Thursday, April 30, 2009

Killing Private Health Insurance

US Rep. Jan Schakowsky (D-IL) has openly stated that the goal of "health care reform" is to kill off the private health insurance sector and replace it with a "single payer" system:

As the sympathetic leftist website People's Weekly World reports:
Rep. Jan Schakowsky (D-Ill.) and co-sponsor of HR-676 answered criticisms from single-payer advocates. She said the public option is not a compromise, but a strategic step toward the single-payer system and the elimination of the private insurance industry.

The private sector is united in opposing any legislation that would expand publicly funded health care over and against the virtual monopoly of insurance companies.

The public option is simply the opening salvo against the private sector, Schakowsky and other speakers said.
(Via Verum Serum and Hot Air.)

Wednesday, April 29, 2009

Knope: Bernie Madoff for Health Czar

Dr. Steven Knope has penned another OpEd on our current unsustainable system of government-managed health care. Here are some excerpts, but read the whole thing:
Bernie Madoff for Health Czar

...As I mentioned in my first healthcare letter, we do not have the money to pay for our current nationalized healthcare experiments, which we call Medicare and Medicaid. To open yet another financial wound, we do not have the money to fund Social Security over the next 30 years. So before you buy something expensive, it would seem wise to ask if you can afford to maintain it. The unfunded liabilities for Medicare and Medicaid alone have been estimated at $47-trillion dollars. This is the cost of insuring 30-million Americans. We do not have enough money for these existing programs, much less to expand these services to cover the lives of 304 million Americans.

What I am telling you is that Medicare and Medicaid will run out of money. The system will go bankrupt. It will be like AIG, which was "too big to fail", but which has failed despite pouring billions into it. People in my generation, and those younger, are "investing" in a Medicare system which promises to pay big dividends in healthcare dollars during our retirement. However, the politicians running the plan understand that this is a fiscal impossibility. It is dishonest. That money will not be there for us. It will be all used up by the time we reach age 65. The reason is that there will not be enough young workers to fund the Medicare system and keep it going for the aging baby boomers. Does this scenario sound familiar to you? Have you recently read about other people who have set up scams like this? You guessed it. Medicare is a Ponzi scheme.

...So why is a doctor like me engaging in "politics" or going on a rant about the healthcare dollar? Because money is a necessary part of the discussion! When you try to buy something on a credit plan that you can't afford, it is only a matter of time before that something is repossessed. Before we scrap private healthcare and open another credit card for nationalized healthcare, we should think about what we will do when we can't afford the payments. The answer is that people won't get the medical care they need, which is what happens in Canada. In all seriousness, I'd start putting away some extra cash in the bank for the day when Bernie Madoff or his sons reject your request for an MRI of the brain. You'll need that extra money to travel to Dubai for your MRI or your knee replacement - to purchase quality healthcare in a free-market system that is not dominated by a government rationing panel.
(Read the rest here.)

For more advice from Dr. Knope on how protect yourself from the upcoming fiasco of "universal" Obama-Care, read this post.

Tuesday, April 28, 2009

Slowing The Push Towards Fast-Tracking

Democrats in Congress are getting close to a deal which would allow them to "fast track" their plans for government-run "universal health care".

As former US Senator John Sununu notes in the April 27, 2009 Wall Street Journal, this would allow a bare miniumum of senators to impose "National Health Care With 51 Votes".

Part of the Congress' apparent urgency on this issue is that they may believe that momentum is slipping away from them unless they strike quickly. The Tea Party protests have galvanized many Americans against further government takeovers of the economy. And David Catron notes that public support is shrinking for "universal health care".

And as we've noted, most Americans are pretty happy with their current health care. But they are legitimately concerned about rising costs. And they've also been led (or misled) to believe that everyone else is having problems (thus justifying more government intervention).

All of these signs indicate that free market reforms might receive a fair hearing -- if Congress decides that it wants to take a deep breath, not rush headlong into creating any new massive government programs, and have a open honest discussion about the kinds of reforms we actually need to correct our current problems.

Americans have already been burnt by the Congressional rush to pass the "stimulus" bill -- which many legislators now acknowledge that they didn't even read before voting for it. Congress should not make the same mistake by rushing to pass "universal health care" legislation.

Our friend Hannah Krenning and my wife Diana Hsieh have sent the following letters to our Colorado Senators Michael Bennet and Mark Udall:
Dear Senators Bennet and Udall,

I have read the recent Reuters article and want to register my vehement objection to this underhanded approach to the debate on health care. I do not want government involvement in my health care decisions. I want a free-market approach to medicine.

Creating new government tentacles to surround my physical well-being and doing so in a way that "rams" it through (Reuters words, not mine) betrays the unprecedented power-lust present in Washington these days. Your participation in this "deal" would be a gross betrayal of your constituents and the Constitution. I hope you will find the conscience and backbone to resist participation.

Hannah Krening
Larkspur, Colorado

Dear Senators,

I am writing to express my dismay over the prospect that some kind of socialized medicine (like mandatory, universal coverage insurance) will be imposed on America by "fast-tracking" health care reform. It is grossly irresponsible for the legislature to take such drastic action without proper debate and discussion. We've already seen too many frantic attempts to do something quick -- anything, no matter how irresponsible -- over the past few months. It's time for the legislature to slow down -- preferably before you grind the economy to a halt.

You might have won an election, but you have no right to dispose of anyone else's life, health, and wealth. For you to attempt to ram socialized medicine down our throats -- without so much as offering Americans the chance to form and express their opinions on the matter -- is morally wrong. It's also a sign that your position is weak -- that you cannot persuade Americans of the merits of your views by any rational appeal to facts. Indeed, you have reason to worry: socialized medicine in any form is always disaster.

I do not want any government involvement in my health care. I do not wish my life and health to be subject to the whims of government bureaucrats. I support the elimination of the whole horrid web of entitlements and controls that are strangling medicine while driving up costs. The free market has not failed: your government controls have failed. Repeal them -- and restore the doctor-patient relationship to its properly private sphere.

Diana Hsieh
Sedalia, CO
(Disclaimer: FIRM is non-partisan and does not support either the Democratic or Republican parties. FIRM does support free market health care reforms.)

Monday, April 27, 2009

Goodman: A Prescription for American Health Care

The March 2009 issue of Imprimis features an article by John Goodman on the future of American health care. The economic picture he paints is pretty bleak.

Here is an excerpt:
A Prescription for American Health Care

...Social Security and Medicare have been spending more than they are taking in for quite some time. As the Baby Boomers start retiring, this deficit is going to grow dramatically. In 2012, only three years from now, Social Security and Medicare will need one out of every ten general income tax dollars to make up for their combined deficits. By 2020 -- just eleven years down the road -- the federal government will need one out of every four income tax dollars to pay for these programs. By 2030, the midpoint of the Baby Boomer retirement years, it will require one of every two income tax dollars. So it is clear that the federal government will be forced either to scale back everything else it's doing in a drastic way or raise taxes dramatically.
Any form of "universal health care" will merely worsen these problems and lead to draconian rationing.

Fortunately, he also describes some free market solutions that would address these problems.

We still have time to act. The big question is whether we will have the political will to do so.

(Disclaimer: With respect to one of the solutions Goodman discusses, I do believe we should allow people to use Health Savings Accounts to pay for their future health care expenses. However, Goodman's piece is slightly ambiguous as to whether he believes this use of HSAs should be voluntary or mandatory. I believe this should be voluntary, and I hope Goodman would agree.)

Friday, April 24, 2009

Gratzer on Socialism and Cancer

David Gratzer, MD, discusses some of the flawed comparisons between health care in the US and other countries in this essay from the Winter 2009 issue of The New Atlantic, "Socialism and Cancer".

Here are a few excerpts:
...In a 2000 assessment of the world’s health systems, the World Health Organization (WHO) ranked the U.S. system thirty-seventh -- lower than even that of Colombia. In Sicko, Michael Moore’s 2007 documentary comparing health care systems, the U.S. system is portrayed as broken and cruel. A Commonwealth Fund study published in early 2008 surveyed nineteen nations in terms of preventable death and ranked the United States last.

This unrelenting stream of negativity has shaped the debate over U.S. health care reform. Consumers are souring on U.S. health care; policymakers are weighing the political and economic costs of changes to the system; and, according to one recent poll, even doctors—historically the most vocal opponents of socialized medicine—now support the idea of government-run health care.

...Ask yourself a simple question: If your daughter had a bad cough, would you call your pediatrician -- or get her on a flight to Bogota, Colombia?

While international comparisons make for good headlines and moving speeches -- Democrats, in particular, like to cite the WHO findings on the stump -- these studies are frequently quite limited and flawed. Most of the work is either highly ideological (Michael Moore's cannot withstand a basic fact-check) or confuses health with health care (the Commonwealth Fund study reflects the fact that Americans smoke more and exercise less than citizens in many other Western countries). The WHO study -- intolerant of any patient-borne expenses, heavily rewarding "equity," and focusing on smoking rates and other public health measures—suffers from both these problems of ideology and confusion. That is how it could reach the conclusion that America's health care lags behind Colombia's -- a conclusion no patient or doctor would second with his feet. (And indeed, even the WHO study had to concede that the American health care system was more responsive to citizens' expectations than any other nation's system.)
Gratzer correctly argues that one should analyze how well a country's health system does once people actually become ill, and he uses cancer diagnosis and treatment as one measure, because we have good comparative data on this set of diseases:
Of course, there is more to health care than a response to one disease -- yet, with the focus of so many governments on cancer care, with the common nature of this illness, and with the excellent statistics available, it's fair to use it as a proxy for health care performance. How does the United States fare? Excellently, two major studies suggest.

...Looking at specific cancers yields striking results: For men, the bladder cancer survival rate in the United States is 15 percent higher than the European average. With prostate cancer, the gap is even larger: 28 percent. For American women, the uterine cancer survival rate is 5 percent higher than the European average; for breast cancer, it is 14 percent higher. The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid, and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular). Lung cancer, once considered a death sentence, now has better survival rates over five years -- and Americans do better than Europeans, 16 percent versus 11 percent.
He also discusses some of the controversy over prostate cancer statistics.

He then discusses the reasons for these differences:
Why then is the United States better in overall survival? There are several contributing factors. Certainly the ability of cancer patients to get access to new medicines is helpful.

...And socialized health care systems don't just lag on cancer drugs -- new technologies, too, are less available. The problem is well illustrated by the story of Deb Maskens, a mother of two young children who suffers from kidney cancer...

Government-managed and -funded health care systems are not simply averse to new drugs and technologies. These systems are often plagued by rationing through waiting. People wait for diagnostic tests and specialist consults, delays that allow cancers to grow and spread. The diagnostic gap is well documented...
And he offers some concluding thoughts:
Government-run health care systems control costs by rationing care. In contrast, for all its flaws, the American health care system does not hesitate to spend, eager to embrace new technologies and treatments. And that’s why Americans do so much better.

...Cancer care in London or Paris may not seem relevant to Americans in Las Vegas or Providence. But in the coming years, Americans will need to think very hard about their health care system. With a Democratic-controlled Congress and White House, the forces are aligned for far greater government involvement. This does not bode well: value in health care -- as in the other five-sixths of the economy -- will come from competition and choice, not a government committee.

...That is why American health care reform demands an American-made solution, one that respects the power of markets and competition instead of putting trust in government bureaucrats.
Overall, he makes many arguments that politicians should heed.

Anyone interested in more discussion along these lines can find it in his book, "The Cure: How Capitalism Can Save American Health Care" (now in paperback.)

Thursday, April 23, 2009

Who Should Control Your Health Care?

In his April 20, 2009 essay at, Jeff Emanuel warns about the latest move by the government to wrest control of medical decision making from doctors and patients. Here's an excerpt from his article:
Who Should Control Your Health Care?

Who should have control over your medical care: your family doctor or a bureaucrat you've never met whose sole job is to look out for the government's financial bottom line?

That question is being debated in court right now, as three states are currently seeking a ruling from a federal judge that the final say in an individual's medical treatment lies with the government and not with that patient's doctor...
Read the whole thing.

The state claims that because it is paying for the care, it should have some say in how that money is spent.

If the US proceeds to adopt any sort of government-run universal health care, then this argument will become the norm -- as it already is in Great Britain and Canada.

The inevitable end result will be rationing.

This is just the latest of the many warning signs that Americans have heard about government-run health care. The critical question is whether we'll heed them before it's too late.

Wednesday, April 22, 2009

Washington Times on Rationing

The April 21, 2009 Washington Times has published their editorial warning about health care rationing under the Obama plan. Here is an excerpt:
Rationing health care

It doesn't matter what your doctor says; the Obama administration plans to decide if you will have cancer treatment or heart surgery.

Appearing on "Meet the Press" on Sunday, Lawrence H. Summers, President Obama's chief economic adviser, stated, "Whether it's tonsillectomies or hysterectomies ... procedures are done three times as frequently [in some parts of the country than others] and there's no benefit in terms of the health of the population. And by doing the right kind of cost-effectiveness, by making the right kinds of investments and protection, some experts ... estimate that we could take as much as $700 billion a year out of our health care system."

Let's be clear - Mr. Summers is talking about rationing...
They correctly note:
Nationalized health care puts bureaucrats - not doctors - in charge of deciding who needs what medical treatment. Rationing is inevitable under these schemes. That's one reason Mr. Obama's universal heath care plans must be stopped.

Tuesday, April 21, 2009

Admin: Twitter Feed

FIRM now has a Twitter account. I'll see if I can automatically mirror the blog posts onto the Twitter feed.

WSJ: When Doctors Opt Out

The April 17, 2009 Wall Street Journal published an OpEd by Dr. Marc Siegel addressing one of the biggest fallacies in the debate over universal health care, namely the conflation of "coverage" with care.

Here's an excerpt:
When Doctors Opt Out
We already know what government-run health care looks like.

Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

...More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.
Read the whole thing.

Governments can make all sorts of promises of theoretical "coverage", but that is not the same thing as delivering actual medical care. And as we've seen in countries such as Canada and the UK, the people are all "covered" but they must often wait months for medically necessary care. And in some case, the government simply denies their care.

David Hogberg summarizes this issue nicely in his OpEd in the June 9, 2007 Washington Times:
'Health care,' more or less

...Believing health care and health insurance are the same thing easily leads to some mistaken, if not dangerous, notions. It leads to the beliefs that (1) universal health care and universal health insurance are the same; and (2) that if a nation has universal health insurance, where the government pays for every citizen's health care, that nation will have universal health care, where citizens will have ready access to health care whenever they need it. As the experience of other nations shows, however, universal health insurance often leads to very restricted access to health care.
There's one final danger that also needs to be raised. If doctors continue to opt out of government-run health care, then the next logical step will be to force them to treat patients. This is inevitable logic of the mistaken notion that health care is some sort of 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 others. There is no such thing as a "right" to a car -- or a tonsillectomy.

Instead, people do have the right to seek health care from providers on mutually agreeable terms free from government interference. The government should protect that right.

Whenever government attempts to guarantee an alleged "right" to health care, it can only do so by violating the actual rights of taxpayers (who must pay for that service) and the health care providers (who must work on the governments' terms, rather than on their own terms). And that is what is fundamentally wrong about "universal health care".

Monday, April 20, 2009

Two From Pacific Research Institute

John Graham and the Pacific Research Institute have published two worthwhile health care items recently.

The first is a short paper on the problems with the proposed "government plan", entitled "Government Health Care Competition: The Audacity of Hope Against Experience".

Graham's bullet points include:
• Instead of a new government plan to compete against private health insurers, President Obama needs to remove the barriers that the government currently maintains against individual choice.

• Even the most benign government enterprise, the U.S. Postal Service, cannot compete against private couriers without a monopoly on basic letter delivery.

• By proposing to eliminate Medicare Advantage, a program that allows private insurers to compete for Medicare dollars, President Obama demonstrates that he cannot tolerate private competition against a government program.
The full paper is available here. (Note: In a fully free market, there would be no need for Medicare Advantage, because Medicare would no longer exist.)

The second item was their blog post, "Is Health Care A 'Right'? Not According to Governments Who Run Health Care".

Apparently in Canada, some provincial governments are arguing that health care is not a right, in order to protect its control over state-run medicine and to put providers of private medicine out of business. Here are a few excerpts from their post:
The advocates of government-run medicine base their claims on the notion that health care is a "right." They thus attempt to occupy the moral high ground over those who advocate reforms based on the principle of individual choice.

...[I]n British Columbia, the monopolistic provincial health plan is suing Dr. Day for allegedly receiving direct payment from patients for performing surgeries in his clinic. What makes the case remarkable is that the provincial monopolists have launched their legal attack against Dr. Day based on their new-found conviction that Canadian citizens do not, in fact, have a right to health care.

...As this episode shows, once the state takes over, the citizen hasn't got a chance. Governments are not competent to provide health care as a "right," any more than they would be competent to provide shoes as a "right." Therefore people who define their right to health care differently will have to continue to fight the state to recognize it.

How should it then be defined? When I'm speaking publicly on health reform, people sometimes ask: "Do you think that health care is a human right?" My answer is: "Yes, I believe that you have a right to spend your own money on health care of your choice, free of government interference."
(Read the rest here.)

In my opinion, this latter point is one of the most important issues in the health care debate -- namely that rights are freedoms of action, rather than automatic entitlements to goods and services that must be produced by others.

Fortunately, Dr. Leonard Peikoff makes this case with great eloquence and clarity in his essay, "Health Care Is Not A Right".

Thursday, April 16, 2009

Two NCPA Analyses Worth Reading

The National Center for Policy Analysis (NCPA) has put out a pair of Brief Analyses worth reading. Click through to each one for more information on the topics listed.

Brief No. 651, "Exposing the Myths of Universal Health Coverage"
Myth No. 1: Employer Mandates Would Make Coverage Affordable.
Myth No. 2: Insurance Costs Can Be Limited to 10 Percent of Income.
Myth No. 3: Guaranteed Issue and Community Rating of Premiums Protect Consumers.
Myth No. 4: Expanding Government Insurance Improves Access to Care.
Brief No. 652, "The Folly of Health Insurance Mandates":
Problem: Employer Mandates Are a Tax on Employees.
Problem: Employer Mandates Are Limited by Federal Law.
Problem: Individual Mandates Are Difficult to Enforce.
Problem: Individual Mandates Are Vulnerable to Special Interests.
Problem: Mandated Acceptance Raises Premiums.
Right Solution: A National Insurance Market.

Wednesday, April 15, 2009

Hard Tax on Soft Drinks?

[In honor of Tax Day, I thought this story was appropriate. -- PSH]

Politicians and would-be do-gooders are continuing to push for massive taxes on soft drinks, according to this story in the April 8, 2009 Science News:
Coming: Hard tax on soft drinks?

In a commentary released today (ahead of print) by the New England Journal of Medicine, Yale's Kelly Brownell and New York City's health commissioner, Thomas Frieden, argue that taxing sugary drinks could go a long way toward putting a brake on obesity. It won't make fat people slim. But it could slow or prevent plump consumers from ballooning into obese individuals, they argue...
Although it maybe unwise to consume too much sugar, note that Brownell and Frieden rely on collectivist arguments to justify government intervention:
Ounces of Prevention -- The Public Policy Case for Taxes on Sugared Beverages

...The contribution of unhealthful diets to health care costs is already high and is increasing -- an estimated $79 billion is spent annually for overweight and obesity alone -- and approximately half of these costs are paid by Medicare and Medicaid, at taxpayers' expense. Diet-related diseases also cost society in terms of decreased work productivity, increased absenteeism, poorer school performance, and reduced fitness on the part of military recruits, among other negative effects.
(Their full NEJM commentary can be read here.)

But as I noted in my January 7, 2009 piece in the Christian Science Monitor, "Universal healthcare and the waistline police":
...Of course healthy diet and exercise are good. But these are issues of personal -- not government -- responsibility. So long as they don't harm others, adults should have the right to eat and drink what they wish – and the corresponding responsibility to enjoy (or suffer) the consequences of their choices. Anyone who makes poor lifestyle choices should pay the price himself or rely on voluntary charity, not demand that the government pay for his choices.

Government attempts to regulate individual lifestyles are based on the claim that they must limit medical costs that would otherwise be a burden on "society." But this issue can arise only in "universal healthcare" systems where taxpayers must pay for everyone's medical expenses.
The growing political push towards universal health care and the related push towards nanny state controls are mutually reinforcing. Americans will soon have to decide who should be in control of their lives and their health -- the individual or the government. It's not just our health at stake, but our basic freedoms.

Tuesday, April 14, 2009

WSJ on the Public Plan

The April 12, 2009 Wall Street Journal has a good analysis of the implications of the proposed public plan:
The End of Private Health Insurance
When government 'competes,' guess who always wins?

Above every other health-care goal, Democrats this year want to institute a "public option" -- an insurance program financed by taxpayers, managed by government and open to everyone, much like Medicare. This new middle-class entitlement is the most important debate in Congress this year, because it really is the last stand for anything resembling private health insurance.

This public option will supposedly "compete" with private alternatives. As President Obama likes to put it, those who are happy with the insurance they have now can keep it -- and if they happen to prefer the government offering, well, gee whiz, that's the free market at work...
The WSJ identifies one extremely crucial point.

We must not let the advocates of the public plan portray this as any kind of "free market" measure. Instead, it must be explicitly identified for what it is -- government control over a major sector of economy. One can debate whether this sort of statism is more properly called fascism or socialism, but it's definitely not the free market!

The article continues:
...Under the aegis of a level playing field, all private plans will be forced to offer benefit packages similar to those in the public option. They will also be required to accept all comers, regardless of pre-existing conditions, and also be forced to offer similar rates to all enrollees, ending the ability to manage risk through underwriting. Any private plan will essentially become a public utility where government decides what products it must offer and how much it can charge.

Democrats couldn't be clearer on this point. House baron Pete Stark -- who thought HillaryCare was too moderate and has long favored Medicare for all -- said at a recent hearing that currently "We have no mechanism to directly push the private sector to do delivery system reform and address rising costs." But the public option, he added, would force private insurers to "modernize," which seems to be his term for industrial policy.
Read the rest here.

The coming government takeover of health care will make their firing of an automobile CEO seem like small change in comparison.

For additional thoughts, I highly recommend this summary by InsureBlog.

Monday, April 13, 2009

Ponnuru on Universal Coverage

The April 8, 2009 New York Times published an interesting OpEd by Ramesh Ponnuru entitled, "The Misguided Quest for Universal Coverage".

Overall, his economic analysis is good.

He notes that the magnitude of the cost-shifting caused by the uninsured has been greatly overexaggerated and that Massachusetts-style mandated insurance will simply drive up costs to benefit special interests with political "pull".

And he also correctly calls for eliminating the current employer-based system of health insurance (which only exists because of bad government tax policies giving those employer plans unfair preferential treatment.)

He also attempts to address the moral dimension as follows:
The moral case for universal coverage is that we have an obligation to see to it that the poor and the near-poor have access to good health care. But universal coverage is only one way of realizing that goal, and not necessarily the best one. For people with pre-existing health problems, for example, direct subsidies would probably be more efficient than rigging insurance markets to make sure they are covered.
In other words, he doesn't argue the case that one person should not be forced to provide another person's health care because it would be a violation of individual rights. Instead, he apparently grants the statists' premise that there is some legitmate government role in guaranteeing "access".

Although "direct subsidies" might be a good temporary intermediate step towards complete privatization of health care, it should not be part of any permanent free market reform. Instead, those who need health coverage but cannot afford it themselves should rely on private charity, as Dr. Peikoff notes in his essay, "Health Care is Not A Right".

Furthermore, if one wants to really improve access to health care, then eliminating various licensing laws that artificially restrict the supply of health care providers would be a far better approach.

Nonetheless, I'm glad that the New York Times has published Ponnuru's piece. His ideas deserve to be part of the debate.

But it also highlights the need for a more integrated economic and moral defense of free market health care reforms.

Sunday, April 12, 2009

Schwartz on Colorado HB 1293

The April 7, 2009 Boulder Daily Camera has published Brian Schwartz's commentary on HB 1293:
Prepare For More Expensive Medical Insurance

The Senate Finance Committee has approved Colorado House Bill 1293. The Denver Post claims that this bill would reduce your insurance premiums. Not so. They will increase.

The Post claims HB 1293 would "increase the number of those covered by government insurance and thereby reduce cost-shifting" from the uninsured and under-insured. Sure, this cost-shifting increases premiums costs. But the cost-shift from those with government insurance far exceeds that from the uninsured.

In Colorado, the cost-shift from the uninsured increases annual premiums by $85 per insured Colorado resident. For the data behind this, search on-line for "uninsured cost-shift scam." Compare this to Medicare and Medicaid: Bloomberg recently reported that "Medicare and Medicaid increase the annual cost of covering a family of four by $1,788." As if the taxes we must pay to fund Medicare and Medicaid weren't enough.

If politicians want more affordable insurance they should repeal prohibitions that make it so expensive. For example, HB 1256 would allow Coloradans to buy insurance available in other states. In four states average annual premiums for individual plans cost $500 less than in Colorado. For family plans the potential savings increases to $1,000 in five states, according to America's Health Insurance Plans.

Government-controlled health care in the U.S. is a disease masquerading as its own cure.

Brian T. Schwartz
Thank you, Brian!

Friday, April 10, 2009

Rhoads on "Comparative Effectiveness Research"

Jared Rhoads, director of the Lucidicus Project, has written another excellent OpEd, this time on the dangers of "comparative effectiveness research". This is an important part of President Obama's intended health care "reform", and is yet another method by which the government will control how physicians practice medicine.

Here is his piece in its entirety, reposted with his permission:
It's not about "effectiveness"
By Jared M. Rhoads

Last month, President Obama signed into law the American Recovery and Reinvestment Act, a piece of legislation intended to stimulate the economy by "laying the groundwork" for recovery with smart investments in infrastructure, jobs, and research. Among the many provisions for healthcare, the act sets aside $1.1 billion for government research to determine which treatments, drugs, and technologies are the most effective in preventing, diagnosing, and treating various conditions and disorders.[1]

From a strictly medical perspective, this type of research is intriguing because the precise risks and benefits of many treatment options are unclear, and often it is not understood why some therapies work for some patients and not for others. But why is this any business of the federal government?

Supporters of the research defend the spending on the grounds that it will help to make programs such as Medicare less wasteful. Comparative effectiveness research, they say, will ensure "responsible stewardship" of the public's funds by allowing the government to pay only for what works.[2] For example, if researchers find that some cheaper alternative works just as well across a population as a more expensive treatment, then the government could change the Medicare reimbursement structure to provide an incentive for the former and a disincentive (or outright penalty) for the latter.

Interestingly, such uses of the research findings are explicitly prohibited in the text of the Act. Section 804 stipulates that the law shall not be construed to permit the Federal Coordinating Council to mandate coverage, reimbursement, or other policies for any public or private payer based on the findings of researchers.

But that will not stop the government. In due time, Congress will strike, amend, ignore, or "provide clarification" such that it will be possible for the government to use these findings to substitute the cheapest possible care for patients, Canadian-style. Guaranteed. After all, if the findings cannot be used to inform policy making, then why bother doing the research at all?

Investing taxpayer money in the name of delivering care more efficiently does not change the fact that there is no rational justification for government involvement in healthcare in the first place. If a man is robbed at gunpoint, does it make any difference how carefully and "effectively" the thief spends the loot?

The purpose of government is to protect rights, not play universal problem-solver for all manners of health and welfare needs. To even discuss the alleged merits of such research is to evade the source of the funds (confiscatory taxes) and lend credibility to those who seek to expand the reach of government into medicine.

Comparative effectiveness research sets the stage for an unprecedented increase in the government's power to control what treatments providers can prescribe and to whom. We already have a mechanism by which to determine and reward best practices: the free market. But unless the market is allowed to operate unhampered and unfettered, we will never escape the cycle of programs breeding programs.


1 H.R. 679; 111th Congress (2009): American Recovery and Reinvestment Act of 2009

2 Paduda, J. "The horrors of effectiveness research" Managed Care Matters. In his article, Paduda writes: "I'm completely disgusted with the hypocrisy of the libertarian right; those who have screamed for years about the ineffectiveness of government, ranting nonstop about how government can't do anything right, yet are now screaming even louder as government attempts to make sure they are responsible stewards of the public's funds."

Thursday, April 9, 2009

IBD on the Public Plan

The April 7, 2009 Investors Business Daily has a good OpEd explaining why the proposed "public plan" will kill the private health insurance industry.

Here's an excerpt:
...President Obama and Congress' plan to offer a government health plan would ultimately be a death warrant for private health insurance. The public must be alerted.

The findings this week of the respected Lewin Group health care consulting firm should be chilling to all Americans. "The private insurance industry might just fizzle out altogether," warned John Sheils, chief author of the study, which looked at the effects of setting up federally managed insurance.

Its premiums could be 30% below the average offered by the private market, assuming Medicare payment levels. If eligibility were only extended to small businesses, individuals and the self-employed, as the president promised in last year's campaign, enrollment in that cheaper public option would reach nearly 43 million. Insurance companies would lose 32 million customers.
FIRM is non-partisan, and I am not a Republican. But I agree with this statement from the article:
"It is not a failure of the market, but the ways the market has been distorted largely due to government policies and programs," the House GOP plan states. "They have undermined the doctor-patient relationship and removed the individual patient from the decision-making process... Layering on more government control, regulation, and 'management' cannot address the problem; it will only reduce the alternatives available to individuals and families."
If this "public plan" goes through, then this will be the inevitable end result.

Wednesday, April 8, 2009

Ralston: Federal Health Board Is Hazardous to Your Health

Richard Ralston, executive director of Americans for Free Choice in Medicine, has written an OpEd on the dangers of the proposed Federal Health Board:
Federal Health Board Is Hazardous to Your Health

By Richard E. Ralston
March 23, 2009

Nearly a century ago, the United States Federal Reserve Bank was established. The stated purpose was to eliminate boom and bust and other fluctuations in the U.S. economy. Federal government control of banking and the money supply was declared to be absolutely necessary to eliminate recessions, panics, depressions, inflation and deflation. Federal Reserve banks were set up in major cities across America under the governance of a Federal Reserve Board in Washington, D.C. It was explained that the Federal Reserve Board would be "independent." All of its "independent" members were appointed by the President with the consent of the Senate (that is, politicians). One wonders what selection process would have made them "dependent."

A century later the Federal Reserve Bank is enshrined as an eternal institution with big staffs and impressive buildings in Washington, D.C. and throughout the country. It appears to be here forever, growing ever more powerful. Politics has never been a factor in the appointment of a board member. The country has been completely free of depressions and recessions. There has never been any inflation. The buying power of our dollars always increases. They are as good as gold. Unemployment has been abolished forever.

Based on this fabulous (i.e., fictional) record, Senator Baucus, former Senator Daschle and others have proposed the creation of a Federal Health Board to govern and ration all medical care in the United States. Such a board, we are told, would be independent from political influence, because its members would be appointed by the President of the United States. It would reduce the cost of medical care and insurance while providing everyone in the United States with all of the medical care they need or want. No new medications approved by the FDA as safe and effective, no new medical devices, no new care facilities or medical and nursing schools will be allowed without the final approval of this board.

Are Americans willing to trust the government with all of their health care requirements? Should we rely on the government to make medical decisions and place our health entirely in the hands of politicians? Should we expect the government to place our needs ahead of powerful hospital groups or public employee unions? Surely we can rely on the government to insure that there are enough medical facilities in our own communities rather than in, say, the district of a powerful committee chairman? Can we expect the Federal Health Board to establish priorities based on the public interest and not their own agendas? Will some diseases become more politically correct than others?

Based on the history of public schools in providing wonderful education to our children—without any trace of ideological indoctrination or politics—shouldn't we ask the government with the help of public employee unions to take over all the medical care of our children? Based on the currently unfunded but rapidly increasing costs of Medicare and Medicaid, shouldn't we trust the government to reduce all medical costs when it takes them over and none of us have anywhere else to go?

Based on its amazingly consistent and ever more competent management of banking and the money supply for one hundred years, should we not immediately take action to create and accept the decisions of a Federal Health Board on each personal detail of our medical care? Do we still really want to allow physicians to decide which drugs to prescribe without first getting permission from the "national health care coordinator"? Based on the spotless record of the Federal Reserve and the flawless performance of public education, what could possibly go wrong with federal control of medicine?

Or should we protect the private patient-physician relationship and the right to manage our own medical care (to the extent those things still exist) and allow investment in as many improved medications and medical devices as possible?

Richard E. Ralston is Executive Director of Americans for Free Choice in Medicine
Any American who values his or her ability to receive quality medical care in the future should heed his warnings.

Tuesday, April 7, 2009

It's All About the Control

I wish this were an April 1 joke, but unfortunately it isn't.

CoyoteBlog notes that, "Government health care initiatives are not about cheaper or better care. They are about control, and increased power for government officials."

He cites two stories to illustrate his point. First, via Carpe Diem:
The state is trying to shut down a New York City doctor’s ambitious plan to treat uninsured patients for around $1,000 a year. Dr. John Muney (pictured above) offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs. His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.

"I'm trying to help uninsured people here," he said.But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan - which it claims is equivalent to an insurance policy. Muney insists it is not insurance because it doesn't cover anything that he can't do in his offices, like complicated surgery. He points out his offices do not operate 24/7 so they can’t function like emergency rooms. The state believes his plan runs afoul of the law because it promises to cover unplanned procedures - like treating a sudden ear infection - under a fixed rate. That's something only a licensed insurance company can do.

"I'm not doing an insurance business," he said. "I'm just providing my services at my place during certain hours." "If they leave me alone, I can serve thousands of patients," he said.
The second story is from the Washington Examiner:
The five plaintiffs, who now include former House Majority leader Dick Armey, are challenging a policy of the Department of Health and Human Services (DHHS) that denies Social Security benefits to anybody who refuses to enroll in Medicare.

Read that again: As the policy now stands, if you want to pay for your own health care rather than let taxpayers finance it through Medicare, government will not let you receive the Social Security benefits for which you have spent a lifetime paying taxes.

Note that nobody is trying to avoid contributing to Medicare. The plaintiffs merely want to decline the tax-funded benefits for which they already have paid. None of them want the bureaucracy, the governmental intrusions into their privacy, and the rationing of care they believe Medicare entails - so they volunteer to let taxpayers off the hook by providing their own health care coverage.

But DHHS won't let them. Or at least not if they want to receive Social Security benefits. Forfeit Medicare, says DHHS, and you must also forfeit Social Security even if you've paid for it for half a century.
In other words, the government is trying its hardest to stop individuals from using their own money to seek their own best interests through voluntary exchanges of goods and services, even if it might save the taxpayers some money.

These government policies show that it is indeed all about the control, rather than some alleged goal of promoting individuals' actual best interests.

Monday, April 6, 2009

Warnings about Obamacare

The Health Policy Consensus Group has been tracking the trends in various proposals for "universal health care" and has issued an important warning about the following elements (PDF version)) which have been floated repeatedly:
• A new government health insurance plan
• An employer "play-or-pay" mandate
• A uniform, government-defined package of benefits
• A mandate that individuals must purchase insurance
• A National Health Insurance Exchange extending federal regulatory powers over private insurance
• Federal interference in the practice of medicine through a federal health board, comparative effectiveness review, and other government intrusions into medical decision-making
Their paper discusses each point in greater detail.

I believe their economic analysis is essentially correct. The American people should know these facts.

If you're opposed to these ideas and wish to support free market health care instead, please sign the Galen petition:

Friday, April 3, 2009

Postrel on the Drug Industry

Virginia Postrel has written two superb articles on the drug industry, the risks they take in drug development, and the dangers we face as a result of government regulations on this vital industry. She also discusses the "universal health care" debate.

The first article is from the March 2009 Atlantic: "My Drug Problem":
If I lived in New Zealand, I'd be dead.

...The American health-care system may be a crazy mess, but it is the prime mover in the global ecology of medical treatment, creating the world’s biggest market for new drugs and devices. Even as we argue about whether or how our health-care system should change, most Americans take for granted our access to the best available cancer treatments—including the one that arguably saved my life.
The second is her response to reader feedback: "Defending 'My Drug Problem'".

I highly recommend reading both articles!

Thursday, April 2, 2009

Knope in New York Times

Concierge physician Dr. Steven Knope was featured in this April 2, 2009 article in the New York Times, "Doctors are Opting Out of Medicare". Here are a few excerpts:
...Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors -- often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists -- are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors' reasons: reimbursement rates are too low and paperwork too much of a hassle.
In contrast, both patients and physicians win with private "concierge medicine":
...Dr. Knope, the author of "Concierge Medicine: A New System to Get the Best Healthcare," has this kind of practice in Tucson. His patients sign a contract agreeing to pay $6,000 a year for individuals and $10,000 a year for couples. The fee covers office visits, physical exams and phone consultations, and Dr. Knope will meet patients in the emergency room, see them in the hospital and occasionally make house calls.

A list of about 500 concierge doctors throughout the country is available on Dr. Knope's Web site,

Is the care worth the money? Harold and Margret Thomas, who are in their mid-70s and live in Cincinnati, spend the winter in Tucson. After many phone calls, the couple were unable to find an internist in Tucson who took new Medicare patients, so they signed with Dr. Knope in 1996. Five years ago, when Mrs. Thomas developed a blinding headache, her husband called the doctor at 8 o'clock one night, and he, suspecting an aneurysm, insisted they get to the emergency room immediately.

The doctor met them and ordered an M.R.I. and a CT scan. The tests revealed an aneurysm, and Dr. Knope found a surgeon who quickly operated. Medicare paid for the emergency room, the surgery and the hospital stay.

"If there were a concierge practice in Cincinnati, I’d be part of it there, too," Harold Thomas said.
This is the benefit when patients and physicians are allowed to contract freely for their mutual self-interest.

Wednesday, April 1, 2009