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.