with our patients and we’re *encouraged* to initiate discussions about, for example, their power of attorney, living will, etc. What their understanding of it is, then to explain it if they’d like to continue talking about it. If they need assistance with it. It’s a very non-invasive hands off approach.

          I have to be honest, with regards to the discussion by the consultant where he/she talks about the, “continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.”… I don’t know that I’d necessarily go out of my way to have this kind of a discussion with a reasonably healthy 65-year old. It doesn’t seem appropriate unless the patient is already near that stage of life where the discussion must happen. There’s preventive medicine and then there’s this, which is almost anticipatory medicine.

          • TexasMirth

            My husband has had these discussions with his patients or their families, and then, they have choices and decisions to make. THEY HAVE CHOICES…that’s the difference from what I fear is being promoted with Obama-care.
            Mandating death sentences based on some form of actuarial charts is a scene from a sci-fi dystopian novel, or it was before Obama decided to make it reality.

      • Ellen D

        Hello medical student.
        For all the put-down of Canada, I had to keep the enthusiastic medical students and doctors there from trying everything to keep my 89 year old mother alive.
        I finally insisted that they stop, and peacefully let her go, and we took her to a lovely home-like section of the hospital where her whole family could say goodbye as she passed away.
        Her age was not a consideration for the doctors.

    • bho boo

      Some have said he has personal experience doing just that. Could explain why he tossed his grannie’s ashes (forensics evasion) over a cliff instead of burying her in the plot beside her husband of 50 years.

      • tzada

        Bingo! Did you also see the picture that looked like he was sneaking out of the alleyway?

        • bho boo

          Yes. I even wrote to the Honolulu Police Department in June of 2008 warning them of this because grannie knew all, they never once let her be interviewed. I count Lt. Quarles Harris, Bland, Young, Grannie as 4

    • tango

      “Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of
      Federal Council on Comparative Effectiveness Research.

      Yes, that’s what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.

      Many doctors are horrified by this notion; they’ll tell you that a doctor’s job is to achieve social justice one patient at a time.

      Emanuel, however, believes that “communitarianism” should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (Hastings Center Report, Nov.-Dec. ’96).

      Translation: Don’t give much care to a grandmother with Parkinson’s or a child with cerebral palsy.

      He explicitly defends discrimination against older patients: “Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years” (Lancet, Jan. 31).”

      And don’t forget Obamas Science Czar John Holdren and the book he co-authored 30 years ago that had some radical views on population control among other things. Though now all 3 authors state the book never endorsed mandatory abortions, sterilizations, etc, but it sure looked that way in the photos of the pages of the book I’ve seen online.

      So older folks and the disabled of any age or those who fall ill to diseases such as Alzheimers so are no longer “useful” to society should be last on the list of medical care.

  • Excellent toon, Pat! And to answer your question, from everything I have seen thus far, YES!!!

  • shannon

    Doesn’t ‘advance care planning consultation’ sound like something out of Orwell?!? I see myself — 30 years from now — in a white room with a glass table and glass chairs and an attractive advanced care consultant with a short skirt and a glittery smile and she’s saying to me: “that tiny birthmark on your cheek might be cancerous, perhaps in the best interests of the United States of Obama, our Heroic Leader of the 2000’s, you should consider taking measures to reduce the financial and emotional burden you pose to our society. And please don’t forget that under section 3.02 of the Ezekiel Emanuel bill you have, not a right, but a responsibility to hasted your end of life care when we, the government, deem it appropriate.

    “So I’m not really encouragining you to think about this, rather informing you that according to our Emanuel calculations you have 2.2 months left to live before you increase your ObamaCare burden to our society over the allowed 1% of Burden Cost. Thereafter, if you wish to continue living, we’ll automatically deduct a penalty from your checking and savings account in the amount of $100,000 USD per week.”

    And she’d say it with the peppiest smile. “Thank you for using ObamaCare! And remember, hope. change. yeswecan! All praise be to Obama.”

    • bho boo

      Plug and chug in the great Obama “care” calculator what your burden cost versus contributory potential is to the “glorious cause”.

    • Docelder

      Interesting thoughts. Add to those thoughts… suppose one had awkward or even dissident political views toward the government or administration. Our constitution would protect the citizen against unlawful detainment presumably… but what if a government health official determined the dissident has H1N1 or something like it and for the good of the country had to be quarantined? Or exterminated possibly to prevent an outbreak of a plague? Thus might make an interesting movie plot, but could it ever happen? But as to the article, if we won’t stand up for the rights of the elderly, or any other group… then we are going to eventually lose rights for everybody.

      • shannon

        Along those lines somebody has mentioned that Edward Kennedy, under ObamaCare, wouldn’t get the operations he’s had in recent years.

        The corollary to this bill, however, would be that if a person is a “contributing” member to society or has some value, then they will be allowed to get ObamaRescueCare.

        Therefore, your mother and my grandmother are insignificant burdens, however Edward Kennedy is of course a vital resource (natch). And Grandmother Obama is the grandmother of our holy leader, ergo she has legal justification for RescueCare.

        And, as you said, if you can find justification for someone not needing to exist, since they have “politically regressive” views as outlined by the ACORN bill of 2011, then said person could be quarantined.

        Hypothetically of course. haha

    • Tricia Spiegel

      Yikes Shannon–You are scaring me!!!

  • elizabethrc

    It’s one thing for Congress to pass such an odeous, age discriminatory bill, but it’s quite another to make the senior citizens, of which I am one, subscribe to the practices. Let them try!
    I see this piece of nonsense being challenged in the Supreme Court.

    • tzada

      Yes, but who will be owned by them, then on the SC?

      People need to remember this. The years go by swiftly and you too will be elderly. Who will stand up for you?

      video link

      Here is what Americans know that Obama and Rham and Axelrod, Pelosi etc. must think we are to stupid to figure out.

      THE health bills coming out of Congress would put the decisions about your care in the hands of presidential appointees. They’d decide what plans cover, how much leeway your doctor will have and what seniors get under Medicare.

      Yet at least two of President Obama’s top health advisers should never be trusted with that power.

      Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.

      Emanuel bluntly admits that the cuts will not be pain-free. “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost control, more for show and public relations than for true change,” he wrote last year (Health Affairs Feb. 27, 2008).

      Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association, June 18, 2008).

      Yes, that’s what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.

      Many doctors are horrified by this notion; they’ll tell you that a doctor’s job is to achieve social justice one patient at a time.

      MSM is already in on the campaign to demonize older citizens. The other day CNN had a banner across it’s programing saying Baby Boomers were to be blamed for too much consumtion

      Zogy Polls (0 dear Muslim friends) had a poll aimed at heavy consumers and of course older Americans we listed as the top of the list of consumption.

      Over the Gates gate. They interview 4 people. Two light skinned blacks, who favored Gates and two elderly whites who favored the officer.

      • tek

        OMG! No wonder Rahm says he’ll push the bill through the House without benefit of committees. His brother is going to benefit big time. I knew the Obama Democrats were a bunch of crooks.

        • b mathews

          we absolutely MUST DEMAND a public forum (not one of obamas fake townhalls)BEFORE this bill is allowed to pass. what happened to transparency and cspan coverage of all health care proposals. another lie by this so called president. he is just trying to make a legacy for himself all costs and screw the public. well he is aready making history as the biggest spender, biggest liar, and biggest racist ever to hold that office, he makes bush look like a choir boy.

  • Dee Fatouros

    Remember Logan’s Run, Soylent Green???

    • oowawa

      Yes! Edward G. Robinson got to watch a happy little travel movie and listen to serene mood music while sipping his Sayonara Cocktail. I hope they’ll be that kind to me!

      And I hope they’ll put a little umbrella in the “cocktail!”

  • donjo

    Look like this is not really a health care bill, but a death-care bill. The govt. has no business sticking its nose into people’s private decisions and problems.
    This is truly 1984 all over again.

    • Stop it with the nonsense. Look at the health care systems of France & the UK. Their health care systems are FAR superior to ours and they spend less money for them.

      Right now we have a system that values health insurance profit over the health of the people. This is the worst possible system.

      Finally we have a chance to fix this system and we have ignorant people like yourself working against your own best interest because you’ve been brainwashed by the health insurance industry/Republican party. It’s disgusting and sad.

      It’s up to Obama and the Democratic party to fight through this nonsense and get it done regardless of all of the lies. We can’t let them stop us this time. CHANGE MUST HAPPEN!

      • TexasMirth

        Stop it with the nonsense. Look at the health care systems of France & the UK. Their health care systems are FAR superior to ours and they spend less money for them

        Suzie Q — Maybe some facts would help –

      • Cahil

        The UK just denied a liver to a 22 year old and let him die because he couldn’t prove that he wouldn’t take another drink in his life.

        If this is superior, I’ll take our inferior system any day.

      • OhioMary

        SuzieQ – Why am I thinking you are not a babyboomer?

        • Obama: Dubya’ 2 Electric Boogaloo

          I’m thinking more like one of the few Obama foot soldiers who heard his call to the bloggers to talk up the Dems piece of shit healthcare legislation on non KoolAid drinking sites…

      • don tufts

        lady i hope you dont have breast cancer and happen to live in either britain or canada.i for one if this passes will not go quietly into that good night.

        • Ellen D

          My dad got cancer in Canada. He was in his seventies. He got excellent treatment – fast and good.

      • jackie

        I have lived in Europe and if you have private insurance you are treated like a king. If you are a regular guy you wait in lines of interminal length and do not get the option for extraordinary care if you are over 55 in the UK, 60 if you are French, and 64 if you are German.

        Quit listening to Michale Moore–go and look. I lived in Europe for 19 years. I like many of the ideas practiced there but there is a 2 tier medical care and it is tremendously unfair to the general population. My co-worker’s wife was given pain treatment for cancer that was fully treatable if they had bothered to start care at diagnosis but she was retired and 64 there for she was not afforded chemo or radiation. SHe died and her husband and children and grandchildren were cheated of her love. Had she been in the US it would have cost a fortune but she would have had a choice–and they would have happily paid it for her to be here today.

        I speak French and German and have talked with the people I lived among about their systems it isn’t the “wonderful” system that we are being told about.

        What our President is doing is fundamentally WRONG!

        We need reform not 1984/Animal Farm

        • bho boo

          Agreed! Nobody voted for a communist euthanasia takeover, they wanted crisis-protection and compassion for low income Americans which would cost but a tiny fraction for the uninsured citizenry. Instead our healthcare is being subjugated to the manipulations of Demokkkrats who want only one thing: POWER.

        • blue orchid

          I lived in Germany for 12 years and in Canada for 5. While you can always find fault with any health care system if you set your mind to. I would pick any other health care system over ours anytime. There is no comparison at all.

        • Senneth

          Thank you, Jackie. I have been saying this as well. I am from Europe and still have many relatives there. It isn’t all orchids and roses. Many people either wait for a long time or they only get pain pills. The best medical care is found in the U.S. – we just need to find a way to give everyone access to it.

    • oowawa

      Suggested caption for your ‘toon, Pat:

      Th-th-th-th-th That’s all, Folks!

  • bho boo

    Eldsters are under assault with Obama”care”.

    Americans didn’t vote for a communist eugenics/euthanasia bank-account monitoring private-records-no-longer-private gutting and raping of the existing health care system.

    Dick Morris says it’s nothing more than utter control over our lives and deaths, a way to get votes from illegals to be given amnesty for vote manipulation for Obama’s dictatorship.

    Americans wanted health insurance reform, not to be bankrupted by crisis medical care, and to cover the low-income American citizenry.
    For the cost of Obama’s plan, we could give health insurance to every low income person in America 41 times over and keep the highest quality health care in the world.

    Canada is returning to capitalism as we seek to reinvent the square wheel.

    • tek

      bho hoo: How does the bill help Obama get the illegal vote? I just read about a case where pols are trying to make it illegal for hospitals to refuse care to illegals who would require lifetime care. They want to make it illegal to deport these illegals. Who are the politicians in this country representing, anyway. Not the American people.

    • Ellen D

      Canada is returning to capitalism as we seek to reinvent the square wheel.

      Source please?
      I haven’t heard any rush to dump the Canadian system. Remember they voted Tommy Douglas, the Baptist minister who first brought it in, “the Greatest Canadian”.

      • WMCB

        I know that private-pay clinics are opening up in Canada at a steady clip, and doing a boom business.

        Canada’s system has advantages and disadvantages, like everything else, including our healthcare. Nothing is a problem-free utopia.

        • Ellen D

          I know that private-pay clinics are opening up in Canada at a steady clip, and doing a boom business.

          Thanks. I’ll check that out. Remember that what is happening in one province (state) may not be something you can generalize as happening – or even wanted across the country.

          Such as the marijuana shop situation here.