WSJ Debate on ACOs

The 1/23/2012 Wall Street Journal features this extended debate on the pros and cons of Accountable Care Organizations (ACOS): "Can Accountable-Care Organizations Improve Health Care While Reducing Costs?"

(If the direct link doesn't work, just Google the title of the article).

There's lots of information here, which I am still digesting.

Orient on Quitting Medicare

The 1/25/2012 Washington Times has published Dr. Jane Orient's OpEd, "Uncle Sam exacts penalty for quitting Medicare".

Federal rules make it extremely difficult for physicians and patients to privately and voluntarily contract for medical services outside of the Medicare system, even when they both wish to.

A good step towards the eventual privatization of medicine would be loosening such onerous Medicare restrictions. Patients and physicians could reap some benefits now, while we work to phase in other free-market reforms.

Par8o: Why EMR is a Four Letter Word to Most Doctors

Hint: It's all about the control.

EMRs (electronic health records) can be excellent tools when developed in a free market in response to physician and hospital needs. EMRs can also act as impediments to good patient care when imposed in a top-down fashion by government fiat.

CO Considering Repealing Health Insurance Exchange

Last year, the state of Colorado agreed to establish a health insurance exchange, after much political debate. This year, state Senator Tim Neville has introduced a bill to repeal last year's bill creating that exchange.

Although I won't be able to testify in person at the hearing on this bill, I was invited to submit a written statement in support of Senator Neville's bill:

Statement to CO Senate Health and Human Services Committee Supporting SB12-053

Paul Hsieh, MD
Co-founder, Freedom and Individual Rights in Medicine (FIRM)

I'm writing to support Senator Tim Neville's bill, SB12-053, "Repeal SB 200 Healthcare Exchange".  Establishing the exchange last year was a mistake.  As a practicing physician concerned about the medical freedom of Colorado patients, I'm glad to hear the state legislature is considering repealing the earlier bill and rectifying last year's error.

The fundamental problem with the state exchanges is that they serve as a vehicle for implementing the federal ObamaCare legislation at the state level.  Rather than facilitating a free market in health insurance, the exchanges would effectively put health insurance under the control of the federal government.  This would allow them to dictate what policies would look like and how doctors would manage their patients covered by exchange-provided insurance.

As Twila Brase of the Citizen's Council for Health Freedom notes, "State-established Exchanges may not write rules that conflict with or prevent implementation of federal rules issued by HHS under the law."  In other words, by creating our own state exchange in Colorado, we did not give ourselves greater flexibility and freedom from federal law, but rather surrendered to it.

Some negative consequences include the following:

1) Federal law will encourage employers to "dump" employees onto the state exchanges.

As reported by Minnesota Public Radio News and Kaiser Health News: "A loophole in the federal health care overhaul could allow employers to game the system by getting their sicker employees to opt into buying coverage on the health insurance exchanges, according to two University of Minnesota law professors.  They say the loophole could have dire consequences for the financial health of the exchanges..."

Hence, the exchanges will become a "budget buster" for the taxpayer-subsidized exchanges.

2) Coverage decisions would be mandated by Washington

For example, the federal government has empowered the USPSTF (United States Preventive Services Task Force) to determine what sorts of preventive care are or are not considered "cost effective".  In 2009, the USPSTF recommended restricting screening mammography to women over 50 (and only at 2 year intervals), despite the proven medical benefits of the current practice of screening women starting at age 40 at yearly intervals.

Under ObamaCare legislation, the USPSTF will set the de facto standards for what preventive services will or will not be covered by government insurance such as Medicare.  These criteria will inevitably also be applied to determine which private plans may be offered on the state exchanges.  Coverage decisions would be made by bureaucrats in Washington, DC.

3) Mandated benefits would drive up costs for patients

In Massachusetts, insurance prices on their state exchanges have risen much faster than the national average because pressure from special interest groups has resulted in mandatory coverage of services, whether or not patients actually need or desire such coverage.  Since 2006, special interests in Massachusetts have successfully lobbied to include 16 new benefits in the mandatory package (including lay midwives, orthotics, and drug-abuse treatment), and their state legislature is considering 70 more.  The decisions over what services will or will not be covered by exchange insurance plans have become fierce "political footballs" to the detriment of patients.  This will likely occur in Colorado as well.

Fortunately, states have a method of fighting back against this unwarranted federal control of health care.  In a recent editorial, Sally C. Pipes (president of Pacific Research Institute) and Dr. Hal Scherz (President of Docs4PatientCare) note the following:

The feds have further stipulated that people can only access billions of dollars in tax credits and subsidies earmarked for the purchase of policies by shopping in the state-run marketplaces.  If a state refuses to set up its own exchange, Obamacare allows the federal government to come into the state and set one up.

But here's the rub. The text of the law stipulates that only state-based exchanges -- not federally run ones -- may distribute credits and subsidies.  Without the federal cash, consumers won't patronize the government-run exchanges -- particularly with all the cost-inflating mandates they impose on insurers who wish to participate.

In other words, the federal government needs the acquiescence and active co-operation of the states to make the government-run exchanges work.  Hence, state governments can block this key feature of ObamaCare simply by refusing to establish a state exchange.

In conclusion, state-run exchanges under ObamaCare will harm patients and taxpayers.  For these reasons, other states such as Florida and Louisiana have already declined to establish their own state exchanges.  Colorado can join them by passing SB12-053, thus correcting last year's mistake.  Passing SB12-053 would be an important step in protecting essential medical freedoms for Coloradans.

=====

References:

"Don't get mugged by a politically controlled insurance exchange"
Brian Schwartz, Denver Post, 5/6/2011
http://www.denverpost.com/recommended/ci_18002925

"State Health Insurance Exchanges Will Impose Federal Control"
Twila Brase, Citizens’ Council for Health Freedom
http://www.cchfreedom.org/pdf/Policy_Insights-Insurance_Exchange.pdf

"Study: Employers Could Dump Sickest Employees On Public Health Care"
http://www.kaiserhealthnews.org/stories/2011/november/30/employers-dump-sickest-employees-public-heath-care.aspx

"Mass. health care costs outpace nation"
Boston Globe, 6/14/2011
http://www.boston.com/Boston/whitecoatnotes/2011/06/mass-health-care-costs-outpace-nation/DFCgMwvVZtunS7TIAn44BN/index.html

"Rejecting health-care exchanges"
Pipes and Scherz, Charleston Post and Courier, 12/29/2011
http://www.postandcourier.com/news/2011/dec/29/29pipes/

The idea of repealing a prior bad law should be proposed more often. I'm glad our state legislators are seriously considering this idea. Perhaps this will be the beginning of a larger trend!

Medicaid Coercion

Christopher Conover discusses, "Medicaid Coercion":

[S]tates face a relatively simple (albeit stark) choice when it comes to Medicaid. They can either accept the new Medicaid spending required under the ACA or they can reject the "deal" offered by Congress, in which case they must forego all federal funding of Medicaid.

States are caught between a rock and a hard place as state spending (and budgets) explode out of control. Conover concludes:

The problem with salami tactics like those encouraged through federal matching programs such as Medicaid is that eventually we will run out of salami. It's very generous for the federal government to offer 90 percent matching in perpetuity for those newly eligible under the ACA. But it is not at all clear Uncle Sam is in a position to fund this promise, especially in light of the fiscal tsunami posed by Medicare in the decades ahead.

If you live by federal money, you die by federal money.

Snopes Disputes Neurosurgery Rationing Claim

On November 26, 2011, I posted about proposed "HHS Restrictions on Neurosurgery" based on a neurosurgeon claiming to receive a briefing from Obama administration officials.

The Snopes.com website states that the American Association of Neurological Surgeons has investigated this issue and determined that anonymous caller was likely not a neurosurgeon and that the call "contained several factual inaccuracies". More here.

CO High Risk Pools and D4PC Response

The 1/16/2012 Denver Post reported, "Colorado high-risk health insurance pool runs up claims twice the U.S. average".

Docs4PatientCare made the following observation:

One year into a 4 year plan, Colorado is just one of a dozen states who have already burned through the federal funds allocated to set up this program. It's deplorable that even before the poorly designed Obama healthcare law is implemented, the bureaucracy claiming it will cover the "uninsurable" is already over budget and asking for a federal bailout.

If this administration understood the healthcare marketplace and truly wanted to provide these high risk patients with affordable medical insurance options, they would unleash the power of the national marketplace by changing the rules that currently [prevent] these patients from "pooling" their risk and using the resulting "purchasing power" to shop across state lines.

Pipes and Scherz: Rejecting Health Insurance Exchange

In the 12/29/2011 Charleston Post and Courier, Sally Pipes (Pacific Research Institute) and Dr. Hal Scherz (Docs4PatientCare.org) discuss "Rejecting health-care exchanges".

They note:

Obamacare instructs states to set up health insurance exchanges where consumers and small businesses can look for coverage starting in 2014. The exchanges would effectively put health insurance -- and the delivery of care -- under the control of the feds, who would dictate what policies would look like and how doctors would treat patients with exchange-provided coverage.

The feds have further stipulated that people can only access billions of dollars in tax credits and subsidies earmarked for the purchase of policies by shopping in the state-run marketplaces.

Pipes and Scherz explain how states can fight back against ObamaCare by choosing not to create such exchanges:

If a state refuses to set up its own exchange, Obamacare allows the federal government to come into the state and set one up.

But here's the rub. The text of the law stipulates that only state-based exchanges -- not federally run ones -- may distribute credits and subsidies.

Without the federal cash, consumers won't patronize the government-run exchanges -- particularly with all the cost-inflating mandates they impose on insurers who wish to participate.

Some states have already rejected the role of abetting the federal government in imposing ObamaCare on unwilling residents. Let's hope more follow suit.

(Read the full text of "Rejecting health-care exchanges".)

Quick Links: Herd Medicine, CO Risk Pools, Government Growth

Dr. Richard Fogoros discusses, "Herd Medicine". Soon, it will be considered ethically obligatory to sacrifice a few patients for the "cost effectiveness" of the herd.

The Denver Post reports more problems with the Colorado high-risk pool.

At PJMedia, Bryan Preston explains "How ObamaCare Grows Government While Reducing Access".