Larry Flynt | Free Speech Activist

"If you're not going to offend somebody, you don't need the First Amendment."

- Larry Flynt

Larry Flynt



By Nat Hentoff
From HUSTLER MAGAZINE September 2011

I’ve never forgotten U.S. Supreme Court Justice William Brennan, in his chambers, firmly instructing me, “From the First Amendment, all our liberties flow.” This fundamental freedom includes objecting to government dictates.

A powerful example is the storm of nonpartisan protests against President Obama’s appointment of Dr. Donald Berwick as administrator of the Centers for Medicare and Medicaid Services (CMS), which is responsible for the healthcare of one in three Americans.

For years, Berwick has been a fervent admirer of how the British nationalized healthcare system decides the costs of treatment and medications. If these costs are deemed too expensive for patients near the end of life or with little prospect of improvement, healthcare is denied.

Here in this country, with the federal government determined to slash staggering budget deficits, cost-benefit healthcare is a primary goal of Obamacare. As it is for Berwick, who infamously made his intentions clear even before being named CMS head honcho. “It’s not a question of whether we will ration care, ”he said during an interview with Biotechnology Healthcare magazine. “It is whether we will ration with our eyes open.”

Fearful that Congressional confirmation hearings would be too controversial prior to the 2010 midterm elections, Obama first sneaked Berwick into a recess appointment. Earlier this year, Berwick did appear at such hearings and—what do you know?—backtracked from his previous declaration of “love”(his word) for the British system.

But what Berwick does truly believe is fully documented in his pre-Obama articles and interviews. Even though anger and fear of Obamacare is mounting nationwide, he still holds his crucial position because the President renominated him in January 2011. But without confirmation, Berwick’s tenure will last only until the end of this year.

On March 5, 2011, Berwick’s doomsday was predicted in a report titled “Senate Democrats Abandon Rationing Czar Donald Berwick.” The Democratic leadership had received an ominous letter from 42 Republicans. If Berwick’s nomination is sent to the floor, it spelled out, they threatened a filibuster—thanks to having enough numbers, plus some errant Democrats—to cut off Berwick’s budding career as the ultimate decider of how long some of us dependent on government healthcare can live.

Considering the number of Americans 90 years old and over requiring medical attention, not to mention hospital stays, Berwick’s presence as head of Medicare and Medicaid Services could have terminal consequences for some octogenarians as well.

But rationing would go beyond that. Many of us younger Americans may well get diagnoses requiring fast and expensive medical care. In a May 2010 article, Michael Tanner—like myself, a senior fellow at the Cato Institute— addressed Berwick’s long public love affair with British healthcare. Tanner pointed out that “750, 000 patients are awaiting admission to British NHS [National Health System] hospitals…. The latest estimates suggest that for most specialties, only 30% to 50% of patients are treated within 18 weeks. For trauma and orthopedics patients, the figure is only 20%.”

And dig this: “Overall, ”Tanner continued, “more than half of British patients wait more than 18 weeks for care. Every year 50, 000 surgeries are canceled because patients become too sick on the waiting list to proceed. The one thing the NHS is good at is saving money. After all, it is far cheaper to let the sick die than to provide care.”

How could Obama have resisted appointing Berwick, an ardent admirer of the NHS—except when testifying before Congress—to run the cost-efficient core of Obamacare? Whatever ruse the President may devise to keep Berwick in charge of reducing part of the national budget deficits, persistent public use of the First Amendment to oust him will only mean the appointment by Obama of yet another healthcare czar. Meanwhile, even if Berwick is removed, he may unobtrusively remain as an adviser to our doctor in chief.

That’s what happened when former Senate Majority Leader Tom Daschle (D-South Dakota)—a key Obama adviser on how to bring the British system to these shores— withdrew his nomination as secretary of Health and Human Services because of what were euphemistically called tax difficulties. Yet Daschle remained a frequent visitor to the Oval Office to counsel Obama on healthcare efficiency.

As long as Barack Obama is President, many of us will be confronted by what Bruce Chapman wrote on “We all face the end-of-life-treatment choices, either because of someone we love, or ourselves. Families, doctors, hospitals all do the best they can and situations vary.

“But when the government is involved and has built-in cost-cutting incentives, there is a tremendous incentive to warp the decision-making process and make it a financial triage issue. That is what President Obama was hinting at in several of the comments he has made in the past about end-of-life care. He thinks that the government cannot afford to take care of all the old and terminally ill and still give full care to the young and fit.”

Whatever your age, it would be reasonable—in self-defense—to keep the ultimate cold-hearted creator of Obamacare in mind when you go to the polls in November 2012.
Nat Hentoff is a historian of the Constitution, a jazz critic and a columnist for the Village Voice and Free Inquiry. His incisive books include The First Freedom:The Tumultuous History of Free Speech in America; Living the Bill of Rights; and the forthcoming Is This America?


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