Orient: Is it Always Better to Have Health Insurance?

Dr. Jane Orient asks the provocative question, "Is it Always Better to Have Health Insurance?"

In particular, she describes a patient who lost her insurance and paid $900 out-of-pocket for treatment to save her eyesight. She didn't have $900 immediately, but was able to work out a time payment plan with the treating physician.

In contrast, she describes what would have happened if the patient had "coverage" from the government:

...Now, what would have happened if the Medicaid program hadn't cut her off -- because she earns $100/month too much? In that case, she wouldn't have had to worry about the bill.

But -- the receptionist would have had to say: "You'll need to fax over a referral."

A Medicaid patient can't be billed, except for a nominal copayment. Without a referral, Medicaid can’'t be billed. So if the specialist, or in this case subspecialist, sees the patient, he cannot be paid. Moreover, he is probably violating a rule and conceivably might be prosecuted for soliciting business (that's called "fraud"). Discounts and freebies are marketing strategies, after all, and the poor and vulnerable have to be protected.

Not just any doctor can give the patient a referral. This doctor couldn't. It has to be the patient's primary care provider, who is contracted with the patient's plan. And the specialist has to be in the plan too.

Say that a seizure patient needs to see a neurologist promptly to have his medications adjusted. Sorry, the emergency room doctor can't write the referral. Neither can the hospitalist who is discharging the patient from the hospital. It has to be the "primary." If the primary happens to know the patient, he might just send the referral. But most of the time, the patient will have to come in. The primary won’t want to risk getting an unnecessary referral or an incident of "inadequate documentation" on his report card.

For a retinal problem, there are probably three hurdles: the primary gatekeeper (who might not even think of the diagnosis), then the general ophthalmologist (who will make the diagnosis but can't treat it), and finally the subspecialist. All probably have waiting times for appointments, especially for Medicaid patients. Most doctors can’t afford to see very many of those.

Not just Medicaid, but all managed-care plans have a structure like that. It's part of the cost-containment strategy. I know of three insured patients who had retinal detachments. They all had premonitory symptoms, and they all -- eventually -- had elaborate and costly operations, as many as six procedures. They were "covered," and they didn't get a bill for $900, but they had a poor visual outcome that might have been prevented by prompt treatment.

(Read the full text of "Is it Always Better to Have Health Insurance?"; link via JG.)

Dr. Orient's analysis vividly illustrates the point that "coverage" does not equal care.

Furthermore, government policies that attempt to guarantee "coverage" will create bureaucratic regulations and cost-control guidelines that will restrict the ability of physicians to offer actual care to their patients.

Or as Dr. Orient puts it:

Insurance is supposed to help you pay bills in the rare event of a catastrophe. If it morphs into a scheme for emptying your wallet in advance, and then prevents bills by preventing treatment, we just might be better off without it.

Ralston: Twelve Ways to Increase the Cost of Health Insurance

Richard Ralston, executive director of Americans for Free Choice in Medicine, dissects the many problems with the recently-passed Senate bill. (This was written on December 22, before the bill was passed).

Here is the full text of his piece, "Twelve Ways to Increase the Cost of Health Insurance":

Health care legislation now being debated in the Senate will do nothing to make health care more affordable but quite a lot to make it more expensive. It serves the purpose of a massive and permanent expansion of the size and power of government and the political class as an end in itself. Twelve of the many provisions that will increase the cost of care include:

The increase in government spending is largely unfunded. The ten years of increased taxes and fees to cover six years of spending conceals the true long-term cost. Taxes collected for four years before the new spending begins will of course not be set aside and hidden under a mattress by Senator Reid and Speaker Pelosi. The government will blow right through it and spend it on other things until the new spending begins. More taxes will accompany much more debt and the cost of serving the debt, which will increase the cost of health care for everyone.

The requirement that insurers take a loss and issue policies to those with pre-existing conditions will shift costs for their care to other premium payers.

The limit on co-payments will shift costs to premium payers.

The limit on deductibles will shift costs to premium payers.

New fees and taxes on medical equipment manufacturers will increase the cost of equipment and insurance.

The cost of medical liability insurance -- and the defensive medicine it forces physicians to practice in order to protect themselves -- punishes financially the states that currently limit the size of non-economic damages and the fees lawyers take from settlements. Rather than limiting such costs, it will provide strong incentives for trial lawyers to increase litigation, which will increase the cost of health care and insurance for everyone.

The tax on insurance companies for policies that provide the most benefits will increase premiums on those policies.

More health care providers will be reimbursed for less than the cost of their services, shifting those costs to other patients and premium payers.

Pre-tax contributions to flexible savings and health savings accounts will be limited and their use made more difficult, increasing the taxes and cost of care for those with such plans.

The legal requirement to buy insurance under penalty of fines and imprisonment will force the purchase of insurance with provisions specified by the government, in response to providers with the political pull to force coverage of their services. That will increase the cost of insurance.

Higher costs will not be limited to private insurance: Medicare taxes will be increased while Medicare benefits are decreased.

Medicare Advantage plans will be eliminated, reducing benefits for the ten million seniors who have them, and forcing them to pay more for "Medi-Gap" insurance -- creating a financial jackpot for the AARP in disregard for the interests of its members.

Other provisions will increase spending and debt, such as forcing states to provide Medicaid to millions of additional people without any revenue to pay for it.

Even though the Congressional Budget Office has not taken many of these costs into consideration -- especially cost shifting -- they have determined that a bill that would create more than one hundred new agencies, boards, and commissions, and that would spend trillions of dollars, would not cut the cost of health insurance.

The Senate bill is a deliberate, systematic deception for the purpose of concealing the cost of a huge expansion of government -- and the forced dependence of citizens on politicians for another crucially important aspect of their daily lives. Senators need to hear from voters now that they must not vote for legislation that increases our medical costs while eliminating our rights and personal choices.

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

(Original link to "Twelve Ways to Increase the Cost of Health Insurance".)

Watkins and Brook: Repudiate The Morality Of Need

The December 28, 2009 Investor's Business Daily carried this piece by Don Watkins and Yaron Brook of the Ayn Rand Center for Individual Rights entitled, "Memo To Foes Of Health Reform: Repudiate The Morality Of Need".

Here is an excerpt:

...The reason we continue to move toward socialized medicine is that everyone -- including the opponents of socialized medicine -- grants its basic moral premise: that need generates an entitlement.

So long as that principle goes unchallenged, government intervention in medicine will continue growing, as each new pressure group asserts its need and lobbies for its entitlement, until finally the government takes responsibility for fulfilling everyone's medical needs by socializing the health care system outright.

They also note:

...The only way to effectively oppose socialized health care is to reject the morality of need in favor of a genuinely American alternative. According to the American ideal, men are not their brother's keeper -- we are independent individuals with inalienable rights to support our own lives and happiness by our own efforts.

That means taking responsibility for your own medical needs, just as you take responsibility for your grocery shopping and car payments. It means no one can claim that his need entitles him to your time, effort, or wealth.

Where is the willingness to defend this ideal by saying, "Your health care is your responsibility -- and if you truly cannot afford the care you need, then you must ask for private charity -- not pick your neighbor's pocket to pay for it"?

(Read the full text of "Memo To Foes Of Health Reform: Repudiate The Morality Of Need".)

Watkins and Brook also note that the Republicans are failing to make this kind of principled moral opposition to the Democrats' plan, instead relying predominantly on more derivative economic arguments.

America will likely soon learn the consequences of this failure.

Socialized Or Not?

The AAPS responds to the common claims by ObamaCare supporters that it's not "socialized medicine", because doctors and hospitals remain private.

In their December 24, 2009 Mythbuster article, they point out the fact that ObamaCare is:

(1) Compulsory; (2) redistributive; (3) collectivized; (4) centralized; (5) dictatorial; (6) oppressive; and (7) intrusive.

(Read the full text of "Myth 30. Healthcare reform is not 'socialized medicine'")

Merry Christmas!

Merry Christmas!

(Unless there is some incredible breaking news, regular posting will resume Monday, December 28.)

Senate Passes Bill, Now Things Get Interesting

Now that the US Senate has passed its version of ObamaCare, it has to be reconciled with the House version through the "conference" process.

However, Dan Perrin thinks this might not be as easy at it seems. For his interesting analysis, see his post "The Best Christmas Present Ever: Senator DeMint Objects to the Appointment of the Conferees".

This may explain why there's talk from the White House that the health care issue won't be sorted out until February 2010.

A lot can happen in the next few days and weeks. Who know what sorts of back room deal-making, compromising, and favor-trading will take place?

But we know one thing for sure -- it isn't over yet.

10 Lumps Of Coal In The Health Care Bill

The December 23, 2009 Investor's Business Daily published an informative analysis by Betsy McCaughey discussion ten specific problems with the proposed Senate health care bill.

Here are some of the points she discusses in, "10 Lumps Of Coal In The Health Care Bill":

1. Higher premiums
2. A cost you can't afford and can't avoid
3. A one-size-fits-all health plan

I also wanted to highlight two points in particular, because they represent a hitherto-unprecedented degree of government interference in the doctor-patient relationship:

5. Government controls on your doctors' decisions:

The Senate bill bars doctors from participating in the private insurance system unless they implement whatever regulations the secretary of health and human services chooses to impose to "improve health care quality" (p. 149). That broad phrase encompasses everything in medicine.

This would be the first time in history that the federal government is given power over how doctors treat privately insured patients.

10. A tell-all relationship with every doctor you see

What happens in your doctor's office must be recorded in an electronic data base that can send the information to insurers and other medical offices (Senate bill, p. 62-66). Every doctor you see will have access to your medical history. See a psychiatrist? Your foot doctor will know about it.

(Read the full text of "10 Lumps Of Coal In The Health Care Bill".)

Advocates of individual rights (including the corollary privacy rights) should be deeply concerned.

Parker WSJ LTE on Health Care Entitlements

The December 23, 2009 Wall Street Journal published an excellent LTE by Dr. Richard Parker that cuts to the heart of the health care debate (second one down):

Scott Harrington rhetorically asks, "How can a new entitlement reduce deficits?" As he concludes, a massive new entitlement cannot and will not reduce government debt. As our experiences with Medicare and Medicaid have clearly demonstrated, whenever the government promises a "free" service, costs will necessarily rise as more and more people scramble to receive their share of "free" health care. Ultimately this can only lead to ballooning deficits and health-care rationing.

It is precisely this type of government intrusion in what should rightly be a free market that has caused health-care expenditures to skyrocket.

You cannot have your cake and eat it too. This focus on costs, however, misses a more fundamental issue with the proposed nationalization of health care -- the rights of physicians and patients.

Under ObamaCare, patients will lose their freedom to choose what health care they receive and which doctor treats them. Physicians will lose the last of their freedom to practice according to their best judgment.

The battle for medicine will be lost or won not on actuarial analysis of costs, but rather on the more fundamental principle of the rights of individuals.

Richard Parker, M.D.
McKinney, Texas

Pipes: Get Ready To Wait

As the US Senate prepares to pass its version of ObamaCare, Sally Pipes warns us "American Patients, Get Ready to Wait".

Here is an excerpt:

...Democratic politicians, liberal leaders, and the mainstream press are fond of criticizing America for spending a greater share of GDP on health care -- 16 percent -- than other countries do. Their remedy for "fixing" our country's high-cost system is more government control.

Yet they rarely disclose the high nonmonetary costs posed by government-controlled healthcare systems. Countries like Canada only spend less on health care by consigning their citizens to waiting lists and depriving them of access to effective cutting-edge treatments.

As of this year, 694,161 Canadians are on a waiting list for medical procedures. Assuming one person per procedure, that means 2.08 percent of the population is queued up for "free" care, according to the Fraser Institute's annual survey on wait times.

These Canadians pay for their health care in both taxes and the hard currency of pain, anguish, and lost wages.

She notes:

...[A]n incredible 16 percent of the population -- five million people -- is waiting to get a primary care doctor.

Once they get one, they have to wait yet again. On average, Canadians waited 16.1 weeks from the time their general practitioner referred them to a specialist until they actually received treatment in 2009, according to the Fraser Institute. That's 73 percent longer than the wait in 1993, when the Institute first started quantifying the problem.

Some specialties fare particularly poorly. Seniors should take note. In the United States, the average wait to see an orthopedic specialist is 16.8 days, according to a survey by medical consulting firm Merritt Hawkins and Associates. Canadians wait 17.1 weeks for the same appointment.

(Read the full text of "American Patients, Get Ready to Wait".)

Under universal health care, governments only promise theoretical "coverage", not actual health care. And the policies they adopt actually worsen the ability of patients to seek and receive actual care.

Canadians have already learned this lesson the hard way. Will Americans be next?

Lewis: "Arbitrary Power, Dictatorship, and Health Care"

Duke University professor John Lewis has a great essay up at PajamasMedia (12/22/2009) entitled, "Arbitrary Power, Dictatorship, and Health Care".

Here is the opening:

The essence of a dictator's method is not to write harsh laws and enforce them rigidly. The world's most destructive thugs have wanted something different. They have wanted to impose their wills on a compliant populace using arbitrary power -- power not limited by laws or constitution, but power that was open-ended, ill-defined, and could be expanded based on the whims of the moment.

Well-written laws are the enemy of the dictator. As philosopher Ayn Rand put it, "When men are united by ideas, i.e., by explicit principles, there is no room for favors, whims, or arbitrary power: the principles serve as an objective criterion for determining actions and for judging men, whether leaders or members." Laws, properly formulated, are based on principles, and serve to translate those principles into firm criteria for judging particular cases. What a dictator wants is to be free of such principles and to use his power as he wishes.

Professor Lewis then proceeds to show how the current ObamaCare health bill gives an unprecedented degree of arbitrary power to bureaucrats to determine what sort of health insurance you may buy and what sort of health care you may receive.

Some examples:

If you are an employer, you will not escape punishment if a bureaucrat decides that your health plan is not "acceptable" and that you must be fined for your failure to meet his decision. If you are an individual who does not want to purchase full-coverage health insurance, but would rather buy catastrophic insurance that covers hospitalization only, your decision will not be "acceptable" and you may face a government audit and a new tax.

Do you have a serious disease? Does your doctor wish to readmit you to the hospital? A bureaucrat will decide whether or not you get treatment, based on a statistical analysis of the number of such readmissions by the bureaucrats: "excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the secretary) of discharges for such applicable condition for the applicable period and such hospital" (Sec. 1151).

(Read the full text of "Arbitrary Power, Dictatorship, and Health Care".)

As Dr. Lewis notes, the current health care debate is not just about health care. It's about basic American freedoms.

Negative Reviews Of Senate Bill

In the wake of the Senate vote to end cloture on the health care bill, numerous analysts have chimed in with negative reviews. Here are some excerpts from a few of them:

"Passing health reform could be a nightmare for Obama" (Samuelson, Washington Post, 12/21/2009):

...Even if Congress passes legislation -- a good bet -- the finished product will fall far short of Obama's extravagant promises. It will not cover everyone. It will not control costs. It will worsen the budget outlook. It will lead to higher taxes. It will disrupt how, or whether, companies provide insurance for their workers. As the real-life (as opposed to rhetorical) consequences unfold, they will rebut Obama's claim that he has "solved" the health-care problem.

"Change Nobody Believes In" (Wall Street Journal, 12/21/2009):

...The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that "reform" has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state.

The WSJ also criticizes the following specific elements:

Health costs
Steep declines in choice and quality
Blowing up the federal fisc
Political intimidation

Finally, this essay has been circulating around the blogosphere: "Why the Reid Bill is Unconstitutional" (Richard Epstein, 12/12/2009). His central point:

In effect, the onerous obligations under the Reid Bill would convert private health insurance companies into virtual public utilities. This action is not only a source of real anxiety but also a decision of constitutional proportions, for it systematically strips the regulated health-insurance issuers of their constitutional entitlement to earn a reasonable rate of return on the massive amounts of capital that they have already invested in building out their businesses.

The big question is whether these arguments will gain any traction against the back room deal-making by the politicians. We'll find out soon...

Rebutting the Mammography Rationers

As many readers know, the US Preventive Services Task Force (USPSTF) recently issued a controversial statement recommending that screening mammography be restricted to women between ages 50-74.

This is at variance with the standard recommendations from the American Cancer Society and American College of Radiology recommendations that women begin screening at age 40 and continue as long as they are in good health.

The political implications have already been discussed elsewhere.

For those who are interested in some detailed scientific rebuttals of the USPSTF rules, here are a few helpful references:

"The importance of mammograms"
Lora Barke, Denver Post, November 20, 2009

(Lora D. Barke, D.O., is the medical director of the Invision Sally Jobe Breast Network and one of my practice partners.)

"American Cancer Society Responds to Changes to USPSTF Mammography Guidelines"
November 16, 2009

"Why the critics of screening mammography are wrong"
Daniel Kopans, Diagnostic Imaging, December 4, 2009

(Daniel B. Kopans, M.D., is a professor of radiology at Harvard Medical School and a senior radiologist in the breast imaging division at Massachusetts General Hospital.)

"Frequently Asked Questions about Mammography and the USPSTF Recommendations: A Guide for Practitioners"
Wendie Berg, MD, PhD, R. Edward Hendrick, PhD, Daniel Kopans, MD, and Robert Smith, PhD

Society of Breast Imaging, December 11, 2009

(Berg - American Radiology Services, Johns Hopkins Green Spring, Lutherville, MD; Hendrick - Department of Radiology, University of Colorado, Denver, CO;
Kopans - Department of Radiology, Massachusetts General Hospital, Harvard University School of Medicine, Boston, MA; Smith - Cancer Control Sciences Department, American Cancer Society, Atlanta, GA)

Coburn: The Health Bill Is Scary

The December 16, 2009 Wall Street Journal published the following OpEd by US Senator Tom Coburn (himself a practicing physician) entitled, "The Health Bill Is Scary".

He warns that even though the "public option" may be off the table for now, there are still several frightening provisions of the ObamaCare bill that would lead to rationing. Here is an excerpt:

...Additionally, the Reid bill depends on the recommendations of the U.S. Preventive Services Task Force in no fewer than 14 places. This task force was responsible for advising women under 50 to not undergo annual mammograms. The administration claims the task force recommendations do not carry the force of law, but the Reid bill itself contradicts them in section 2713. The bill explicitly states, on page 17, that health insurance plans "shall provide coverage for" services approved by the task force. This chilling provision represents the government stepping between doctors and patients. When the government asserts the power to provide care, it also asserts the power to deny care.

...But the most fundamental flaw of the Reid bill is best captured by the story of one my patients I'll call Sheila. When Sheila came to me at the age of 33 with a lump in her breast, traditional tests like a mammogram under the standard of care indicated she had a cyst and nothing more. Because I knew her medical history, I wasn't convinced. I aspirated the cyst and discovered she had a highly malignant form of breast cancer. Sheila fought a heroic battle against breast cancer and enjoyed 12 good years with her family before succumbing to the disease.

If I had been practicing under the Reid bill, the government would have likely told me I couldn't have done the test that discovered Sheila's cancer because it wasn't approved under CER. Under the Reid bill, Sheila may have lived another year instead of 12, and her daughters would have missed a decade with their mom.

(Read the full text of "The Health Bill Is Scary".)

Senator Coburn is completely right about this. Americans who value their health must not let down their guard. Instead, we must continue to let our elected officials know where we stand.

(Note: I agree with Coburn on most of his health care policy positions, but I have sharp disagreements with him on a variety of so-called "social issues".)

The Public Option In 40 Seconds

This video pretty much sums it up:



(Via State House Call, who correctly notes "The legislative proposal may be dead -- for now -- but the idea isn't. Not yet, anyway.")

How Leftists View America

The leftist health care advocacy group Public Option Please recently held a contest for the best pro-public option art.

Here's the winning entry:



(Click on the image to see it full size.)

As Jonathan Adler noted:

I suspect many health care reform supporters find this poster inspiring for the same reasons many health care reform opponents find it disconcerting.

"Freedom To Contract" Article Now Available On Audio

My print article from the Fall 2009 issue of The Objective Standard entitled "How the Freedom to Contract Protects Insurability" is now available on audio.

Audio files of selected TOS articles are available here.

The audio version of the article is also available as a downloadable MP3.

I'm deeply grateful to editor Craig Biddle for posting it!

Mythbusting From McCaughey

Former New York lieutenant governor Betsy McCaughey debunks some common myths about the US health system.

Here is an excerpt from her December 14, 2009 New York Post OpEd, "US Health Care Still Tops":

... On Nov. 20, for example, Sen. Kent Conrad (D-ND) pointed to a large blue chart showing the United States in last place in health performance. "All of these countries have much lower costs than we do," he said, "and they have higher-quality outcomes than ours."

Conrad was duped by a bag-of-tricks report from the Commonwealth Fund (Health Affairs, vol. 27, no. 1, 2008). This put America in 19th place due to our nation's large number of preventable deaths -- meaning deaths from diseases that are curable if treated soon enough.

Yet most of these deaths are caused by heart disease and circulatory diseases. The United States has a high incidence because for 50 years Americans were the heaviest smokers and now are among the most obese. Bad behavior, not bad medicine, is to blame. Our health-care system treats these diseases very effectively.

As the National Bureau of Economic Research concluded, "It seems inaccurate to attribute... high death rates from these causes to a poorly performing medical system."

She also debunks other commonly promulgated myths about prostate cancer, breast cancer, and life expectancy which are often used by leftists to justify government-run health care.

For more details, read the full text of "US Health Care Still Tops".

The US health care system does have some serious problems. But those would be addressed by genuine free-market reforms, not bogus "reforms" that merely result in a government takeover of health care.

Goodman on the Senate Bill

John Goodman discusses several problems with the current incarnation of the Senate Bill.

Some of his points include:

1. Millions of jobs lost.
4. Very high marginal tax rates.
6. Fewer insurance choices.
10. Exacerbating the problems of cost, quality and access.

These economic problems are a predictable consequence of the fundamental problem with the Senate Bill -- namely it violates the rights of individuals and insurers to voluntarily contract for their mutual benefit.

Hsieh OpEd at PJM: "ObamaCare: Tightening the Noose Around Private Health Care"

The December 15, 2009 PajamasMedia.com has just published my latest OpEd, "ObamaCare: Tightening the Noose Around Private Health Care".

My theme is that some little-discussed provisions of the health care bill will increasingly limit the freedom of patients to seek (and doctors to deliver) medical services based on the patient's best interest. Instead, doctors will be increasingly forced to practice according to collectivist "cost-effectiveness" government criteria.

Here is the introduction:

The U.S. Senate is making increasingly Byzantine backroom deals in an attempt to pass some form of universal health care by the end of the year. But even though the final bill isn't settled yet, one fact is becoming increasingly clear. Any plan they pass will result in the government seizing an unprecedented degree of control over previously private health spending decisions.

Two of these proposed new controls are worth highlighting, because they are not often discussed in most mainstream media reports...

(Read the full text of "ObamaCare: Tightening the Noose Around Private Health Care".)

Note: This is an expanded version of my earlier blog post, "Tightening The Noose Around Private Medicine".

Message From Louisiana

"LT" sent me the following:

This past Saturday, hundreds of people gathered in the pouring rain in New Orleans, Louisiana, to tell Senator Harry Reid and Senator Mary Landrieu that they do not support a government takeover of health care. As you may know, Senator Reid was supposed to attend a fundraiser in New Orleans, but cancelled his plans to attend when he started taking heat for "asking Republicans for the weekend off."

Despite Reid's cancellation, the protest still happened. This video tells the story of the people who participated in the protest and why they want to see the health care bill rejected in the Senate:

Most of these ordinary Americans understand that government promises of "free" health care will result in a government takeover of their lives.

More such protests take place here in Colorado (and the rest of the country) tomorrow (12/15/2009) as part of the "Code Red" series of rallies.

Americans are starting to speak out!

"Doing Nothing" Is An Option

Remember when President Obama insisted that health care "reform" had to be done his way, and that doing nothing was "not an option"?

Well, the American people disagree.

In "Do Nothing, Majority Says" (Wall Street Journal, December 10, 2009), James Taranto notes a recent Fox News poll showing:

While 41 percent of Americans want Congress to pass major health care reform legislation this year, a 54 percent majority says they would rather Congress "do nothing on health care for now," up from 48 percent who felt that way in July.

Taranto also adds:

...[A] CNN poll found that an even bigger majority -- 61% -- oppose the Senate's version of the ObamaCare bill.

One of the core principles every first-year medical student learns is "Primum non nocere", which is Latin for "First, do no harm". In other words, it's better to do nothing than to take a positive action that will make the situation worse -- a principle that should apply to politics as well as to medicine.

Our current health care system has many problems. But the proposed ObamaCare "reforms" would make things worse, not better. In this case, doing nothing is an option, at least until genuine free-market reforms are on the table.

The American people understand this. Will our politicians?

John Lewis Talk: "Individual Rights and Health Care Reform"

Duke University professor John Lewis give the following lecture to the Davison Council, Duke University Medical School on November 13, 2009.

Over 100 medical students heard his talk, "Individual Rights and Health Care Reform" followed by an energetic Q & A. Here is his talk, in 6 parts:

Part 1



Part 2



Part 3



Part 4



Part 5



Part 6

Schwartz: Why To Condemn Insurance Companies

In the December 5, 2009 Boulder Daily Camera, Brian Schwartz explains why we should or should not condemn insurance companies:

Why to condemn insurance companies

Is the for-profit insurance industry a "predator" that "prevent[s] us from having a decent health care system"? Letter writer Bruce Robinson says so (Daily Camera, December 1). He's partially right. The real predators are politicians who inhibit needed health policy reform. But insurers are guilty for concealing how they benefit from Congress's predatory practices, which shield them from competition and accountability to patients.

Predators gain value by using force or threats of force. Politicians prey upon patients who prefer to finance their own medical care in "politically incorrect" ways. As a result, insurers need not compete for your business. Politicians punch you with a tax penalty for buying insurance directly from an insurer instead of through your employer. They prohibit you from buying affordable policies available in other states. They tax you more for paying cash for routine medical expenses rather than buying an expensive health plan with tax-deductible premiums.

Like a true predator, politicians support legislation that backs you into a corner -- where as the patient, you are the consumer but not the customer. Hence, neither insurers nor doctors aim to please you. They cater to who pays them. Employers pay the insurers and insurers pay the doctors.

So don't condemn for-profit insurance. The profits are "anemic," reports the AP. Condemn insurers for supporting an un-free market, where profit is disconnected from pleasing consumers. Only in a free market insurers' profits would depend on satisfying you, the patient, rather than satisfying employers and politicians.

(The original is here, and a version with HTML hot links can be found on the PatientPowerNow.org website.)

Tightening The Noose Around Private Medicine

As many know, the U.S. Preventive Services Task Force (a government task force) made headlines recently when it recommended new restrictions on screening mammography for women.

There are two critical dangers these sorts of government guidelines pose for private insurance plans if ObamaCare becomes law.

First, plans may be required to include certain types of preventive care as covered services, whether or not patients want them. Such benefits mandates would raise prices and violate the rights of patients and insurers to freely contract for lower-priced plans without such mandates.

In the December 2, 2009 Baltimore Health Examiner, Dr. Delia Chiaramonte notes that it will do exactly that. From her article, "What the healthcare reform bill says about preventive care":

The section on preventive care has a hidden limitation that is likely to escape the notice of non-physician Senate reviewers. It states "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for evidence-based items or services that have in effect a rating of 'A' or 'B' in the current recommendations of the United States Preventive Services Task Force."

That is, health insurers must pay for preventive services that the U.S. Preventive Services Task Force (USPSTF) recommends.

(Emphasis in the original.)

Second, government rules may make it more difficult for patients to receive preventative care that diverges from government guidelines.

Sue Blevins of the Institute for Health Freedom notes in her December 2009 article, "Health-Reform Bills: Would Restrictions on Cost-Sharing for Preventive Services Outlaw Private Payment?":

Regardless of whether you agree or disagree with the U.S. Preventive Services Task Force's recommended changes for mammograms, its recent proposal raises important questions for all Americans: Do you want government panels making preventive health-care decisions for you? And do you want government to outlaw private payment for preventive care? Government could end up with both powers under the health-reform bills being considered.

...[I]t appears the House version could prevent Americans from paying privately for covered preventive care. That's because H.R. 3962 states that there shall be no cost-sharing for covered preventive services. (The Senate bill includes a similar provision.) The definition of cost-sharing appears to include out-of-pocket spending. Thus without further clarification, this provision could be interpreted to prevent anyone from paying out of pocket for covered preventive care.

If this were to become law, what would happen if a physician doesn't accept insurance payments? Would he or she be legally free to bill patients directly for covered preventive services? And would patients be legally free to pay out of pocket? If the answer to both of these questions is no, then physicians who currently do not accept insurance will either have to begin doing so or stop offering preventive services.

It appears the following provisions in the House bill would infringe on both patients' and physicians' freedom to contract privately for preventive health-care services...

(Emphasis in the original.)

In other words, under ObamaCare you will be forced to pay for certain kinds of preventative care whether you want it or not. And you may not be able to pay for other kinds of medical care outside of government-set guidelines, even if you want to!

Note that the latter problem is already a serious issue in other countries with "universal health care". Canada and the UK typically forbid patients from paying out-of-pocket for many medical services on the private market on the grounds that it would permit a "two-tiered" system of care. The way they avoid having a two-tiered system (one good and one bad) is to force everyone into a single-tiered bad system.

Let's hope this doesn't happen in the US.

Five Questions On Health Reform Americans Should Be Asking Now

The December 9, 2009 Investor's Business Daily published an analysis piece by Parente and Howard discussing the "Five Questions On Health Reform Americans Should Be Asking Now".

Their questions include:

How will health reform legislation affect existing insurance coverage?

Does the final bill lower the government's unsustainable spending commitments for existing programs (Medicare and Medicaid) or expand them?

Given Congress' track record on spending, what is the realistic projection for the cost of health reform when it's fully implemented?

If health reform does generate a surplus, will this money be used to pay down the debt — or fund new government spending?

How will adding a new, government-run insurance program increase competition in private insurance markets?

(Read the full text of "Five Questions On Health Reform Americans Should Be Asking Now".)

From an economic perspective, those are all good questions.

But unless opponents also challenge the more fundamental moral and philosophical underpinnings of these proposals, raising such primarily economic concerns will be insufficient.

As Dr. Leonard Peikoff pointed out in "Health Care Is Not A Right":

Most people who oppose socialized medicine do so on the grounds that it is moral and well-intentioned, but impractical; i.e., it is a noble idea -- which just somehow does not work. I do not agree that socialized medicine is moral and well-intentioned, but impractical. Of course, it is impractical -- it does not work -- but I hold that it is impractical because it is immoral. This is not a case of noble in theory but a failure in practice; it is a case of vicious in theory and therefore a disaster in practice.

Durand On Rationing

I don't know much about Sarah Durand, but she wrote an interesting piece on PajamasMedia on the planned health care rationing algorithm entitled, "Health Care vs. the Value of Human Life".

Here is an excerpt:

...In fact, most countries with socialized medicine, including Britain, are already using a mathematical formula that expresses the numerical value of one year of a human life in a measurement called the QALY, or "quality-adjusted life year." In terms of determining medical care, the mathematical formula of the QALY is based on both how much a treatment may lengthen your lifespan and the quality of the life you will be living.

Basically, if you are in optimal health, the QALY of one year of your life is 1.0. But if you have any underlying conditions, like asthma or muscular dystrophy, your QALY is much lower. Under the QALY system, the blind are worth less than those with sight, as those who can walk are worth more than those in wheelchairs. Sound like discrimination against persons with disabilities? It gets worse.

...As if that's not bad enough, the health advisor to the president, Ezekiel Emanuel, is proposing a system even more deleterious. His system, similar to the QALY, is "the complete lives system," which not only allows for discrimination against the elderly and disabled, but also targets the very young, i.e., our children.

Emanuel says of his system: "When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated."

Leave it to American progressives to take the QALY one step further by defining quality of life as how useful you are to society -- that is, how likely you are to increase the government's tax revenue, hence the emphasis on those between ages 15 and 40. Health care gets a lot cheaper by rationing care to all non-taxpayers.

(Emphasis mine.)

This collectivist mindset towards human life will be the inevitable outcome if we let the government control our health care.

(Read the full text of "Health Care vs. the Value of Human Life".)

Mundy: Comparing Screening of Breasts and Shoes

Lee Mundy asks the following very perceptive question in this LTE in the December 7, 2009 Wall Street Journal:

Compare Screening Of Breasts and Shoes

The U.S. Preventative Services Task Force feels that mammograms are a waste of time and money because of false-positive exams, and anyway, the risk is evaluated at a meager 0.05% (Letters, Dec. 2). If, indeed, mammograms for women under 50 are not cost effective, and only save a few lives, then why are we taking our shoes off at every airport in the country?

Lee Mundy
Ellensburg, Wash.

Spot the Fallacy

According to Senator Harry Reid, if you oppose his plan for health care "reform" then it's comparable to supporting slavery.

Can you spot the logical fallacy?

Hint: Supporters of free market health care reform are fighting for individual rights, whereas slaveholders (and Senator Reid) want to violate [fill in the blank]...

(Via LT.)

Arguing That Less Choice Is Good

Linda Gorman of the Independence Institute points out a new rhetorical tactic being adopted by advocates of "universal" health care.

They're now claiming that the current semi-free market offers too much choice, and that government-run health care would eliminate that pesky burden of choice.

In essence they're arguing, "Don't worry. Let the government do your thinking for you!"

Light Posting Notice

Administrative note: Blogging might be sporadic this upcoming week due to external obligations.

John Lewis: What HR3962 Actually Says

Professor John Lewis of Duke University has posted a detailed analysis of the most recent House health care bill HR3962.

In particular, Professor Lewis asks the following key questions in his essay: "What the House Health Care Bill, HR3962, Actually Says":

1. Will the plan punish Americans who do not carry the required insurance, or employers who do not provide it?
2. Will the plan make private insurance illegal?
3. Will the plan ration medical care through budgets?
4. Will the plan ration care through waiting lists?
5. Will the plan impose special, higher taxes on Americans who earn more than others?
6. Will the plan levy special taxes and surcharges on medical devices?
7. How will the plan affect health insurance provided by employers?
8. Does the plan allow the government to set fees?
9. Can the government officials audit taxpayers, employers, and insurance plans to enforce compliance?

Most Americans aren't going to like the answers.

Professor Lewis also lists "new boards, committees, programs, and other bureaucratic encumbrances" established by the bill.

Read the full text of "What the House Health Care Bill, HR3962, Actually Says".

(Thanks to Jason C for the summary!)

ObamaCare At Any Cost

The December 2, 2009 Wall Street Journal notes that the alleged cost savings of ObamaCare are illusory.

Here is an excerpt from their piece, "ObamaCare at Any Cost":

...Instead, CBO is confirming that new coverage mandates will drive premiums higher. But Democrats are declaring victory, claiming that these higher insurance prices don't count because they will be offset by new government subsidies. About 57% of the people who buy insurance through the bill's new "exchanges" that will supplant today's individual market will qualify for subsidies that cover about two-thirds of the total premium.

So the bill will increase costs but it will then disguise those costs by transferring them to taxpayers from individuals. Higher costs can be conjured away because they're suddenly on the government balance sheet. The Reid bill's $371.9 billion in new health taxes are also apparently not a new cost because they can be passed along to consumers, or perhaps will be hidden in lost wages.

This is the paleoliberal school of brute-force wealth redistribution, and a very long way from the repeated White House claims that reform is all about "bending the cost curve." The only thing being bent here is the budget truth.

Fortunately, David Catron notes, most Americans don't believe the "cost cutting" BS.

They're wise not to.

And the WSJ reaches the natural conclusion:

...Democrats don't care because their bill isn't really about "lowering costs." It's about putting Washington in charge of health insurance, at any cost.

(Read the full text of "ObamaCare at Any Cost".)

Turner: Ten Reasons Public Won't Buy Senate Health Plan

The November 25, 2009 Washington Examiner published an OpEd by Grace-Marie Turner discussing, "Ten reasons public won't buy Senate health care plan".

Here are her key points:

1. Exploding costs
2. Losing your current coverage
3. Job-killing taxes on employers
4. Budgetary gimmick -- tax now, spend later
5. Increasing future health care spending
6. Cost-shifting gimmick
7. Taxpayer-financed abortion
8. Twenty-four million uninsured -- still
9. Scarce subsidies
10. Mandates cause higher premiums and more uninsured

(For further details on each of her points, read the full text of "Ten reasons public won't buy Senate health care plan".)

Some of her points are at the level of economic analysis. Her points 2, 3, and 10 also touch on more fundamental issues of individual rights.

Polls consistently show that a majority of Americans are opposed to ObamaCare.

The big question is whether Congress will disregard Americans' wishes and ram their agenda down our throats anyways.

(Via Patient Power.)

UK Health System FAIL

The November 30, 2009 Investor's Business Daily describes the "Deadly Decline" we can expect in our health care if we adopt ObamaCare:

..."Up to 10,000 people," the British Guardian reported Sunday, are dying needlessly of cancer each year "because their condition is diagnosed too late, according to research by the government's director of cancer services."

...Researchers at Durham University have identified four other types of delays patients encounter in receiving cancer care: doctor delay, delay in primary care, system delay and delay in secondary care. All are part of a state-operated system that has a poor record of keeping its trapped patients alive and healthy.

And Elbert County Forum links to more problems in the UK health system.