Hsieh LTE in Gazette on Amendment 63

The August 30, 2010 Colorado Springs Gazette has published my LTE supporting their position on Amendment 63 (the second one down):

Doctor gives thanks for 63

Thank you for speaking out in favor of the Colorado Health Care Choice Initiative protecting us from mandatory health insurance. This idea forming the core of ObamaCare has already been tried -- and failed -- in Massachusetts, resulting only in skyrocketing health costs, a desperate shortage of doctors, and significantly longer waits for medical care than in the rest of the country. Some Massachusetts patients must now wait almost a year for a routine physical exam.

As a practicing physician, such Massachusetts-style problems are the last thing I want here in Colorado. Colorado voters can avoid the mistakes of Massachusetts by supporting Amendment 63.

Paul Hsieh, MD
Sedalia

The original Gazette OpEd can be found at: "Amendment 63 protects our freedom".

Catron: The Laugher Curve

David Catron illustrates the unintentional comedy stylings of the advocates of ObamaCare in his latest piece, "The Laugher Curve".

Here's an excerpt:

Among the most hilarious ObamaCare justifications is the claim that it will reduce the federal budget deficit. No less a jokester than Paul Krugman produced this gag in a recent blog post, "the Medicare actuaries believe that the cost-saving provisions in the Obama health reform will make a huge difference to the long-run budget outlook... All the facts we have suggest that health reform was the biggest move toward fiscal responsibility in a long, long time."

The comedy writers from whom Krugman got this quip are the CMS bureaucrats who produced the latest Medicare Trustees Report, which claims "reform" will control Medicare spending enough to keep the program solvent while easing upward pressure on the deficit.

Alas, not everyone appreciates this brand of humor. One such stick-in-the-mud is Richard Foster, Medicare's Chief Actuary...

(Read the full text of "The Laugher Curve".)

Fortunately, we have a chance in November to send a message to our elected officials that we want ObamaCare repealed.

Let's make sure the last laugh is on the ObamaCare supporters, rather than on us.

Laugesen Defends Amendment 63

In the August 27, 2010 Colorado Springs Gazette, editor Wayne Laugesen defends the Right to Health Care Choice Initiative in their editorial "Amendment 63 protects our freedom".

In particular, Laugesen notes:

This is not a country in which might makes right. It's a country designed to protect minority interests against big government and mob sentiment. Therefore, the massive size of the federal bureaucracy alone does not equal legal authority to impose upon individuals and state governments. Congress has no authority to require individuals to buy private insurance, which is the basis of the lawsuit filed by states. It has no such authority because the Constitution does not grant it, not by any twisting of any phrase. That might not bother a majority in Congress, but it will most certainly matter to federal judges when they determine which rights belong to whom -- based entirely on their interpretation of the Constitution.

(Read the full text of "Amendment 63 protects our freedom".)

I'm glad to see newspapers like the Colorado Springs Gazette and editors like Laugesen speaking out for limited government and individual rights!

CO Amendment 63 and Risk Pools

Brian Schwartz discusses "Colorado Amendment 63, risk pools, & health care costs" at PatientPower.

Go check it out!

CastroCare In Crisis

So how's that universal Cuban health care working out?

Laurie Garrett discusses the current state of health care in Cuba in "Castrocare in Crisis". Here's an excerpt:

For years, Cuban hospital patients have needed to provide their own syringes, bed sheets, and towels. Some say they fear getting infections while visiting clinics because of shortages of soap, disinfectants, and sterile equipment.

A preventable form of cancer, cervical carcinoma, now ranks as the fourth leading cause of death for Cuban women. In most of the world, cervical cancer is on the decline thanks to annual gynecological screenings (with the Pap test) and the use of the human papillomavirus vaccine. In Cuba, however, the number of routine Pap tests performed has fallen by more than 30 percent and the number of diagnosed cervical cancer cases has doubled since 1985...

Cuba's doctors are increasingly strained. Physicians return from years abroad because they must, both contractually and to avoid repercussions for their relatives in Cuba. They then must accept whatever assignments the government gives them, including sometimes years of service in a remote village, a Havana slum, or a sparsely populated tobacco-growing area.

Many doctors and nurses leave the health-care system altogether, taking jobs as taxi drivers or in hotels, where they can earn CUCs. In February 2010, seven Cuban doctors sued the Cuban and Venezuelan governments, charging that the mandatory service they had performed in Venezuela in exchange for oil shipments to the Cuban government constituted "modern slavery" and "conditions of servilism for debt."

(Read the full text of "Castrocare in Crisis".)

Michael Moore must not have gotten the memo...

Via NCPA.

CO Health Care Choice Qualifies For Ballot

Today's Denver Post reports that the "Right to Health Care Choice" amendment has qualified for the November 2010 ballot, as Amendment 63.

There's also an official website for Amendment 63, where you can read the text of the Amendment.

I'm glad to see CO joining the list of states where voters are able to express their desire for genuine health care choice!

(Via @AriArmstrong.)

Quick Links: Innovation, Medicaid, Braking ObamaCare

Cleveland Clinic CEO Toby Cosgrove warns that "health-care reform could stifle medical innovation". (Cleveland Plain Dealer, 8/19/2010)

John Goodman points out how government-run Medicaid arbitrarily withdraws benefits from patients ("recissions") in far more arbitrary and abusive fashion that private insurance. (Kaiser Health News, 8/12/2010)

Grace-Marie Turner discusses 6 ways to slow down ObamaCare until its eventual repeal. (WSJ, 8/25/2010)

Hsieh PJM OpEd: "Avastin and Your Life"

PajamasMedia has just published my latest OpEd, "Avastin and Your Life".

Here is the introduction:

The Food and Drug Administration (FDA) is on the verge of taking the highly unusual step of "decertifying" the cancer drug Avastin that it had previously approved.

In addition to sparking concerns that this is another step towards medical rationing, the FDA's proposal will worsen another important but less-frequently recognized danger of government-run health care -- namely, the politicization of health benefits. Both problems will accelerate under ObamaCare unless our politicians repudiate the principle of government-run health care...

(Read the full text of "Avastin and Your Life".)

Fast Track To Government Health Care

Grace-Marie Turner explain how regulators' interpretation of the seemingly arcane "medical loss ratio" could determine whether private insurance survives as an industry, or whether it becomes a back-door path to a government-run "single payer" system.

Her piece in the August 20, 2010 Investors Business Daily is entitled, "Fast Track To Government Health Care".

Here's more political wrangling over the same issue: "Debate Heats Up Over Medical Loss Ratios".

Economist on Consumer DNA Testing

The Economist has a short series of articles on consumer DNA testing:

"What lies within" (The personal genetic-testing industry is under fire, but happier days lie ahead)

"Reading genes" (Alas, a DNA test probably won’t reveal your future. But a crackdown on consumer genetics is unwise)

"The part where I find out that I may get fat" (What our science correspondent found out about herself when she tried commercial gene testing)

"The part where I find out the government doesn't like what I'm doing"

(My own piece on this topic is available at PajamasMedia: "Should You Be Allowed to Know What’s in Your DNA?")

Stuff Found In Patients

As a change of pace from heavy policy stuff:
"Medical Tales Of Strangest Objects Found In Patients".

(Via Cosmic Log.)

Pipes: Why ObamaCare Must Be Repealed

In the August 17, 2010 RealClearPolitics, Sally Pipes discusses "Why ObamaCare Must Be Repealed".

She draws on the experience in Canada and Massachusetts to show how ObamaCare's proposed incremental "reforms" will inevitably lead to a full government takeover of American health care. Here's an excerpt:

Obamacare promises to expand coverage in the same way that Massachusetts did -- by expanding government-funded insurance. Canada did the same thing. Worse, Rep. Lynn Woolsey (D-CA) - introduced on July 21 an amendment to the Affordable Care Act, backed by 128 lawmakers, to bring back the "public option" that failed to make it into the final health reform package.

To pay for all this new coverage, Obamacare introduces a number of new taxes on individuals and businesses. Once the Treasury has its hands on all that new revenue, it's unlikely that it will ever be able to let go. Those taxes will be here to stay.

And when costs spiral out of control -- as they have in Canada and in Massachusetts -- American officials will likely double-down on their bets and seize ever-greater control of the healthcare system. Canada banned the private delivery of medicine in response to runaway costs, while Massachusetts sees a system of global per-patient budgets as the solution to its cost problems. Federal officials will no doubt implement some combination of the two...

(Read the full text of "Why ObamaCare Must Be Repealed".)

It's still not too late to repeal it!

Colorado Updates

In the August 14, 2010 Wall Street Journal, Stephen Moore describes some of the obstacles that had to be overcome in order for the Colorado Health Care Freedom Act to qualify for the November ballot. The details can be found in his piece, "Health Care Freedom Comes to Colorado".

In the August 9, 2010 Colorado Springs Gazette, Seth Richardson discusses the benefits of that initiative in his piece, "Opposing Obamacare with the 'Right to Health Care Choice' initiative".

Brian Schwartz explains why the CO initiative is not just a PR stunt. Instead, it's carefully crafted to avoid the standard objection of "a state law (or state constitutional amendment) can't trump federal law".

(First two links via StateHouseCall.)

Update: One sharp-eyed reader noted a minor inaccuracy in the Moore WSJ piece. The CO initiative does not block any federal law. Instead it blocks any state-level measures to require residents to purchase health insurance. Also, it's not yet officially on the ballot.

Off Topic: Hsieh OpEd on NYC Mosque

Off topic: For those who are interested, the August 17, 2010 American Thinker has published my OpEd, "The Real Problem Is Not the Mosque But the Nukes".

My theme is the NYC Mosque would become a non-issue if the US would adopt a proper foreign policy, explicit identify our enemy, and take the necessary action against Islamic Totalitarianism and its primary state sponsor Iran.

I also cite and quote John Lewis' article from The Objective Standard, "No Substitute for Victory" as an example of the approach our current political leaders should adopt.

Hsieh PJM OpEd: "Transparency For Me, But Not For Thee"

PajamasMedia has just published my latest OpEd, "Transparency For Me, But Not For Thee".

My theme is that our government's ever-increasing demands for access to our personal data while simultaneously preventing us from gathering information about it threatens to turn America into a chilling "interrogation room society" where transparency only goes one way. Hence, Americans must demand government transparency as a corollary to the broader principle of properly limited government.

Here is the opening:

When President Barack Obama took office, he pledged to make his administration "the most open and transparent in history." However, government officials are now demanding ever-increasing amounts of information about ordinary Americans, while preventing citizens from gathering similar information about government operations. If this ominous trend continues, this "transparency" will be in one direction only -- which bodes ill for the future of our republic.

(Read the full text of "Transparency for Me, but not for Thee".)

The Specialist Wall

Physician-blogger "911doc" describes the latest response of specialists to federal EMTALA requirements that they treat emergency room patients for free, regardless of need.

Here is an excerpt from his post, "The Specialist Wall":

If you are unfamiliar with EMTALA or our take on it you can read about it here, but to be brief, EMTALA is an unfunded federal mandate passed in 1986, which, de facto, has made it a crime to tell anyone 'no' in the ER. Because of this, the specialists on call have learned to hate the ER. The ER is no longer a place from which one can build a practice, it is, rather, a place that compels you lose sleep, and money. It compels consultants to expose themselves to full malpractice liability EVERY SINGLE TIME they accept a patient from us whether they ever get paid or not.

No doubt there is a strong tradition in western medicine to treat first and seek payment later. This dates to Hippocrates and is part of the original oath. My question is this. How far should this obligation extend, AND, should it be extended by force of law rather than by individual choice?

...[T]he specialists are fed up, and they have figured out how to fight city hall. For years their battle has been against the system or even the ER doc downstairs. But now (oh the genius!) they have turned the bureaucrats game against them. EMTALA and the bylaws, policies, and rules that it has generated are being followed to the letter.

For instance, almost all hospitals have an on-call policy for specialists that require them, if the ER doc requests it, to come in to the ER and evaluate the patient. Well, they can be forced to do this, but in many cases they CAN NOT be forced to treat the patient. Unheard of twenty years ago and before EMTALA, but specialists are now routinely coming in, evaluating the patient, and finding reasons why this particular case is out of their area of expertise, or not appropriate for their care, or not in need of surgery immediately, and the specialists are going home.

Recently, a child came in to the ER after sustaining a facial laceration. Two different surgeons were called to fix the cosmetically sensitive but clearly non-emergent laceration. Both came in, and both told the ER doc, "No issue, you can do this." And that's exactly what happened -- the ER doc sewed it up (I hope he did it well). And that's exactly what EMTALA means, and exactly what Obamacare means, and it ends up hurting people who do not deserve it, and it ends up rewarding those that do not deserve it. And yes, I said "DESERVE", and yes, I mean it. Punishing the doers eventually causes them to slip the yoke.

(Read the full text of "The Specialist Wall".)

This is a tragic (and predictable) consequence of the notion of an automatic "right" to health care. Attempting to create such a right necessarily enslaves those who must be compelled to provide such care. Many doctors will refuse to work under such terms, recognizing the gross injustice of such attempted automatic claim upon their time and expertise -- especially when it only brings them medico-legal risk with no compensation.

I thank for "911doc" for analyzing this important issue at a deeper moral level (rather than at simply the economic level), for showing how bad ideas will have real-life consequences for patients and doctors, and for speaking his conscience.

Medicare Miscounting

The August 10, 2010 Chicago Tribune summarizes the various bad accounting tricks and assumptions used to falsely bolster the fiscal health of Medicare.

Here's an excerpt from "Medicare's Rosy Health*":

For example: The report assumes that Congress will deeply slash doctors' Medicare pay. Congress has threatened to do so, but has always backed off. That's the infamous "doc fix." The doctors are due for a 23 percent pay cut in December. Congress will back down, as it always does.

Scratch about $250 billion to $300 billion in "savings" over a decade.

...Another example of the absurdity of these projections: Under an inflation formula imposed by the new law, Medicare payments would tumble below the abysmally low Medicaid payments by the end of the decade. They'd fall from nearly 80 percent of private insurance prices now to about 50 percent by 2050. That would squeeze many doctors, hospitals, surgical centers and other providers into oblivion.

Long before that happens, hospitals and other facilities will stop treating Medicare patients and raise costs for private patients...

(Read the full text of "Medicare's Rosy Health*".)

Sooner or later, reality will always catch up with bad accounting. The only question is when.

Haynes on Social Justice and Medical Ethics

Dr. Beth Haynes of the Black Ribbon Project makes some insightful observations about the recent push to teach "social justice" to medical students.

Here's an excerpt from her essay, "Social Justice and Medical Ethics":

Since 2005, the "Initiative to Transform Medical Education" has been working to correct what it views as deficiencies in the current training of phsicians. These include an over-emphasis on the ability to acquire knowledge and problem solve-- to the detriment of "caring." Traditionally, physicians have expected to be autonomous decision-makers -- but that clashes with "increasing requirements...to be more accountable to various constituencies, including...the public, payers and government." Although physicians are recognized as "prepared to do what they believe is best for individual patients... [t]hey are not...prepared to participate in ethical and political discussions about the allocation of health care resources, which are not limitless."

"Social justice" is a euphemism for economic egalitarianism--and since people do not naturally come by equal wealth, "social justice" requires taking from some to give to others. "Social justice" is in direct conflict with the principles of equality before the law and the right to private property. "Social justice" also requires that a physician NOT advise his patients solely based on what is in the patients own best interest. He must instead somehow "balance" the patient's interests with those of the rest of society.

This collectivist view of "social justice" places doctors at odds with their Hippocratic Oath to do their best for the individual patient. Yet this is what our government attempting to force doctors to do.

Dr. Haynes goes on to explain the proper way to approach medicine -- as a business in which physicians and patients exchange value for value as traders in a free market. In other words, capitalism:

Capitalism is nothing more than individual rights applied to trade. Profits, in medicine as in any economic transaction, are not gained by exploiting patients or customers. Profits are simply the proper reward for successfully offering a value to others which is worth more to them than it costs to produce. In a system of free trade, self-interests are not in conflict -- not even between a physician and a patient. In a direct-pay, fee-for-service relationship, it is in the best long term interest of the physician to offer advice and treatment based on the patient's best interest. And, it is in the best long term interest of the patient to only deal with a physician who does!

We can not defend patients' freedom without also defending the freedom of physicians. We can not protect the doctor-patient relationship without protecting the autonomy of both. Freedom of association and freedom to contract are interrelated principles fundamental to a free republic, to capitalism and to the ethical practice of medicine. "Social justice" requires that the individual be sacrificed to the collective. Such an act is as immoral in medicine as it is anywhere else.

Read the whole thing.

And if you like her work, feel free to contribute to the Black Ribbon Project!

What To Expect Under Berwick

Dr. Richard Amerling of AAPS explains "What to Expect Under the Reign of Berwick".

Here's an excerpt:

How will standardized care be implemented? One route will be the electronic health record (EHR). They cite the example of HealthPartners in Minnesota who, in order to cut down on the use of high-tech imaging procedures "incorporated appropriateness criteria for radiological tests into the EMR as a reminder to primary care doctors."

There will also be a "primary focus on changing professional practice culture through the engagement of physicians in developing and implementing practice standards. The framework derives partly from known principles and methods of guideline or protocol development." They suggest starting small with "selective, smaller scale efforts to reduce overuse," as this will "prepare the local culture for broader changes in the future."

There can no longer be any doubt that this is what the future holds should ObamaCare survive the dozens of legal challenges. The underhanded recess appointment of this devoted central planner confirms our grim predictions. There is also no question this approach will fail, and fail on a grand scale. There will be shortages, dislocations, more massive bureaucracies, huge cost overruns, and what may be an irreversible loss of quality. Along the way, thousands, if not millions of patients will be harmed.

(Read the full text of "What to Expect Under the Reign of Berwick".)

The government will seek to control ever-increasing aspects of health care in the name of "efficiency" and "standardization". But once you give the government control over the people's health, you've given it control over their lives. Our freedoms and our individual rights will be the inevitable casualties.

Ten Inconvenient Truths

Dr. Richard Reece lists 10 "Inconvenient truths about our health care system".

Here are a couple of examples:

4. The next political crisis will be limited access to doctors; this is already occurring in Boston, where waiting times to see doctors are 2 to 3 times the national average for comparable cities.

7. Passing federal laws permitting patients to enroll in plans and "portability" of plans across state lines would make a public option unnecessary and would render private plans "competitive."

8. Ending "community ratings," which force the young to pay the same premiums as older individuals, and reducing "standard benefit plans," which often include unnecessary benefits, would reduce premiums for the young and decrease the number of uninsured.

Read the whole thing.

(My only comment is that I don't think we should try to salvage Medicare by patching the low rates paid to primary care physicians; instead we should gradually phase the program out entirely and privatize it.)

Get Ready For the Bureaucracy

How much bureaucracy will we be in for under ObamaCare? Nobody knows -- not even Congress.

According to this recent article in Politico, "Health reform's bureaucratic spawn":

Don't bother trying to count up the number of agencies, boards and commissions created under the new health care law. Estimating the number is "impossible," a recent Congressional Research Service report says, and a true count "unknowable."

The reasons for the uncertainty are many, according to CRS's Curtis W. Copeland, the author of the report "New Entities Created Pursuant to the Patient Protection and Affordable Care Act"...

(Read the full text of "Health reform's bureaucratic spawn".)

What we do know is that costs will continue to go up and freedoms go down.

Green Light for Paul Hsieh's Top-Tier Op-ed

[From Diana.]

I'm pleased to announce that, thanks to your generous pledges, Paul Hsieh will be diligently working on publishing an op-ed on a top-tier paper over the next few months. Hooray!

Many thanks to those of you who pledged -- 48 people in total! You've made this step-up in Paul's activism worth his extra time and effort. But please don't send any money now... Paul has to publish the op-ed for any of us to owe him so much as a cent. (Yes, I pledged!)

The pledge form will remain active until Paul publishes the op-ed -- or until the deadline expires at the end of 2010. (Let's hope for the former!) So if you missed the original pledge drive but wish to offer Paul some additional motivation, you're welcome to pledge below.

Our many, many thanks to everyone who pledged. It's so gratifying to see people support Paul's work, as we've seen here. It's major spiritual fuel for us -- and I hope for you too!

Here's the pledge form:

How's That Swedish Universal Care Going?

John Stossel discusses the latest medical outrage in Sweden in his blog post, "Great Moments In Government-Run Health Care":

...What really astounds me is not that a Swedish man sewed up his own leg after waiting for a long time in a hospital. Heck, I wouldn't be surprised if things like that happened in all nations.

The really disturbing part of the story is that the hospital then reported the man to the police. A classic case of "blaming the victim." The bureaucrats in Sweden's government-run healthcare system obviously were not pleased that he called attention to their failure.

Here's the original news story.

Lucidicus Interview With Peter Schiff

The Lucidicus Project has a nice interview with US Senate candidate Peter Schiff.

Schiff gives several good suggestions for free market health care reforms. Read the whole thing!

Brook: How To Free Health Care

From ARC-TV:

Yaron Brook presents a series of concrete suggestions on how to bring us closer to a free market in health care. This is an excerpt from the Q-&-A session of a talk that Dr. Brook delivered at the University of Pennsylvania on May 11, 2010.

Virginia Update

David Catron explains the importance of the latest positive court decision on Virginia's challenge to ObamaCare.

Ilya Somin offers some additional legal analysis.

Market Shift

Are Americans really cutting back on health spending, as the Wall Street Journal suggests?

Professor Mark Perry argues that they're just spending their money more efficiently:

Consumers aren't necessarily consuming less health care like the WSJ suggests; rather, they are shifting their demand for health care away from expensive, conventional physician offices with limited hours to affordable and convenient retail clinics. Especially when consumers are spending their own out-of-pocket money for health care and they have a choice, they prefer market-driven, consumer-driven options like affordable, convenient retail clinics over conventional physician offices.

People can be rational actors when it comes to their health spending. We need the government to respect that fact, and protect our freedom to act in our medical self-interest.

(Via K.V.)