Pipes on ObamaCare

The December 30, 2008 Wall Street Journal published the following OpEd by Sally Pipes on President-elect Obama's health care proposals. Here is an excerpt:

...Now Mr. Daschle proposes nothing less than a giant HMO with a federal bureaucracy setting the benefit plan.

Mr. Daschle's model is Massachusetts. But Massachusetts's plan is an unfolding disaster and demonstrates how Mr. Daschle's private/public model is merely a stalking horse for government-dominated health care.

The headline claim is that the program has signed up 442,000 more people for health insurance. The reality is that 80,000 of these were simply put on Medicaid and 176,000 more on the taxpayer-subsidized plans. Costs have exploded, requiring additional tax hikes and the entire system is only possible due to sizable transfers from the federal government. The plans are so unaffordable that in 2007, 62,000 people were exempted from the individual mandate. So much for universal coverage.

The only way the Massachusetts plan will survive is with continued and increasing federal subsidies -- that is, tax revenue from the residents of other states. The only way Mr. Daschle's proposed plan would survive is with massive deficit spending -- that is, with taxpayer money from future Americans, many of whom are not yet born.

Once the national version of the Massachusetts plan collapses, this will pave the way for the even worse "single payer" system so beloved by the socialists. Hence, it's important to oppose the seemingly less-dangerous Massachusetts-for-all plan now, before it becomes the law of the land.

The False Promise of EMRs

There have been several good discussions lately debunking President-elect Obama's claim that electronic medical records (EMRs) will achieve huge health care cost savings.

Dr. Steve Knope explains, "Why This Concierge Practice Prefers Paper Records".

Lee Gomes writes, "Why Tech Can't Cure Medical Inflation".

Dr. Kevin Pho discusses, "Why doctors still balk at electronic medical records".

Newsweek dissects, "Obama's Inflated Health Savings".

As these articles note, the fundamental problem with our health care system is not one of information technology. In fact, a government-mandated adoption of EMR could hamper good clinical practice. Rather, the fundamental problem is the perverse economics caused by decades of government policies. Hence, instead of a bogus technical "fix", we need fundamental free market health care reforms.

Schwartz OpEd: "Liberty is Best Prescription for Health Care"

The December 26, 2008 Rocky Mountain News has published Brian Schwartz's most recent OpEd on liberty and health care:

Liberty is best prescription for health care

At the recent Colorado Health Care Summit, Barack Obama's Cabinet pick Tom Daschle said his boss’s "commitment to changing the health-care system remains strong and focused." But in the wrong direction.

Obama has stated that "capitalism is great for consumers" when they have "many alternatives," when customers, "not government bureaucrats ... are the judges of what best serves their needs." Obama's health insurance proposals fail these standards and would fail patients.

Obama would further empower government bureaucrats to judge what insurance is best for you. By increasing private premium costs, new controls would drive patients to Obama’s proposed "new public plan."

This would make way for what Obama would want if he could "start from scratch": A "single-payer" government monopoly on health insurance.

This is the opposite of the "many alternatives" that Obama says are "great for consumers."

Before Medicare, retirees bought voluntary insurance in increasing numbers. Medicare killed this trend and soon monopolized the market. Obama's proposal to expand eligibility for Medicaid and the State Children's Health Insurance Program would coercively increase government's dominance in low-income and children's insurance markets.

Politicians capture these markets by making private premiums more expensive with burdensome regulations, and then offering tax-funded government-run insurance to many who cannot afford these premiums.

Obama's insurance controls would continue this strategy.

Obama would subject all insurance to new national mandates, letting government bureaucrats decide what insurance is good for you. The result? Look at Massachusetts, where the average family plan costs almost $17,000, compared to $5,400 in Colorado and $3,000 in Wisconsin, according to America's Health Insurance Plans. The Boston Globe reports that "mandates are helping to drive up costs, making coverage unaffordable." Residents with policies that don't meet "minimum standards set by state regulators could face a hefty tax penalty."

One mandate would force insurers to sell policies to all applicants, while another would forbid charging different premiums based on the customer's health. These controls have dire consequences: "a rise in insurance premiums, a reduction of individual insurance enrollment, and an exodus of health insurers" from the market, concluded The Milliman actuarial firm.

Having driven out competition, politicians would use tax dollars to expand Medicaid and SCHIP for the poor. For every 10 children enrolled in SCHIP, six dropped private insurance to do so, reports the National Bureau of Economic Research. Like Medicaid, SCHIP is a "low-wage trap" that punishes parents for increasing their income -- which makes them ineligible for government insurance.

Insurance for retirees, the poor, and kids -- government insurance has squashed competitors in these markets. Why has Obama proposed a new tax-funded "public plan"? "So people can opt out of private insurance," says New York Times columnist Paul Krugman -- and hence monopolize all health insurance. And the insured will opt out. Insurance companies cannot compete with government-run insurance, which can keep premiums low by forcing taxpayers to subsidize them.

Obama says his plan "strengthens employer-based coverage." But government's favoring this has been disastrous. The tax exemption for employer-provided insurance has turned insurance into prepaid health care, so people consume medical care like business travelers on the company expense account.

It also coddles insurance companies, who know that for you to buy a competitor's product you must either change jobs or pay a stiff tax penalty plus the full premium. As Obama's own economic adviser Jason Furman says, this tax exemption "reduces competition and choice for enrollees that could otherwise lead to better-designed insurance plans."

Government-favored employer-based insurance is bad enough. The single-payer insurance monopoly endorsed by Obama and others is worse. If you don't like single-payer, you cannot escape by changing jobs. You must leave the country.

President-elect Obama should remember that "customers—not government bureaucrats ... are the judges of what best serves their needs." He should eliminate damaging laws that lead to a government insurance monopoly. This would advance real change that is truly "great for consumers": economic liberty.

Brian Schwartz of Boulder blogs at the Independence Institute's PatientPowerNow.org.

Hsieh OpEd: "Polis vs Polis on Cars and Health Care"

The December 28, 2008 Boulder Daily Camera has published my latest OpEd on health care. Interestingly, the first online comment in response was from Congressman-elect Jared Polis himself.

Here's the OpEd:

Polis vs. Polis on cars and health care

By Dr. Paul Hsieh
Sunday, December 28, 2008

Boulder's Congressman-elect Jared Polis recently took a bold stand against a federal bailout of the automobile industry, correctly arguing that that the car manufacturers' problems should be handled by the private sector, not the government. Coloradans should urge him to apply the same principles to the issue of health care reform.

In the Dec. 10 Wall Street Journal, Polis wrote: "Our United States Congress... now finds itself poring over 'business plans' submitted this week by Ford, GM and Chrysler. People who have never before in their lives seen -- no less implemented -- a business plan are now trying to decide if these companies will succeed by means of a 'capital infusion' with... [taxpayer] money. Something is wrong with this picture."

Polis is absolutely correct on this point. As a successful businessman himself, he knows that government cannot and should not be manufacturing cars.

His argument applies even more strongly to the issue of health care. Although he campaigned on a platform of government-run "single payer" health care, he should recognize that government cannot and should not be running health care.

Similar socialized medical systems in other countries are consistent failures, leading only to harsh rationing and long waiting lists. In Canada's "single payer" system, a woman who feels a lump in her breast might wait months for the surgery and chemotherapy she needs. In contrast, a Boulder woman could get the care she needed in a few days.

Furthermore, whenever government attempts to guarantee "universal health care," it must also control it. Government then decide who gets what health care and when, not doctors and patients. In single payer systems, far from being a "right," health care becomes just another privilege dispensed at the discretion of government bureaucrats.

A 20-year old Canadian snowboarder who hurts his knee on the slopes might wait almost a year for an MRI scan, if the government does not consider it an "emergency." Yet such a delay in proper diagnosis and treatment could result in a permanent crippling arthritis by age 30. A Colorado snowboarder with the same injury could receive the necessary scan and surgery in a few weeks, avoiding such a life-long disability.

Finally, single payer health care necessarily interposes the government into the doctor-patient relationship in the name of cost control. According to the Telegraph, Great Britain's National Health Service paid bonuses to primary care physicians who reduced the numbers of referrals to hospital specialists -- thus forcing those doctors to choose between their oaths to their patients or the government which pays their salaries.

This corrosive effect on the doctor-patient relationship is one of the worst evils of single payer health care. The evil is not that it allows a few doctors to act badly, but rather that it takes good doctors and encourages them to become bad physicians willing to betray their patients' best medical interests.

The fundamental flaw behind single payer systems (or any other form of "universal health care") is the assumption that health care is a "right" that must be guaranteed by the government. Health care is a need, not a right. Rights are freedoms of action (such as the right to free speech), not automatic claims on goods or services that must be produced by another. There's no such thing as a "right" to a car -- or a tonsillectomy.

Individuals are legitimately entitled to health care that they purchase with their own money, are promised by prior contractual agreements, or are given to them via voluntary charity.

Any attempts to guarantee an alleged "right" to health care must necessarily violate the genuine rights of others -- such as the physicians who are forced deliver health care on the government's terms (rather than their own) and the taxpayers who are forced to pay for others' health care against their will.

Socialism doesn't work for car manufacturing, and won't work for health care. Congressman-elect Polis correctly understands that the government should not be running the auto industry. If Coloradans value their lives and their health, they should urge him to apply that same understanding to health care and to support free market reforms, instead of a "single payer" system. After all, it is their own future health care at stake.

Dr. Paul Hsieh of Sedalia is co-founder, Freedom and Individual Rights in Medicine

Merry Christmas!

Due to the holiday, there will be no more posts for the rest of the week. Regular blogging will resume Monday, December 29. Merry Christmas!

Truth or Consequences -- the Beth Ashmore Chronicle

Physician Jonathan Cargan alerted me to this video on the horrors of single-payer health care in Great Britain entitled, "Truth or Consequences -- the Beth Ashmore Chronicle".



According to the producers, the National Association of Health Underwriters:

Our new single payer video "Truth or Consequences—the Beth Ashmore Chronicle" demonstrates through the personal experiences of Beth Ashmore and her mother why the purported advantages of a single-payer health care system are really myths. The Beth Ashmore Chronicle offers real world evidence of the inadequacies of the single payer concept versus the quality and expediency of our current private market health care system.

Just one additional comment in response to a line in the video: There is a solution to the current health care problems in the US -- the free market.

Rhoads: Message to PhRMA

Jared Rhoads, director of the Lucidus Project, has written the following message to the pharmaceutical industry group PhRMA (Pharmaceutical Research and Manufacturers of America). It is reposted here with his kind permission:

Message to PhRMA
by Jared M. Rhoads (November 30, 2008)

According to a recent article in the Washington Times, the nation's largest and most influential lobbying group for the pharmaceutical industry is preparing to launch a multi-million dollar public relations campaign to trumpet the benefits of the free market in healthcare. The intent of the campaign, confirmed by the Pharmaceutical Research and Manufacturers of America (PhRMA) group, is to preempt an expected push by the Obama administration for price controls on prescription drugs.[1]

The group's concern over the political desire for new controls is certainly justified. During the presidential campaign, Obama promised to "take on the drug and insurance companies and hold them accountable for the prices they charge and the harm they cause."[2] He also promised to "tell the pharmaceutical companies thanks, but no thanks, for the overpriced drugs." Central to these price reforms is a plan to allow the federal government to "negotiate" (i.e. dictate) for Medicare to pay lower prices for prescription drugs for its enrollees. Such a move would have major implications. After all, Medicare is not just any payer; it is the largest single payer of healthcare services in the United States. According to some estimates, the hit on revenues for pharmaceutical companies would be between $10 billion and $30 billion. That is about equivalent to wiping out the entire annual revenue of Merck, the third largest drugmaker in the U.S.

But does PhRMA really have the fortitude to run an effective ad campaign in support of free markets? In the past, the group has taken some pro-market stances on issues involving intellectual property rights, regulatory barriers, and e-pedigree requirements. But the group has also been a vocal supporter of government-supported research, post-market surveillance requirements, SCHIP expansion, and worst of all, the 2006 Medicare Prescription Drug Benefit -- the largest new entitlement program since the inception of Medicare in the 1960s. And if recent comments by PhRMA representatives are any indicator, then the group views the fight against price controls as more akin to "moving the pieces on the chess board" (i.e. manipulating members of Congress) than an opportunity to make a strong, philosophical case for free-market reforms.[3]

Setting aside some doubts, let us assume that PhRMA is in fact serious about defending the free market. How should it go about doing this? Here are three pieces of advice:

1) Don't allow opponents to claim that the market has failed. Seemingly every discourse on healthcare begins with a harangue about how Americans spend more on healthcare and allegedly get less, and how the U.S. is the only industrialized nation that does not provides universal healthcare to its citizens. As a result, many people are led to believe that the cause of our problems is too much privatization and not enough government. The reality is precisely the opposite: it is the policies, controls, and interventions of government that raise costs, divert investment capital, and thwart innovation. PhRMA's campaign needs to remind (or educate) the public that the pharmaceutical industry today is not a free market but a thoroughly hampered one, and that the only "change we can believe in" is change in the direction of a free market. The problem is not that markets have failed; markets haven't even been given a chance.

2) Name your principles. Proponents of price controls on prescription drugs can offer no rational objection to the argument that individuals have the right to produce and offer their products on whatever terms they wish. This is a fundamental point, and -- to paraphrase a famous fictional architect -- it has to be said. Unfortunately, in today's climate of pragmatism, principles do not get the respect they deserve. A principled, rights-based argument alone will not silence those who are pushing for price controls, so PhRMA should tout the practical and economic case for free markets as clearly as possible. But please, PhRMA: anchor your message in the principle of rights, and refer to it at every opportunity. Whether you know it or not, this is what will sustain your fight over the long run (if there is to be a long run).

3) Demonstrate some integrity. Don't ask for laissez-faire treatment one minute, and then demand increased subsidies, research grants, or bailouts the next. To be sure, a mixed economy is a funny thing; it is a system of contradictions. And in the midst of oppressive regulations, taxes, and fees, no organization reasonably can be blamed for exerting their influence in Washington as a matter of self-defense. But to the fullest extent possible, PhRMA should be willing to explore ideas that trade today's goodies for increased freedom. With an incoming administration that will be looking for ways to control spending in the current economic crisis, 2009 will be a favorable time for new ideas. For instance, the pharmaceutical industry could offer to negotiate a 50 percent reduction in its share of NIH extramural research grants in exchange for a 50 percent reduction in the time or paperwork required for drug approvals. Or the same, in exchange for the lifting of liability on developmental drugs. Or for the removal of restrictions on advertising. Yes, it is a shame that your industry must "buy back" its own freedom -- but that is one of the consequences of having failed to defend it properly in the first place. As for the forgone grant money, you won't miss it. Not when you realize the wealth of innovations and discoveries that your minds are capable of producing when left free to think.

As PhRMA begins to launch its campaign for the defense of free markets, advocates of laissez-faire will be watching -- and hoping -- for a confident and principled approach. If executed properly, it could be effective in stemming the tide of new price controls. If botched, it will be worse than offering no defense at all.

_____

[1] Lengell, S. "Drugmaker ads to target Obama idea," Washington Times, November 14, 2008

[2] "Remarks in Newport News, Virginia" Barack Obama, October 4 2008. (This sentiment, by the way, was to a large extent shared by Obama's Republican opponent John McCain.)

[3] Lengell, November 14 2008

Ralston and Hsieh LTEs in Wall Street Journal

The December 22, 2008 has printed two contiguous LTEs critical of Obama's health care plans. One is by Richard Ralston, director of Americans for Free Choice in Medicine and the second is by myself. Both were in response to their December 9, 2008 article, "The Obama Health-Care Express".

Here are the two LTEs:

Three Big Problems With Obama's Health-Care Plan

You are probably correct that a major new national health-care program will be rushed through the next Congress without substantial debate through some mechanism such as budget reconciliation. That is because many of its elements would not survive close examination. The fatuous claim of Sen. Max Baucus that placing the nation's medical care under the rule of an "independent" council of presidentially appointed experts would not constitute government management of care is only the most conspicuous example. Others include the claim that computerizing those remaining medical records still on paper would reduce insurance costs by $2,500 a year per family.

But the main reason for the big rush is that nobody has a clue how the government will pay for it -- anymore than they know how the current unfunded liability of Medicare and Medicaid can be honored.

The last thing that proponents want is for anyone to ask where the money will come from, except perhaps questions about such details as the individual rights of patients and physicians to make their own medical decisions without the approval of presidentially appointed experts.

Richard E. Ralston
Executive Director
Americans for Free Choice in Medicine
Newport Beach, Calif.


Businesses expecting to save money under President-elect Barack Obama's universal health-care plan are going to be in for a rude awakening. President-elect Obama's plan includes an employer mandate in which businesses must either pay their employee health insurance or else pay into a government fund to cover the uninsured.

A similar mandate has already been in place in Massachusetts for two years. As health costs there have skyrocketed, the state government has asked for more and more "contributions" from businesses. During this financial crisis, the last thing America needs is yet more economic burdens on the businessmen who create jobs and prosperity.

The fundamental problem with Mr. Obama's plan is the premise that health care is a "right" that must be guaranteed by the government. Health care is a need, not a right. Rights are freedoms of action, not automatic claims on goods and services that must be produced by another. Attempting to guarantee an alleged "right" to health care must necessarily violate actual individual rights and will destroy the American economy in the process.

Paul Hsieh, M.D.
Sedalia, Colo.

Alliance of Health Care Sharing Ministries

As an alternative to the current system of employer-based insurance, the Alliance of Health Care Sharing Ministries provides voluntary mutual aid to members to help cover their medical expenses.

Their system works as follows:

A health care sharing ministry (HCSM) provides a health care cost sharing arrangement among persons of similar and sincerely held beliefs. HCSMs are not-for-profit religious organization acting as a clearinghouse for those who have medical expenses and those who desire to share the burden of those medical expenses. These organizations are known as health care sharing ministries (HCSM).

* HCSMs receive no funding or grants from government sources.
* HCSMs are not insurance companies. HCSM do not assume any risk or guarantee the payment of any medical bill. Ten states have explicitly recognized this and specifically exempt HCSMs from their insurance codes.
* HCSMs serve more than 100,000 members, with members in all fifty states.
* HCSMs' members share more than $60 million per year for one another’s health care costs.
* HCSMs strive to be accessible to members regardless of their income, because traditionally shares are a fraction of the cost of insurance rates.

This is exactly the sort of private, voluntary charity that Dr. Leonard Peikoff speaks of in his essay, "Health Care Is Not A Right":

Some people can't afford medical care in the U.S. But they are necessarily a small minority in a free or even semi-free country. If they were the majority, the country would be an utter bankrupt and could not even think of a national medical program. As to this small minority, in a free country they have to rely solely on private, voluntary charity. Yes, charity, the kindness of the doctors or of the better off -- charity, not right, i.e. not their right to the lives or work of others. And such charity, I may say, was always forthcoming in the past in America. The advocates of Medicaid and Medicare under LBJ did not claim that the poor or old in the '60's got bad care; they claimed that it was an affront for anyone to have to depend on charity.

I fully support the right of organizations such as AHCSM to engage in such charitable mutual aid, free from the onerous restrictions that the government places on insurance companies. And although the AHCSM bases its policies on Christian Biblical principles, in a free society any group of people (religious or non-religious) could band together to create a similar system of voluntary mutual aid.

I therefore commend the AHCSM for showing that it is possible to create a real-life positive alternative to traditional insurance that many Americans would gladly support and benefit from.

The AHCSM has also correctly taken a strong position against government-mandated health insurance. In one of their policy briefings (not on their website, but sent to me as a PDF), they wrote:

CONCERNS: Mandating health insurance will infringe on the religious and economic liberties of members of health care sharing ministries and ultimately destroy these unique ministries.

• Mandatory Insurance Will Cripple An Innovative Approach to Meeting Health Care Expenses. HCSMs are the result of a cooperative effort of individuals and employers organized around a religious principle of "bearing one another's burdens" in a time of need. Requiring these sustaining communities to use their scarce resources to purchase health insurance or pay taxes and penalties for failing to do so will drain the financial lifeblood from these vibrant ministries.

• Mandatory Insurance Infringes on Religious Liberty. Members of HSCMs are presently in charge of the decisions regarding their own health care and able to refrain from supporting practices contrary to their moral convictions. Mandatory insurance, on the other hand, would legally require the purchase of insurance policies that force citizens to give financial support to treatments that violate their convictions.

• This Innovative Solution to Rising Health Care Costs Works. HCSM members help with medical burdens by sending a monthly share that is significantly lower than individual or employer insurance rates. HCSMs also provide the spiritual and emotional support of a community of believers that helps to heal the whole person rather than just the illness.

THE SOLUTION: Do not mandate the purchase of health insurance. Instead, give increased liberty to all consumers and allow them to control their health care dollars. In HCSMs this approach has resulted in greater individual control of health care spending and improved quality of care...

All Americans should support and defend the right of the HCSMs to engage in this sort of charity. One of the evils of mandatory insurance is that it would violate the rights of individuals to create and engage in these sorts of innovative mutual aid activities. This is yet another reason to oppose mandatory health insurance.

Poem: 'Twas the Night After Single Payer

In the spirit of Christmas, long-time FIRM supporter Gina Liggett has composed the following poem, "'Twas the Night After Single Payer":

'Twas the Night After Single Payer
By Gina Liggett, RN, MPH

'Twas the night after Single Payer, when all through the land
Not a creature had health care that could be called grand;

The ERs were stuffed with those seeking care,
In hopes Dr. Daschle soon would be there;

The patients were all nestled sick in their beds,
Hallucinating that sugar-plums danced in their heads;

And doctors at their post, and nurses at their station,
Had just hunkered down for a long Administration,

When on the Rose Garden lawn there arose such a clatter,
I turned on CNN to see what was the matter.

Away to the screen it flew like a flash,
Camera shutters were clicking, Dr. Daschle with his sash.

TV lights shined in faces hailing the plan
Gave the lustre of "quality" for each woman and man,

When, what to my wondering eyes be endured,
But a huge new department, and forty-eight million more insured,

With a powerful new driver, two roles to fulfill,
I knew in a moment it would be government overkill.

Regulations not treatments his ideas they came,
New restrictions, new rules, and he called them by name;

"Now, Daschle! now, Dollar! now, Payer and Taxin'!
On, Common! on Cure-all! on, Daunting and Blighted!

To the top of the White House! it will hit the wall!
Now cash away! cash away! cash away all!"

As dry heaves that before an intestinal flare,
With patients on the wait list, what do they care?

So up in the bureaucracy the coursers they flew,
Through the cabinets of paperwork, and Dr. Daschle too.

And then, in a news conference, I heard more restrictions
The limits and taxing and fewer prescriptions.

As I called 911, one day writhing in pain,
The response that I got could only be called insane.

He was dressed in his scrubs, and checked my citizen's ID,
And the equipment malfunctioned, but the diagnosis was free;

A bundle of supplies, the treatment room disordered,
But they lacked what was needed, what the Dr. had ordered.

His eyes--how they glazed! dark circles how weary!
His cheeks were so sallow, his job was so dreary!

Another patient in line dehydrated like wheat,
Uncontrolled diabetes, his blood sugar too sweet;

The stump of a leg infected for weeks,
It was surgical care that this patient seeks;

He had Universal Insurance and a sad-looking face,
Because it only covered some gauze and an Ace.

He was pale and sweaty, a sickly young man,
And I cried when I saw him, in spite of his free-coverage plan.

A wink of the bureaucrat and a nod of her head,
Said, with Single Payer I had nothing to dread;

She spoke no more words, but took her first break,
Civil servants remember their rules are at stake.

And the Doctor came back, his fingers rubbing his eyes,
And he gave me a med and some vague replies;

He sprang to his computer, the new high-tech efficiency
Sent my records to D.C. for some clerk to see.

But I heard him exclaim, ere he walked out of sight,

"Single Payer for all has become a nightmarish fright!"

(Via NoodleFood.)

Polis Vs. Polis

Democratic Congressman-elect Jared Polis of Boulder, Colorado, recently wrote a fairly good OpEd for the December 10, 2008 Wall Street Journal in which he warned that Congress should not bail out the auto industry, but instead let the private sector take care of the problem:

Our United States Congress... now finds itself poring over "business plans" submitted this week by Ford, GM and Chrysler. People who have never before in their lives seen -- no less implemented -- a business plan are now trying to decide if these companies will succeed by means of a "capital infusion" with... [taxpayer] money. Something is wrong with this picture.

Instead, if the private sector takes on this issue, then:

At the very least, my constituents in Colorado won't find themselves as limited partners in a private equity fund run by Congress making speculative investments in flagging automobile manufacturers and who knows what else with their taxpayer money.

Polis concludes:

Reading business plans and making investments is the job of equity funds and turnaround specialists, not members of Congress.

Polis is quite right on that point. The function of government is not to run businesses but to protect individual rights.

Yet he fails to apply his own argument to health care. Polis is a proponent of government-run "single payer" health care, and he would use Medicare as the model:

Medicare, a universal access, single-payer, government-administered, publicly financed and efficient program, has high patient satisfaction and only 3% administrative expenses – less than any private insurance plan. While there are many improvements we need to focus on within Medicare, it serves as a model of a single-payer healthcare system.

Yet this is the same Medicare system that is faced with perennial funding crises, which achieves these artificially low administrative costs by foisting them on private physicians' office staff, and which pays so little that many doctors are thinking of dropping Medicare patients.

If we expanded this system to cover all Americans (not just the elderly), those problems would merely multiply.

Polis is right -- the US government is not capable of running the auto industry. If it attempted to do so, it would merely destroy those companies.

His argument applies just as well to health care. Health care is not a right, and any attempt to guarantee it with a single-payer system (or any other form of "universal coverage") would destroy American health care.

Polis-on-automakers is right. Polis-on-health-care is wrong.

Coloradans should urge Polis to apply his correct understanding on the issue of the auto bailout to the health care issue.

New Insurance Option

Amidst the gloomy news of some insurance industry lobbyists supporting yet more government controls of health insurance, there are occasional bits of good news.

One is the concept of being able to purchase an option now to be able to buy future insurance in the event of a future illness, offered by United Health Care in some states.

This sort of innovative insurance product is precisely the sort of creative offering one would expect in a free market. There is a need (consumers' concerns about being able to be insured in the future) and a potential for profitable service (an option that insurers can sell), making it possible for a mutually beneficial exchange.

If current government restrictions on insurers (such as guaranteed issue, community rating, and guaranteed renewability) were lifted, insurers and patients would be free to negotiate even more financial and contractual innovations such as this one -- to the tremendous benefit of us all.

Americans already know the benefits of our current semi-free market in other sectors of the economy, with massive innovations in computers, cell phones, food, clothing, and other consumer goods. This can and should be the norm for health insurance as well.

Knope Translates Insurance Double-Speak

Dr. Steven Knope translates the words behind the insurance industries new-found enthusiasm for mandated universal coverage:

Here is how the insurance industry stated they would make their plan work: "The group called on Congress to establish a public-private advisory group to recommend action in three areas: reducing wasteful spending, changing how doctors and hospitals are paid, and reducing administrative costs."

Let me translate this insurance double speak for you.

"Reducing wasteful spending" translates into rationing medical care to patients for profit.

"Changing how doctors and hospitals are paid" translates into paying them less. Clearly, if doctors and hospitals were paid more or even paid at current rates, spending could not be reduced. This fee reduction will result in doctors seeing even more patients than they see now, spending less time with each and further rationing healthcare.

Finally, "reducing administrative costs" translates into allowing the insurance companies to become the administrators for the program. What this means is that much of the new healthcare dollar will flow through insurance company pipelines, which will be designed with leaks in strategic places.

Instead of trying to use the power of the government to force consumers to purchase insurance on their terms, they should be advocating a free market that allows patients to purchase insurance (or not) based on their own assessment of their needs. For some patients, that might involve paying routine costs out of pocket (or with a Health Savings Account), then using catastrophic-only insurance for expensive events. Other patients may wish more of a pre-paid model, with richer benefits but higher premiums. Others might wish to retain a concierge physician and pay directly for all medical services with no insurance whatsoever.

But patients should have the freedom to choose in a free market. The insurance companies' proposed unholy alliance with the government is a direct infringement of this basic right, and will inevitably lead to an even worse "single payer" system.

No Posting

There will be no blogging for a few days. My wife and I had to put our dog Kate to sleep this morning. She had been suffering from an abdominal tumor which finally spread to her spinal cord.

We had her for almost 9 years (adopted from a shelter as a full-grown adult). She was a sweet, cheerful, faithful, loyal, and protective girl who gave us many years of happiness.

Rest in peace, Kate.



For more pictures, see here.

Hsieh LTE in Boston Globe

The December 8, 2008 Boston Globe has published my LTE opposing mandatory insurance in response to their December 3, 2008 article, "Lobbies Backing Health Care Reform".

My LTE reads as follows:

Steer clear of making purchase mandatory

The insurance industry proposal to force all Americans to purchase health insurance would be as wrong as Detroit automakers asking Congress to force all Americans to purchase a new GM or Ford car every year. Americans have the right to purchase (or not purchase) insurance in a free market, based on a rational assessment of their needs. When health insurance is mandatory, the state must necessarily define what constitutes "acceptable" insurance, meaning that individuals must purchase insurance on terms set by lobbyists and bureaucrats.

Instead of mandatory health insurance, America needs free-market reforms, such as allowing patients to purchase insurance across state lines and to use health savings accounts for routine expenses, and allowing insurers to sell inexpensive, catastrophic-only policies to cover rare but expensive events. Such reforms could reduce costs and make insurance available to millions who cannot currently afford it.

Dr. Paul Hsieh
Sedalia, Colo.
The writer is cofounder of Freedom and Individual Rights in Medicine.

Hsieh LTE in Los Angeles Times

The December 4, 2008 Los Angeles Times printed my LTE submitted in response to their December 1, 2008 article, "Consensus emerging on universal healthcare".

My LTE is the 3rd one in the section "Health Care Debate":

The government should not be guaranteeing "universal healthcare." Healthcare is a need, not a right. Rights are freedoms of action, not automatic claims on goods and services that must be produced by another. There's no such thing as a "right" to a car or an appendectomy. Whenever the government attempts to guarantee a service such as healthcare, it must control it, leading to Canadian-style rationing and waiting lists.

Instead of universal healthcare, we need free-market reforms, such as allowing patients to purchase insurance across state lines and use health savings accounts for routine expenses, and allowing insurers to sell inexpensive, catastrophic-only policies to cover rare but expensive events. Such reforms could reduce costs and make insurance available to millions who cannot currently afford it.

Paul Hsieh, MD
Sedalia, Colo.

(They also printed two letters from local residents supporting single-payer health care.)

Shared Medical Appointments in Massachusetts

Waiting times for medical care in Massachusetts have gotten so long as a result of their "universal coverage" system, that some patients are accepting "group medical appointments", giving up privacy and one-on-one time with their physician in exchange for getting a timely appointment.

The story includes a video of such a group appointment.

As one commenter stated:

In the group setting, the patients are not allowed to remove clothing for proper physical examination due to the lack of privacy. In the video, Dr. Lindsey is shown auscultating and percussing through the patients' clothing.

As a medical student, I would flunk, that's right, flunk my standardized patient examinations if I even thought of auscultating or percussing through clothing. It is obvious that the lack of privacy even in the cardiology setting restricts the doctor from doing a proper physical examination.

If Senator Baucus has his way with his planned expansion of the Massachusetts plan to the national level, we'll soon see this in all 50 states.

(Via AAPS News.)

Amerling on Arizona

The December 1, 2008 Wall Street Journal printed the following LTE by Dr. Richard Amerling, commenting on the defeat of Arizona's ballot initiative which would have guaranteed that patients could pay for private health care (2nd letter on the page):

The apparent defeat of Proposition 101 in Arizona strongly suggests the ultimate goal of the single-payer wonks is to delegitimize, or frankly outlaw, private medical contracting. Based on experiences in Canada and the U.K., the only way a government-run health-care system can survive (finances notwithstanding) is with a private pay option to handle the excess demand such systems always create.

If private medicine is outlawed in the U.S., doctors will no longer work for patients, and a basic freedom will be lost. I hope my colleagues, many of whom naively endorse the single-payer concept, are paying attention.

Richard Amerling, M.D.
Director
Outpatient Dialysis
Beth Israel Medical Center
New York

I also hope that more doctors listen to Dr. Amerling.

Ralston on the FDA

Richard Ralston, executive director of Americans for Free Choice in Medicine, has written an OpEd sharply critical of the Food and Drug Administration (FDA):

Freedom from the FDA
By Richard E. Ralston
November 28, 2008

It took the Food and Drug Administration more than a century to grow into a massive, expensive, wasteful, inflexible, ineffective, distant and indifferent bureaucracy. It now violates a founding principle of the practice of medicine: "First, do no harm."

The FDA does a lot of harm, every day. Why do we allow that?

The FDA has kept some unsafe or ineffective drugs off the market (although a consortium of independent research organizations could have done the same thing). But at what cost? We can summarize in ten ways how the FDA threatens or does real harm to our health:

1. The FDA adds billions to the development cost and price of new drugs.

2. The FDA delays the availability of new drugs for years.

3. The FDA prohibits the use of new drugs that treat conditions for which other drugs are available, regardless of how much better they might work for some patients.

4. The FDA withholds new drugs—even those that passed initial safety tests—from terminally ill patients, in the name of preserving safety. When one of these patients wins access to the drugs by going to court, the FDA, apparently in a relentless effort to protect the health of the dead, appeals the ruling until the patient dies, at which time the appeal is of course dismissed.

5. The FDA and Congress allow the drug approval process to be politicized to protect the interests of firms with political pull or to serve the anti-corporate political agenda of those who would rather see Americans die than allow any investors or businesses to make money developing new medications.

6. The FDA suppresses off-label use of drugs with proven ability to treat other conditions and restricts the circulation of information about such successful off-label use of drugs that have already been approved as safe.

7. The FDA actively seeks to extend the authority it so ineptly applies to drugs—and for which it asserts to have insufficient staff—to controlling all vitamins and food supplements. Whenever the reach of the FDA exceeds its grasp, it always tries to extend its reach.

8. The FDA constitutes a roadblock to new developments in anti-aging drugs by refusing to consider any science that would extend healthy lifespans—because "aging is not a disease."

9. The FDA states that it lacks the resources to ensure human drug safety but requests more resources to review veterinary medicine.

10. The FDA now publishes lists of drugs it approved but the safety of which it questions—leaving physicians in the lurch and creating a potential jackpot for litigation.

The FDA adds billions of dollars to the cost of developing new drugs and delays their use for years. Yet it is so obsessed with predicting exactly how each drug will perform for any patient—with any condition, in any dosage, for any length of time and in any combination with any other drug or combination of drugs in any dosage—that it often loses sight of safety. So a few years ago the FDA proposed the creation of a new "Drug Safety Board" to provide for drug safety. One would have thought that was the purpose of the whole agency.

That hypocrisy is consistent with the history of the agency. Every failure to fulfill its purpose is met with a review or a study by another government-related organization hired by the FDA to make recommendations. The recommendations are always the same: more staff, more budget, more authority, more buildings, more office furniture and more regulations.

If we want the tremendous progress in the development of medications in recent years to continue, we must act to eliminate the awesome ability of the FDA to destroy that progress. The first steps in reform should be to direct the FDA to focus entirely on safety and allow physicians and their patients to determine efficacy. Research must be encouraged, not restricted, and information on that research must be open to all.

Richard E. Ralston is Executive Director of Americans for Free Choice in Medicine.

The Obama Health Plan Emerges

The November 20, 2008 Wall Street Journal has more analysis of the Obama health plan, including why it will lead to a government takeover of medicine. Here are a few excerpts:

The Obama Health Plan Emerges

...First, Democrats want the government to create a national insurance exchange, or marketplace, in which all comers could buy into a range of heavily regulated private policies at group rates. These private plans would then "compete" with a new public insurance option, i.e., a program managed by the government and modeled after Medicare. Lower-income earners would get subsidies to make coverage "affordable." Businesses that didn't cover their employees would pay a tax on some portion of their payroll.

... Even if Congress doubled all individual and corporate tax rates, it still wouldn't raise enough revenue to pay for Medicare and Medicaid.

The Obama-Baucus solution to this slow-motion catastrophe is to add tens of millions more people to the federal balance sheet. Because the public option will enjoy taxpayer sponsorship, it will offer generous packages to consumers that no private company could ever afford or justify. And because federal officials will run not only the new plan but also the "market" in which it "competes" with private programs -- like playing both umpire and one of the teams on the field -- they will crowd out private alternatives and gradually assume a health-care monopoly.

Many proponents of plans similar to Mr. Baucus's openly cite this as one of their goals. Eventually, the public option will import Medicare's price controls into the private sector as it tries to manage the inevitable cost overruns. When that doesn't work, Congress will deal with the problem by capping overall spending and rationing care through politics (instead of prices) -- like Canada does today.

Whether the advocates of the Democratic plan(s) open admit it or not, this is the natural logic of their ideas.

Concierge physician Dr. Steve Knope predicts the following:

...I also believe that there are enough people, limousine liberals included, who would never tolerate a Canadian system in which they would have to wait to see an overworked, governmental employee who calls himself a doctor. Even they will pay for real doctors. So I think we are destined to have an English system, in which people with means pay for good care and the rest get a diluted form of Medicare medicine. The only way that excellence will be preserved will be inside the private arena, which is why I believe our movement will grow.

(From private correspondence, quoted with his permission.)

I hope he's right. If Arizona's "Freedom of Choice in Health Care Act" (which would have guaranteed that, "No law shall interfere with a person's right to pay directly for lawful medical services") had passed, then concierge medicine would remain a viable option.

But if the federal government decides to outlaw this practice (on some supposed grounds of "equal access" or "fairness"), then we'll all suffer. Whether this happens is up to us.

Hsieh OpEd: "Asking For Trouble In Health Care"

The November 22, 2008 edition of the Colorado Springs Gazette has published my OpEd on the bailout crisis and lessons for those advocating "universal health care":

Asking For Trouble in Health Care

Paul Hsieh, M.D., Guest Columnist

In the 1990s, politicians wanted to make home ownership as universal as possible. They used laws such as the Community Reinvestment Act to force banks to make unsustainable loans to millions of people. They also expanded quasi-government agencies such as Fannie Mae and Freddie Mac to guarantee these loans.

This scheme could last only a few years. In 2008, the housing bubble finally burst and economic reality caught up with the politicians. American taxpayers were stuck with the tab for these "toxic" mortgages. The result was the Wall Street Bailout of 2008 and the worst economic crisis since the Great Depression.

In 2008, politicians want to guarantee "universal health care" with new laws and new government programs. President-elect Barack Obama wants to require health insurers to sell policies whether or not those policies are economically sustainable (for instance by requiring them to issue policies regardless of pre-existing conditions). He has also proposed creating a massive new "National Health Insurance Exchange" to help ensure "universal coverage."

But no politician can evade the laws of economic reality. Massachusetts' program of "universal coverage" requires hundreds of millions of dollars of federal money a year to stay afloat, paid for by the taxpayers of the other 49 states. If the U.S .attempted this at a national level, there would be no one to bail us out.

When Obama's proposed national system inevitably collapses under the weight of market inefficiency and bureaucratic overhead, this will merely pave the way to fully socialized single-payer health care. Health care spending now comprises one-sixth of the U.S. economy. Forcing taxpayers to pay for everyone's medical expenses would make the $700 billion Wall Street bailout look like pocket change in comparison.

Even worse, under nationalized health care the government will eventually have to ration medical services to control costs. This is already commonplace in other countries. A Canadian woman who feels a lump in her breast oftens wait months before she receives the surgery and chemotherapy she needs. In contrast, an American woman can get the treatment she needs within days.

According to The Telegraph, Great Britain's National Health Service paid bonuses to primary care physicians who reduced the numbers of referrals to hospital specialists - thus forcing those doctors to choose between their oaths to their patients or the government which pays their salaries. Whenever government attempts to guarantee a "right" to health care, it must also control it. Bureaucrats then decide who gets what health care and when, not doctors and patients.

The fundamental problem with "universal health care" is the mistaken premise that health care is a "right." Rights are freedoms of actions (such as the right to free speech), not automatic claims on goods and services that must be produced by others.

Individuals are legitimately entitled to health care that they purchase with their own money, are promised by prior contractual agreements, or are given to them via voluntary charity.

Attempting to guarantee an alleged "right" to health care must necessarily violate someone's actual rights - the rights of those compelled to pay for it. The ultimate victims will again be the taxpayers, just as they were the ultimate victims of the Wall Street bailout.

Instead of universal health care, we need free market reforms that reduce costs, reward individual responsibility, and respect individual rights. Some examples include eliminating mandatory insurance benefits, repealing laws that forbid purchasing health insurance across state lines, and allowing individuals to use Health Savings Accounts for routine expenses and to purchase low cost, catastrophic-only insurance for major expenses. Such reforms could lower costs up to 50 percent, making health insurance available to millions who cannot currently afford it.

We can't go back in time and avoid the Wall Street Bailout of 2008. But we can still make the right decision with respect to health care. We must reject calls for "universal health care" or else we'll be faced with a massive "Health Care Bailout of 2018." The events of the past few months have taught us some important lessons about economic reality. The only question is whether we're willing to learn from them.

Hsieh, of Sedalia, is the co-founder of Freedom and Individual Rights in Medicine.

Happy Thanksgiving!

Regular posting will resume on Monday, December 1.

Herrick on Single-Payer Care

The November 24, 2008 Modesto Bee has printed the following OpEd by health care economist Devon Herrick:

Most Americans want freedom to make health care decisions

As a new Congress begins to look at health-care insurance options, some of the members are discussing proposals for a single-payer, universal health-care plan.

That's not the best solution. Senators and representatives would be much better off focusing on health-care solutions that effectively bring down health-care costs, expand access to quality care, and reward patients for shopping around.

Advocates of single-payer health plans want the U.S. government to be the only entity that pays for health care: With Uncle Sam picking up the tab, proponents predict health-care spending would be reduced, administrative burdens would be eliminated, and doctors would be free to practice as they wish.

Do they really believe that adding another major program to the federal government would actually eliminate administrative headaches and make it easier for doctors? We need only to look to our neighbors to the north, in Canada, for a clear view of what we could expect under a single-payer system.

The biggest problem is the wait -- for office visits, diagnostic tests, lab work, even surgeries.

There are only so many doctors and so much medical equipment in Canada. That means that most patients can't get the help they need when they need it. At any given time, nearly 750,000 Canadians are waiting for a medical procedure. According to a report by the Commonwealth Fund, 42 percent of Canadians with chronic illnesses said they had to wait more than two months to see a specialist.

Another major problem faced by those in a single-payer system is the health risk that is faced by participants.

A recent study by the Fraser Institute indicates that much of the health technology in Canada is aging and outdated. Such equipment has a higher risk of failing, may be less accurate, and may not provide the most up-to-date medical readings.

As consumers, we want is health care that is reasonably priced, of high quality and that is convenient -- without having to wait months on end for needed surgery.

Many of us have had experiences with limited access to health care — through HMOs. Such plans tried to control health costs by controlling which doctors patients could see, limiting the specialists that one can visit, and reducing the options that were available.

It didn't catch on because few Americans like limited health-care options. We want to make our own choices, based on what's best for our health and our wallet.

Instead of wasting time on a system that limits our choices, creates long waiting times and has the potential to jeopardize our health, the United States should opt for a system of innovation and choice.

The best reform would liberate doctors to meet patient needs in innovative ways, free patients to become smart shoppers, and allow a competitive medical marketplace to allocate resources, while raising quality and lowering cost in the process. Mandates should be avoided in favor of making more options available through consumer-driven health plans. Most such plans include the expansion of health savings accounts to encourage greater participation. Patients with health savings accounts are significantly more likely to talk to their doctor about treatment costs and options, track their health-care payouts and estimate future expenses.

So, would you rather make your own choices on medical care and cost options or delegate the quality, cost and timing of your care to the federal government?

Now is not the time to move ahead with proposals for single-payer, universal health care. Nor is next year or the year after that. Instead, Congress should act now to let American consumers, not federal bureaucrats, make their health-care decisions.

When we force medical providers to compete on price, we're all much better off.

Herrick is a senior fellow specializing in health-care economics at the free-market oriented National Center for Policy Analysis (www.ncpa.org).

Herrick's economic analysis is spot-on, and I wish more elected officials would listen to him. The serious economic problems associated with single-payer care are the predictable consequence of the fact that it violates individual rights, such as the rights of patients, providers, and insurers to contract freely in the marketplace for their mutual benefit.

Mandatory Insurance Article Now Free

Craig Biddle (publisher of the journal, The Objective Standard) has graciously agreed to make the full text of my article in the Fall 2008 issue on the dangers of mandatory health insurance available for free, to subscribers and non-subscribers alike.

The full article can now be found at:

"Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America"

This issue is heating up much faster than I expected.

Senator Max Baucus, a powerful Democrat, has just proposed adopting the Massachusetts plan on a national scale:

"Healthcare reform gets backing in Congress"

Even more ominously, insurance companies have agreed to support this idea, saying that they'll accept new government regulations in exchange for the federal government requiring all citizens to purchase health insurance:

"Insurers make pitch for health coverage mandate"

President-elect Obama has pledged to make universal health care one of the highest priorities of his new administration.

If we don't want to go down this dangerous path, we'll have to speak out in opposition to this bad idea.

Hence, please feel free to link to this article and/or send it to friends, coworkers, elected officials, and anyone else who might make a difference. A few active minds in the right places could make more difference than you think. And it's your future health care at stake:

"Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America"

Sooner State Says "Later" to Mandatory Insurance

The November 21, 2008 Oklahoman reported that Oklahoma state insurance commissioner Kim Holland wanted to use the power of government to force citizens to purchase health insurance, but she recognized that it might be difficult to pass a Massachusetts-style law. So she proposed an alternate method of mandating health insurance:

Barring a law requiring the purchase of health insurance, which Holland concedes would be a political long shot, "inducements" that penalize those who fail to insure themselves would help, she said.

Among the possible inducements Holland proposed was forfeiture of football season tickets to University of Oklahoma or Oklahoma State University games, forfeiture of lottery or gaming winnings, loss of state income tax deductions or licenses to drive, hunt or fish.

"None of those are very pleasant, but there needs to be a consequence," Holland said.

Oklahomans were justifiably outraged at the possibility of forced to give up their football tickets, and the let her know. As the November 22, 2008 Oklahoman reported, she quickly had to backpedal, saying she was just kidding:

Holland said the idea of a football ticket takeaway is impractical, unenforceable, and wasn't meant to be taken seriously.

"It was one small part of a larger discussion, and it was generally in jest," Holland said of the ticket takeaway concept.

I'm glad that residents of the Sooner state were willing to stand up for their rights, when their football tickets were threatened.

I hope the rest of the country responds as strongly when Senator Max Baucus tries to impose the Massachusetts plan on the entire United States.

(Via Morality War.)

Insurers Asking To Be Socialized

Brian Schwartz has alerted us to the following story in the November 19, 2008 Denver Post:

Insurers make pitch for health coverage mandate

The health insurance industry said Wednesday it will support a national health care overhaul that requires them to accept all customers, regardless of pre-existing medical conditions—but in return it wants lawmakers to mandate that everyone buy coverage.

Of course, these companies would stand to make money in the short term if everyone were required to buy their policies. But once the costs leap out of control, the government will start imposing rationing, clamping down on payments to insurers as well as services covered.

As Grace-Marie Turner of the Galen Institute predicts, this will then destroy private insurance and leave us with no alternative except a "single-payer" (i.e., government-run) medical system.

In his essay "Health Care is Not a Right", Dr. Leonard Peikoff uses the following analogy of the haircut to illustrate this point:

Take the simplest case: you are born with a moral right to hair care, let us say, provided by a loving government free of charge to all who want or need it. What would happen under such a moral theory?

Haircuts are free, like the air we breathe, so some people show up every day for an expensive new styling, the government pays out more and more, barbers revel in their huge new incomes, and the profession starts to grow ravenously, bald men start to come in droves for free hair implantations, a school of fancy, specialized eyebrow pluckers develops -- it's all free, the government pays. The dishonest barbers are having a field day, of course -- but so are the honest ones; they are working and spending like mad, trying to give every customer his heart's desire, which is a millionaire's worth of special hair care and services -- the government starts to scream, the budget is out of control.

Suddenly directives erupt: we must limit the number of barbers, we must limit the time spent on haircuts, we must limit the permissible type of hair styles; bureaucrats begin to split hairs about how many hairs a barber should be allowed to split.

A new computerized office of records filled with inspectors and red tape shoots up; some barbers, it seems, are still getting too rich, they must be getting more than their fair share of the national hair, so barbers have to start applying for Certificates of Need in order to buy razors, while peer review boards are established to assess every stylist's work, both the dishonest and the overly honest alike, to make sure that no one is too bad or too good or too busy or too unbusy. Etc.

In the end, there are lines of wretched customers waiting for their chance to be routinely scalped by bored, hog-tied haircutters some of whom remember dreamily the old days when somehow everything was so much better.

Do you think the situation would be improved by having hair-care cooperatives organized by the government? -- having them engage in managed competition, managed by the government, in order to buy haircut insurance from companies controlled by the government?

If this is what would happen under government-managed hair care, what else can possibly happen -- it is already starting to happen -- under the idea of health care as a right?

Whether the insurers realize it or not, they're committing slow suicide, and threatening to take the rest of us down with them.

Whether we let them is up to us...

Which Obama Will We Get On Health Care?

David Catron explains why President Obama will inevitably be pushed towards proposing single-payer health care.

Kennedy Jumps In

The November 18, 2008 Washington Post reports that Senator Ted Kennedy will be proposing his own form of "universal health care" soon.

The Wall Street Journal also notes that some observers expect that the current financial crisis "will be a big barrier" to any such plans -- a slender silver lining to the economic mess.

And this may be a good time to also revisit Dr. Richard Parker's essay, "Ted Kennedy vs. Universal Healthcare: A Double Irony".

Reverse Capitalism in Massachusetts

Massachusetts government regulators will impose tough new restrictions on hospitals attempting to provide build more outpatient clinics to compete with existing facilities. The claim is that these new centers will drive up costs by "duplicating services". Hence, government restriction of patient choice is essential in order to keep costs down for their "universal health care" system.

I don't have a PhD in economics. But I notice that prices keep going down down whenever there are multiple restaurants or grocery stores in the same area engaging in this sort of "wasteful duplication". And customer service improves.

Perhaps there's a word for this sort of government restriction of vital services to control costs in the name of "fairness" that begins with an "R" and ends with "ationing". But I'm not an economist, so I'm not sure what it might be...

(Via Jared S.)

More Massachusetts Madness For Montana Max

Senator Max Baucus (D-Montana) will propose a "universal health care" plan which is basically a nation-wide version of the failed Massachusetts plan.

The Baucus plan does include an individual insurance mandate (unlike the Obama plan, which does not, although President-elect Obama has stated that, "he could support a mandate if the system proves impossible without one".)

In Massachusetts, the approach of individual mandates, employer mandates, benefit mandates, a state-run "insurance exchange", and state-subsidies has merely led to skyrocketing costs and long waiting lists. Individuals, insurers, and providers are prohibited from negotiating in the free market to their mutual benefit, but are instead forced to act against their own rational judgment and instead follow the state's requirements for health care and health financing. The bad economic consequences are a predictable outcome of this violation of the fundamental right to contract.

Adopting the Massachusetts plan at the national level would only multiply these problems 50-fold.

One definition of madness is, "Trying the same thing over and over again, but expecting different results". If that's the case, perhaps we should refer to this as the "Mad Max" plan...

Colorado Hospital Association and Universal Coverage

The American Hospital Association (AHA) will be pursuing "universal health care" in 2009, and according to my sources the Colorado Hospital Association (CHA) is reportedly in agreement with this agenda.

One of the basic principles espoused by the AHA is "Health Coverage For All, Paid For By All" -- a very collectivist slogan reminiscent of the Marxist dictum, "To each according to his need, from each according to his ability."

To accomplish this goal, the AHA advocates the following:

Every individual must have and contribute to the cost of health care coverage

Every employer must take responsibility for providing health care coverage for their employees and contribute to the cost

Every insurer must guarantee access to coverage that is affordable, gives consumers the protection they need, and delivers value

Governments must maintain their current responsibility forcoverage for seniors, disabled and certain low income people

Collective financing will be needed

These goals will dovetail nicely with what we know about President-elect Obama's health care plan, which includes the following:

Mandated insurance for children

State subsidies for those families who don't qualify for other government programs (such as Medicaid or SCHIP)

Mandates on employers to provide a "meaningful share" of employees health insurance premiums (or else pay a special fee to the government for the government plan)

Expansion of SCHIP and Medicaid government programs, "for the children"

Creating a National Health Insurance Exchange to serve as a clearinghouse where people could purchase government-approved plans

New restrictions on insurers so that they could not exclude applicants based on pre-existing conditions

The Obama plan has many similarities to the ill-fated Massachusetts plan, except for not imposing an individual insurance mandate on everyone. Massaschusetts imposes this mandate on all adults, whereas Obama's plan would only impose it on children. For more on the problems in Massachusetts, see some of our earlier posts.

We'll be hearing much more about both the AHA proposals and the Obama plan in the near future. For now, I just wanted to alert FIRM readers that these issues may be arising at both the state and national levels here in Colorado.

Stay tuned!...

Montgomery on Moore's "Sicko"

Colorado blogger Jeff Montgomery has recently written a detailed review of Michael Moore's 2007 movie, "Sicko". Given that "universal health care" has taken on new life in the aftermath of election 2008, I thought it would be good to revisit this topic.

He has graciously given me permission to repost his review here in its entirety:

Comments On Moore's Sicko

For a long time I was not going to watch this movie. I held out for a year, after all. However, I know various people in health care, so I agreed to watch it so I could discuss it with them.

Silly me.

The good news is, especially if you are an Objectivist or other type of classical liberal or advocate of individualism, and you haven't seen it already then you don't need to. Save an hour and 58 minutes of your life for something more valuable. It was a chore.

Before I criticize, I have to say that in a very limited context, Moore succeeded on an emotional level. The limited context is that of evoking sympathy for the people in the film and their situation, and in picking attractive aspects of other countries' medical systems to portray. Who cannot feel sympathy for the medical cases portrayed in the film? And taken out of context, it certainly is a pleasant thought to not have to worry about paying for medical care, isn't it? I'm sure other countries have nice hospitals and nice doctors too. Certain other aspects of the quality of life in France, Canada and Great Britain are also attractive: the long vacations, the good schools... the baked goods. After one such sequence of happy people, Moore cuts back to a scene in the U.S. where a confused hospital patient is intentionally dropped off by an ambulance on the street near a city mission. Ouch.

However, it is precisely that limited context that prevents Sicko from succeeding as documentary or political commentary. You can't comment on a society that you don't investigate. Moore is content to show scenes from everyday life, but never delves into the full context of history or the causal workings of government and the economy. He wishes to suggest that the horror stories he shows are the result of "free market" medicine, but he doesn't investigate causes, so he can't do that. Anecdotal evidence is only as good as the theory it supports, and in the case of Sicko, there is no theory.

Well, there is the usual half-hearted stab at greed, but that falls flat like it always does. He doesn't investigate the nature and extent of government involvement in medicine, or compare countries by that standard, and he doesn't touch on economic theory or even the simplest moral implications of the universal health coverage he pines for.

To Moore, society is a metaphysically divided realm, with helpless citizens on the inside, and the incomprehensible machinations of politics and markets on the outside (the noumenal world of politics?). According to the film, what should matter to the average citizen is what's right in front of us, and nothing more; it is a world without causality, where medical care administered through a slot in a prison door would be identical to medical care in a hospital, because either way it magically shows up. The same inattention to causality regarding the source of care also prevents Moore from seeing the causal relations in the wider phenomenon of health care in society in general. Therefore it fails dismally as real political commentary.

Morally speaking, if your world is made of little more than what appears in front of you, you must advocate altruism, the idea that human beings live to serve one another. That is the only way to keep goods and services magically appearing in front of you without considering where they came from; you must harness others to do it for you. It is not something Moore explicitly explores, it is simply assumed to be true. There is not even one second of reflection in the entire film about whether it is right to use others for such purposes. That is a particularly vicious omission, because it means you, the viewer, have been tried and sentenced to serve, with absolutely no chance to speak in the matter. It is assumed you are to be a slave.

There is one more issue I'd like to mention, and that is the general portrayal of America's health care system. The thesis of the film is that in our country, many are left without important medical care, lives are being ruined, lives are being lost, and we have to just do whatever will fix it, period. I don't doubt that plenty of unpleasant things happen. However, the reason for it is simple: we are neither free enough to provide a wide range of affordable, quality medical services, nor socialist enough to provide care for anyone regardless of their condition or ability to pay. The patients Moore highlights are the ones who drop through that gap in coverage.

However, the solution is not to fully socialize medicine, and Moore has not demonstrated anything of the kind because his narrow focus has prevented such analysis. The solution is to undo the controls on the allegedly free medical and insurance industries so they can provide the best products, just like any industry. As always, the solution is thought, and the freedom to act on it.

Bailing Out Maine

Maine governor John Baldacci will ask President-elect Obama to bail out the state's failing Dirigo "universal health care" system with federal Medicaid money.

If universal care is adopted at the national level, who will bail out the US?

(Via State House Call.)

Who Broke Health Care?

Richard Ralston, executive director of Americans for Free Choice in Medicine asks this question in his latest OpEd:

Who Broke Health Care?
by Richard E. Ralston

Many politicians now tell us that health care in America is "broken."

The best initial response to that is to ask yourself whether you think that your own health care is broken. And if it is, do you want to turn your decisions about your own health over to politicians who claim they can fix health insurance? Or, if you are generally satisfied with your health care, do you want politicians to take your current care away and replace it with a uniform government system? That is what they want to do, whether you think your own health care is broken or not.

More generally, we all need to ask why politicians assert that American health care is broken, and what agenda does it serve. We should ask, if health care is broken, who broke it and how did they break it?

Health care was much more affordable in the 1960s. The government paid for less than 10 percent of all health care. Then the federal government created Medicare and Medicaid and wrote 130,000 pages of Medicare regulations. Now the government pays for 50 percent of all health care.

Has that fixed health care, or broken it?

In the same period, state regulation of medical insurance rapidly expanded, adding many coverage mandates that each policy must comply with. In some states you have to buy coverage for electric shock therapy, or in vitro fertilization, or acupuncture, or chiropractic, or hairpieces, or a social worker, or a marriage counselor, or a long list of other things, whether you want such coverage or not. And new mandates are added all the time, driving up insurance costs every year. Moreover, you are not allowed to buy better priced insurance from a competing provider in another state.

Has that fixed health care, or broken it?

The government could easily make reforms that would reduce the cost of insurance without any additional spending: Basic policies without mandates. Tax deductible premiums. Competition between insurance companies across state lines.

Why is it, then, that the more government controls health care in order to fix it, the more expensive health care invariably becomes?

Politicians who broke health care and now complain that it is broken do not want people to be able to afford reasonable insurance. They see that as an obstacle in their path to eliminate all private insurance. They are not in favor of fixing anything, but of making us all dependent on the favor of politicians for our health and well being.

State legislators and members of Congress have destroyed objective law and created a litigation system that is designed not to justly compensate those who have been harmed by medical mistakes, but to create a gigantic and perpetual financial bonanza for a small number of trial lawyers. Liability insurance premiums have exploded and increased the cost of all health care for everyone -- as has the "defensive" medicine of unnecessary tests and procedures that physicians have had to adopt to protect themselves from such legal extortion.

Has that fixed health care, or broken it?

When confronted with claims that health care is broken from the politicians who broke it, the last thing we should do is give them additional powers to break it further. Instead, we need to direct them to reverse the damage they have done, to stop forbidding the options that would make insurance affordable and to start leaving our health care alone.

Richard E. Ralston is Executive Director of Americans for Free Choice in Medicine

Obama's Plan to End Private Health Insurance

Grace-Marie Turner of the Galen Institute makes the case that the Obama plan will end private health insurance as we know it. Here are excerpts from her article:

Obama's Plan to End Private Health Insurance

...ObamaCare would create a new National Health Insurance Exchange (NHIE), which would function as a 50-state clearinghouse in which people could connect with insurers. Through the NHIE, participants would be able to purchase private coverage or buy into a new federal insurance program.

On the surface, this arrangement seems fair. But Obama would also stipulate what type of coverage the private plans had to offer. In other words, the federal government would heavily regulate the cost and content of private health insurance, albeit indirectly.

..."Guaranteed-issue" statutes require insurers to accept all applicants regardless of their health status, and "community-rating" requirements prohibit insurers from pricing their premiums according to expected risk. Both regulations make health insurance significantly more expensive.

If people know they can get insurance at a fixed price regardless of their health status, they have an incentive to buy the policy only after they've gotten sick and need medical care. It's no coincidence that the six states with guaranteed-issue laws have the six highest average premium prices. Of those six states, the three that also have community-rating laws—Massachusetts, New York, and New Jersey—have average annual family premiums that are roughly double the national average.

Nevertheless, Obama supports nationwide guaranteed-issue and community-rating laws. He has pledged that "no American will be turned away from any insurance plan because of illness or pre-existing conditions." He might as well pledge to double everyone's insurance rates.

Under ObamaCare, public insurance programs and their private competitors would likely be subject to the same rules regarding benefits and underwriting. But public programs would be supported by a constant stream of tax dollars. They could undercut premiums and offer generous benefits that would bankrupt private insurers—and then cover the losses by drawing on taxpayer subsidies. In other words, the federal government would have the ability to drive up the cost of private health insurance while keeping its own insurance program artificially cheap.

If the Obama plan were implemented, Americans would naturally flock to the new public insurance program. Advocates of government-run healthcare would claim "victory" and demand an expansion of it. Slowly but surely, private insurers would be supplanted by the public program.

Once private insurers are driven out of the market by unfair competition from the government plan, Americans will then be left with a defacto single-payer system -- something President-elect Obama has already said would be his first choice for a health care system.

Americans may wish to recall either the metaphor of the frog in the boiling water or the similar parable of "catching the wild pigs":

[In a classroom discussion a student asks his professor,] 'Do you know how to catch wild pigs?' The professor thought it was a joke and asked for the punch line. The young man said this was no joke. 'You catch wild pigs by finding a suitable place in the woods and putting corn on the ground. The pigs find it and begin to come every day to eat the free corn. When they are used to coming every day, you put a fence down one side of the place where they are used to coming. When they get used to the fence, they begin to eat the corn again and you put up another side of the fence. They get used to that and start to eat again.

You continue until you have all four sides of the fence up with a gate in the last side. The pigs, who are used to the free corn, start to come through the gate to eat; you slam the gate on them and catch the whole herd. Suddenly the wild pigs have lost their freedom. They run around and around inside the fence, but they are caught.

Soon they go back to eating the free corn. They are so used to it that they have forgotten how to forage in the woods for themselves, so they accept their captivity.

The young man then told the professor that is exactly what he sees happening to America. The government keeps pushing us toward socialism and keeps spreading the free corn out in the form of programs such as supplemental income, tax credit for unearned income, tobacco subsidies, dairy subsidies, payments not to plant crops (CRP), welfare, medicine, drugs, etc. While we continually lose our freedoms -- just a little at a time.

Top 10 Myths of Health Care

Patient Power has alerted us to Sally Pipes' new book on the top 10 myths of American health care:

Myth One: Government Health Care Is More Efficient
Myth Two: We're Spending Too Much on Health Care
Myth Three: Forty-Six Million Americans Can't Get Health Care
Myth Four: High Drug Prices Drive Up Health Care Costs
Myth Five: Importing Drugs Would Reduce Health Care Costs
Myth Six: Universal Coverage Can Be Achieved by Forcing Everyone to Buy Insurance
Myth Seven: Government Prevention Programs Reduce Health Care Costs
Myth Eight: We Need More Government to Insure Poor Americans
Myth Nine: Health Information Technology Is a Silver Bullet for Reducing Costs
Myth Ten: Government-Run Health Care Systems in Other Countries are Better and Cheaper than America's
Solutions: Markets, Consumer Choice, and Innovation

The full PDF version of her book is available here for free!

A Few Updates

It looks like Arizona's Proposition 101 (Freedom of Choice in Health Care) just barely failed, 49.9% to 50.1%. (Via Patient Power.)

The UK may start allowing patients to use their own money to purchase small amounts of extra private medical care, without automatically forfeiting their government NHS medical care. (Via RS.)

Canadian patients are facing waits of up to 5 years for government-run sleep apnea testing. Canadian medical guidelines call for a maximum of two to six months for this disorder. (Via DS.)

Mayfield on End Of Life Decisions

Dr. Douglas Mayfield, an anesthesiologist, has submitted the following guest blog post on end-of-life decision making. If you wish for your individual rights be respected by the legal system, you may find his advice helpful:

I am an anesthesiologist. I give anesthetics so that patients will be unaware during painful procedures. Recently, I encountered the following cases.

A 102 year old woman who is comatose and requires a machine to breathe for her. Her heart, kidneys, and liver are failing. Her son, 77, demands that we ‘do everything’ to keep his mother alive.

Because her heart rate is less than 40, a cardiologist will put in a pacemaker to make her heart to beat faster. I will give drugs to combat any deterioration in her vital signs.

A 94 year old man who requires care 24/7 and cannot eat or speak. If you simply step to his bed side, he cowers and screams in fear and will not stop until you leave.

Because a tube to his stomach (bypassing chewing and swallowing) is plugged, a gastroenterologist will replace it. His family has given consent. I will give small doses of medication to block his awareness of the procedure.

Whatever your beliefs, you know that your life will end. As human beings living and enjoying life, we don’t dwell on death, but it will come. When it does, do you want to be in a situation like those above?

Once I can no longer think, I don’t wish to be kept alive. What your beliefs might be, I don’t know, but I suggest you think about it and take steps to give your decisions the force of law.

Don’t force your loved ones, who care about you, to decide what will happen when your health deteriorates.

What steps do I suggest you take?

1) Create a living will. Leave copies with a family member or a legal advisor, as well in a safe place of your own.

2) Purchase a long term care policy. For mine, I pay $1800 per year. It can yield $4000 per month if I am unable to care for myself. The rate is low because I cannot receive benefits for several years and because I bought the policy years ago. If you want more information, you might discuss long term care with a medical professional whom you trust.

Regarding your living will, be specific. Under what circumstances do you not want to be kept alive? Perhaps you wish no extraordinary steps to be taken. But whatever you believe, make your own decision now.

Why do I mention a long term care policy? Because the cost of caring for the patients above, and for thousands, perhaps millions, of people like them all across this country, is paid by Medicare or other government programs.

I encounter such cases often and I don’t want the end of my life to be paid for by other people’s hard earned money. If you don’t want this, or something similar, to happen to you, take reasonable steps now to make sure that it does not.

If you have any comments or question, you can reach Dr. Mayfield directly at: mayfwriter@aol.com