The American Spectator : Don Berwick's Death Panel?

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Don Berwick’s Death Panel?

By Robert M. Goldberg on 11.16.10 @ 6:08AM

Time to ask the man from Medicare why he thinks Provenge too expensive even though it helps save prostate cancer victims’ lives.

Are Medicare director Don Berwick and the Obama administration delaying or denying patients access to medical innovations? That’s a question the Senate’s Finance Committee should ask Berwick, who heads up the Center for Medicare and Medicaid Services (CMS), when he testifies November 17.

The timing couldn’t be better. Medicare won’t pay for Provenge, the first cancer vaccine, since it was approved in April. It’s waiting for the Medicare Coverage Advisory Committee (MEDCAC) — also meeting on the 17th — to decide whether the Food and Drug Administration, the National Cancer Institute, and cancer experts are right in supporting Provenge use for prostate cancer patients.

MEDCAC was established in 1998 so CMS could ask leading scientists and doctors to recommend what information should be collected to determine the best use of new technologies. But recently MEDCAC has — under CMS direction — begun evaluating whether innovations are cost-effective.

In November 2008 Medicare bureaucrats asked MEDCAC: At current Medicare prices, how confident are you that CTC has a similar ratio of cost per LYS (Life Years Saved) as optical colonoscopy? In 2009 CMS asked MEDCAC: What are the desirable measures of the cost-effectiveness of screening genetic tests for the prevention or early detection of illness or disability? By 2010 CMS was simply asking MEDCAC whether CMS should cover new technologies unless there was evidence of its cost and clinical effectiveness from long and expensive studies. As one speaker at a MEDCAC hearing about genetic tests noted, “if clinical outcomes as defined… become[] a requirement for reimbursement, it will reduce investment in new genetic tests and the market introduction of these tests, and ultimately their use. “

That’s the goal. But given Provenge’s high profile, asking about its cost-effectiveness would be controversial. Since the one-time treatment runs about $90,000, CMS thought it could ask if Provenge was effective without mentioning cost. Hence, Dr. Louis Jacques, the director of the Coverage and Analysis Group at Medicare, told Forbes: “We’ve been getting questions from people,” says Jacques. “‘Well, what’s up with Provenge? Is it a drug? Is it a biologic? Is it something else? Does it really work? It has been interesting to look at the evidence around it.”

Does it really work?!

Maybe Dr. Jacques didn’t get the memo about the FDA approving Provenge. The FDA said Provenge “substantially improved survival to patients with a fatal disease. The risks… are minor relative to the benefit of improved survival.” Or perhaps he didn’t see the May 6 National Cancer Institute statement asserting: “The field of cancer immunotherapy received an important boost last week with the FDA’s approval” of Provenge. On May 29 the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium added Provenge to its list of standard therapies. On June 15 Aetna said it would cover Provenge.

Federal law requires that CMS cover any cancer drug approved by the FDA or NCCN compendium therapy. Instead, on June 30, an anonymous individual requested that CMS hold a MEDCAD hearing on Provenge before it covered the drug. CMS immediately accepted the query from the secretive party. Perhaps the Finance Committee can find out who that was.

MEDCAC will render its decision based on a just released evaluation of the FDA data conducted by the Agency for Health Research and Quality (AHRQ). AHRQ tried to pretend it wasn’t second-guessing the FDA and the NIH. In October, the report name was changed on AHRQ’s website from “The Efficacy and Safety of Sipuleucel T” (Provenge) to “The Outcomes of Sipuleucel T.” The reviewers determined the FDA data used to approve Provenge was “adequate” but not entirely convincing. You might wonder: What expertise in prostate cancer did the authors use to draw to that conclusion? The answer is none unless you count nursing, a master’s degree in statistics, or a PhD in sociology. Apparently CMS believes AHRQ’s collective wisdom towers over the oncology expertise of the FDA, NCI, and NCCN.

The AHRQ report understates the impact of Provenge on survival. First, it begrudges the fact that many patients receiving chemotherapy after taking Provenge live longer. It focuses on the median survival benefit of 4.5 months (which tells you the midpoint of patient survival but not how many patients lived longer and for how long). Then it raises doubts about safety. And finally the study glosses over the finding that terminal prostate cancer patients who received Provenge were 40 percent more likely to be alive in three years than those who did not receive it. The AHRQ report is ideology masquerading as medical facts. The routine and expanding using of AHRQ to guide life or death decisions undermines the legitimacy of real science.

MEDCAC meets this week but CMS can take months to decide. This callous and possibly illegal process reflects Berwick’s stated belief that only a centralized entity should decide what’s best for us. People with prostate cancer have died and will die waiting. If that’s not a death panel, I don’t know what is.

About the Author

Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.

Letter to the Editor View all comments (68) | Leave a comment Leave a comment

Carol| 11.16.10 @ 6:28AM

Can't tell a single bit of difference between the Commies in the Obama Regime.

Cold, evil, nasty beings. I won't dare call them human.

Grill him hard, GOP.

Make him say why he just loves the non-healthcare system in Great BritainStan.

Thomas and Beth T.| 11.16.10 @ 9:09AM

Death Panels? Bring them on.

My father, suffering terminal cancer, was placed under the "palliative care" of Hospice, an organization that promises to "control pain."

Hospice did not control the pain of my dying father, who died in agony over a period of four days, begging for more morphine.

Nurses would not give more morphine because it would "kill him." Hospice nurses and doctors in Tennesee are not allowed to intentionally give an overdose of morphine to the dying patient to hasten their death.

Euthanasia is legal in only two states: Oregon and Washington.

My wife and I want laws changed to allow euthanasia to be available to terminal patients who are suffering uncontrollable pain.

Bring on the death panels if this is what it will take . . . and soon!

I am furious that my father had to die a slow, painful death because of the idiotic rules of Hospice. I have contributed regular donations to Hospice over the years, but I will never give them another penny.

Leslie| 11.16.10 @ 10:16AM

While I believe you have the right to your feelings and I'm sorry for your loss, I do not believe that any government has the right to decide who lives and who dies. I also had to deal with Hospice NOT doing anything for my mother who was dying. I had been told that surgery was possible for her cancer then only later told that I was wrong. I also believe that in a terminally ill patient, giving morphine to help with pain should be done. The nurses can't administer it without orders and doctors are too scared to go with their guts.

ann| 11.16.10 @ 11:54AM

Thomas and Beth T.
I cannot believe how greedy and callous you are. I am sorry about your father, but when you say bring on the death panels, you are condemning thousands of other people to the same fate as your father. These death panels will be responsible for the deaths of premature infants who require hundreds of thousands of dollars in medical care, extremely ill children who require the same, etc. Death panels are not the answer for most people. Kindness, compassion and a government that allows us to choose our own health care is the answer.

Route 88| 11.16.10 @ 2:18PM

"These death panels will be responsible for the deaths of premature infants who require hundreds of thousands of dollars in medical care . . ."

Hundreds of thousands of dollars for premature infants who often are deformed and live painful childhoods! It's not worth it, folks.

No wonder our health care system is broke.

It's this type of thinking that is bankrupting our medical systems.

Something must be done to stop this waste of health care dollars!

Not Always Right| 11.16.10 @ 4:42PM

I was under the impression it was only for God to decide who was to die. Are you willing to play God with someone else's life?

Absurd| 11.17.10 @ 3:29PM

Yes. God alone. Enough with the vaccines already, let's just let God decide. Seems like someone is actually trying to look at value for money, and AS jumps on them. If AS's gripe is that they couldn't come out more directly in saying the emperor has no clothes (money) for $90K treatments that prolong terminal cases by 1/3 of a year, it's because that is a suicidal comment. So they try to make a financially smart decision in couched phrases, and get hammered anyway. I agree they should call a spade a spade and have a cost-benefit analysis applied to every case in which the government is paying, but that's life. That's how real people make decisions in real life. If only the government did too. Calling that a death panel is absurd.

Aindyin| 11.17.10 @ 2:59PM

Maybe you should change your name to
Route 666

Ray| 11.16.10 @ 12:27PM

Did it ever occurred to you that you could have brought your father home in his last days for home hospice care? That's what my family did when we knew my step-father was dying and we didn't have a problem obtaining sufficient amounts of the morphine my step-father need in his last day. We administered it orally ourselves and he passed-away pain free and quite comfortable. No doctors "orders" required, and no timid staff necessary to care for our dying loved ones. We took that responsibility onto ourselves, as is proper.

Instead of blaming doctors and nurses for what you perceive is undignified treatment of a loved one in their final days, you should be placing the blame upon yourself for fostering off the care for his final days onto others. Next time, take this type of responsibly onto yourself, or don't complain when others do what you should have been doing yourself.

Occam's Tool| 11.16.10 @ 5:42PM

My dear sir:

I am sorry for your father's pain. However, death panels will not help with this---your father would still be in pain, as injections cost money.

What would happen is that life saving care would not be paid for.

MDs do not prescribe aggressive dosages of pain meds for fear of lawyers and Medical Boards. If you want to change prescribing habits, change that setting, and MDs will comply.

Tom| 11.17.10 @ 7:27PM

Then there’s the other side of the coin. I am a doctor who on a significant number of occasions has encountered hospice nurses who take it upon themselves to decide that a patient needs to “end his suffering.” The nurse faxes an order, which I am expected to rubber stamp, for morphine 10 mg hourly as needed for pain or shortness of breath, a dose that in a matter of hours will be enough to abolish the patient’s respiratory drive. I call the nurse who tells me the patient is getting much more short of breath, or has started having increased pain. I have then called either the patient, a family member, or the non-hospice nurse caring for the patient at the nursing home. They tell me, “Mrs Smith [or “Mom”] is resting comfortably–her pain is under control with her current pain regimen.”

Spike| 11.17.10 @ 10:48PM

Thomas and Beth T.

My Father-in-law just passed, and we too had to deal with some very serious end-of-life challenges.

THE ISSUE, is whether these issues are dealt with at the direction of the family, or some bureaucrat in some cubicle looking at an actuary table, determining the cost of treatment versus the value of a persons life.

Carlos| 11.18.10 @ 10:26AM

I certainly feel that communism is suceptible to corruption, but I am also skeptical of pharmaceutical companies who need to make profits to stay in business. Would be interesting to know how much lobbying the "cancer vaccine" companies do to make sure this debate surfaces. Afterall there is no such thing as a pure market anymore; we don't trade bread for eggs, instead we have only a vague idea as to the necessity of what we are purchasing. Should tax-payers be expected to pay for every expensive new treatment? In times of fiscal constraint, how many thousands of dollars should the average American tax payer contribute to these expensive treatments? I for one don't want to be taxed 60% of my income to help pay for something that might cause more side-effects than benefit.

Appleby| 11.16.10 @ 7:06AM

Millions of Canadians will die because of ObamaCare; the only thing that has been propping up our *health care* system here (which forbids private insurance) is the USA.

However, in Canada it seems to be the universal belief that its okay to die on a waiting list provided a rich person dies five minutes before you.

Get used it. Those who refuse to learn from those who have tried and failed are doomed to repeat that failure.

Dave | 11.16.10 @ 7:43AM

Nightmare on 666 Elm Street

My initial suspicion is that Mr. Berwick's delay or rejection of Provenge as part of a treatment for prostate cancer may simply be part of the greater plan that was successfully hidden in President Obama's national healthcare takeover. My suspicions were verified this past Sunday when the radical left wing's all knowing, all seeing prognosticator of things to come, Paul Krugman, went on national television and finally confirmed, after nearly two years of degrading Sarah Palin ... the Obama "death panels" were, in fact in the long range mill. While the prediction came only from an econominist, writer and not an actual medical doctor or member of the current administration, the admission should surely serve as an eye opener for those among us already in (or) approaching our Golden Years.

For those who followed the Pelosi, Reed, Obama bull-rush to take over one-sixth of our economy - Sarah Palin was absorbing the cuts of a thousand cheap shots when, early-on, referring to the, so called, death panels now fully exposed within Obama's healthcare scam. The left's media lap dogs had a field day with Palin's analysis. But then the agenda was running full steam ahead, and there was no one to stop it.

Yet last Sunday morning ...

The Left, through, Krugman ... finally confirmed on the record exactly how they view those potential death panels and what they'd expect to gain if put into official, practical use.

As is often stated regarding truth, politics and practicality: "Follow the money."

Fortunately for this writer and leftist economist; one who's carried many-a-pail of water for his party of choice and people of his ilk ... he'd be among the elite who'd never be forced to mix in with The Great American Unwashed. The privileged, like Paul Krugman and others within this current administration, would continue to receive top of the line, on demand health care services and all that it can provide to those at the front end of our political and pop culture food chain.

In the beginning, this was certainly not the "change" millions were looking for. For the remaining millions - its ended up looking more like Nightmare on Elm Street: Chapter 666.

For the rest of us, simply trying to scratch out a last few peaceful seasons here in Peonville, U.S.A. - Paul Krugman simply confirmed a long range, liberal mindset which is now firmly engrained into their way of looking at the old.

The comments from Krugman are frightening, but ones that all too typically ended up buried by the MSM during the pre-Obamacare push to ram the Little Kenyan Corporal's brand of socialized medicine down our collective American throats.

At this date, Mr. Krugman has, as is often the case with comments like his ... backtracked and tried to cover-over part of the dirt trail behind him. The problem for the writer is -- the hounds have already picked up his scent. This past election just turned them loose.

As of today - one of socialism's prime agendas has been finally confirmed to the earlier mentioned Great Unwashed, and by (perhaps) ... the mere slip of a loosened tounge. Now ... it's on the record.

Ken (Old Texican)| 11.16.10 @ 8:18AM

Dave,

Well spoken, sir.

Mark| 11.16.10 @ 1:42PM

You poor, dumb saps.

I know that Rush told you what to think about this but you might give thinking for yourself a go too.

Krugman is talking about people reviewing the efficacy of particular treatments for particular conditions (he is clearly using the phrase "Death Panel" with irony), not panels of faceless bureaucrats deciding who lives and who dies.

If you are curious to know what a panel of faceless bureaucrats deciding the fate of sick people looks like, you could apply afor a job at any one of the insurance companies currently in operation. They all make decisions in exactly that way, right now, and thousands of people die each year as a result of their decisions.

You can shriek your hysterical epithets at Obama, Krugman or liberals in general, but what you cannot avoid is the plain fact that all the Western nations that have higher taxes, robust social safety nets, universal healthcare, and strong consumer protections, all have less poverty, better health, lower healthcare costs, more social mobility, and longer life expectency. These are not coincidences.

Dai Alanye | 11.16.10 @ 2:41PM

Poor, dumb Mark--he's such a sap. If you talk to healthcare folks--nurses, primarily, since they are the ones usually responsible for researching insurance eligibility--Medicare is the most stringent authority, not insurance companies. Get an OK from Medicare and the Part B providers fall right in line.

That's in the USA, of course, but as the examples of the UK and Canada indicate, it's even worse in those countries.

Death panels already exist here in rudimentary form, and the fact that Krugman made a sort of deliberate Freudian slip simply confirms what we instinctively know. Once we're dependent on a single payer we'll have problems beyond our present nightmares.

Medical savings accounts are the only realistic answer to high medical costs.

Mark| 11.16.10 @ 4:38PM

As it happens, Dai, I'm married to a nurse. This has helped me see through many of the lies put out by the right-wingers about the current system (the idea that tort reform will solve all our problems, being just one).

I also lived in the UK for almost thirty years, and contrary to the mis-information being touted by people like yourself, the NHS (while not perfect by any means) is better run and more-efficient than the "system" we have in this country. In fact, I have seen inner-city doctors' offices in this country that are more run-down and clearly struggling than anything I saw in even the poorest parts of East London. If you're curious to know where they are, they are in those parts of the city that most Spectator readers lock their doors when driving through.

Bruce | 11.16.10 @ 5:19PM

So a socialist from the UK tunes in. A wife paid by the NHS can hardly be considered an impartial observer. Firstly - NOBODY on the right has said tort reform ALONE would solve all of our problems. If you are going to try and make a point - be accurate of STFU about it. Tort reform is but one part of solving this mess. If it's all lies I'd be interested in your opinion why every legal association of trial lawyers is totally against any kind of tort reform. Of course not - they are making millions out of BS cases that do nothing but drive up the costs of practicing medicine. Why do you think those "struggling doctors" exist? Because of ridiculous malpractice insurance costs, perhaps? Because of the astronomical costs of administering absurd insurance coverages dictated by the government? My Cardiologist pays over 1/4 million dollars per year for insurance, and he has NEVER had so much as a single complaint. He has 3 women on his staff who do nothing but insurance billing, and has to pay for their advanced schooling twice a year to keep up with ever-changing government mandates.
If you so much prefer the wonderful UK system, why don't you take advantage of it and move back there?

Mark| 11.16.10 @ 6:08PM

Sorry Bruce, wrong again.

Both my wife and I live and work in the good old, US of A. She has never worked for the NHS. As for being a socialist, I own my own business, employ more than fifty people (for whom I provide health insurance), and live a comfortable, capitalist life. I'm clearly one step away from Marx himself.

I previously owned a similar business in Britain, and was always able to provide decent pay raises for my employees, now I just pay increased health insurance premiums for them. They never see any of that money.

Truth is, the insurance model doesn't really work for healthcare. It costs too much, shifts expenditures to people with no incentive to limit them, and creates bureacracy like you just described. As a business owner, I'd rather we all paid tax and let the government handle it. That's not socialism, just common sense. All experience indicates that we would pay considerably less if we did so.

Want guess how many people NHS doctors have to employ and train to handle insurance billing? None, of course.

Negro X| 11.16.10 @ 9:24PM

Mark troll, Your bogus story was posted here a few months ago by another troll, too bad you lose idiot.

Dai Alanye | 11.16.10 @ 9:25PM

My daughter is a professor of medicine, but so what--she doesn't get involved with the nitty-gritty of insurance approvals. My info comes from speaking with numerous medical staff about specific treatments for two family members with excessive health problems. The important thing is we've had very few difficulties with ANY private insurance outfits, including HMOs.

Sound miraculous? Perhaps everyone automatically senses we’re such wonderful people we deserve superior treatment. Or perhaps the American standard of medical care, despite its cost, is simply the best in the world.

As far as Mark's defense of state-run healthcare, I live in a county that borders Lake Erie. Of the immigrant doctors in our system Canadian refugees form by far the largest contingent, and I don't think they leave Canuckistan due to the unimaginably high quality level of care on the other side of the lake. It's a heck of a swim, so you know they truly want to be here.

What next from Mark, a defense of Cuban medicine?

Occam's Tool| 11.16.10 @ 5:45PM

Kiwis have better health because they walk more. And not all Kiwis have better health---the Maori have the highest lung cancer rate in the world.

Kiwis have less healthcare access, less social mobility, and higher taxes. They also have craqploads of poverty and child abuse. An NHS affects none of those things. Subtract motor accidents and shhoting deaths, and Americans have the best health care and the longest life expectancy.

Stormzeye| 11.16.10 @ 7:53AM

I don't know. Am I a heartless person to wonder if $90,000 for a vaccine that might prolong life for a cancer patient another three years is too much? I don't want anyone to say "What if it was you (your father, your son, etc.)?" That's too easy an argument and doesn't really address the very real problem of limited resources, the expense of medical research and learning to die with dignity. As a Christian, I don't cling to life but I also don't want to see people suffer and die unnecessarily. Help me to understand why "money is no object when it comes to prolonging every person's life regardless of age, etc."

JP| 11.16.10 @ 8:01AM

Stormzeye,

People asked the same questions 30 years ago concerning the cost effectiveness of then newly implemented heart bypass surgey, transplants. and valve replacements. Now, most of those procuedures are available even at rural hospitals. In 1986 there were only 5 MRIs in the entire US. Now, you could go to even rural hospitals in West Virginia and Wyoming and find MRIs.

Resources do not have to remain limited. However, they will in fact get more limited thanks to Obama and the votes the Dems gave his ObamaCare reforms.

jack| 11.16.10 @ 8:16AM

the 4 month survival for provenge is from trials of men who were basically beyond hope. the question that has to be answered is how will provenge work on patients in the early stages of the disease. this question will not be answered if the government continues down this course.
But we all know the only way government can hope to contain costs in a gov run system is to deny treatment. Denying access to provenge will also lower the number of people on social security,so the Communist regime now in charge can kill two birds with one stone

Ned| 11.16.10 @ 10:45AM

what was the cost of the first therapeutic dose of penicillin? or how about the cost per recipient of the first rounds of Salk polio vaccine? small pox vaccine? hip or knee replacement? $90,000 today for Provenge is $9000 in two years, and in four or six years men over 65 will be able to be routinely vaccinated against prostate cancer... unless Barry Bullsh*t has his way, and he's permitted to destroy our health care system.

C'mon Republicans - grow a pair and repeal this monstrosity.

Impeach Don't Wait| 11.16.10 @ 3:40PM

"Am I a heartless person to wonder if $90,000 for a vaccine that might prolong life for a cancer patient another three years is too much?"

Okay, maybe I'm dumb, but:

Why does the vaccine have to cost $90,000?

Cost of R&D I guess...

Occam's Tool| 11.16.10 @ 5:46PM

Cost of R & D and marketing for a new drug---1.8 Billion and climbing. Max 15 years to recoup costs before it becomes generic.

DCD| 12.23.10 @ 7:14PM

I'd be willing to bet you'd pay 90K to live 3 more years.

I would.

Curly Smith| 11.16.10 @ 7:58AM

You don't bend the cost curve downward without cutting costs. ObamaCare will both ration care and outsource prostate exams and radiological treatments to the TSA. Just think of the airport lobby as a combination hospital/morgue and enjoy poking, prodding and groping.

MikeD| 11.16.10 @ 10:10AM

I read somewhere about a future best selling novel. The plot is this: Out of nowhere, socialistic/communistic members of the 'Anointed One's" administration begin disappearing. Law enforcement agencies are clueless as the disappearances begin to add up, at first, one a month, then 2 or 3 the next month, until 10 or 15 mid-level appointees are vanishing every month. Nobody takes responsibility, no group sends any twitters or e-mails claiming credit. Finally, none of the 'agents of death' in the 'Messiah's" administration leave their houses until one night a suspicious fire burns down one's house, taking him to his well erned place in Hades. Sounds like a very exciting novel! Pure fiction, of course. No sane person would ever advocate such a thing...

Mike| 11.16.10 @ 2:09PM

See, you weren't listening. He didn't say he would "bend the cost curve downward"---he said
"bend over and face downward."

Melvin| 11.16.10 @ 8:00AM

The only humans that will die are those who do not have a choice in the matter. This is the choice that the Proletariat bureaucrat makes for us eh, Comrade?
These Communist bastards don't want to hear our pleas, they want us to be good little Comrades and die quietly without making a fuss.
We have pinned so many of our hopes on the election of 2010, and as I had feared that the cancer of Fascism runs too deep within the Fascist plutocracy.
We are to work our whole lives as long as we are economically viable, but when it comes time that our broken and worn out bodies are no longer able to carry the heavy burden of taxation that our Facsist government taskmasters have placed upon us, then we're told, "I'm sorry, your just not economically cost effective. Please, step out of the line sir."

Ken (Old Texican)| 11.16.10 @ 8:22AM

Melvin,

Just hang in there two years, friend. We can kick Mr. Berwick's butt up between his shoulder blades.

wbheff| 11.16.10 @ 11:20AM

Ken,

That sounds good, but, think about this. Obama and his fellow traitors and thugs in the democrat party allowed the election this year to proceed, and they lost, big. Not as big as was hoped, but big nonetheless. Given that, how sure are you that they won't create a "crisis" that will justify "postponing" the schedulled 2012 election indefinitely?

Ken (Old Texican)| 11.16.10 @ 5:29PM

wbheff,

I hear you, but I believe they missed their chance November 2. If the Republicans will keep their jocks pulled up tight, we own the purse strings.

Man, I heard some stuff that would curl your hair over the six months prior to the election. I have some close friends that are very "in the loop", and the word was quietly delivered to the communists, (pardon the shorthand), that we would not accept a "crisis"....period.
I worked my arse off to complete my book before the elections for precisely that reason. I hope you will buy it. ( www.texassaidno.com )

Our constitution is a binding social contract. The communists, (pardon the shorthand), were quietly told that if they broke the contract, their lives were forfeit...and that no civil war was necessary to accomplish that.

Robert Heinlein once wrote: "You cannot enslave a freeman. You can only kill him."

Well...we aren't so easy to kill. Thank you, God for our Founders and our "contract".

Occam's Tool| 11.16.10 @ 5:48PM

Please see my following book review:

Imagine an attack on America's energy industry by state sponsored terrorists. Then imagine a President who is a panderer to Islamists, and who takes himself more seriously than the Constitution. Then imagine a white knuckle ride that never lets up!

We know the second statement is true, and the third statement is a book describing the first, called Texas Said No!.

Texas Said No! grabs you by the throat by page 6, and then is LITERALLY unputdownable through the last page, where it ends all too soon. To tell any more would be to give away too much stuff, but if you liked The Last Centurion by John Ringo, you'll love this one, as it is very similar to Ringo's book, only stripped down without any padding, slamming through its talking points like the TCU defense on a roll. If you care about your country and the course it's taking, buy this book and put it next to America Alone on your shelf. It's that good, and that important.

It is published as an E-book. Check it out at www.texassaidno.com

MikeD| 11.16.10 @ 8:11PM

I was disappointed election night and the following morning when the Demoncraps had stolen just enough votes to keep the Senate. Then I thought a bit more about it and found the silver lining.

Now Obama and his fascist thugs can't blame the difficult decisions on the Republicans. The Senate will stop everything done in the House, and Obama$$hole will veto anything that might make it past Harry (Scumsucker) Reid. So, if the GOP sticks to their guns, there will be deadlock and they can stop the flow of money to the healthcare abomination and everything else the 'messiahole' comes up with. Based on reports from Democrats who are as disturbed by the wanna-be dictator as the rest of us, he's becoming more unhinged by the day. Maybe he'll crack up all the way and be led off to the home for bewildered vote thieves before he leads his party to new levels of depravity between now and 2012.

Anthony| 11.16.10 @ 8:31AM

MEDCAD, isn't that the medication Paul Krugman takes for his delusions?
ApparentlyKrugman was off his meds last week when he saw death panels. Poor, poor , delusional Paul, death panels are only for Sarah Palin, silly boy.

Petronius| 11.16.10 @ 8:33AM

Dr. Don Berwick is in the wrong line of work. He should have been a game show host. But then, he is, in a way. " Welcome all you non elitists and plebes to Beat The Reaper: the show where you have just 60 seconds to tell the viewers out there and the studio audience what you've got, to win your cure, and Beat The Reaper." The prescience of Firesign Theater aside, the idea that the survival of anyone being contingent on his or her value to the State or any other power is utterly repellent. Well, not really. Abortion on demand will soon turn 40 and keep going until our legal establishment becomes civilized. Is there any evidence that will happen?

WRTolkas| 11.16.10 @ 8:40AM

Dear Ken (Old Texican),

I enjoy reading your posts that state the obvious in an entertaining and somewhat earthy manner. Your post has brightened my day. Buy the way, the old tune "Sunshine go away today," substitute the word sunshine with obama. This makes for more of a delightful tune.

Be safe all,
WRTolkas

ARealist| 11.16.10 @ 8:52AM

Berwick and his ilk, including our "representatives" in govt., are all well connected and typically very wealthy. They, and their families and friends will never, ever be denied any sort of medical treatment because they have connections and money. It's just the rest of us that will get screwed. This is why Berwick and his ilk, have no problem denying care or treatment; they have nothing to worry about.

Appleby| 11.16.10 @ 11:43AM

This is what happens routinely in Canada today. The Premier of Newfoundland himself went to the States to get treatment not available here. He did it openly and paid his own cash money for it.

Fellow Newfies who are not as wealthy or well connected remain on a five year waiting list. Only in Quebec, so far, has it been ruled that a position on a waiting list is not health care.

P.S. Don't worry about the prostate treatment, kids. Anything that has to do with the care and maintenance of the wee-wee will always go to the head of the line.

Ron| 11.16.10 @ 9:20AM

The comments made by the author are not fact-based. Provenge is being reimbursed by CMS at this time. That can be confirmed by Dendreon's (maker of Provenge) most recent quarterly report statements.
It is prudent on the part of CMS to review the efficacy of an expensive "first in class" drug if the taxpayers are paying the bill. How is that unreasonable?

Ken (Old Texican)| 11.16.10 @ 9:28AM

Folks,
A note on Sarah Palin: The Oxford Dctionary folks will add the word "refudiate" to their dictionary, and award Sarah "the word of the year" prize because they say the word perfectly bridges the gap between "repudiate" and "Refute"
Go Sarah!

Ned the Red| 11.16.10 @ 10:04AM

Refruitiate: replace the fries and nuggets in a San Francisco "Happy Meal" with fruit when ordered to do so by fruitcakes.

Ned| 11.16.10 @ 10:50AM

Yo, Red - did you see SF Mayor Gavin-boy VETO the Commissars dictat against Happy Meals on Fox last night? Is that a shocker, or what? Turns out the guy isn't a 'total' lunatic after all. And his justification for the veto was that they had gone too far! Coulda knocked me over with a feather!

Ned the Red| 11.16.10 @ 12:26PM

Ned, I did not know that (Johnny Carson). Must be worried about going to far to fast.

LadyVet| 11.16.10 @ 9:45AM

I guess Congressman Alan Greyson was right that the new health care's plan to cut costs was that we should "die quickly" but he incorrectly stated that it was the Republicans plan when it was really Obamas' plan. But I guess thats in keeping with everything that comes out of a Democrats mouth, it's either misdirection, half truth or an outright lie .

George S| 11.16.10 @ 10:14AM

We are never going to reduce our debt or reduce the federal government's power as long as the taxpayers continue to purchase the medical treatment of other people.

It is not a death panel thing if Medicare chooses not to pay for Provenge -- you can still buy it yourself. But 90 grand? Well it's either that or pretend the drug doesn't exist, what can I say? Provenge is a scarcity and 90 grand is the free market version of the death panel because there's not enough to go around so some have to do without. This is why the free market is targeted by socialist -- and this example is why we vote for them. We are cheering Provenge, yet none of us are bothered about the cost if we vote in Democrats. Federalism or Medicare and free Provenge? Can't have both.

But what we are getting a glimpse into is the process ObamaCare will use to determine whether or not you can get the drug, even if you can afford it. The cost ratio benefit analyses only work when there is no free market alternative.

Leslie| 11.16.10 @ 10:27AM

I think it is all in the pockets of the pharmaceutical companies. Why should a vaccine cost so much if it helps people live longer? Most of the men with prostate cancer are elderly, not all but most and supposedly it is a slow growing cancer so these people are expendable...why give a vaccine to someone who is 80? Unfortunately, there are young men who are getting prostate cancer who need this. It is the same with all "cures", there never will be cures for anything as long as pharmaceutical companies stand to lose money ie loss of a chronic disease that requires medication for the long term - MS is an example. Why would they actually sell something that would cure that? They stand to lose millions of dollars even tho there has been a treatment in Europe.
As for anyone deciding what is best for me and mine, well, that should be my business, not the government telling me that I can't have it because they don't deem me "necessary" in life. Where would it stop? Where will it stop? And who has the right to make that decision? Who are they to tell me that my mother/father or child needs to die with all the technology we have in this country? Because they don't think that we're "worth it"?

Philip Atwood| 11.16.10 @ 11:52AM

So you think my father should die because he's 80 and your father should live because he's younger.What a crock of crap.I hope yopur father gets prostate cancer when he's 80 then see if you still feel the same.I'm 58 so lets just kill anyone over 50 and call it good is that your plan.

Occam's Tool| 11.16.10 @ 5:51PM

Dear Leslie:

We in the US pay for Europe's R and D. The last time I looked at the cost of a new drug coming to market, about two years ago, it was 1.8 billion. In 1993, it was $300 million. Due to generic laws, the manufacturers have about 15 years to recoup all their costs and get the costs of finding the replacement drug. Prozac, for example, no longer makes Eli Lilly lunch money.

Richard| 11.16.10 @ 12:22PM

These acronyms and bean counting are driving me crazy. Get the government the hell out of my medical life. I don't need them and I don't want them.

Ben| 11.16.10 @ 3:54PM

Say goodbye to your Medicare then.

Perusha The Offender| 11.16.10 @ 1:48PM

Let the free market work, that’s my opinion.

Is it now working? Of course not! And, how long has it been failing?

A true story---in 1974, at a popular “alternative medicine” retreat near Escondido, California, Hidden Valley Health Ranch, owned by a famous chiropractor, Dr. Bernard Jensen, I personally witnessed a cancer “cure”. (Ever heard of Iridology? The very good doctor had written THE book on this subject. Turns out the iris reflects areas of the body, and can be “read” as a diagnostic tool, to find out where problems in the body are.)

The free market certainly worked for this one lady who came there in final desperation, after trying all the “scientifically” credentialed medical doctors, and failing to help her cancer.

She was put on a carrot juice fast and given daily colonics. I was even tasked with preparing her carrot juice, for a time. And, yes, she did “cure” cancer.

The “free” market in America has long been in the control of the junk food industry, and I include the “drug” companies in that category---from cradle to grave, eh?

When “your” body (which by 85 years of age, has “taken in” over a thousand TONS of air, food and water) is continually abused---poor child!---at a growing pace as time passes, and crap “passes” through and as it, what else can logically be expected but rampant “diseases”, such as cancer, and the putatively “helpful” industry that tries to rearrange elements into little pills to cure them.

In a Universal way, though, Nature can’t be fooled, so the “free” market is working.

Just because the majority at any given time believes such and such doesn’t make it true!

Americans learned THAT lesson about tobacco, and maybe eventually future survivors of the junk food epidemic we are now suffering will also wake up, AND change,

Hopefully. Until then, enjoy the sick and fat spectacle of circus junk food consumption IS.

“Back To Eden”, by Jethro Kloss, from 1971 provides many gut-wrenching tales that can make a difference. (In high school, in 1959 or 1960, in a health class, we got to watch a movie of the post mortem on a smoker, as his chest was opened up to reveal his ugly black lungs---I’ve NEVER smoked!)

“Enjoy” this quote---

“We opened up one man who had been a great eater of meats, rich pastries, pies, cakes, puddings, white bread and peeled potatoes, etc. We found his liver about three times its normal size. There were tumors all around the liver, ranging in size from a small marble to a small-sized potato. The heart was also very much enlarged, more than once again its normal size, and the walls of the heart were very thin and flabby and of a dark color, as if bloodshot. The spleen and pancreas were both enlarged and diseased, and he had gallstones and gravel in the bladder. His stomach was also very much prolapsed and diseased.

He was a middle-aged man, quite fleshy, who had died of heart failure.” Pages 24-25

Keep this example in mind, when viewing all the heavy and/or obese people roaming around America these days. Behind the well-clothed body and, perhaps, forced grin and good nature, the skin hides inner “turmoil”, sure as eating excrement!

karina| 11.16.10 @ 4:47PM

You sound like a shill for the "alternative healing modality" quackery industry.

Perusha The Offender| 11.16.10 @ 6:13PM

Really?

I thought I was just reporting my own experiences.

Bleeding sick people used to be conventional wisdom, but is now known to be "quackery".

I wonder how much of today's CW will someday be seen the same.

Two guys meet in the middle of a one-lane bridge.

One guy yells at the other one, "I ain't backing up for any son of a biscuit eating basketball player!"

The other guy says, "I am."

Intelligent Design| 11.16.10 @ 3:30PM

Obama and his fellow Demo-Socialists want to recreate the USSR here in the USA. They have learned absolutely nothing from the collapse of the Soviet Union. They think the American Kremlin can manage the entire economy, healthcare, and education. But virtually everything great and exceptional about the U.S. was developed by private enterprise. "Government" should be cut in half, and then the remaining half should be inspected for waste, corruption, mediocrity, and redundancy.
The new Congress needs to reverse the damage caused by the Demo-Socialists, before it's too late.

gingadecorgi| 11.16.10 @ 4:29PM

Heard a story about a 92 yr old woman who chipped up her pelvis and hips in a fall. When she was discharged the doctor told her to stop taking her regular medications. After all she is 92 and her health is slowly deteriorating. I'm considered "elderly." Death panels scare the hell out of me. Who will determine if I am fit to live? In pretty good health. A dutch cousin of mine left the Netherlands in the 90s because he saw death panels coming. He was in poor health. He didn't want the gov. or his children to determine if he was fit to live. Yes, I'm on medicare. I remember, now fondly, when my doctor office visits were 20 bucks a pop, paid with cash or check. No insurance stuff. I'd go back to that any day. No, death panels are frightening. Krugman revealed himself and his balance the budget crap nicely.

John| 11.16.10 @ 4:58PM

People, don't argue about something that come hell or high water WILL be paid for by Medicade. There is an advanced technology at hand, and sooner or later it WILL also be exported and create thousands of jobs for this full of sh*t administration. So in the end everyone will win, and so will I, two years from now, when I start singing sha na na na, hey hey hey Goodbye Obama!!!!

Bruce | 11.16.10 @ 5:00PM

We have here a dichotomy. On one hand the gubmint doesn't want to pay for drugs like Provenge, while on the other it's advising men that you don't need annual PSA/DRE exams. If they had any sense at all they would see that regular PSA/DRE exams can pretty much prevent prostate cancer from getting to the point that Provenge or other life sustaining drugs would not be needed!

As an example, I started annual PSA tests at age 45 due to BPH - which my health plan covered 80% of. By age 55, my urologist found my PSA was creeping upwards. Then at age 59 it jumped almost 4 points within one year. I had a biopsy and was diagnosed with prostate cancer in its early stages, with a PSA of 7.8 and a Gleason score of 8. Of the options open to me I decided on IGRT (image guided radiation therapy) - 45 treatments of 1 hour for 45 days. I am now cancer free with a PSA of 0.3 at age 64. Had I not had regular PSA/DRE exams over the years, I could very well have been in the "untreatable" class, or a class for whom Provenge would be helpful. IRGT was not cheap, at a total cost of $65,000, but considering my age and the alternatives I feel was money well spent. Under ObamaCare/Berwick I would have been denied that course of treatment. The usual story from these hacks is that 90% of men die with - not because of - prostate cancer. That may be true of men of advanced age who develop it - like my grandfather at age 75 - but does nothing for younger men who can expect to live another 20-25 years at minimum.

I would tell all men to get yearly PSA/DRE exams no matter what - especially so if they have any symptoms of BPH. The blood test itself is inexpensive even if your insurance doesn't cover it. The DRE, while somewhat uncomfortable (mostly embarrassing unless you're Barney Frank) takes but a few seconds. Do it, catch a cancer early, get treated, and enjoy your life.

Rick Z| 11.16.10 @ 6:01PM

Cost of first Smallpox Vaccination ?

Probably about 2 shillings.

General Washington ordered the troops encamped at Valley Forge be inoculated against smallpox.

Nite| 11.16.10 @ 9:51PM

Dr. Daniel Berwick is another unconfirmed Czar of Obama's that holds the power of life or death not only of seniors but chronically ill babies, children and other adults. He is outside the main stream of physicians and adores the UK public health system. He believes in rationed care for the above mentioned populations and is truly setting up death panels. Unelected or confirmed Czars should not be in control of these types of departments. The Healthcare bill is a monstrosity and I read the things 3 times. The Democrats did not even read the things before ramming them down our throats. However, Congress and their staff are exempt along with labor unions and others. The Independent Medicare Board now reports to Obama and if Congress wants to stop any changes it will take 2/3 majority of both houses. The Dems and Obama have been lying to seniors. The cuts to Medicare will make it much weaker because the money will be spent elsewhere. There will be steadily increasing cuts to benefits. Seniors will be darned lucky if we even find physicians who will provide care. People who voted for Dems, you do NOT have the slightest idea what you have done and how it will affect your family.

BERT| 11.17.10 @ 3:08AM

Its nice to see that Soro's Puppet regime has a budget to fund the astroturfing by the likes of the Troll named Mark, Tom and Beth and Route 88 .
Its sad to see the hate filled lying left will never rest until we are all under the evil control of Soros and company.
Can you imagine going around posting lies and propaganda like these vile slime do every day for a living?
The souless evil leftists like Pres Soros,Puppet Obama, and Berwick are what we all must fight everyday . These creatures never rest and the destruction of our country and healthcare system are their ultimate fantasies.

TOM | 6.2.11 @ 1:17AM

nice blog.......)

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