Monday, November 30, 2009

5 Paragraphs You Must Read In Senate Health Bill

The November 23, 2009 Christian Science Monitor published an OpEd by Sue Blevins and Robin Kaigh on how the Senate health bill will undermine Americans' health freedom and privacy.

They cover five specific points, including what the bill says, what that translates into in real life, and the bottom line. Here are excerpts from their essay, "Senate health care bill: the five paragraphs you must read":
1. Mandatory insurance

Translation: Uncle Sam will now serve as your national insurance agent and force you to buy "minimum essential coverage" -- or else you'll have to pay an annual fine.

2. Electronic data exchanges

Translation: Requiring everyone to buy federally sanctioned health insurance, and then forcing qualified plans to comply with Administrative Simplification requirements, provides the government and health industry with power they would not be able to exercise in a free market.

3. Real-time health and financial data

Translation: Administrative Simplification rules are being expanded to gather real-time financial and health data on individuals through a tracking ID, possibly a "machine readable" ID card (electronic device).

4. Health data network

Translation: Your personal health information may soon be studied by government scientists. Washington is creating a new research center that plans to use patients' electronic health records for conducting research and creating disease registries. The data network is comprehensive and includes use of electronic health records.

5. Personal health information

Translation: Think your health privacy is protected? It's not. This language refers to "applicable confidentiality and privacy standards," but HIPAA's so-called privacy law permits individuals' personal health information to be exchanged – for many broad purposes – without patients' consent (See 45 CFR Subtitle A, Subpart E – Privacy of Individually Identifiable Health Information; section 164.502(a)(1)(ii) "Permitted uses and disclosures").
(Read the full text of "Senate health care bill: the five paragraphs you must read".)

Congress is prepared to seize an unprecedented degree of power over individuals' personal medical information and decision making.

Sunday, November 29, 2009

Schwartz LTE On Public Option

Brian Schwartz just alerted me to an LTE of his which had been published in the October 30, 2009 Denver Post.

The topic was the so-called "public option":
Health care reform and the public option

Say your neighborhood deli rigged its scales so that customers who paid for a pound of meat left the store with less. Does such fraud justify a government-run "public option" for delicatessens?

Surely not, but this is how Colorado AFL-CIO Director Mike Cerbo argues for a new government-run insurance plan. Cerbo says it should "impermissible" for insurers to "drop coverage due to pre-existing medical conditions" -- presumably when patients had been honest about medical histories.

This is called "post-claim underwriting," and it violates the insurer's contract with the policy-holder. But this is no justification of a "public option." Rather, if it happens frequently and without penalty, it shows that government has been lax in one of its legitimate duties: enforcing contracts.

Brian T. Schwartz, Boulder

Saturday, November 28, 2009

Letters from Peck and Stoddard

Recent polls show that even more Americans are opposed to ObamaCare than ever before.

The November 23, 2009 Rasmussen poll reports, "Support for Health Care Plan Falls to New Low".

Rasmussen notes that only 38% of Americans now support the proposed changes vs. 56% against -- "the lowest level of support measured for the plan in nearly two dozen tracking polls conducted since June".

And more Americans are speaking out against the plan. I especially liked these two recent letters and want to highlight them.

The first was written by Tim Peck of Ashville, NC, and published in the November 28, 2009 Ashville Citizen-Times. The second was written by William Stoddard, and sent to his two California Senators. Both are reposted here with their permission.

First Tim Peck's letter:
Health pitch a violation of basic American rights

The health care legislation in Congress contains mandates to obtain individual health insurance coverage. With this provision, Congress would violate my rights, rather than protect them, which is Congress's constitutional mandate.

This provision is a clear violation of my right to voluntarily associate and contract with health care professionals and insurance providers to our mutual benefit without the interference of a predatory third party.

It violates my right to economic freedom by forcing me to purchase health insurance services against my will. It violates my right to property by forcing me to pay penalties for declining to participate in a coercive program. It violates my right to liberty by forcing me to submit to incarceration for nonpayment of penalties or additional taxes.

It violates my right to self-determination. It violates my right to use my mind to make judgments regarding my own interests and actions.

In short, this legislation violates my right to peaceably live my life as I see fit. I oppose these violations. I say "no" to the coercive mandates contained in this proposal.

And it is my hope and wish that Senator Hagan will stand with me and say "no" to this rights-violating health care bill.

Tim Peck, Asheville
And William Stoddard's letter:
One of the principal stated purposes of the Democratic Party's proposed health care legislation is to better meet the health needs of those who are currently uninsured. As a self-employed man of 59 who cannot afford health insurance, I am strongly concerned with that issue, and have followed it closely over the past year and a half. I regret to say that the passage of the proposed legislation will make my situation worse, rather than better. I urge you to protect the uninsured by voting against it.

The reason I'm uninsured is that health care, and therefore health insurance, costs too much. But the proposed legislation would require me to purchase health insurance from the same insurance industry that is now failing to restrain the growth of health care costs, either from the uncompetitive private firms that now dominate it, or from a government-run system that is likely to charge even more. It offers subsidies for this purchase so inadequate that they would be laughable, if not for the real hardship they will inflict on people who pay them. And when the many people who still can't afford insurance remain uninsured, it fines them nearly $1,000 yearly... which will only make it harder for them to get health care. The CMS estimates that of the uninsured people who won't be eligible for Medicaid, 12 million will become insured, but 18 million will remain uninsured and suffer punishment for it.

Advocates of this punitive approach attack the irresponsibility of people who remain uninsured, and who depend on emergency rooms for health care. But under this bill, the people added to Medicaid will largely continue to do exactly that, as most doctors don't want to take patients at Medicaid rates. And the many millions of people who can't afford insurance will often have to do the same... until they are diagnosed with some serious and costly illness, when they will be able to sign up for insurance, and insurance carriers will be compelled to accept them despite their "preexisting conditions," further driving up insurance costs and premiums. And in any case, the reason many self-employed people and employees of small businesses don't have insurance is not irresponsibility, but fear of financial ruin if they have to pay for it.

If buying health insurance remained voluntary, and you came up with a system under which it cost too much, the uninsured could remain uninsured, and at least not be any worse off... and send you a message that your efforts weren't good enough. By resorting to compulsion, you are making it a violation of law to send that message. And that very fact is the strongest reason to believe that your plan will not make health care affordable, but make its costs even more ruinous.

I urge you to reconsider, and reject this proposal.

William Stoddard
I liked both letters because they show the bad consequences that will result from basic violations of the right to contract in a free market.

Americans are speaking out to oppose ObamaCare. Will our elected officials listen?

Friday, November 27, 2009

Who Will Determine Who Gets a Mammogram and How Often Under ObamaCare?

Hint: It's not you and your doctor.

As John Goodman notes:
...Ever since the U.S. Preventive Services Task Force called for fewer mammograms and fewer Pap smears, the Obama Administration has been trying to distance itself from the organization -- referring to its recommendations as "nonbinding."

Yet the National Center for Policy Analysis has discovered that the Reid health care bill refers to the task force no less than 26 times. And, yes, the task force will determine what screenings will and will not be included in the minimum coverage that everyone will be required to buy.
No matter how much the government says it's not engaging in rationing, Americans are starting to catch on to the double-speak.

(Via David Catron.)

Thursday, November 26, 2009

Happy Thanksgiving!

Admin Note: Because of the holiday, we'll be taking a break today.

Happy Thanksgiving!

Wednesday, November 25, 2009

An American Physician Reports From New Zealand

Dr. Ross Stevens is an American radiologist currently working temporarily in New Zealand. He recently composed this detailed analysis of the NZ state-run medical system, which I received as an e-mail forward from a colleague.

Dr. Stevens has graciously given me permission to post the full text of his e-mail here. Any American who wants to know what his or her health care future will look like under "universal health care" should read this eye-opening piece:
I am currently on a sort of sabbatical and am working in New Zealand for a public government hospital. New Zealand has a purely socialist medical system although there is also private insurance that can be obtained as well. This is a single payer system from a government ministry that controls all care through District Health boards. Each District Health Board gets a lump sum of money each year to provide for their population.

Primary care physicians (general practitioners) are private contractors and are paid fee for service from the government plus a copay from the patient. Specialists (including radiologists as well as surgeons, pediatricians, internists, cardiology, gastroenterology, urology, etc) are paid a salary which is based only upon the number of years since board certification plus bonus for after hours call coverage.

All specialists are paid the same. The top salary band (15 years + after certification) is about NZ $200.000 which is about $150,000 US. Call coverage can add another 15-25% depending on how busy and how frequent. All New Zealand citizens and permanent residents are covered by the National Health Service.

General practitioners see one patient every 7 minutes and, I am told, can make up to NZ$600K - $800K with their fee for service.

Patients must go first to their GP for all initial care--adult and pediatric. Pediatricians are specialists and only see patients after referral from GPs. All routine obstetrics is handled by midwives who receive 2 years training post high school. To go to the ER you must have a referral from your GP unless it is emergent (trauma, etc).

How does this work? Well, my hospital is over budget for the year, so they are closing the hospital (the only one within a 3-4 hour driving radius) to all but emergent patients for 6 weeks in December and January!! No elective surgery or non emergent patients. I could give many stories about delays in diagnosis that would be unheard of in the US.

That said, patients are generally happy with their healthcare and are glad that it is "free". The mentality of patients here is different from the US. Patients are not as demanding. No one gives a second thought to waiting 4-6 weeks for a staging CT for their newly discovered lung cancer prior to treatment -- many don't accept treatment anyway. If they are told they have a cancer, they just go home to die. They are generally happy for what they have and don't worry (or know) what they don't.

For radiology, I am working in a small rural district, so our waiting times are good, but in many of the urban districts, the waiting times for a routine CT scan are up to 9 months. GP's cannot order CT or MRI -- only specialists. The radiology department runs 8:30 am - 5:00 pm and I read about half of what I would read in the US. If it is not done by 5:00, it doesn't get done until tomorrow. In some cases, it might be weeks until a routine film is read. Call back after hours are pretty much only for trauma or surgical emergencies. Everything else can wait until the next morning, or Monday.

Our department is over budget, because they forgot to include the $35,000 equipment maintenance contract in this years budget. They installed a PACS system but didn't buy the Physicians Hanging Protocol software or the RIS [Radiology Information System] -- they are using a 20 year old system that is no longer supported.

Physicians who live here are generally satisfied due to the light workload and the lifestyle. However, there is a huge brain drain from the country. Many New Zealand doctors emigrate to Australia, Canada, or the US where the pay is better.

The country is critically short of physicians, especially specialists such as radiologists. In my hospital, about 2/3 of the medical staff in not native New Zealander -- most from South Africa or Europe) and about 1/4 of the staff is made up of locum tenens like me -- people from outside of New Zealand who come here for 6-12 months for the experience.

It is an interesting system and I have had an interesting time here. They spend about 1/4 per capita compared to what we spend in the US for health care. The care is good but not great here. They have a hard time recruiting and keeping physicians and are critically in short supply. I do not think that the American public would accept the level of care that is provided here. We will see what our future brings!

Ross Stevens, MD
Dr. Stevens is absolutely correct. Americans would not accept the levels of restrictions on access and quality of care caused by New Zealand's government policies.

Long waits, outdated technology cost overruns, patients going home to die -- this is not change I can believe in.

Let's hope the US health system never gets to this point!

Sticking It To The Young People

The November 23, 2009 Washington Post carries a column by Robert Samuelson explaining why the AARP (the major lobbying group for Americans over 50) are so in favor of health care "reform" -- because it allows them to stick young people with the bill.

Here is an excerpt from "Health 'reform' that burdens our young":
...Now comes the House-passed health-care "reform" bill that, amazingly, would extract more subsidies from the young. It mandates that health insurance premiums for older Americans be no more than twice the level of that for younger Americans. That's much less than the actual health spending gap between young and old. Spending for those age 60 to 64 is four to five times greater than those 18 to 24. So, the young would overpay for insurance that -- under the House bill -- people must buy: Twenty- and thirtysomethings would subsidize premiums for fifty-and sixtysomethings.

...Not surprisingly, the 40-million-member AARP, the major lobby for Americans over 50, was a big force behind this provision. AARP's cynicism is breathtaking. On one hand, it sponsors a high-minded campaign called "Divided We Fail" and runs sentimental TV ads featuring children pleading for a better tomorrow. "Join us in championing your future and the future of every generation," ended one ad.

...AARP justifies the cost-shifting as preventing age discrimination. Premiums based on age should be no more acceptable than premiums based on medical expenses reflecting race, gender or preexisting health conditions, it says. The House legislation bans those, so it should also ban age-based rates. AARP dislikes even the 2-to-1 limit. It thinks premiums for someone 22 and someone 62 should be identical. (In insurance jargon, that would be full "community rating.")

This is unconvincing. All insurance aims to protect against risk -- but within groups facing similar risks. Put differently, most insurance is risk-adjusted. Auto insurance premiums vary by age; younger drivers pay higher rates because they have more accidents. Homeowners' policies for similar houses cost more in high-crime areas. This is not "discrimination"; it's a reflection of risk and cost differences. Insurers that ignored these differences would soon vanish because they'd suffer heavy losses and lose customers.
(Read the full text of "Health 'reform' that burdens our young".)

Young, healthy adults will be the most unjustly affected by this proposed legislation. These patients consume the fewest medical resources and therefore most heavily subsidize the costs of the older, more-frequently-ill patients.

ObamaCare would rob them of money they could use for their own goals, such as saving to buy a first house or to start a business or a family. In essence, it would force them to sacrifice their lives and futures for the sake of the collective.

(For more on the fallacy behind the "anti-discrimination" argument, see "In defense of health insurance discrimination" by Don Watkins of the Ayn Rand Center.)

Tuesday, November 24, 2009

The End Of HSAs?

The November 23, 2009 Wall Street Journal warns that the Senate health care bill could destroy Health Savings Accounts for many Americans.

Here are some excerpts:
Liberals claim people who choose these options aren't helping as much to finance a common pool and may encourage adverse selection if too many young or healthy people opt out. While all insurance involves some degree of risk-sharing, Democrats want to impose true social insurance a la Europe by obliterating the flexibility of insurers to design products that are tailored to suit different individual needs.
In other words, the government wants to prevent you from spending your own money for your own health based on your judgment, on the grounds that you are failing to live up to your obligation to pay for everyone else's health care.

The Wall Street Journal also notes:
...David Goldhill, a media executive, recently wrote in the Atlantic Monthly that if a 22-year-old starts at his company today earning $30,000 and health costs grow at 3%, by the time he retires he'll have paid out $1.77 million in premiums, lower wages, out-of-pocket costs and both sides of the Medicare payroll tax.

If all that money were instead available via an HSA, including by borrowing against future contributions, "wouldn't you be able to afford your own care?" Mr. Goldhill asks. "And wouldn't you consume health care differently if you and your family didn't have to spend that money only on care?"

This is precisely the future liberals fear because it would make health care less susceptible to political control. The Reid bill makes it impossible for people to choose better reform alternatives, the ones that can only be discovered through innovation and competition in a dynamic marketplace.
The politicians don't want you to control your own money. Instead, they want to do your spending (and your thinking) for you.

Will we let them?

(Read the full text of "The End of HSAs". Article link via Brian Schwartz.)

Monday, November 23, 2009

Jane Orient: View From 35,000 Feet

Dr. Jane Orient, author of Your Doctor Is Not In, has posted a good analysis of the health care debate taking a "view from 35,000 feet".

Here's an excerpt from her essay, "Forget the Trees; Look at the Forest on Healthcare":
...The question is whether we want to put the federal government in control of American medicine. And about the related question of what medicine should be.

Traditionally, medicine is practiced by physicians, one patient at a time. The outcome is assessed by that patient. The right decision is the one chosen by the patient, in consultation with the physician, based on what is optimum for that patient, considering all aspects of his circumstances. The standard of care is the Oath of Hippocrates: providing treatment for the good of each patient according to the best of the doctor's ability and judgment.

In the "reformed" delivery system, healthcare is practiced from on high by committees of "experts" pulling the strings of marionette physicians (rankings, payment rates, other incentives and disincentives) who are judged on how well they achieve population-based outcomes. Patients are like sheep in the flock, categorized by race, income level, quality-adjusted remaining years (QARYs), compliance, functional ability, diversity score, or whatever metrics the rulers adopt. Any individual can be sacrificed for the good of the whole.

All information is to be coded and fed into a huge database, so that the herd's behavior and health can be monitored on a "granular" (minutely detailed) level. Non-reporting is punishable by fines or exclusion or worse.

One of the most common words in the House healthcare reform bill is "eligible." Obviously if you have to be eligible, you can also be ineligible -- and probably are, until proved otherwise. If subsidies can be given, they can be denied, or taken away. If the price-fixers can raise the doctor's pay, they can also cut it. If a committee can mandate coverage and level of payment for a service, it can refuse coverage or set the allowable charge below cost. If it has to certify need, it can declare that there is no need.

There is no need to report something to an official, unless the official has the power to act on the report: by allowing, disallowing, punishing, or making additional demands.

There is no need for a 2,000-page bill unless it is enabling government control over formerly private matters.

There is no need for a "place at the table" unless the czars can serve you a share of the collective goods -- or carve you up.

There is no need to read the bill -- unless it will affect your life. And a bill that creates winners and losers on every page, and that concerns everyone who is born, lives, and dies, will affect your life.

Some Americans may gain something from the bill, at least temporarily. But all lose freedom.
(Read the full text of "Forget the Trees; Look at the Forest on Healthcare".)

Sunday, November 22, 2009

The Importance of Mammograms

The November 20, 2009 Denver Post published an OpEd by Dr. Lora Barke, one of my practice partners, rebutting the newly proposed government restrictions on mammograms.

Here's the full text of her piece, "The Importance of Mammograms":
The Importance of Mammograms
Dr. Lora Barke

Recently, the U.S. Preventive Services Task Force issued recommendations suggesting women refrain from getting their mammograms until age 50, and continue every two years thereafter.

With my colleagues at Invision Sally Jobe, I reject the USPSTF recommendations and support the American Cancer Society, American College of Radiology, Society of Breast Imaging, and many other respected professional organizations in their strong opposition to the new guidelines.

These new guidelines, if taken to their logical conclusion, will lead to diagnosing later stage cancer, resulting in more drug therapy, more radiation therapy and more late-stage intervention.

The American Cancer Society's (ACS) current screening guidelines state that women at average risk for breast cancer should have their first mammogram by age 40 and should repeat mammograms every one to two years thereafter. This can reduce the risk of dying of breast cancer by 20 to 25 percent for women aged 40 years or older. The ACS also says to continue routine mammograms beyond age 74, as long as the patient is in good health and has 10 years of life left.

A careful look at the most recent data shows us that about 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s, and 22 percent occurred in women diagnosed in their 50s. Furthermore, the risk of dying of breast cancer in women diagnosed in their 40s is reduced by 35 to 44 percent, not 15 percent as the USPSTF analysis incorrectly reported.

The USPSTF methodology greatly underestimates the benefit of modern mammography, while the ACS takes a more thorough and valid approach. The ACS looks at all the data used in issuing the USPSTF guidelines, more carefully reviews each individual study, and reviews many newer studies that have not been examined by the USPSTF. Despite this shortcoming, the USPSTF's own evidence review shows that mammography reduces the risk of dying in women in their 40s and women in their 50s at about the same rate.

Because fewer women develop breast cancer in their 40s compared with women in their 50s, the USPSTF has said the small benefit isn't worth the cost of screening in that age group. Among the costs are false positive examinations, including procedures. The USPSTF fails to cite the literature that reveals that women do not regard these costs as important drawbacks.

As for the screening interval, annual screening is especially important for women under age 55, and still produces better results for women 55-plus. As for false positives, remember that false positives do not double when comparing yearly mammograms to mammograms done every two years. In fact, research shows that going to the same high quality imaging facility on a regular basis reduces the likelihood of false findings.

Screening mammography in women in their 40s saves just about as many lives as it does for women in their 50s, and the breast cancer death rate in the U.S has decreased by 30 percent since 1990, primarily due to screening mammography. The USPSTF relies on old data, ignores compelling new data, creates confusion and ultimately concludes that it's just not worth it to save the lives of women in their 40s.

Screening mammography saves lives, and regular mammograms should remain an important part of women's preventive health care beginning at age 40.

Lora D. Barke, D.O., is the medical director of the Invision Sally Jobe Breast Network.
Her Denver Post OpEd is a slightly modified version of her open letter to patients and doctors, "Stick with the evidence: Women should begin mammograms in 40s".

(Note: My writings for FIRM are my own opinion only, and do not necessarily reflect the views of any of my professional colleagues or practice partners.)

Hsieh Cited in Heartland Article on Insurance

The November 3, 2009 article by the Heartland Institute, "Baucus Health Care Legislation Advances" contained a brief quote by me.

The topic was the PricewaterhouseCoopers (PWC) report for the health insurance industry which stated that the Baucus plan would result in higher prices and less flexibility for the insured.

The quoted section includes:
..."The PWC report correctly notes that the Baucus bill would impose tremendous financial hardships on many middle-class Americans by forcing them to purchase expensive state-mandated insurance on terms set by the politicians," said Paul M. Hsieh, M.D., cofounder of Freedom and Individual Rights in Medicine in Denver, Colorado.

...Hsieh believes insurers ultimately will regret not fighting the reform package by arguing for market freedom.

"Earlier this spring the insurance industry could have taken a principled stand in favor of genuine free-market reforms, such as repealing laws banning sales across state lines as well as laws mandating guaranteed issue and community rating," Hsieh said.

"Such reforms could have greatly reduced insurance costs for millions of Americans currently priced out of the market," Hsieh continued. "Instead, they chose to make a deal with the devil and accept new regulations requiring them to cover everyone regardless of preexisting conditions, in exchange for a Massachusetts-like individual mandate."
(Read the full text of "Baucus Health Care Legislation Advances".)

I'm grateful to the Heartland Institute for allowing me to appear again in its newsletter.

Saturday, November 21, 2009

Liggett DP LTE on Junk Food Tax

The November 17, 2009 Denver Post printed the following LTE by Gina Liggett opposing proposed new taxes on so-called junk food:
Governor's proposal to tax candy and soda

The Post reported on Gov. Bill Ritter's proposal to tax candy and soda pop. Ritter said, "We thought that people would be willing to pay 3 cents on a dollar candy bar." How utterly arrogant of him to decide what any citizen would be willing to pay for anything. What I do with my money and property should be my business in a free society.

America's local, state and federal governments are becoming ever-more authoritarian, serving themselves instead of protecting individual liberty. Wake up! Our individual rights are in serious jeopardy. The people must fight against this creeping and metastatic growth in governmental power or America will die.

Gina Liggett, Denver
Her letter was a response to the November 15 news story, "Ritter's plan to tax soda and candy gets cheers, jeers".

Friday, November 20, 2009

Howard: The Medicaid Monster

In a recent issue of City Journal, Paul Howard describes how a combination of perverse funding formulas, political corruption, regulations on private insurance, and entitlement mentality have driven up New York state's Medicaid costs.

In particular, he describes some of the controls placed on the private insurance market:
Why is private health insurance so expensive? Blame Albany. First, state lawmakers have mandated that all health plans cover a host of procedures and "alternative-medicine" services, far more than companies in most states offer. Even the most stripped-down plan must include coverage of off-label drugs, surgical second opinions, and midwife and podiatrist services. Each mandated benefit makes the policy more expensive. Two state insurance regulations -- "guaranteed issue," which forces insurers to sell to any applicant, and "community rating," which requires them to offer the same price to everyone, regardless of age and health -- inflate prices further. Finally, the state has added billions of dollars in taxes and fees to private insurance policies, making them even pricier.

The perverse result: the young, healthy, and self-employed -- facing higher premiums for insurance that they seldom use, and realizing that they can always wait until they become ill to buy insurance -- tend to drop their coverage. (If New York regulated home insurance like this, you could buy a policy after your house had caught fire.) What's left is an insurance pool of older, sicker people, which drives private premiums higher still. Worse, the large number of uninsured people -- a consequence of Albany's bad policies—then becomes a justification for expanding the Medicaid rolls.
(Read the full text of "The Medicaid Monster".)

Despite the fact that such bad laws have driven up the price of insurance in New York (and in other states such as Massachusetts and New Jersey), these laws are being proposed at national level.

That's a recipe for disaster.

(Note: I agree with some but not all of his proposed reforms. In my opinion, he moves partially in the direction of free market reforms, but could go further.)

Thursday, November 19, 2009

Mammography and Rationing

The mammography and rationing story is now big news. I don't have time right now to write up a detailed discussion.

But here are a few good pointers for more information and analysis of this story:

"A Breast Cancer Preview: Mammograms Provide Preview of ObamaCare"
Wall Street Journal, November 19, 2009

"Rationing's First Steps"
Investor's Business Daily, November 18, 2009

"Former Red Cross chief: Feds' new mammography policy is 'a shocking thing'", November 18, 2009

Here's the original Washington Post story that started much of the discussion:

"Breast exam guidelines now call for less testing"
Rob Stein, Washington Post, November 17, 2009

Health Care Hoops

CMPI explains the danger of unfair competition between a "public plan" and private insurance in their latest video, "Health Care Hoops":

Do we really want a government that competes against its own people (and is the referee to boot)?

Wednesday, November 18, 2009

Failing Grade For ObamaCare

Dr. Jeffrey Flier, the Dean of Harvard Medical School, has just given ObamaCare a failing grade in the November 18, 2009 Wall Street Journal.

He cites the current and pending problems in Massachusetts as part of his reasons:
...There are important lessons to be learned from recent experience with reform in Massachusetts. Here, insurance mandates similar to those proposed in the federal legislation succeeded in expanding coverage but—despite initial predictions -- increased total spending.

A "Special Commission on the Health Care Payment System" recently declared that the Massachusetts health-care payment system must be changed over the next five years, most likely to one involving "capitated" payments instead of the traditional fee-for-service system. Capitation means that newly created organizations of physicians and other health-care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change -- necessitated by skyrocketing costs and a desire to improve quality -- are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.
(Read the full text of "Health 'Reform' Gets a Failing Grade".)

I strongly share his concerns about the effect of capitation on quality of patient care, as I mentioned in my own November 2, 2009 LTE in the Wall Street Journal.

Mammography Rationing?

The federal government has announced new guidelines, recommending fewer screening mammograms for women. This advice flies in the face of long-established scientific positions from the American Cancer Society and the American College of Radiology.

Ed Morrissey at raises the question as to whether this is the first sign of rationing in the form of government bodies overruling medical opinion.

Fortunately, for now many doctors will ignore these guidelines and continue to practice according to their medical conscience.

For a long time, President Obama and his political allies have said that his proposals will save money by cutting back unnecessary expensive high-tech health care, and focusing on preventative care.

Now they want to reduce one of the most scientifically proven preventative measures (screening mammography) on the grounds that it would eliminate unnecessary patient worry and treatment complications. In other words, these restrictions are for our own good.

Just remember, they're from the government and they're here to help us!

The Deceptive WHO Rankings

This October 21, 2009 Wall Street Journal article explains why we should take the WHO (World Health Organization) study that ranks the US as 37th in the world in health care with a grain of salt.

Here's an excerpt from "Ill-Conceived Ranking Makes for Unhealthy Debate":
The WHO ranking was ambitious in its scope, grading each nation's health care on five factors. Two of these were relatively uncontroversial: health level, which is roughly the average healthy lifespan of a nation's residents; and responsiveness, which is a sort of customer-service rating encompassing factors such as the system's speed, choice and quality of amenities. The other three measure inequality in health-care outcomes; responsiveness; and individual spending.

These last three measures struck some analysts as problematic, because a country with unhealthy people could rank above a healthier one where there was a bigger gap between healthy and unhealthy people. It is certainly possible that spreading health care as evenly as possible makes a society healthier, but the rankings struck some health-care researchers as assuming that, rather than demonstrating it.

An even bigger problem was shared by all five of these factors: The underlying data about each nation generally weren't available. So WHO researchers calculated the relationship between those factors and other, available numbers, such as literacy rates and income inequality. Such measures, they argued, were linked closely to health in those countries where fuller health data were available. Even though there was no way to be sure that link held in other countries, they used these literacy and income data to estimate health performance.
John Stossel makes similar criticisms of the WHO methodology here.

Tuesday, November 17, 2009

The Rationing Commission

The November 15, 2009 Wall Street Journal explains how the pieces are coming together to implement health care rationing in the US.

Here are some excerpts from, "The Rationing Commission":
...Democrats are quietly attempting to impose a "global budget" on Medicare, with radical implications for U.S. medicine.

Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission "critical to our fiscal future" and "one of the most potent reforms."

...The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.

Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June.
The article also describes how a similar commission has functioned in Washington state:
The Washington [state] commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a "naturopath" who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn't worth the money, then Olympia won't cover it for some 750,000 Medicaid patients, public employees and prisoners.

So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a "high" efficacy but also a "high" cost.
(Read the full text of "The Rationing Commission".)

Bureaucrats thus overrule physicians in medical decision making.

Do we really want this for America?

Monday, November 16, 2009

Reed Daly Fax Project

Free market supporter Reed Daly has asked me to announce his current project to send key legislators copies of Dr. Leonard Peikoff's essay, "Health Care Is Not a Right".

If you have any questions, his e-mail address is:

His announcement follows below (also mirrored here):


On Monday, November 16 we will be faxing and emailing copies of Dr.Peikoff's "Health Care is Not a Right" to the Senate, specifically persuadable Blue Dogs and GOP Senators on the Finance and HELP Committees.

The Finance and HELP Committees (Health, Education, Labor and Pensions) drafted the two versions of the Bill in the Senate, which must first be reconciled with one another and then with the House Bill.

You can help by sending copies to the Senators below or to those of your choice.

The Link to the PDF of Dr. Peikoff's Speech is here: PDF of Dr.Leonard Peikoff's "Health Care Is Not a Right"

I have included the Youtube channels in case you also wish to send them messages or videos of Dr. Peikoff's speech. You can also post links to the speech on their Facebook walls.

Link to Youtube video of Dr.Peikoff's speech

List of Persuadable Blue Dogs in Senate:

Evan Bayh (IN)

Evan Bayh On Youtube

Evan Bayh On Facebook

Evan Bayh E-mail Web Form

Washington, D.C. Fax: (202) 228-1377

Indianapolis, IN Fax: (317) 554-0760

Evansville, IN Fax: (812) 465-6503

Fort Wayne, IN Fax: (260) 420-0060

Hammond, IN Fax: (219) 852-2787

South Bend, IN Fax: (574) 236-8319

Michael Bennett (CO)

Michael Bennet E-mail Web Form

Michael Bennet On Facebook

Michael Bennet On Youtube

Washington, D.C. Office Fax: (202) 228-5036

Denver Metro Office Fax: (303) 455-8851

Four Corners Office Fax: (970) 259-9789

Pikes Peak Office Fax: (719) 328-1129

North Central Office Fax: (970) 224-2205

High Plains Office Fax: (970) 542-3088

Northwest/I-70W Office Fax: (970) 241-8313

Arkansas River Office Fax: (719) 542-7555

San Luis Valley Office Fax: (719) 587-0098

Jeff Bingaman (NM)

(Note Bingaman is one of the few who can be e-mailed directly. Bingaman has no fax numbers.)

Jeff Bingaman E-mail address:

Jeff Bingaman E-mail Web Form

Thomas Carper (DE)

Thomas Carper E-mail Web Form

Washington, D.C. Fax: (202) 228-2190

Wilmington Fax: (302) 573-6434

Dover Fax: (302) 674-5464

Georgetown Fax: (302) 856-3001

Kent Conrad (ND)

Kent Conrad On Youtube

Kent Conrad E-mail Web Form

Washington D.C. Fax (202) 224-7776

Minot Fax: (701) 838-8196

Grand Forks Fax: (701) 746-1990

Bismarck Fax: (701) 258-1254

Fargo Fax: (701) 232-6449

Byron Dorgan (ND)

Byron Dorgan E-mail Web Form

Byron Dorgan On Youtube

Washington, D.C. Fax (202) 224-1193

Bismarck Fax (701) 250-4484

Fargo Fax (701) 239-5112

Minot Fax (701) 838-8196

Grand Forks Fax (701) 746-9122

Kay Hagan (NC)

Office Locations

Kay Hagan E-mail Web Form

Senator Hagan On Youtube

Senator Hagan On Facebook

Washington, D.C. office Fax: 202-228-2563
Greensboro office Fax: 336-333-5331
Raleigh office Fax: 919-856-4053
Charlotte office Fax: 704-334-2405

Mary Landrieu (LA)

Mary Landrieu E-mail Web Form

Washington, D.C. Fax:(202) 224-9735

New Orleans Fax:(504) 589-4023

Baton Rouge Fax:(225) 389-0660

Shreveport Fax:(318) 676-3100

Lake Charles Fax:(337) 439-3762

Joe Lieberman (CT)

Washington, D.C. Office (202) 224-9750

Hartford (866) 317-2242 Fax

Joe Lieberman E-mail Web Form

Blanche Lincoln (AR)

Blanche Lincoln On Youtube

Blanche Lincoln E-mail Web Form

Washington D.C. Office Fax: (202)228-1371

Little Rock Office Fax: (501) 375-7064

Dumas Office Fax: (870)382-1026

Jonesboro Office Fax: (870)910-6898

Fayetteville Office Fax: (479)251-1410

Texarkana Office Fax: (870) 774-7627

Ben Nelson (NE)

Ben Nelson E-mail Web Form

Ben Nelson On Facebook

Ben Nelson On Youtube

Washington, D.C. Fax: 1-202-228-0012

Omaha Fax: (402) 391-4725

Lincoln Fax: (402) 476-8753

Bill Nelson (FL)

Bill Nelson On Youtube

Bill Nelson E-mail Web Form

Washington, D.C. Fax: 202-228-2183

Orlando Fax: 407-872-7165

Miami-Dade Fax: 305-536-5991

Tampa Fax: 813-225-7050

West Palm Beach Fax: 561-514-4078

Tallahassee Fax: 850-942-8450

Jacksonville Fax: 904-346-4506

Broward Fax: 954-693-4862

Fort Myers Fax: 239-334-7710

Mark Pryor (AR)

Mark Pryor E-mail Web Form

Washington, D.C. Office Fax: (202) 228-0908

Little Rock Office Fax: (501) 324-5320

Jon Tester (MT)

Jon Tester E-mail Web Form

Washington, D.C. Fax: (202) 224-8594

Billings Fax: (406) 252-7768

Bozeman Fax: (406) 586-7647

Butte Fax: (406) 782-4717

Glendive Fax: (406) 365-8836

Great Falls Fax: (406) 452-9586

Helena Fax: (406) 449-5462

Kalispell Fax: (406) 257-3974

Missoula Fax: (406) 728-2193

Mark Warner (VA)

Mark Warner E-mail Web Form

Senator Mark Warner On Youtube

Mark Warner Linkedin

Washington, D.C. Fax: 202-224-6295

Abingdon Fax Number: 276-628-1036

Norfolk Fax Number: 757-441-6250

Richmond Fax Number: 804-775-2319

Vienna Fax: 703-442-0408

Roanoke Fax Number: 540-857-2800

Jim Webb (VA)

Jim Webb On Facebook

Jim Webb On Youtube

Jim Webb E-mail Web Form

Washington, D.C. Fax: 202-228-6363

Danville Fax: 434-972-0978

Hampton Roads Fax: 757-518-1679

Northern Virginia Fax:703-573-7098

Norton Fax: 276-679-4929

Richmond Fax: 804-771-8313

Roanoke Fax: 540-772-6870

Republican Senators on the Finance and HELP Committees

(The number for the Subcommittee)

HELP Subcommittee on Children and Families

Washington, D.C. 20510

Fax: 202-228-0494

Lamar Alexander (TN)

Lamar Alexander E-mail Web Form

Washington, D.C. Fax: (202) 228-3398

Chattanooga, TN Fax: (423) 752-5342

Jackson, TN Fax: (731) 423-8918

Knoxville Fax: (865) 545-4252

Memphis,Fax: (901) 544-4227

Nashville, TN Fax: (615) 269-4803

Tri-Cities, Fax: (423) 325-6236

Jim Bunning (KY)

Jim Bunning On Youtube

Jim Bunning E-mail Web Form

Washington, D.C. Fax: 202.228.1373

Ft. Wright (Main State Office) Fax: 859.331.7445

Hopkinsville Fax: 270.881.3975

Owensboro Fax: 270.689.9158

Louisville Fax: 502.582.5344

Hazard Fax: 606.435.1761

Lexington Fax: 859.219.3269

Richard Burr (NC)

Richard Burr E-mail Web Form

Washington, D.C. Fax: (202) 228-2981

Asheville Fax: (828) 350-2439

Rocky Mount Fax: (252) 977-7902

Winston-Salem Fax: (336) 725-4493

Gastonia Fax: (704) 833-1467

Wilmington Fax: (910) 251-7975

Tom Coburn (OK)

Tom Coburn E-mail Web Form

Washington D.C. Fax: 202-224-6008

Tulsa: Fax: 918-581-7195

Oklahoma City: Fax: 405-231-5051

Susan Collins -R ME (Collins office says to please include a coversheet listing your name and address with your message, comment, or request. )
Washington, D.C. Office Fax: (202) 224-2693
Augusta Office Fax: (207) 622-5884
Bangor Office Fax: (207) 990-4604
Biddeford Office Fax: (207) 283-4054
Caribou Office Fax: (207) 493-7810
Lewiston Office Fax: (207) 782-6475
Portland Office Fax : (207) 828-0380

John Cornyn (TX)

John Cornyn E-mail Web Form

John Cornyn On Facebook

John Cornyn On Youtube

Washington D.C. Fax: 202-228-2856

Houston Fax: 713-572-3777

Harlingen Fax: 956-423-0193

Lubbock Fax: 806-472-7536

San Antonio Fax: 210-224-8569

Austin Fax: 512-469-6020

Tyler Fax: 903-593-0920

Dallas Fax: 972-239-2110

Mike Crapo (ID)

Mike Crapo On Youtube

Mike Crapo On Facebook

Mike Crapo E-mail Web Form (Note 5,000 character limit in the e-mail form)

Washington, D.C. Fax: (202) 228-1375

Idaho Falls Fax: (208) 529-8367

Boise (Main state office) Fax: (208) 334-9044

Lewiston Fax: (208) 743-6484
Caldwell Fax: (208) 455-0358

Pocatello Fax: (208) 236-6935

Coeur d' Alene Fax: (208) 664-0889

Twin Falls Fax: (208) 733-0414

John Ensign (NV)

John Ensign E-mail Web Form

Washington D.C. Office Fax: (202) 228-2193

Las Vegas Office Fax: (702) 388-6501

Reno Office Fax: (775) 686-5729

Carson City Office Fax: (775) 883-5590

Michael B. Enzi (WY)

Michael B. Enzi E-mail Web Form

Washington D.C. Office: Fax: (202) 228-0359

Gillette Fax: (307) 682-6501

Cheyenne Fax: (307) 772-2480

Cody Fax: (307) 527-9476

Jackson Fax: (307) 739-9520

Casper Fax: (307) 261-6574

Chuck Grassley (IA)
Chuck Grassley E-mail Web Form
Washington D.C. Office FAX (202) 224-6020
Cedar Rapids, Fax: (319) 363-7179
Council Bluffs Fax: (712) 322-7196
Davenport Fax: (563) 322-8552
Des Moines Fax: (515) 288-5097
Sioux City Fax: (712) 233-1634
Waterloo Fax: (319) 232-9965

Judd Gregg (NH) (Gregg has no Fax numbers)

Judd Gregg E-mail Web Form

Orrin G. Hatch (UT)

Orrin Hatch On Youtube

Orrin Hatch E-mail Web Form

Washington D.C. Office Fax: (202) 224-6331

Salt Lake City Office Fax: (801) 524-4379

Provo Office Fax: (801) 374-5005

St. George Office Fax: (435) 634-1796

Ogden Office Fax: (801) 394-4503

Cedar City Office Fax: (435) 586-2147

Johnny Isakson (GA)

Washington, D.C. Fax: (202) 228-0724

Atlanta, GA Fax: (770) 661-0768

Johnny Isakson E-mail Web Form

Jon Kyl (AZ)

Jon Kyl On Youtube

Jon Kyl E-mail Web Form

Washington, D.C. Office Fax: (202) 224-2207
Phoenix Office Fax: (602) 957-6838
Tucson Office Fax: (520) 797-3232

John Mccain (AZ)

John Mccain On Facebook

John McCain On Youtube

John McCain E-mail Web Form

Washington D.C. Office Fax: (202) 228-2862

Phoenix Office:Fax: (602) 952-8702

Prescott Office Fax: (928) 445-8594

Tempe Office Fax: (480) 897-8389

Tucson Office Fax: (520) 670-6637

Lisa Murkowski (AK)

Lisa Murkowski E-mail Web Form

Lisa Murkowski On Myspace

Lisa Murkowski On Youtube

Lisa Murkowski On Facebook

Washington D.C. Fax: 202-224-5301

Fairbanks Fax: 907-451-7146

Anchorage Fax: 907-276-4081

Matsu Wasilla Fax: 907-376-8526

Ketchikan Fax: 907-225-0390

Kenai Fax: 907-283-4363

Pat Roberts (KS)

Pat Roberts E-mail Web Form

Pat Roberts On Youtube

Washington, D.C. Fax: (202) 224-3514

Overland Park Fax: (913) 451-9446

Topeka, Fax: (785) 235-3665

Wichita Fax: (316) 263-0273

Dodge City Fax: (620) 227-2264

Olympia Snowe (ME)

Olympia Snowe E-mail Web Form

Washington D.C Fax: (202) 224-1946

Auburn Fax: (207) 782-1438

Augusta Fax: (207) 622-7295
Bangor Fax: (207) 941-9525
Biddeford Fax: (207) 284-2358
Portland Fax: (207) 874-7631
Presque Isle Fax: (207) 764-6420

Hsieh OpEd in Washington Examiner: Mafia-Style Health Insurance

The November 16, 2009 Washington Examiner has just published my latest OpEd, "Mafia-style Health Insurance: An Offer You Can't Refuse".

Here is the opening:
Suppose the mafia came to your town and forced everyone to purchase all their meals at mob-approved restaurants. The mafia would also select the menu items.

If you liked broccoli but their vegetable choice was spinach, then tough luck. Everyone would also have to purchase dessert, whether they wanted it or not. And if some customers couldn't afford the high-priced meals, the mafia would force you to "contribute" to cover their bills.

Most Americans would be outraged at such violations of their basic rights. But this is precisely what the president and Congress want to do with health insurance...
(Read the full text of "Mafia-style Health Insurance: An Offer You Can't Refuse")

Friday, November 13, 2009

Beezley: Market Driven Health Care Saves Lives

The Independence Institute has published an OpEd by Donald Beezley, arguing that "Market Driven Health Care Saves Lives".

Here's an excerpt:
...President Barack Obama thinks government bureaucrats can determine what [Beezley's diabetic son] Connor needs, when he needs it, and then get it to him--and to hundreds of millions of others. This is a lie. The President's scheme to seize control of our bodies through our health is dangerous, and will leave us helpless victims with no control over our health care. Government control also means an inevitable decline of supplies, and rationing via simpleminded regulations.

Only a system of competing prices, profits and producers--capitalism--results in the right thing being in the right place at the right time. Without prices and profits you have scarcity, rationing and poverty: the Soviet Union was one of the most fertile regions on earth; an army of central planning bureaucrats couldn't keep bread on the shelves for a reason.

It doesn't matter if rationing is "in the bill." Shortages are unavoidable without a profit-driven market providing price and profit signals to consumers and producers. Under government control doctors, insulin, test strips and all health resources will be disconnected from the needs and priorities of real people and driven instead by political priorities and the stunted thinking of bureaucrats. Freedom and capitalism respect the choices of individuals and provide incentives that align the interests of disparate people. This is true of healthcare just as surely as bread or anything else.
Beezley then offers some common-sense free market health care reforms:
...There are four essential reforms [that] offer an immediate start to protecting the lives of Connor and every American. To start, the federal government must assert its authority under the Interstate Commerce Clause and knock down foolish, expensive barriers to health insurance purchases across state lines so Americans can buy the insurance they want.

As another important reform, state governments must end coverage mandates that radically increase the cost of insurance and enrich health insurance companies at patients' expense.

In addition, lawsuit abuse must be curbed with sensible malpractice guidelines and limits.

And finally, tax policy that disconnects patients from their doctors must be changed by moving tax benefits to the individual level while empowering individuals with vehicles like Health Savings Accounts.

...My son doesn't deserve to have his life diminished by a government run healthcare monstrosity.

He and all Americans deserve a free, vibrant, competitive market in health care.
These reforms would make life much better for Connor as well as millions of Americans.

(Read the full text of "Market Driven Health Care Saves Lives".)

Thursday, November 12, 2009

Maine Still In Trouble

Maine's attempt at universal health care gets less media coverage than Massachusetts'. However, the November 10, 2009 New York Times reports that it's still in trouble.

Here's an excerpt from their article, "Maine Finds a Health Care Fix Elusive":
Maine is the Charlie Brown of health care. The state's legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded. Indeed, many overhauls to the system have done little more than squeeze a balloon -- solving one problem while worsening another.

...Maine's history is a cautionary tale for national health reform. The state could never figure out how to slow the spiraling increase in medical costs, hobbling its efforts to offer more people insurance coverage. Many on Capitol Hill have criticized national reform legislation for similarly doing little to tame costs.
(Read the full text of "Maine Finds a Health Care Fix Elusive".)

Although the details differ from Massachusetts, the problems are very similar. Despite massive government regulations, costs continue to rise, patients continue to have a hard time getting access to care, and doctors are getting squeezed by low reimbursement. In other words, their statist policies are making things worse, not better.

Will the rest of the country learn from Maine's experience, or will we adopt those same failed policies at the national level?