Wolf On Death Panels

Dr. Milton Wolf has a new OpEd in the Washington Times, "Lies, damn lies and death panels".

In particular, he makes a powerful point about the new government policy of "encouraging" end-of-life counseling:

...[T]here is nothing certainly inappropriate about discussing end-of-life care with patients so long as the patient and their family can maintain complete trust that their doctor is providing caring -- and this is crucial -- uncoerced advice. Quite the contrary, it absolutely should be done, but it's a far too important part of the doctor-patient relationship to permit the government to determine how and when. These difficult decisions are undermined unless they are made freely by the patient and his or her family...

Not only have I, as a physician, counseled many families in these trying end-of-life times - a heart-rending and life-changing experience for all of us involved -- but I learned firsthand of their importance when my father, himself a physician, made his own wishes known to us in the final months of his life. If ever a family's decision should be held sacred from the government, this is it.

(Read the full text of "Lies, damn lies and death panels".)

Once the government starts specifying which medical options are "reasonable" or "effective", it undermines physicians' ability to be honest advocates for their patients and instead turns them into agents of their government paymasters.

The end result: Bureaucrats then determines whether patients live -- or die. But just don't call them "death panels".

Criminalizing Patients and Doctors

In the 12/24/2010 Daily Beast, Shikha Dalmia describes how ObamaCare will criminalize both patients and doctors.

In particular, if physicians render "unnecessary" or "ineffective" care to Medicare patients, they could be punished for committing Medicare fraud. Of course, the government gets to decide what counts as "ineffective". Patients may not have heard much about "comparative effectiveness research" -- but they soon will.

With respect to Medicare patients the government is in effect saying, "We won't tell you how to practice medicine -- we don't presume to interfere with your professional judgment. But by the way, if you treat patients in a way we don't approve of, you'll be punished."

(Read the full text of "Obamacare Criminalizes Medicine".)

ObamaCare must go.

Effects of ObamaCare

How have insurers responded to new ObamaCare rules? This list discusses the various rate increases and coverage drops across the country.

Read more at, "Hurtling to Single-Payer: A Reference Guide to ObamaCare's Trail of Destruction".

Of course, government official keep insisting that we can't blame ObamaCare for these rising costs.

Is your state next?

(Via WolfFiles.)

New Rules For 2011

Paul Gessing explains that, "ObamaCare hits my health care (and maybe yours) starting Jan. 1".

In other words, more government controls over how you can spend your own money for your own benefit.

Price Controls and Life Controls

The New York Times published a couple of interesting stories lately on government plans for health insurers and for you:

"Health Insurers to Be Required to Justify Rate Increases Over 10 Percent" (12/21/2010)

"Obama Returns to End-of-Life Plan That Caused Stir" (122/25/2010)

In other words, the government will tell insurance companies how much they will be allowed to charge for their services.

And they will "encourage" doctors to help patients plan for their deaths.

My prediction: Over time, this will inevitably lead to government "encouraging" doctors to help patients decide that certain treatments to extend their lives are too expensive and not worth considering. The government will hijack the the trust patients currently place in their physicians to be their honest advocates and instead use financial incentives to have physicians promote the government's preferred end-of-life spending priorities.

But just don't call them "death panels"!

Unless ObamaCare is repealed, expect to see more such price controls and life controls.

(Links via ReasonPharm and Instapundit.)

Holiday Break

Because of the Christmas holiday, I'll be taking a short blogging break. Regular posting will resume next week.

Merry Christmas, everyone!

Quick Links: Turner, Ralston, Fraser

In the 12/21/2010 Washington Examiner, Grace-Marie Turner explains why "Obamacare is a government takeover".

In the 12/17/2010 Orange County Register, Richard Ralston discusses the FDA Avastin ruling at "Political mugging of a valuable drug".

The Fraser Institute has published, "Waiting Your Turn: Wait Times for Health Care in Canada 2010 Report". A couple of excerpts:

The total waiting time between referral from a general practitioner and delivery of elective treatment by a specialist, averaged across all 12 specialties and 10 provinces surveyed, has risen from 16.1 weeks in 2009 to 18.2 weeks in 2010.

Canadians wait nearly 3 weeks longer than what physicians believe is "reasonable" for elective treatment after an appointment with a specialist.

Full Fraser Institute report (PDF version) here.

Catron: Obamacare and the Broccoli Mandate

David Catron has a new OpEd in AmSpec, "Obamacare and the Broccoli Mandate".

As he notes, the issues run much deeper than health care. Instead, the key issue is freedom -- specifically, should the government be able to deprive you of your freedom to act on your own best judgment and instead force you to do what it thinks is "best" for you?:

...[T]he Obama administration... presumably believes that the commerce clause gives the federal government the authority to regulate virtually every decision we make in our day-to-day lives. Indeed, the belief that Washington can -- and should -- supervise us as if we were a nation of children is the core tenet of their nanny-state political philosophy.

This is the belief system that prompted First Lady Michelle Obama to say, as her husband signed a law that will regulate what children eat during summer vacations and what can be sold in school vending machines, that child nutrition is something "We can't just leave... up to the parents." Without the "help" of the federal government, some mother might fail to force broccoli on her kids.

Likewise, we "can't just leave it up" to the patients to decide for themselves if they should buy health insurance. Indeed, according to the Obama administration, there is something sinister in the very suggestion that we must allow them to do so.

In other words, "We're from the government, we're here to help you -- And if you don't let us, we'll punish you."

Fortunately, more and more Americans aren't buying it. A recent Rasmussen poll shows, "For First Time Ever, Most Voters Think Health Care Repeal Likely".

Let's hope our new Congress and our judges take heed.

What Every Medical Student Should Remember About Randomized Clinical Trials

Classic story by Dr. E. E. Peacock, Jr.:

One day when I was a junior medical student, a very important Boston surgeon visited the school and delivered a great treatise on a large number of patients who had undergone successful operations for vascular reconstruction. At the end of the lecture, a young student at the back of the room timidly asked, "Do you have any controls?"

Well, the great surgeon drew himself up to his full height, hit the desk, and said, "Do you mean did I not operate on half the patients?"

The hall grew very quiet then. The voice at the back of the room very hesitantly replied, "Yes, that's what I had in mind."

Then the visitor's fist really came down as he thundered, "Of course not. That would have doomed half of them to their death."

God, it was quiet then, and one could scarcely hear the small voice ask, "Which half?"

Dr. E. E. Peacock, Jr., University of Arizona College of Medicine; quoted in Medical World News (September 1, 1972), p. 45, as quoted in Tufte's 1974 book Data Analysis for Politics and Policy.)

(Quote via Raw Meat, found via Marginal Revolution.)

Flirting With Unintended Consequences in Massachusetts

The December 18, 2010 Boston Globe illustrates yet another unintended consequence of mandatory insurance benefits in Massachusetts, this time involving flirtatious models wearing short skirts and blue wigs (!)

Here's an excerpt from, "Surge in marrow testing probed":

The state’s largest health insurers began noticing at least a year ago that UMass Memorial Medical Center was submitting an extraordinary number of expensive claims for bone marrow testing and charging higher rates than other providers.

But it was not until this week that one reason for the surge in claims became clear: The Worcester hospital hired models who wore short skirts, high heels, and sometimes sported neon blue wigs to recruit bone marrow donors at malls in Massachusetts and New Hampshire, Red Sox and Patriots games, and flower shows.

The article continues:

The situation is a window into how costs can spiral in the health care system, and the unintended consequences that can occur, when insurers are required to pay for a particular service, even a worthy one.

In the last decade, Massachusetts, New Hampshire, and Rhode Island became the only states where legislators mandated insurers pay for bone marrow testing.

(Read the full text of "Surge in marrow testing probed". The issue is also covered in this December 16, 2010 New York Times story "Flirty Models Were Hired in Bid to Find Bone Marrow".)

This should come as no surprise to journalists. Whenever the government compels insurance companies to pay for a specific service, it creates a natural incentive for others to artificially inflate both the price and the demand for that service. The only unusual aspect about this case was how blatant the manipulation was, which was what allowed the hospital to get caught more easily.

Otherwise, the high costs incurred by the hospital of hiring these attractive young models would have been quietly passed along to the insurance companies, then eventually to Massachusetts residents forced to purchase mandatory insurance (or to the taxpayers).

What we don't know yet is how many more similar-but-stealthier examples of this are still happening with respect to other medical services in Massachusetts? Or how much of this will happen in the other 49 states under ObamaCare?

(Link via @Bettina702.)

Cuba Banned Michael Moore Film "Sicko"?

According to the December 17, 2010 Guardian, Cuba banned the Michael Moore film "Sicko" because it falsely portrayed their socialized health system as better than it really was.

From the article:

Cuba banned Michael Moore's 2007 documentary, Sicko, because it painted such a "mythically" favourable picture of Cuba's healthcare system that the authorities feared it could lead to a "popular backlash", according to US diplomats in Havana.

The revelation, contained in a confidential US embassy cable released by WikiLeaks , is surprising, given that the film attempted to discredit the US healthcare system by highlighting what it claimed was the excellence of the Cuban system.

But the memo reveals that when the film was shown to a group of Cuban doctors, some became so "disturbed at the blatant misrepresentation of healthcare in Cuba that they left the room".

Castro's government apparently went on to ban the film because, the leaked cable claims, it "knows the film is a myth and does not want to risk a popular backlash by showing to Cubans facilities that are clearly not available to the vast majority of them."

(Read the full text of "WikiLeaks: Cuba banned Sicko for depicting 'mythical' healthcare system".)

I don't condone the actions of Wikileaks in releasing secret US diplomatic documents.

But the irony in this particular case was simply too perfect.

Update: Michael Moore is disputing this story.

Hmm, who should we trust here: US government officials or Michael Moore? Unfortunately, neither have a great track record with respect to unassailable honesty!...

Hsieh PJM OpEd: "Beware Counterfeit 'Responsibility'"

PajamasMedia has published my latest OpEd, "Beware Counterfeit 'Responsibility'":

My theme is that the Obama Administration's version of "individual responsibility" (also shared by many Republicans) is a counterfeit version of the concept aimed masking its drive to subvert genuine responsibility and freedom.

Here is the opening:

The ObamaCare individual insurance mandate met its first courtroom defeat when Judge Henry Hudson ruled it unconstitutional in Commonwealth of Virginia v. Sebelius. But while the legal battle is likely to smolder on for years until it reaches the U.S. Supreme Court, the rhetorical battle is heating up in the court of public opinion.

In particular, the Obama administration is attempting to defend the individual mandate as a matter of "individual responsibility." If Americans allow them to get away with this counterfeit notion of "responsibility," it will jeopardize the freedoms that make genuine individual responsibility possible...

(Read the full text of "Beware Counterfeit 'Responsibility'".)

Domestic Medical Tourism

As health costs continue to rise, some entrepreneurial doctors and patients are taking advantage of domestic medical tourism for elective procedures. From the article:

Employers who fund their workers' health coverage are also eager to contain mounting medical costs, Stephano says. They may offer a range of inducements to persuade a patient to have a more affordable procedure, she says.

A $100,000 heart bypass could be had for as little as $32,000 at hospitals working with a facilitator (according to figures provided by BridgeHealth).

Bob Ihrie, senior vice president for employee rewards and services at Lowe's Companies Inc., led a group of five large employers who negotiated special rates with the highly respected Cleveland Clinic to perform heart, back/spine and knee/hip surgeries. While the other companies have not yet announced their plans, Lowe's has already sent 16 employees to Cleveland for surgery since the program launched on April 1, with 14 others scheduled for procedures or awaiting approval.

(Read the full text of "Healthcare: Pay Less, Travel Less".)

As with overseas medical tourism, patients can shop around for quality care at heavily-discounted prices. And one advantage of domestic (as opposed to foreign) medical tourism is that US malpractice laws still apply -- thus giving patients legal recourse if something goes wrong.

This isn't a complete solution to the problems raised by ObamaCare. But it may help in the short-to-medium turn until our politicians finally repeal that law.

For other strategies patients can adopt in the meantime, see "How to Protect Yourself Against ObamaCare" from the Summer 2010 issue of The Objective Standard.

(Article link via J.G.)

Quick Links: Forbes, Florida, and II

Forbes recently published two pieces on ObamaCare:

"The Irresponsible Individual Mandate" by Yaron Brook and Don Watkins of the Ayn Rand Center for Individual Rights.

"Don't Tweak ObamaCare; Repeal It" by Dr. Scott Atlas. (Dr. Atlas is both a senior fellow at the Hoover Institute as well as a professor of radiology at Stanford. I used Dr. Atlas' excellent neuroradiology textbook during my residency.)

HealthCareLawsuits.org discusses the next big legal challenge to ObamaCare happening today in a Florida court.

Brian Schwartz of PatientPower links to this audio from the Independence Institute (aka "II"), "Kopel & Natelson discuss Virginia v. Sebelius".

Wolf: Mr. President, Tear Down This Law

In the 12/15/2010 Washington Times, Dr. Milton Wolf offers some good advice to the President, "Mr. President, tear down this law".

From the OpEd:

...[I]t was the individual mandate to purchase insurance that was determined to exceed the letter and spirit of the Constitution. But this ruling threatens the entire edifice of Obamacare because that mandate is the central linchpin of the Affordable Care Act. In the simplest of terms, the goodies Obamacare promises depend on the money brought in by compelling young, healthy Americans to purchase more insurance than they need. It's a clever version of redistribution, but it's not immune from this one simple reality: no money, no goodies.

Dr. Wolf then goes on to explain how the combination of requiring insurers to take all comers regardless of pre-existing conditions but without the mandate will make private insurance quickly unaffordable. Many patients will "game" the system and only purchase insurance when they become ill.

Or as Amanda Teresi once explained, "It would be the equivalent of not having any car insurance, hitting a tree, and then calling Geico and saying you want to sign up. It doesn't make sense."

Dr. Wolf advises the President:

Be bold. Lead the charge to repeal Obamacare. I know this is against every instinct you have, but look where your instincts have gotten you. This is your chance to hit that reset button.

This is excellent advice from the good doctor. Whether the President listens is a separate matter altogether...

(Read the full text of "Mr. President, tear down this law".)

Quick Links: Orient, Cowen, Siegel

Dr. Jane Orient of AAPS explains, "What Healthcare Reform “Comparative Effectiveness Research” Means to You".

In the 12/11/2010 New York Times, Tyler Cowen notes, "Following the Money, Doctors Ration Care"

In the 12/10/2010 New York Post, Dr. Marc Siegel discusses the "Flight of the MDs" from ObamaCare.

Some Hudson Ruling Reactions

Now that Judge Hudson has ruled the ObamaCare individual mandate to be unconstitutional, what does that mean and what's next? Here are some helpful reactions and analyses:

"A Noxious Commandment", Randy Barnett, New York Times.

"Highlights From the Ruling", and a more detailed analysis, "ObamaCare Loses in Court", Wall Street Journal.

"Key points in Virginia v. Seblius", David Kopel, Volokh Conspiracy.

"Initial Thoughts on the Virginia Health Care Ruling", Jonathan Adler, Volokh Conspiracy.

"Health Care Law Individual Mandate Unconstitutional", Doug Mataconis, Outside the Beltway.

Breaking News: ObamaCare Ruled Unconstitutional

This is obviously a fast-breaking story.

From AP, "Federal judge in Va. strikes down health care law".

You can read the full ruling by Judge Hudson here in PDF format (mirrored here) or here on Scribd.com.

Law professor William A. Jacobson also quotes from Hudson's ruling:

However, the bill embraces far more than health care reform. It is laden with provisions and riders patently extraneous to health care -- over 400 in all.... [at p. 38]

This will almost certainly now go to the US Supreme Court.

Severability Update

At the Volokh Conspiracy law blog, Randy Barnett notes, "White House Concedes Individual Mandate is Not Severable".

If so, this could make today's expected court ruling on ObamaCare very interesting, as Thomas Lifson notes in, "Court to rule on ObamaCare constitutionality Monday" (American Thinker, 12/10/2010).

Today's Wall Street Journal has a nice background piece, "Federal Judge to Rule on Health Law's Constitutionality".

If you missed it earlier, David Catron covered some important background information in his 12/7/2010 article, "Of Severability and Sins of Omission".

The Avastin Travesty

At today's PajamasMedia, Thomas Bowden of the Ayn Rand Center for Individual Rights discusses "The Avastin Travesty".

In particular he describes why the flawed view of a "right" to health care leads to insoluble problems of rationing and cost control in this Pajamas Media piece. The collectivist approach to health policy necessarily harms individual patients in the end. Read the full text.

(For more on this topic, see my related PajamasMedia piece, "Avastin and Your Life".)

Why Health Care Costs Are Still Rising

Devon Herrick at NCPA discusses, "Why Health Costs Are Still Rising".

The short answer:

A primary reason why health care costs are soaring is that most of the time when people enter the medical marketplace, they are spending someone else's money. When patients pay their own medical bills, they are conservative consumers.

In particular, Herrick notes that our current third-party payor system results in:

* For every $1 worth of hospital care consumed, the patient pays only about three cents out of pocket, on the average; 97 cents is paid by a third party.

* For every $1 worth of physician services consumed, the patient pays less than 10 cents out of pocket, on the average.

* For the health care system as a whole, every time patients consume $1 in services, they pay only 12 cents out of pocket.

Herrick contrasts that with the sectors of medicine where consumers pay the bills rather than third parties, such as cosmetic surgery. He notes that in those sectors, demanding consumers seek the best value for their dollar -- and the result is that providers offer ever-improving services at lower prices.

(Read the full text of "Why Health Costs Are Still Rising".)

Suppose food were treated the same way as health care, where one paid a monthly premium to a "food co-op", then got to eat at restaurants where the coop would pay 88-97% of the bill. Hence, consumers only had to cover a "food co-pay" of 3-12%. Would most people eat frugally? Or would they eat lavishly as if they were dining from their boss' expense account?

Of course, this would be unsustainable. Under such a system, the food co-ops (or eventually the government) would quickly have to set strict limits on what foods members could purchase. The end result would be the government telling you what you could or could not eat -- on the grounds that others are paying for your meals. Americans may consider such arguments absurd in the realm of food, but the precise same arguments are currently being made in the realm of health care.

Of course third-party payors play a valuable role in providing voluntary catastrophic insurance. Such a service would be of value to many Americans and would thus naturally arise in a free market. But the current system of third-party employer-based insurance is an artifact of bad government tax policies, and would never have arisen in a true free market.

(For more details, see "Moral Health Care Vs. 'Universal Health Care'" from the Winter 2007-2008 issue of The Objective Standard.)

Prospective Vs. Retrospective Medicine

This ER physician discusses a typical "damned if you do and damned if you don't" scenario in, "Inevitable Malpractice".

As he notes, this the difference between prospective and retrospective medicine: "Doctors have to make decisions in five minutes and lawyers have 5 years to tell you why those decisions were wrong".

Although our broken tort system is not the primary contributor to rising health costs, from personal experience, I know that the amount of defensive medicine that ER doctors must practice in the form of ordering radiology tests is enormous. And given the legal climate in which they must operate, I don't blame them one bit.

(Via @DrVes and @KevinMD.)

Catron on Severability

One of the interesting aspect to the legal challenges to ObamaCare is the fact that the legislation does not contain a "severability" clause. Hence, some argue that if the courts strike down the individual mandate provision as unconstitutional, then the whole law is deemed unconstitutional. At least, that's the argument.

David Catron analyzes this issue in depth in his most recent article, "Of Severability and Sins of Omission".

In particular, he discusses:

1) Was the omission of a severability clause a screw-up or a clever Machiavellian maneuver?

2) Will it make a difference in the long run?

(Read the full text.)

We'll find out soon enough...

Quick Links: Schwartz, Catron, Eck

Brian Schwartz asks, "Should you trust the Colorado Trust?" on the cost-shift argument.

David Catron discusses, "ObamaCare vs. Kids and Seniors".

The rich and powerful always do well under socialized medicine because they have "pull".

Dr. Alieta Eck warns about, "Electronic Medical Records in the Age of Wikileaks".

Can a government that can't even guard its own classified diplomatic secrets be trusted with your personal medical data?

Tech Blogger Vs. FDA

Technology blogger James Kendrick describes how the FDA interfered with a medically necessary treatment for his blocked carotid artery:

It became apparent to me on the table that things weren’t going as the specialists anticipated. It turns out the imaging clearly demonstrated that the blockage was only 70-75 percent, and not the 80-90 percent previous imaging had indicated. That turned out to be very significant, as the FDA only allows the stents to be used in patients like me when the blockage is 80 percent or greater.

Even though the specialists felt I needed the stent to correct my problem, they were not allowed to put it in. [Emphasis mine. -- PSH] So after three hours of intense work by a great medical team, and even though I was already on the operating table ready for the full treatment, the doctors had to pull out without doing anything other than the angiogram. They faced serious sanctions by the FDA had they continued as planned with the actual correction of my medical problem.

(Read the full text of "FDA Takes Over in the OR".)

The FDA claims to be protecting patients against unscrupulous doctors and medical device makers. However, it appears that what patients really need is protection against the FDA.

(Via R.K.)

Update: Reader J.S. correctly points out that the FDA does not directly regulate the practice of medicine. However, it does set the legal climate in which uses of certain devices in certain settings are permissible (or not).

For instance, the FDA might authorize the use of a device only for certain clinical trials until the FDA gives the green light for broader use. In that case, a doctor who strayed beyond the FDA restrictions might risk lawsuits or penalties from licensing/credentialing boards. Or if the physician has commercial ties with the device maker, his use contrary to FDA rules might viewed as "promotion". In either case, the physician is thwarted from using the device as he deems appropriate, even if that would be in the patient's best medical interests.

Hence, the FDA still exerts tremendous indirect effect on how innovative new devices can be used by physicians, even if it doesn't directly overrule the physician's judgment at the time of treatment.

A Day In The Life Of A Neurosurgery Resident

What does it take to become a neurosurgeon?

At KevinMD.com, one aspiring neurosurgeon wrote up a detailed description of a typical day of residency. The countless number of crucial decisions he has to make each day is staggering. I highly recommend reading the full text of his post, "A neurosurgical resident's typical day".

(My own residency in radiology was not as grueling as his, but still pretty damned busy. I saw how hard the neurosurgery residents worked at Washington University of St. Louis during their 7-year program, and I had tremendous respect for them.)

Some day, if you ever have a serious head injury (or develop a brain tumor), your life may lay in the hands of a well-trained neurosurgeon like this one, practicing according to his best independent rational judgment. Yet this the kind of person whom the government wishes to regulate via "universal health care" and "cost effectiveness guidelines". When your life is on the line, who should decide what's best for you -- your neurosurgeon or the government bureaucrat?

In Ayn Rand's classic novel Atlas Shrugged, one of the characters is physician Thomas Hendricks who put the issue into essential terms:

..."I quit when medicine was placed under State control some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I could not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward.

"I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything -- except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but 'to serve.' That a man's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards -- never occurred to those who proposed to help the sick by making life impossible for the healthy.

"I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind -- yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn.

"Let them discover the kind of doctors that their system will now produce. Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it -- and still less safe, if he is the sort who doesn't."

We have been warned.

Health Reform and the Decline of Physician Private Practice

A recent report from Merritt Hawkins discusses how ObamaCare will "will dramatically change how physicians conduct business and likely will mean the end of full-time, independent, private practitioners".

The full report can be found here (PDF version).

The report notes:

[R]esults from a national survey of 2,400 physicians, only 26% of whom said they would continue practicing the way they are in the next one to three years. The remaining 74% said they would retire, work part-time, close their practices to new patients, become employed and/or seek non-clinical jobs.

The physicians who remain in practice will increasingly be herded into large "accountable care organizations" which will require them to practice according to government "cost-effectiveness" guidelines. This trend has already been noted by the New York Times, and will accelerate in the next few years.

If you loved the "managed care" of the 1980s, including the denial of service to save money, then you'll love the new "Government Managed Care version 2.0"!

Medical Bribery in Canada and Japan

Under the system of medical rationing in Canada, some patients are resorting to very desperate measures:

A Quebec woman who claims that she paid a doctor $2,000 to expedite surgery for her cancer-stricken mother is raising questions about whether bribery is being practiced in the province's health-care system.

Vivian Green said she was doing what she had to in an effort to save her elderly mother, who had been diagnosed with pancreatic cancer after she developed a pain in her side.

"When you're desperate you don't care who you bump and how sick they are," Green told CTV News. "I was desperate."

(Read the full text of "Quebec woman claims she bribed doctor for treatment".)

Basically, the Canadian medical system puts decent people in an impossible situation where they must choose between following the rules vs. saving their own lives.

Nor is this limited to Canada. In Japan, those willing to pay appropriately large "gifts" to doctors and hospital administrators get bumped to the head of the waiting lists.

Under such socialized medicine, those who are able to "grease" the system through money or political influence will always do well. In contrast, ordinary people will lose out.

(Link via Zip and K.V.)

Update: More details at the Montreal Gazette, "Want fast care? Slip an MD some cash":

Minimum $2,000 to guarantee that a woman's doctor will be there for the birth. "And it can go up to $10,000," he added.

For general surgery, the cost runs between $5,000 to $7,000 to jump the wait list into the operating room, he said.

For Green and Marcus, the $2,000 got their mother's operation bumped up -- but not the surgeon they wanted.

(Via @debbywitt and Mark Perry.)

The Medicare Squeeze

The November 26, 2010 Washington Post notes that Medicare patients continue to have difficulty seeing their physicians, and that such problems are likely to worsen soon.

Here's an excerpt from, "Doctors say Medicare cuts force painful decision about elderly patients":

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you're a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he'll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District's Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

"It's not easy. But you realize you either do this or you don't stay in business," she said.

The article also notes that this is the current situation after the temporary one-month government "fix" -- but that the underlying problems with Medicare will soon return with a vengeance after the latest fix expires.

As always, these Medicare patients have theoretical "coverage" -- but that's not the same as access to actual medical care.

Perhaps those on the political Left who advocate for universal health care as "Medicare for all" should first try to find a doctor as a new Medicare patient.

(Link via Dr. Milton Wolf.)

Senators Barrasso and Coburn To Medical Students

US Senators John Barrasso, M.D., (R-Wyoming) and Tom Coburn, M.D. (R-Oklahoma) have written an open letter to American medical students about ObamaCare. Both of them are practicing physicians as well as US senators.

Here are a couple of key excerpts, discussing both current problems -- and future problems under ObamaCare:

Today, many physicians face a series of obstacles. They are forced to watch the clock. They are over-burdened by Washington mandates, paperwork requirements, and low reimbursement rates. And they feel tremendous pressure to increase the volume of patients they see each day—rather than having sufficient time to give each patient the attention they deserve. Unfortunately, even bigger changes for the medical community lie ahead.

...Instead of making it easier for doctors to connect with their patients, the new health care law gives Washington more power to determine care. Washington already funds 60 percent of health care in America. The health care law increases Washington’s role by creating more than 150 boards and entities invested with new powers that will inevitably intrude on the patient-physician relationship.

The new law also encourages "cookbook medicine" with new comparative effectiveness authorities that will make coverage determinations based on cost -- rather than what may be best for individual patients.

Another similar new entity is an Independent Payment Advisory Board -- a panel of unelected, unaccountable bureaucrats who are empowered to administer top-down reimbursement cuts designed to reduce federal health care spending.

(Read the full text of their open letter.)

Note: Although I don't necessarily agree with all of Coburn's proposed alternatives expressed elsewhere, they have nicely summarized some critical problems with ObamaCare.

Holiday Hiatus

I'll be taking the rest of the week off from health care blogging due to the Thanksgiving holiday. Regular posting will resume on Monday, November 29.

Happy Thanksgiving, everyone!

The Wrong Kind of Competition

The November 20, 2010 New York Times notes that ObamaCare will lead to a decrease in market competition for medical services and prices. Here's an excerpt from "Consumer Risks Feared as Health Law Spurs Mergers":

Now, eight months into the new law there is a growing frenzy of mergers involving hospitals, clinics and doctor groups eager to share costs and savings, and cash in on the incentives.

They, in turn, have deployed a small army of lawyers and lobbyists trying to persuade the Obama administration to relax or waive a body of older laws intended to thwart health care monopolies, and to protect against shoddy care and fraudulent billing of patients or Medicare.

Consumer advocates fear that the health care law could worsen some of the very problems it was meant to solve -- by reducing competition, driving up costs and creating incentives for doctors and hospitals to stint on care, in order to retain their cost-saving bonuses.

But we'll also see a different kind of competition -- for political favors.

Those with sufficient political clout will get coveted waivers from onerous ObamaCare insurance rules.

Furthermore, once mandatory insurance is imposed nationally, we can expect a frenzy of special interest groups seeking to include their own pet benefits in the mandatory package that all Americans must purchase.

This already happened in Massachusetts after that state passed its "universal health care" system in 2006, based on a similar system of mandatory insurance:

Since 2006, providers have successfully lobbied to include 16 new benefits in the mandatory package (including lay midwives, orthotics, and drug-abuse treatment), and the state legislature is considering 70 more.

These mandatory benefits raise prices for everyone to benefit the politically-favored few. Soon, the other 49 states will experience the pain that Massachusetts residents must now endure.

Even self-described liberal Democrat Morris Panner notes the problem in his November 19, 2010 Washington Post OpEd, "Strangling innovation with red tape":

We are creating so much regulation -- over tax policy, health care, financial activity -- that smart people have figured out that they can get rich faster and more easily by manipulating rules on behalf of existing corporations than by creating net new activity and wealth. Gamesmanship pays better than entrepreneurship.

Instead of fostering competition for improved medical services at lower prices (which is the norm under a free market), ObamaCare will suppress that kind of competition -- and instead spur competition in the realm of political "pull", cronyism, and gamesmanship.

Is this the kind of competition we want?

Update: Welcome WolfFiles readers!

ER Waiting Times

The November 17, 2010 National Post highlighted a growing problem of long waiting times in Canadian emergency rooms under their system of "universal health care".

Here's an excerpt from, "Wait Time Problems Continue to Fester":

Therese de Repentigny, 78, had still not been seen by a doctor for her pain-related complaints when she tried to climb off a gurney to go to the washroom and collapsed. Medical staff finally rushed to her aid, but it was too late, her family said. Within moments, they said, she was dead...

A Quebec patients' group said Wednesday that such waits are anything but uncommon. In Alberta, meanwhile, emergency doctors and senior health administrators were planning to meet Friday for a brainstorming session on how to reduce queuing in emergency wards. Physicians there have said overcrowding is setting the stage for a "catastrophic collapse." Police in Manitoba began a criminal investigation last month into the death of a disabled man who died in a Winnipeg emergency room following a wait of 34 hours.

Similar problems will hit America soon under ObamaCare. Under the Massachusetts system of universal care (on which ObamaCare is closely modelled), ER visits increased significantly rather than decreased.

From the July 4, 2010 Boston Globe:

The number of people visiting hospital emergency rooms has climbed in Massachusetts, despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use.

According to state data released last week, emergency room visits rose by 9 percent from 2004 to 2008, to about 3 million visits a year.

When the Legislature passed the insurance law in 2006, officials hoped it would increase access to primary care doctors for the uninsured, which would improve their health and lessen their reliance on emergency rooms for the flu, sprains, and other urgent care.

As ObamaCare is phased in nationally, we expect similar problems in the other 49 states.

Do we want a Canadian-style "catastrophic collapse" here in the U.S.?

(National Post link via A.B.)

Quick Links: Rhoads, WSJ, Malkin

Jared Rhoads of the Lucidicus Project explains why we should "Brace for chaos in 2014". (If you like what he does, you can support him here.)

The 11/18/2010 Wall Street Journal tells newly-elected state officials to sign onto the Florida lawsui: "Joining the ObamaCare Suit".

Michelle Malkin asks, "Dude, where's my Obamacare waiver?"

Wolf: Inside the Belly of the Beast

In the November 17, 2010 Washington Times, Dr. Milton Wolf describes his journey into the "belly of the beast":

In six months I went from a political outsider to the only Tea Partier our president actually knows. Until recently, I had never been to a political rally, much less been an activist. I frankly found politics to be a repulsive display of backroom deals, dishonesty, personal attacks and smear tactics designed to intimidate normal Americans from joining the process. But everything changed with Obamacare...

(Read the full text of "My journey into the 'belly of the beast'".)

The best quote: "The Tea Parties exist because of the failures of the Republican Party".

Scherz: Meet the 'New' Donald Berwick

Dr. Hal Scherz of Docs4PatientCare urges us to "Meet the 'New' Donald Berwick".

Despite the Obama administration's attempt to put a friendly new face on the rationer-in-chief, Berwick has a long paper trail of advocating government controls over health care. Scherz does a nice job of reviewing Berwick's past statements:

Dr. Berwick has always viewed himself as a "leader" who needs to radically change American health care; he cannot now suddenly alter these years of radical opinions about how terrible American healthcare is by giving a hopeful speech about his plans for Medicare. This is a man who has stated that healthcare by definition involves wealth redistribution, and he intends to make good on his promises.

(Read the full text of "Meet the 'New' Donald Berwick".).

Dr. Scherz isn't fooled by the "New" Berwick. Let's hope America isn't either.

The Compromise Trap

Some Republicans are talking about trying to keep the "good" portions of ObamaCare, and just eliminate the bad portions.

Dr. Jane Orient debunks this fallacy at, "Saving the 'Good' in Healthcare Reform: a Thought Experiment". She discusses the dangers of keeping some of the "popular" provisions such as "stopping insurers from discriminating according to pre-existing conditions", "guaranteed issue", "affordability" provisions, and "performance incentives".

All of these allegedly "good" features merely impose further economic controls, which will eventually harm patients and doctors.

The proper solution is not to try to "save" ObamaCare, but scrap it.

Dr. Michael Hurd on ObamaCare

Dr. Hurd warns us, "You Get What You Pay For".

And it won't be worth much...

Dialysis Blues

From the December 2010 Atlantic: "God Help You. You're on Dialysis" Is this our future?

The 11/10/2010 Denver Post reports a similar story, "ProPublica review: State of U.S. kidney dialysis bleak".

Breaking ObamaCare

In the 11/9/2010 Washington Examiner, Paul Howard describes "How Republicans can break Obamacare before they repeal it".

The tactics he describes are good ones, because they highlight the bad economic effects of ObamaCare.

If coupled with more fundamental moral arguments against ObamaCare, including the idea that health care is not a right, then they could be highly effective. Without such arguments, they may not gain sufficient traction amongst the American people.

The most recent election showed that many Americans want to have a debate at the level of fundamental ideas -- such as the proper role of government in people's lives. Let's hope the Republicans are up to that debate.

New Government Smoking Warnings

The federal government wants to help you better understand that smoking will kill you, with these proposed new warning labels.

The nanny state mentality is the one thing that isn't dead here.

Massachusetts Update

The Massachusetts Medical Society recently released its "2010 Physician Workforce Study".

The results confirm what we've known from prior years -- waiting time to see a doctor remains long. Some key findings include:

* The primary care specialties of family medicine and internal medicine are in critically short supply, the fifth consecutive year of shortages for these specialties.

* 10 of 18 specialties studied have been found in short supply, 3 more than last year.

* High percentages of primary care practices are closed to new patients: 54 percent of family medicine physicians and 49 percent of internal medicine physicians are not accepting new patients.

* Wait times for new patients for primary care continue to be long, with an average wait time of 29 days for family physicians and 53 days for internists.

The head of the MA Medical Society, Dr. Alice Coombs, attempts to argue that the MA "universal" plan has resulted in "improved access to care". But she is committing the standard fallacy of conflating "coverage" with actual care. Patients in MA may have theoretical "coverage" but that's not the same as actually getting medical care.

The MA plan remains a failure. And once the newly-elected Congress is sworn in, they should make a priority of defunding (and eventually) repealing ObamaCare, before the rest of the country experiences the same failure.

Gardner: Obamacare -- Seven Months In

At the Wolf Files, guest blogger Brent Gardner discusses "Obamacare -- Seven Months In".

He notes how mandatory benefits and mandated coverage of pre-existing conditions raises costs for people and destroy the principle of rational pricing for insurance.

Here's an excerpt:

The lowest cost health insurance policy that I could sell (and purchase, at my current age) had a premium of $26 per month before the new law went into effect. Underwriting on this policy was reasonable, and the average person in America would qualify medically. Only one person in twenty could expect to be charged an extra premium, or declined coverage, for excessive pre-existing conditions. The policy would do exactly what it was designed to do: Keep the insured out of bankruptcy due to an extraordinary medical event, a catastrophic sickness or injury.

Today, that policy is not available. The insurance company looked at the new law, all the mandates that were being forced on them, and they decided that their capital was better employed in another line of business. The result was that my favorite low-premium policy was withdrawn from the market.

The least expensive alternative available today is $64 per month, subject to much stricter medical underwriting with a different company. The average slightly overweight American would not qualify for this policy, and one can forget about it if they smoke, have one traffic ticket, or take ANY prescription pills. I know this from first hand experience.

In the simplest of terms, the absolute lowest toll for major medical insurance has more than doubled, and it is more difficult to obtain.

But...there's more!...

(Read the full text of "Obamacare -- Seven Months In".)

Catron: How the GOP Can Stop the Spread of Obamacare

The 11/5/2010 American Spectator published a nice piece by David Catron explaining, "How the GOP Can Stop the Spread of Obamacare".

He shows how a similar strategy worked in Massachusetts after then-Governor Dukakis signed into law their first failed attempt at "universal health care" in 1998.

Catron discusses a 3-part strategy to do the same at the national level. One especially good point he raises is as follows:

In addition to the power of the purse, the new House majority will also have subpoena power that can be used to delay implementation.

They can hold numerous and protracted public hearings, while demanding all manner of documentation from the Department of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS). They can summon HHS Secretary Kathleen Sebelius to answer questions about her 2009 gag order to insurance companies and her growing reputation as an enemy of the First Amendment.

It would also be instructive to hear CMS administrator Donald Berwick to elaborate on statements like, "Any healthcare funding plan that is just... must redistribute wealth."

I believe this will have to be a crucially important element.

ObamaCare must be attacked not just on wonkish economic grounds, but at the level of fundamental ideas such as:

"Is it just to redistribute wealth in this fashion?"

"Should doctors be able to practice according to their own best judgment, or should they be compelled to follow government practice guidelines?"

"Does your life ultimately belong to you -- or to the state?"

The election results showed that American voters understood what was at stake -- and they elected the Republicans as their way of saying so.

For Republicans, the big question is whether they will have the political will (i.e., the moral courage) to follow through on their many promises to "defund" and repeal ObamaCare.

Right now the Republicans are talking the talk. Will they also "walk the walk"?

(Read the full text of "How the GOP Can Stop the Spread of Obamacare".)

AARP Cites ObamaCare For Raising Costs

Today's bit-o-irony, "Citing health overhaul, AARP hikes employee costs":

AARP's endorsement helped secure passage of President Barack Obama's health care overhaul. Now the seniors' lobby is telling its employees their insurance costs will rise partly as a result of the law.

In an e-mail to employees, AARP says health care premiums will increase by 8 percent to 13 percent next year because of rapidly rising medical costs...

I wonder if the Obama administration will go after them for spreading "misinformation"?

The Mandate To Repeal ObamaCare

Dr. Beth Haynes pointed me towards this nice video, with the message that the new Congress has a mandate to repeal ObamaCare:



Of course, immediate repeal is extremely unlikely in the face of Obama's presidential veto.

But the GOP can "defund" it. And interestingly enough, this pro-ObamaCare article in the New England Journal of Medicine tells how it can be done:

"The Midterm Elections - High Stakes for Health Policy" (PDF file)

(Go to the 2nd page of the article in the paragraph that begins, "A more serious possibility is that ACA opponents could deliver on another pledge: to cut off funding for implementation. Here is how such a process could work...")

Hsieh PJM OpEd: "GOP: Dance With The One Who Brung You"

The November 3, 2010 PajamasMedia has published my post-Election Day OpEd, "GOP: Dance With The One Who Brung You".

My theme is that I voted for the Republicans because I want them to pursue an agenda of limited government, fiscal responsibility, and defending individual rights -- not the "social conservative" agenda.

Here is the opening:

Republicans are rightfully celebrating their recent successes in the midterm elections, recapturing the House and making major gains in the Senate. But before House GOP leader John Boehner starts measuring the curtains for the speaker's office, he and his fellow Republicans would do well to remember the old proverb popularized by legendary University of Texas football coach Darrell Royal: "Dance with the one who brung you."

In this case, that means: Don't forget who put you in office and why -- namely, the independent-minded Tea Party voters.

Hence, the Republicans should take to heart three key lessons...

Those lessons include:

1) Americans don't want "ObamaLite".
2) Don't mistake this as a mandate to pursue a divisive "social conservative" agenda.
3) Respect the Constitution and the principle of individual rights.

(Read the full text of "GOP: Dance With The One Who Brung You".)

Update: Thanks for the Instapundit mention!

Amendment 63 Wrapup

Unfortunately, Amendment 63 lost last night here in Colorado.

However, similar health freedom measures did pass in Arizona and Oklahoma.

I'd like to take moment to thank my friend Brian Schwartz for his tireless writing and blogging on health care.

And I'd like to thank his colleagues at the Independence Institute for fighting the good fight on this issue.

Rhoads On Republicans

Jared Rhoads of the Lucidicus Project tells conservative, "I've given you a Republican voter... if you can keep me".

Let's hope they listen.

Antos: Confessions of a Price Controller

Joseph Antos explains how government price controls have distorted the market for medical services in Medicare, leading to many of its current problems.

One key quote:

Medicare's experience demonstrates how hard it is for a government agency to set physician payment rates that clear the market. Some prices are too low, requiring patients to wait for treatment or even go without as the demand for those services exceeds the supply. Some prices are too high, unnecessarily raising the cost of Medicare to the taxpayer as physicians respond to the incentive to use more expensive services—even when those services do not produce better outcomes for patients. If the prices are not right, the consequences are unavoidable.

The problem for a government price controller is that he can never know when the price structure is "right." He can know when physicians are unhappy with their prices because they will complain, but that does not necessarily mean that those prices should be raised. He cannot know when prices are too high, because physicians benefiting from that mistaken generosity will not complain. The bias is always to raise prices, not lower them.

Medicare tries to solve that problem by limiting how much average prices may rise using the infamous sustainable growth rate (SGR) formula. That formula sets an arbitrary limit, unrelated to conditions in the market for physician services, on year-to-year increases in physician payment rates. Just as the price controller cannot know the "right" structure of relative prices, he also cannot know the "right" average price or its rate of growth. Again, the only signals come from those who want more, not less.

The inevitable result is that Congress breaks its own price control rules. In an annual rite of political contrition, Congress overrides the cuts in Medicare physician payment called for by the SGR. To maintain the fiction that someday we will take those reductions, they are pushed off to the next year -- compounding both the amount to be cut and the political problem.

(Read the full text of "Confessions of a Price Controller".)

Basically, when government fiat replaces the marketplace, there no longer is any "right" price.

No bureaucrat can possibly know what would have been the price settled upon by thousands (or millions) of actors seeking their own best values in a free market. Hence, all he can rely on is some combination of guesswork, whim, and political favoritism. The current Medicare mess is the inevitable consequence of such government price setting.

(Via @MatthewBowdish and WolfFiles.)

Ralston: Health care queries for candidates

The October 28, 2010 Orange County Register has published the latest OpEd by Richard Ralston of Americans for Free Choice in Medicine entitled, "Health care queries for candidates".

He recommends that voters ask their candidates some of the following:

...[A]sk why all your medical records must be turned over to the government without your permission, as required by the stimulus bill of 2009. The records must be computerized, and if they already are, they must be changed to conform to government guidelines and handed over.

...Ask congressional candidates why the legislation known as Obamacare regulates the sale and purchase of gold.

...Ask the candidates why your physicians will be punished financially if, in treating you, they follow their own judgment instead of new government protocols and "best practices."

...Ask the candidates why they think it is immoral for anyone in the medical arena to make a profit -- except trial lawyers.

Ask the candidates what will happen to the cost of new drugs when, after many years of development and trials to obtain government approval, they must go through yet another lengthy review in a "comparative effectiveness" bureaucracy.

Ask them if a new drug that would help you will be forbidden if it does not help everyone else in the same way.

...Ask them what might happen to terminally ill patients -- many thousands of whom have already died -- while being denied access to these drugs.

(Read the full text of "Health care queries for candidates".)

And if you don't like the answers you get, you'll soon have a chance to let them know.

The Repeal Pledge

An excellent short video (via Black Ribbon Project):




The October 1, 2010 Wall Street Journal has more information at "The Repeal Pledge".

Tea-Minus One Day.

Why I'm Voting Straight-Ticket Democrat on Tuesday

Because I want to support President Obama's agenda and continue his string of domestic and foreign policy successes, including:

1) Getting the federal budget deficit under control

2) Getting our economy back on track

3) Guaranteeing universal health care, while making sure everyone who likes their current health plan gets to keep it

4) Reducing unemployment to near-record lows

5) Getting our troops out of Iraq and Afghanistan and getting our enemies abroad to stop hating us

6) Fighting for the rights of gays serving in the military

7) Changing the rancorous tone in Washington and moving us in a "post-partisan" direction

...Wait, what's that? ...Hang on a sec

[Quick internet search]

...Um, never mind

Two Doctors In The Washington Times

The October 27, 2010 Washington Times carried two good health care OpEds by physicians.

Dr. Daniel Johnson, Jr. wrote, "Patient beware of accountable care organization".

Johnson warns how ACO's being promoted with government help will set physician practice standards and payment incentives that will likely lead first to capitation -- then a single-payer system.

Dr. Mark Neerhof of Docs4PatientCare wrote, "Repeal president's ploy".

Neerhof shows how the insurance regulations will drive private insurers out of business and herd Americans into single-payer, government-run health care.

ObamaCare thus constitutes a two-pronged attack on the freedoms of American patients and physicians.

If Americans don't like this prospect, they should let their elected officials know next Tuesday!

A Humorous Look at ACOs and Medical Homes

The Disease Management Care Blog has posted two short videos on ACOs (Accountable Care Organizations) and "Medical Homes":





For a more serious look at ACO's, read Dr. Beth Haynes' recent post at the Black Ribbon Project.

Schwartz: Amendment 63's Foes Only Want You for Your Body

The October 26, 2010 Huffington Post has just published Brian Schwartz's latest piece, "Amendment 63's Foes Only Want You for Your Body".

Here is the opening:

Should Colorado mandate that each car owner buy a comprehensive lifetime vehicle warranty? By the logic of a common argument against Colorado Amendment 63 and for mandatory medical insurance, the answer is "Yes." Mandatory insurance treats your body as a means to political ends, rather than respecting your rights as an individual.

He goes on to show how the mandatory insurance in ObamaCare is both a form of exploitation as well as a restriction of basic freedoms.

(Read the full text of "Amendment 63's Foes Only Want You for Your Body".)

Quick Links: MLRs, Employers, Alternatives

David Hogberg at the 10/21/2010 Investors Business Daily looks at the proposed new "Medical Loss Ratio (MLR) rules and asks, "Will New ObamaCare Regulation Reduce Insurance Competition?"

This 10/24/2010 AP story reports, "Employers looking at health insurance options".

As those first two stories indicate, ObamaCare rules will slowly strangle the current insurance market, thus herding Americans into the state-run "exchanges". The inevitable result will be a "single-payer" government-run system.

John Goodman at NCPA offers some positive alternatives to this bleak future in his 10/25/2010 post, "A Radically Different Approach to Health Insurance"

My Latest in Denver Post and CapMag

Two of my health care pieces have just been published:

The October 23, 2010 Denver Post has published "The 'Right To Health Care Choice'is right for Colorado".

Here is the opening:

Suppose the government required everyone to purchase their meals from state-run restaurants. The government would also select the menu items. If you liked spinach but their vegetable choice was broccoli, then tough luck. Everyone would also have to purchase dessert, whether they wanted it or not. And if some customers couldn't afford the overpriced meals, you'd have to cover their tab.

Most Coloradans would be outraged at such a violation of their basic freedoms. But this is precisely what ObamaCare does with health insurance -- and which the "Right To Health Care Choice" Initiative (Amendment 63) would help prevent.

(Read the full text of "The 'Right To Health Care Choice'is right for Colorado".)

Also, Capitalism Magazine has just posted "A Medical Doctor Explains the Pros and Cons of ObamaCare: An Interview with Dr. Paul Hsieh".

(Thank you, Joshua Lipana, for that nice interview!)

Hsieh/Armstrong on Personhood and Health Choice

The October 22, 2010 Denver Daily News published the OpEd by Diana Hsieh and Ari Armstrong, "A62, A63 Reveal Ideological Rifts". In this piece, they discuss Amendment 62 (the "personhood" measure) and Amendment 63 (the Health Care Choice measure).

They discuss why a proper approach to individual rights leads them to oppose Amendment 62 and support Amendment 63. In particular, they note:

Both the left and the religious right, then, express contradictory views about liberty and individual choice. They support it in some cases, but not in principle. Why is that?

The left rejects America’s founding ideal of liberty as each person’s freedom to pursue his own life and happiness using his own property. They regard rights as entitlements to goods and services provided by others, not freedoms to think and act without coercive interference.

...The religious right claims to support individual rights, but its conception of rights is little more than sectarian dogmatism. Rights are whatever God declares them to be, on this view.

By contorting some Bible passages and ignoring others, advocates of Amendment 62 claim that newly fertilized zygotes -- even before implantation in the uterus -- must be declared persons with full legal rights. By similar methods, they ignore the Bible's overt hostility to individual rights and capitalist values.

The consistent, secular view of individual rights is opposed to both the entitlements of the left and the dogmatism of the religious right. Rights, on this third view, define the individual's proper sphere of freedom in a social context. They enable each person to act by his own judgment and for his own life and happiness.

Such rights are based on the facts of man's rational nature, not the whims of the majority or the arbitrary commands of God. They apply equally to every person, to individuals living in society, as opposed to an embryo or fetus entirely contained within a pregnant woman’s body.

(Read the full text of "A62, A63 Reveal Ideological Rifts".)

Wolf: Obamacare's Unkeepable Promises

Dr. Milton Wolf has a new OpEd in the 10/22/2010 Washington Times, "Obamacare's Unkeepable Promises".

In it, he debunks all of the promised benefits, including cost savings, "you can keep your own insurance", "no rationing", an open legislative process, etc.

Read the whole thing.

I doubt the President will take Dr. Wolf up on his invitation for a chat. But it never hurts to ask!

You can read more from Dr. Milton Wolf at his blog, The Wolf Files.

Killing Marcus Welby

Scott Gottleib discusses how Accountable Care Organizations (ACOs) will destroy independent small private practices and lead to indirect rationing.

Otis On WA Regulations

Maryallene Otis of Lynwood, WA responds to her state regulators forcing insurers to sell child-only policies.

This is her LTE in the October 19, 2010 Seattle Times:

State regulator orders Regence to reinstate child-only plans

Profit motive more dependable than government bureaucrats

State insurance commissioner Mike Kreidler has ordered Regence BlueShield to resume selling child-only insurance policies ["WA orders Regence to resurrect child-only plans," seattletimes.com, Oct. 15].

Regence (and insurance companies across the country) recently made the sound business decision to stop selling these policies because of the new federal law forbidding them to exclude children with pre-existing conditions.

To force a company to sell policies without considering pre-existing conditions, means that what Regence would be selling would not be insurance. Insurance takes risk into account. Kreidler is forcing Regence to make a bad business decision, on which they cannot possibly make any money.

Government is strangling the business of medicine and the business of medical insurance with more and more regulations. Then, when the regulations create a disaster, bureaucrats vilify medical professionals and insurance companies for wanting to make a profit.

Capitalism, the political system that protects individual rights to property and contract, is the moral and practical way to provide goods and services. I would far rather depend on the profit motive than the whim of a bureaucrat.

-- Maryallene Otis, Lynnwood

I especially liked how she linked the specific regulatory issue to the broader theme and proper definition of capitalism.

Thank you, Maryallene, for speaking out in Washington state!

Schwartz and Novack on Amendment 63

Brian Schwartz debunks the latest anti-A63 alarmists at the 10/18/2010 Huffington Post: "Amendment 63 vs. the Unlicensed Vampire Alarmists"

Dr. Eric Novack discusses in the 10/14/2010 Boulder Daily Camera why "Amendment 63 is good for Colorado".

Zawistowski: Lessons Learned From The ER

Stella Zawistowski tells her "Lessons learned from the ER".

Not Just Bad PR

The Obama administration has been spending millions of dollars on advertisements to promote the alleged benefits of ObamaCare. (Via David Catron.)

But as the 10/15/2010 Wall Street Journal notes, "Voters on ObamaCare: Informed and Opposed". Many Americans actually understand that ObamaCare will hurt them by raising their costs and limiting their freedoms -- and they don't like it.

The problem with ObamaCare is not just bad PR.

ObamaCare Unravelling

The October 8, 2010 Investors Business Daily discusses "The Unraveling Of ObamaCare".

As more companies and special interest groups get waivers from ObamaCare rules, it highlights two facts:

1) The rules are bad.
2) Those with political pull will get special treatment.

At best, this will create rule by men, rather than rule by law. At worst, this is a recipe for widespread political corruption.

Maybe the entire country should request a waiver from ObamaCare...

Legal Scholars On Latest ObamaCare Ruling

Hadley Heath has a nice round-up of various legal scholars' reactions to the latest court ruling allowing the multi-state lawsuit against ObamaCare to go forward.

(Via David Catron.)

Carrots and Sticks for Electronic Medical Records

The AMA has summarized the various financial carrots and sticks that the government will wield against doctors to get them to adopt electronic medical records (EMRs, also known as EHR for "electronic health records").

The laws require "meaningful use", to prevent doctors from buying the machinery but just letting it sit on the shelf. Initially, the inducements are in the form of carrots (rewards), but later they turn into sticks (penalties):



These EMRs will be used to track physician compliance with "practice guidelines".

When Big Brother watches your doctor and decides whether or not your doctor will get paid, it could lead to a chilling effect on physicians' ability to use their best independent judgment.

Pro Amendment 63 Commercial

Let's hope this doesn't become a reality:

Quick Links: Costs, Rebellion, Greeks, Wolf

Dr. Beth Haynes of the Black Ribbon Project discusses, "The Real Reason Medical Costs Are Rising".

Jeffrey Anderson describes rising discontent within the medical profession against ObamaCare at, "Battling ObamaCare: The Health Care Industry Starts to Awaken".

The Greek health care system announced the following gruesome policy:

...[T]he nation's largest government health insurance provider would no longer pay for special footwear for diabetes patients. Amputation is cheaper, says the Benefits Division of the state insurance provider.

And on a personal note, last week I had the pleasure of meeting in person Dr. Milton Wolf, who coincidentally happened to be attending the same medical conference as myself. We had a nice chat about his activities and goals. All I can say is that it's too bad we can't clone 50 more of him.

(But then, Mizzou alumni might not want that many more Jayhawk fans roaming the earth...)

Catron: The Criminal Intent of ObamaCare

David Catron warns about a provision of ObamaCare that undermines the legal rights of physicians and a core principle of our justice system.

Read his piece, "The Criminal Intent of ObamaCare".

Preventing You From Spending Your Own Money

Dr. Eric Novack discusses how the "no cost sharing" provision in ObamaCare will drastically curtain your ability to spend your own money for some legal health services.

Read his 9/23/2010 piece, "ObamaCare: The Used Car Contract of Lawmaking".

(Dr. Novack is the author of the Arizona Health Care Freedom Act, which is a 2010 ballot initiative similar to Colorado's Amendment 63.)

Update: Some readers commenting on Dr. Novack's piece have asked about the "no cost sharing" rule and whether that amounts to banning spending your own money (as opposed to merely obliging insurers to provide certain services "for free".

Here's something I wrote earlier on this topic, from "ObamaCare: Tightening the Noose Around Private Health Care":

Similar restrictions against "cost-sharing" or out-of-pocket spending are already established policy for Medicare -- the federal government’s "universal heath care" program for the elderly.

Under current federal law, if a doctor accepts Medicare patients (i.e., he is a "participating physician"), he must accept the payment set by Medicare. If the doctor can't make ends meet on the low Medicare fees, then that's his problem. Medicare rates are currently so low that many physician practices would go under if they had to rely solely on Medicare -- which is why many doctors currently limit the number of Medicare patients they are willing to accept.

But suppose a patient tells his doctor, "I know that Medicare doesn't pay you enough to cover your costs of performing the surgery which you and I both agree is necessary. I'll pay you extra in addition to Medicare to get it done."

By law, the physician cannot accept this offer. If he did, he could face stiff fines (or possibly jail) for illegal "cost-sharing." As long as he is a "participating physician" in Medicare, he may not accept any out-of-pocket money from his patients for covered Medicare services.

So a combination of "no cost sharing", pending government price controls, and physician exclusion from "qualified plans" if they accept money from patients creates the problem of patients being effectively prevented from spending their own money.

It's already the case for Medicare patients. As ObamaCare is implemented, this will likely affect millions of non-Medicare patients as well.

Lawsuits Update

As many know, a federal judge in Michigan has just upheld the Obamacare insurance mandate.

At the Volokh Conspiracy law blog, Ilya Somin offers his initial critique. So does Randy Barnett.

As many observe, this issue will likely end up being decided in the US Supreme Court.

If you're interested in more information, the Health Care Lawsuits blog and their main website look like promising sources.

Schwartz Rebuts Semro on Amendment 63

The 10/6/2010 Huffington Post carried Brian Schwartz's latest piece on Amendment 63, "Colorado Amendment 63: Freedom Is Too 'Haphazard' for Bell Policy Center".

In it, he rebuts the various objections raised by Robert Semro of the Bell Policy Center in Semro's earlier Denver Post OpEd, "No on Amendment 63: It won't hold down health care costs".

One excerpt from Schwartz's piece:

Semro also does not like Amendment 63 because it would "tie the hands of policymakers who want to reduce costs by expanding health care coverage in Colorado." Yes, and this is a good thing. "Reducing costs by expanding coverage" is code for turning health insurance into a tax, or compulsory charity. Mandatory insurance doesn't mean just any kind of insurance, but policies loaded up with mandated benefits and minimum copayments and deductibles. All of these drive up premium prices and force many people to buy more insurance than they'd otherwise want. This "cost-shift" or hidden tax is larger than that from the popular scapegoats, the uninsured.

Semro continues with Orwellian Newspeak. Amendment 63 would prohibit government from forcing you to buy an insurance plan designed by politicians. It also protects your right to pay cash for medical care. But Semro claims Amendment 63 "will obstruct the ability of Coloradans to make decisions about their health care." Nonsense. Amendment 63 does just the opposite. It obstructs the ability of the Colorado politicians and bureaucrats to make decisions about your health care.

(Read the full text of "Colorado Amendment 63: Freedom Is Too 'Haphazard' for Bell Policy Center".)

Thank you, Brian!

Lawsuits Update

The September 29, 2010 Christian Science Monitor discusses the status of the various anti-ObamaCare lawsuits in "Lawsuits to undo key parts of health-care law move forward, so far".

Some excerpts:

State of Florida v. United States Department of Health and Human Services, was filed in federal district court in Pensacola and joined by 12 other states via their attorneys general. In May, four states via their governors and three states via their attorneys general joined Florida's suit. Also joining the suit were the National Federation of Independent Business and two individuals from Florida and Washington State.

Mr. Cuccinelli's suit was filed on behalf of Virginia alone in US district court in Richmond. Cuccinelli, a Republican, has championed conservative causes since taking office in January...

Further, the states claim that Congress is commandeering traditional state powers under the 10th Amendment, such as regulating intrastate insurance programs.

To bolster their 10th Amendment claims, Virginia and five states in the Florida suit -- Georgia, Idaho, Louisiana, Utah, and Arizona -- created conflict between federal and state laws by passing laws prohibiting government from compelling their citizens to purchase health insurance.

More information in the full article.

The October 3, 2010 Washington Times has more information on the separate voter initiatives in CO, AZ, and OK to exempt residents from the ObamaCare mandatory insurance requirements. Read more at "Voters in 3 states to consider opting out of 'Obamacare'".

Update: USA Today has its own summary, "Lawsuits over health care law heat up".