On Obama's Portsmouth Town Hall :

a) I don't think the now-famous end-of-life consultations are what Palin was referring to by "death panels," contrary to what Obama claims at the beginning of the meeting. If she was referring to any actual, existing proposal it would be to the IMAC panel , or what she fears the IMAC panel might turn into--as Obama himself admits at the end of the meeting; ... Backfill: Ezra Klein made the same mistake  on Monday. ... 8/13 Update: Er, Palin makes the same mistake on Wednesday. Somebody should maybe tell her what she was talking about! Her latest Facebook post focuses on the end-of-life consultations. She does say, "Of course, it’s not just this one provision that presents a problem." ...

 b) Here's Obama's full answer on rationing:  

Now, in fairness, the underlying argument I think has to be addressed, and that is people's concern that if we are reforming the health care system to make it more efficient, which I think we have to do, the concern is that somehow that will mean rationing of care, right? -- that somehow some government bureaucrat out there will be saying, well, you can't have this test or you can't have this procedure because some bean-counter decides that this is not a good way to use our health care dollars.  And this is a legitimate concern, so I just want to address this.

We do think that systems like Medicare are very inefficient right now, but it has nothing to do at the moment with issues of benefits.  The inefficiencies all come from things like paying $177 billion to insurance companies in subsidies for something called Medicare Advantage that is not competitively bid, so insurance companies basically get a $177 billion of taxpayer money to provide services that Medicare already provides.  And it's no better -- it doesn't result in better health care for seniors.  It is a giveaway of $177 billion.

Now, think about what we could do with $177 billion over 10 years.  I don't think that's a good use of money.  I would rather spend that money on making sure that Lori can have coverage, making sure that people who don't have health insurance get some subsidies, than I would want to be subsidizing insurance companies.  (Applause.)

Another way of putting this is right now insurance companies are rationing care.   They are basically telling you what's covered and what's not.  They're telling you:  We'll cover this drug, but we won't cover that drug; you can have this procedure, or, you can't have that procedure.  So why is it that people would prefer having insurance companies make those decisions, rather than medical experts and doctors figuring out what are good deals for care and providing that information to you as a consumer and your doctor so you can make the decisions?

So I just want to be very clear about this.  I recognize there is an underlying fear here that people somehow won't get the care they need.  You will have not only the care you need, but also the care that right now is being denied to you.

Hmm. Better. But there are two separate problems Obama's discussing: a) stopping the rationing being done by insurance companies; b) promising that Medicare won't start rationing any more than it does now, especially in the years after the 10 year window Obama discusses, when the boomers will need lots of treatments. Obama addresses (a), but what does he really do to reassure those anxious about (b)? Medicare recipients don't worry about insurance company rationing (there's your message!).  So telling them that Lori, who isn't on Medicare and isn't getting private coverage, will now get it doesn't really answer their concern. .. 

I still don't quite understand why Obama can't bring hmself to say some variation of a) "There won't be rationing" or b) there won't be rationing under the Kinsley definition --"Any treatment that I, the President, would get you will get," or c) "Medicare doesn't ration now and won't ration in the future, period. There will be no change in how Medicare decides what treatments to pay for. The goal is to get it to pay for more, not less." Read My Lipitor!** No New Rationing.  ... 

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**--Obama's answer to a questioner who had to "go through two different trials of other kinds of drugs" before being allowed by Medicaid to go back on brand name Lipitor (which he'd been taking for years) was basically that the outcome was good because "once it was determined that, in fact, you needed the brand name, you were able to get the brand name." Spoken like a lawyer! (So you had to fight for a few months or years? You won didn't you? Process costs don't count.) ... 1:32 A.M.

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