We have been told repeatedly by Obamacare supporters and media alike, that worries about seniors being pushed by end of life counseling into voluntary rationing are all so much fear mongering. Indeed, all it does (despite Compassion and Choices being at the table helping to create the provision), we have been lectured, is pay doctors and nurses to help people on Medicare with advance directives and the like.
Yet, the easy answer to the confusion–to amend the bill to mandate that the sessions be non directed and purely voluntary for both patient and provider–has not been pursued. Now, rather than fix the darn thing to make the point clear, the Secretary of HHS says the provision will be dropped. From the story:
Sebelius said the end-of-life proposal was likely to be dropped from the final bill. “We wanted to make sure doctors were reimbursed for that very important consultation if family members chose to make it, and instead it’s been turned into this scare tactic and probably will be off the table,” she said.
This is exceedingly strange. If the counseling is as important as its supporters have been saying, why not just ensure voluntariness? Why, instead, would the administration rather kill the counseling provision altogether? Maybe they plan to put the provision in by regulation instead of legislation? Inquiring minds want to know.
None of this makes any sense if Section 1233 was truly benign. Maybe the “alarmists” were onto something after all.
August 16th, 2009 | 10:49 pm
I think it shows immaturity and dishonesty on the part of the legislators involved. I’m glad it’s off the table, as it looked very fishy to me the way that it was. If they can’t perform the very simple task of including the necessary language to make it completely voluntary, than thank goodness that it’ll be gone. The only thing that could be worse as a result of this is if this really was a method of trying to coerce seniors and others into forgoing treatment and they are now going to try some other tactic that is harder to find within the labyrinthian healthcare bill.
August 17th, 2009 | 12:27 am
WS: “None of this makes any sense if Section 1233 was truly benign. Maybe the “alarmists” were onto something after all.”
Wesley: that is a patently disingenuous conclusion and just gratuitous innuendo on your part. If they do strike this portion of the bill, it is clearly a case of conceding some bathwater to save the baby. It also indicates that fearful distortions and conspiracy threories shouted loudly and often enough are near-impossible to quell. You can’t learn if you don’t listen, and you will never listen if you preemptively dismiss the possibility that Democrats are actually not interested in euthanizing their expensively ill loved ones or yours. This is becoming political theatre of the absurd.
C’mon, Wesley — you castigate Palin for her hyperbolic remarks but reserve the right to make your own? How consistent is that?
SHS ceases to be a serious forum if the moderator panders more than he enlightens.
August 17th, 2009 | 12:34 am
WS: “This is exceedingly strange. If the counseling is as important as its supporters have been saying, why not just ensure voluntariness? Why, instead, would the administration rather kill the counseling provision altogether?”
Given the extremist rhetoric and plethora of conspiracy-laden theories already canonized by the extreme Right that purports to be speaking for all Republicans, do you actually believe that merely adding an explicit voluntariness provision would dissuade these angry mobs who are hijacking the debate? If you do, please explain. Better yet, survey your SHS community.
I think you already know what their collective answer would be ;)
August 17th, 2009 | 12:56 am
Okakura: I can’t agree with you. No need to throw out the bathwater if you put in protections. So, it makes no sense to me. If the counseling is important, why kill it when you could probably save it by making it explicitly voluntary and non directed? I find it very puzzling. And my wry comment was hardly the equivalent of “death panels.”
August 17th, 2009 | 1:02 am
Check out the table outlining the Advance Care Planning, End of Life Provisions and POLST (Physican Orders for Life Sustaining Treatment, which really means to WITHDRAW Life Sustaining Treatment) provisions in each of the four proposed bills (one of the four listed is the “House Tri-Committee Bill.) This table was produced July 16. So what is being dropped and what is NOT being dropped, exactly? Take a look at those senate bills in their table. WOW! And just who will design all those educational materials, and is that included in what is being dropped or not? Will Ctr for Practical Bioethics be the designer, complete with their Health Care Directives that have as their default setting NO food and water unless you cross it out???? See their table here: http://www.practicalbioethics.org/FileUploads/Side-by-side%20EOL%20legislation%207-16-09.pdf
August 17th, 2009 | 1:18 am
Wesley, perhaps this helps explain it:
http://www.americanthinker.com/2009/08/death_panel_is_not_in_the_bill.html
‘Death panel’ is not in the bill… it already exists – By Joseph Ashby
Former Alaskan Governor Sarah Palin has come under fire for her Facebook post accusing President Obama and the Democrats of including a “death panel” provision the health care bill. The Associated Press recently ran a ‘Fact Check’ article rebutting Palin’s claim.
AP argues that the bill’s end-of-life counseling provision has been mistaken as a promotion of euthanasia and thus the death panel assertion by Palin and many other conservatives is false and misleading.
The New York Times has joined in the death panel bashing. Jim Rutenburg and Jackie Calmes assert the following:
There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure.
The AP is technically correct in stating that end-of-life counseling is not the same as a death panel. The New York Times is also correct to point out that the health care bill contains no provision setting up such a panel.
What both outlets fail to point out is that the panel already exists.
H.R. 1 (more commonly known as the Recovery and Reinvestment Act, even more commonly known as the Stimulus Bill and aptly dubbed the Porkulus Bill) contains a whopping $1.1 billion to fund the Federal Coordinating Council for Comparative Effectiveness Research. The Council is the brain child of former Health and Human Services Secretary Nominee Tom Daschle. Before the Porkulus Bill passed, Betsy McCaughey, former Lieutenant governor of New York, wrote in detail about the Council’s purpose.
Daschle’s stated purpose (and therefore President Obama’s purpose) for creating the Council is to empower an unelected bureaucracy to make the hard decisions about health care rationing that elected politicians are politically unable to make. The end result is to slow costly medical advancement and consumption. Daschle argues that Americans ought to be more like Europeans who passively accept “hopeless diagnoses.”
McCaughey goes on to explain:
Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them.
Who is on the Council? One of its most prominent members is none other than Dr. Death himself Ezekiel Emanuel. Dr. Emanuel’s views on care of the elderly should frighten anyone who is or ever plans on being old. He explains the logic behind his discriminatory views on elderly care as follows:
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.
On average 25-year-olds require very few medical services. If they are to get the lion’s share of the treatment, then those 65 and over can expect very little care. Dr. Emanuel’s views on saving money on medical care are simple: don’t provide any medical care. The loosely worded provisions in H.R 1 give him and his Council increasing power to push such recommendations.
Similarly hazy language will no doubt be used in the health care bill. What may pass as a 1,000 page health care law will explode into perhaps many thousands of pages of regulatory codes. The deliberate vagueness will give regulators tremendous leverage to interpret its provisions. Thus Obama’s Regulatory Czar Cass Sunstein will play a major role in defining the government’s role in controlling medical care.
How does Sunstein approach end of life care? In 2003 he wrote a paper for the AEI-Brookings Joint Center for Regulatory Studies arguing that human life varies in value. Specifically he champions statistical methods that give preference to what the government rates as “quality-adjusted life years.” Meaning, the government decides whether a person’s life is worth living. If the government decides the life is not worth living, it is the individual’s duty to die to free up welfare payments for the young and productive.
Ultimately it was Obama himself, in answer to a question on his ABC News infomercial, who said that payment determination cannot be influenced by a person’s spirit and “that at least we (the Federal Coordinating Council for Comparative Effectiveness Research) can let doctors know and your mom know that…this isn’t going to help. Maybe you’re better off not having the surgery, but taking the painkiller.”
Maybe we should ask the Associated Press and New York Times if they still think we shouldn’t be concerned about a federal “death panel.”
August 17th, 2009 | 12:28 pm
Okura, “Given the extremist rhetoric and plethora of conspiracy-laden theories already canonized by the extreme Right that purports to be speaking for all Republicans.”
What universe are you living in Okura to call opponents of this junk all these things. The White House and Congressional leaders are comparing opponents to Nazis, angry mobs, people carrying swatzidas, evil mongers, new racists, comparing us to the KKK and etc. That’s from your leaders, not just the kooks on MSNBC and leftwing radio-which almost no one listens to, and the F bomb throwing blogs. It means there’s no argument left. I hope you utopian leftists keep it up. You are just making more people mad.
August 17th, 2009 | 12:50 pm
Mary Kay…
How does this panel relate to what has been referred to as the IMAC board? do you know? is it the same but given official and permanent status? different?
August 17th, 2009 | 2:56 pm
Wesley: I too stand by my comments, though I will concede that your “wry” quip was not on the level of Palin’s.
I do think, however, that my poll idea for SHS would prove my suspicions accurate. That is, ask folks if clarifying the voluntariness of the end-of-life counseling provision would remove their fears about forced health care rationing for the terminall ill and the non-terminally ill elderly. I think “no” would win in a landslide.
the lion’s share of conservative minds are already and unshakeably made on this issue. Thus, adding such a useful clarification/concession (which I am personally in favor of) will in all likelihood just chum the waters for those looking to torpedo the bill as a whole. I believe this is the political rationale behind removing the clause entirely.
August 17th, 2009 | 3:14 pm
What I fail to understand is why anyone would think that curtailing physician-patient communication about end-of-life issues is a good idea.
If there is no eugenics agenda at work, then patients, families and doctors engaging in advance care planning discussions is a categorically good thing. Having volunteered hospice, you know this to be the case, Wesley.
If there IS some rationing-based futility metric being codified into law, you would think that patients would make damn sure what their personal physicians’ take was on the matter — if for no other reason so they could select a doctor who shares their values and maximizes their corresponding medical choices. Simply opting out of the voluntary counseling wouldn’t help you in such a scenario; it would only increase the divide between you and your physician.
On either side of this issue, direct information and increased patient-physician accountability easily trumps ‘opt-out’ passivity.
August 17th, 2009 | 3:21 pm
I would be very, very glad for them to drop it. Frankly, I think provisions for neutrality in such counseling are incredibly difficult to enforce, and I also find it difficult to see how Hemlock could be prevented from becoming the “go-to” people for this. They could always claim, “Oh, yes, we will abide by the law and provide neutral rather than goal-directed counseling,” and how could that possibly be monitored? I’d much rather see them drop it. I see no great benefit whatsoever to funding such sessions.
August 17th, 2009 | 8:12 pm
Don: I was calling out the extreme right wing shouters who have literally and figuratively been accusing this reform package of plotting to “kill grandma.” This belief is, to me, so clearly unsupported by the actual text of the clause that it justifies the adjective “conspiratorial.” Implicit in my remarks was that I was referring to extremists, not mainstream Rebulicans. The majority of conservatives I know have a multitude of serious questions about many aspects of the bill but, like Wesley, they do not feel the need to invoke insert over-the-top hyperbole (like Hitlerian eugenics, for example) to voice their concerns.
You, on the other hand, appear quite comfortable slingin’ derogatory labels at folks that you don’t even know (though admittedly, “utopian leftist” is gentler than many). I personally don’t believe that passion justifies rudeness, that your opponents are necessarily your enemies, or that hyperbole unveils truth (or wins debates).
If you are truly angry at the crude tone of discourse that is generated on daily basis by the Left, it is only logical that you would be equally offended by the same sort of tripe that emanates with equal force from the Right. Frankly I find wingnuts on both sides to be ridiculous and inane and feel that the noise they generate actually lowers the intelligence of those who listen to them on a regular basis. There are far better sources of news and credible information on such matters than FOX or MSNBC.
Thanks for your post.
-Oka
August 18th, 2009 | 12:34 am
To the question posed to me, the answer is that I do not know. As to other concerns, even if voluntary, the more important question I believe is whether or not it is directed. The bills require a lot of educational/training material, 24 hour hotline, etc. re the end of life care aspect. The Center for Practical Bioethics here in K.C. brags that it was their work with Sen. Danforth that created the Patients Self-Determination Act which requires patients be offered the opportunity to make out a living will/ h.c. directive/power of atty for health care, etc. every time they enter a hospital anywhere in the U.S. They hint in a recent interview that they have already been working with HHS and CDC on “these very issues.” The document they tout includes a Health Care “Directive” (pun intented) that has as its default a directive to refuse any and all treatments/food/water in more than “end of life” situations. If the person disagrees, and they can, they have to cross the item(s) out and initial. But what of an elderly, weak, uninformed person facing this “choice” as presented by a doctor who is already going to be pressured like crazy to be done with such a patient as soon as possible. Like the recent WP writer (Charles Lane) asked, who is going to design these things, the Catholic Church or Jack Kevorkian? Good question indeed. The Center for Practical Bioethics and groups like them will act as though they are right in the middle fo the two. THEY ARE NOT! And to add worry, the CEO of Practical Bioethics is personal friends with Kathleen Sebelius, who put her on as a citizen member of the KS Board of Healing Arts last year. The woman has also been on the citizen board of the local Planned Parenthood here. Gee, maybe I’m just a worrier and see conspiracies where they don’t exist. But I have a hard time thinking not.
August 18th, 2009 | 1:15 am
Mary Kay: You should consider the possibility of introducing yourself to Myra Christopher if/when the opportunity presents. She is a very engaging, compassionate and open-minded woman. You might be surprised at how many views you hold in common and how respectful she would be on those issues where you differ.
I don’t know her well but discovered firsthand (in a lengthy conversation with her) that she is both knowledgeable of and respectful toward conservative bioethics.
I hope you find this characterization to be accurate should you meet her one day.
August 18th, 2009 | 10:09 am
Okura, please. You start the slinging by calling these calling these people angry mobs, the extreme right who are hijacking the debate and etc like they are a bunch of loons. I point out your side is the mudslinger starting with the president of the United States and his staff, the speaker of the house, my senator Harry “they are evil mongers” Reid and John “I haven’t seen anything like this since the KKK” Dingle, and you end up trying to make me look like the mudslinger for pointing it out. Nice.
That’s how those same represenatives and the left started saying we people opposed to the garbage in this bill were Nazis. They called us that. We pointed out that Pelosi was saying that. They turn around and say we are calling them Nazis. You say I’m slinging at you, a person I don’t even know, and you do the same and then try to make it look like you really are the reasonable one in a house of nuts.
As to the people who are upset, read the polls. It’s not just the “right wing” unless the majority of the nation were right wing, which would be a good thing. As to shutting down debate, what party has been trying to pass bills this session without allowing amendments in big bills? I think the left is paranoid about debate. Obama wouldn’t have won if he told us who he really was. They can’t win and they are now resorting to intimidation, name calling, putdowns and etc. They, not those people coming out to the meetings, are afraid of the truth. And those people you think are nuts are furious because of what the bill is going to do to them. They’re not stupid. They get it. They’ve read it. They are showing up with chapter and verse and reading it right back to those congressmen who say it doesn’t say what they are reading. How funny. The people know they are going to get robbed. For what the Congress and the left is trying to do to them, I frankly think they have been for the most part, remarkably restrained.
This bill has ugly stuff in it. It will ration health care, fund, mandate abortion and mandate abortion clinics, pre-empt state laws.
August 18th, 2009 | 11:58 am
Don: You continue to misconstrue my posts in an apparant attempt to portray me as some kind of bigoted liberal. And you seem predisposed to dismiss any possibility that there can be a moderate position in this debate and bristle at the suggestion that a moderate and respectful debate is more constructive than the rabid few (note the word few, Don) screaming “Liar!” drowning out one’s fellow citizens, even (lately) carrying unconcealed handguns to these events as a not-so-subtle attempt to intimidate. (Regardless of the 2nd Amendment, it is hard to justify the need to carry lethal weapons to a civic meeting, be it a twon hall or PTA meeting.) This sort of behavior is juvenile and despicable when it emanates from the left or the right. You’re refusal to say as much speaks volumes about your willingness to embrace a utilitarian ethic when it serves your purposes.
Given that you appear to frequent SHS, I would think that such an approach would be anathema
I continue to believe that the majority of Americans want health care reform AND a significant number also have major qualms with the current proposal.
What I don’t believe is
August 18th, 2009 | 12:00 pm
…is that you represent the majority of conservatives who are consistently able to communicate their concerns, fears — even their indignation — in an adult manner.
August 18th, 2009 | 2:02 pm
Dear Okakura: I have met Ms. Christopher. I have seen her at forums. I have followed her/them for a long time. Yes, she is charming as she insists that the the only thing that matters is what a patient “wants”–usually years prior to an actual situation and all its particulars arising. I know what they’ve done regarding certain cases and I believe they are responsible for many quiet, anguished deaths by starvation/dehydration that yes, they can charmingly deny responsibility for, because after all, the “patient” made the decision. Plus, since the patient often goes into a coma-like state before actually dying and pain meds are used, everyone is spared the inconvenience of listening to moaning/groaning, etc. But many like my husband’s aunt are patients who were scared into signing such documents by those like Myra’s group that preach–even now!–that if such documents are not signed one is likely to end up being “overtreated” or “flogged” or “tortured” by doctors who fear lawsuits or whatever. And their version of the documents have refusal of any and all things as the default, unless you cross it/them out. And yet groups like hers now accuse US of scaring the elderly! Their whole schtick is based on fear. I also have experience with their buddy Bill Colby (the Nancy Cruzan lawyer) as we fought for her life and that of Christina Busalacchi back in the ’90′s. He and another of their folks has been busy trying to influence the Kansas legislature now on end of life issues in ways I completely disagree with, like the POLST (physican orders “for” life sustaining treatment) initiative to counter relatives, who, unlike the one who signed their rights away, are way too cognizant at the time their relatives “wishes” are about to be imposed, and threaten hospitals/nursing homes if care or food/water is discontinued. My father had no health care directive, but my sister was power of attorney, and despite all the reassurances that one can choose either direction, we had to fight to get a feeding tube, which as it turns out he only needed for 2 months and is now eating 3 full meals a day by mouth and wheeling around his nursing home again. And this is BEFORE any Obama care! Found out later that that hospital’s CEO acts as the treasurer for Myra’s organization. No, I’m not comforted by Myra’s charm, nor by the nun or retired priest they have made certain is on their board. Not even a little! — Mary Kay Culp, State Executive Director, Kansans for Life — former President of Missouri Right to Life.
August 18th, 2009 | 4:32 pm
Okakura, re-read my posts. You can get away with this with other people, but not me. You are acusing others of being name callers, but you are a name caller. I quoted your name calling, not someone else. Your citation of a couple people out of millions out there is desperate and inflamatory rhetoric.
I am offended by the administration and the Democratic leadership for starting the name calling and then accusing others of doing it. I’m offended by saying that these brave citizens, who are daring to show up at these meetings, are cutting off debate when the Congress and the President are running from it. Their name calling is cutting off debate and it is intended to impugn them so their arguments and concerns aren’t taken seriously. If they can make them and their lack of suave the story, then they don’t have to defend the plan or answer objections. What a bunch of con artists-acuse others of the very things you do and make them defend it. I haven’t seen this good of a con going on since leaving our family plastering business in east Oakland, CA. That says a lot.
August 18th, 2009 | 5:18 pm
Mary Kay: Thanks for your thoughtful response. I am glad both to hear that you were successful in obtaining the care your father needed and that he is recovering. Sounds like it was a nightmarish experience for your entire family, and I hope that you chronicled your experience and sent it to the CEO, board of directors, and especially to the chair of that institution’s ethics committee.
Suffice to say, nearly every bioethicist I know
readily admits both to the fundamental problems (not the least of which is precedent autonomy) and potential dangers inherent in a black-and-white ‘directive-centric’ approach to advance care planning. You and I may differ on the extent of the problem/danger but certainly not on the more important fact that it exists. I am currently writing an article on this very subject. Perhaps (with Wesley’s indulgence), I will share an brief excerpt or two with SHS at some point. I beleive there is great potential for truly bipartisan reform of advance care planning, and stories like yours underscore how badly needed such reform still is.
I appreciate reading your posts.
-Oka
August 18th, 2009 | 5:32 pm
Don: You win; I’ll concede.
To recap your argument…
1. Right good, left bad.
2. Left compares us to Hitler (bad). Right compares Obamacare to Hitler-style eugenics (factual).
3. Left “started it” by proposing a bill we didn’t like and by saying rude thngs at us. Right only supports polite & inclusive public debate.
I got it; thanks for sweeping away the gray for me ;)
August 18th, 2009 | 11:40 pm
The last word on “death panels?”
President Bush’s 2003 Medicare prescription drug bill (which passed w/ the votes of 204 GOP House members and 42 GOP Senators).
Covered services in that bill are: evaluating the beneficiary’s need for pain and symptom management, including the individual’s need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning.” The only difference between the 2003 provision and the Section 1233 is that the first applied only to terminally ill patients. Section 1233 would expand funding so that people could voluntarily receive counseling before they become terminally ill.
Incidentally, after the Bush administration expanded Medicare reimbursement to cover hospice care, which is less expensive than hospital care, hospice use grew 240%.
(http://www.foxnews.com/politics/2009/08/06/end-life-counseling-intensifies-health-reform-debate/)
August 19th, 2009 | 12:11 am
Without knowing anything but what you are saying, I would say that was a bad move by Bush, even if well intentioned. But also note. The end of life counseling in the HCR bills goes beyond terminal illness. They now include any change in health status as an excuse. And did you know that they allow absolutely NO I.V. fluids in hospice unless you come into hospice already on a feeding tube. Don’t know who caused that or when, but it is wrong, wrong, wrong!
August 19th, 2009 | 9:40 am
Okakura, nice talking to you. Where ever you are I hope you have a nice day. As for me, I’ll go back to my right wing nut job, angry mob, swatztika carrying, Nazi, KKK looking, racist, evil mongering, redneck blue haired no nothing illiterate, how dare they show up and challenge the intelligencia-those media and Democratic party defined friends. Maybe we’ll be able to ward off black helicopters, blue helmets, kill NAFTA, the NAU, keep Mexican trucks off American roads and most important of all, hold back the liberal progressives and their army of bioethicists for another day. Don’t have much time. Rush is coming on soon to give me my marching orders for the day. Left bad, right good. Gray is for hair not ethics:)
See you around.
August 19th, 2009 | 10:00 am
[...] HHS secretary Sebelius is now saying they’ll probably drop it from the bill altogether! As Wesley Smith said, that’s [...]
August 19th, 2009 | 7:32 pm
Mary Kay: I have personally not encountered a ‘no IV’ policy at any of the hospices that I have worked with or volunteered at. Hospices are even prohibited from mandating DNR orders and, some hospice patients actually do receive resuscitation attempts (CPR, intubation, or both) prior to death.
Don: Did a liberal kill your dog when you were a kid?
Seriously, you are by far the most angry, defensive & bombastic person I’ve ever encountered at SHS. The only perceivable intent of your largely ad hominem ‘responses’ appears to be expressing your unveiled contempt for dialogue itself. This is both ironic and pointless, and it lowers the quality of this (or any other) forum.
If you have something serious to say then say it like an adult. If, on the other hand, you are hell-bent on ‘screed-ing’ your thoughts instead of expressing them, there are a bevy of echo chamber partisan forums you can visit where everyone type-yells in CAPS and no one learns a damn thing.
August 19th, 2009 | 10:10 pm
Okakura: When trying to decide about where my dad could go when he left the hospital, still semi-comatose, but getting better, I called Catholic Hospice. In speaking with the director I think it was, and explaining that we couldn’t go to most nursing homes because he would need fluids I.V. I was informed that once accepted into hospice NO fluid I.V. was allowed. I said, “What’s so ‘Catholic’ about that?” He said, “You’re kinda blunt.” And I said, “Yeah, I Kinda am.” He said it was because they accept Medicare money. (I am making an appointment with my bishop to inform him and talk about this.) Hospice did say that people can go into and out of hospice and that if someone comes in with a feeding tube, they can keep it. And they said they offer people drinks of water. But the outline of the senate HCR bills done by the Center for Practical Bioethics show it would expand Hospice to more months, and also include children, and while that otherwise might be a good thing, given how hospice has changed and may change more if HCR passes, it may become a situation where people are just hurried along to die by denial of a way to get food/hydration when they can’t swallow, and in all kinds of medical situations, instead of cared for during a natural death from a terminal illness. As has been pointed out, there are things in place already that are very scary, as well as the health care directives that direct a certain direction. Did anyone else notice the news item yesterday that said that the population of Florida has gone down, instead of up, for the very first time since 1946. Is that a coincidence?
August 20th, 2009 | 12:28 am
Okukura, I’m going to overlook your comments and assume that you either didn’t read them, you have no humor like most liberals, or I violated Dale Carnegie’s dictum to never try to be funny unless you’ve inherited the mantle of Mark Twain. I’m usually a good speaker who gets people rolling, but maybe I failed here. It was supposed to say, “nice talking with you Okukura. Let me make light of myself on the way out at my expense. See you next time.” Wherever you are, have a nice day.
August 20th, 2009 | 1:18 am
[...] HHS secretary Sebelius is now saying they’ll probably drop it from the bill altogether! As Wesley Smith said, that’s [...]
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