ACOs: Repackaged HMOs?

Americans are beginning to realize what ObamaCare will mean to them, unless repealed.

From the 1/27/2011 New York Times article by Dr.Pauline Chen discussing her conversation with friends about Accountable Care Organizations (ACOs), "The Missing Ingredient in Accountable Care":

Unlike fee-for-service, payers will give A.C.O.'s a lump sum to cover all care, but the A.C.O.'s will be able to keep any savings that result from more efficient and better care.

In this way, I concluded to my friends, A.C.O.'s will be able to stem spiraling costs, increase efficiency and improve quality. Clinicians and hospitals will have a financial motive not to do more procedures and incur more visits but to keep patients healthy and out of the hospital.

..."Thanks for the explanation, Pauline," she said. She pulled her phone out and quickly glanced at its screen. "I hate to break it to you," she continued, "but whatever that care plan is called, it still sounds like an H.M.O. to me."

But at least with an HMO, patients know who their doctor is working for. Under the ACO system, patients may be "virtually assigned" to an ACO without their knowledge (or consent). Hence, the doctor's practice statistics for all his patients (# of referrals, tests ordered, etc.) would be used in determining if he was practicing "efficiently" or not. Patients might naively trust their doctor to be working for their best interests, without realizing that the doctor was also simultaneously trying to please an unseen ACO bean counter.

Hence, these "virtual assignments" are even scarier than explicitly joining HMO.

Furthermore, the article highlights the other problem with ACOs theoretical strategy for cost containment. If patients are allowed to freely go outside of the network (i.e., "no lock-in") for their care, then the ACO will have a hard time controlling costs (i.e., "leakage") -- and will fail.

On the other hand, if patients are forbidden from going outside of the network (or subject to heavy financial penalties for doing so), then the ACOs operate much like the much-reviled HMOs that Americans resoundingly rejected in the 1980s.

Fortunately, Americans are starting to catch on to the fact that ACOs may be harmful to their health.

(Via @Lucidicus.)

Wolf: ObamaCare's Privileged Escapees

Dr. Milton Wolf has a new OpEd in the January 29, 2011 Washington Times, "Tawdry details of Obamacare".

Here's an excerpt:

f you would like to know what the White House really thinks of Obamacare, there's an easy way. Look past its press releases. Ignore its promises. Forget its talking points. Instead, simply witness for yourself the outrageous way the White House protects its best friends from Obamacare.

Last year, we learned that the Department of Health and Human Services (HHS) had granted 111 waivers to protect a lucky few from the onerous regulations of the new national health care overhaul. That number quickly and quietly climbed to 222, and last week we learned that the number of Obamacare privileged escapes has skyrocketed to 733...

(Read the full text of "Tawdry details of Obamacare".)

This kind of selective enforcement (or selective exemption) from the law cuts to the heart of the American system. In effect, the Obama Administration replaces the rule of law with the rule of men.

Benefits From EHR or P4P?

Two recent articles add fuel to skepticism about two ObamaCare initiatives -- EHRs (electronic health records) and P4P (pay for performance).

How much do Electronic Health Records (EHRs) help patient care?

According to this article, not much: "Electronic Health Records and Clinical Decision Support Systems" (By Max J. Romano, BA; Randall S. Stafford, MD, PhD, Arch Intern Med. Published online January 24, 2011.)

EHRs may not help patients. But they will be used by the government to determine if doctors are complying with government practice standards.

(Via @MatthewBowdish.)

How about P4P ("Pay for performance") incentives? Those are another big part of planned savings under ObamaCare.

According to "Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study", the answer is "no". (By Serumaga et al, BMJ 2011; 2011; 342:d108; 25 January 2011)

(Related article: "Financial Rewards for a Doctor’s Care", New York Times, 1/26/2011.)

Surprise -- when the government tells doctors how to practice and makes them jump through hoops, rather than letting them use their own training and judgment, it does not improve patient care!

Government Official Tells Truth About ObamaCare

A little bit of refreshing truth at, "Medicare official doubts health care law savings":

Two of the central promises of President Barack Obama's health care overhaul law are unlikely to be fulfilled, Medicare's independent economic expert told Congress on Wednesday.

The landmark legislation probably won't hold costs down, and it won't let everybody keep their current health insurance if they like it, Chief Actuary Richard Foster told the House Budget Committee. His office is responsible for independent long-range cost estimates.

Foster's assessment came a day after Obama in his State of the Union message told lawmakers that he's open to improvements in the law, but unwilling to rehash the health care debate of the past two years. Republicans want to repeal the landmark legislation that provides coverage to more than 30 million people now uninsured, but lack the votes.

...The comments Wednesday were unusually direct because Foster generally delivers his analysis in complicated technical memos.

(Read the full text of "Medicare official doubts health care law savings".)

Those points mirror some of the issues raised by Dr. Milton Wolf in his OpEd from last fall, "ObamaCare's Unkeepable Promises".

Let's hope more people start raising these questions, both inside and outside of government.

(Via Dr. Beth Haynes.)

Quick Links: Catron, Zawistowski, Rich

More good blog posts to read while I'm busy this week on nightshift duty:

David Catron: "Magical Thinking About ObamaCare"

Stella Zawistowski: "Drug dealing by the federal government"

Dr. Rich: "Fugitive Busted By His Pacemaker (And His Doctor)"

One excerpt from Dr. Rich's post:

To DrRich, the interesting part of the storyline only peripherally involves the pacemaker. The real story is this:

* A patient goes to a hospital for medical help.

* A medical procedure is done which generates certain data for the medical record.

* The data in the medical record is immediately cross-referenced with data from a federal database that lists persons of interest.

* The FBI shows up at the bedside in less time than it takes to raise a nurse with a bedpan.

Now, that's actually a pretty interesting story.

(And people wonder why the Central Authority is so hot to have electronic medical records.)

Quick Links: Wolf, Rhoads, Schwartz, Scandlen

My personal schedule continues to be busy, so I won't be blogging much this week. But in the meantime, go check out:

Milton Wolf: "If ObamaCare is such a great law, why does the White House keep exempting its best friends from it?"

Jared Rhoads: "Four brief observations about repeal"

Brian Schwartz: "Yes, Medicare is an (unsustainable & bankrupt) welfare program"

Greg Scandlen: "How Accountable Care Organizations Came About"

Light Posting

Admin Note: Because of my work schedule, blogging may be lighter than usual this upcoming week.

Catron: A Natural Born Job Killer

David Catron has a new piece in AmSpec, "A Natural Born Job Killer". In it, he describes the many ways in which ObamaCare will destroy jobs and worsen unemployment in this country.

I especially liked this point he raised:

...[R]emember that reform-induced job losses will not be limited to the health care industry. As health care economist John Goodman points out, the various mandates imposed by Obamacare will effectively raise the cost of labor across the economy.

He estimates that they will add "$2.28 an hour for full time workers (individual coverage) and $5.89 an hour (family coverage) for fulltime employees." Many businesses simply cannot absorb such increases without cutting labor costs. This is why we have heard so many cris de coeur from low-margin employers like White Castle, which says the financial hit "will make it hard for the company to maintain its 421 restaurants, let alone create new jobs."

(Read the full text of "A Natural Born Job Killer".)

This is a vitally important point. As economist Frederic Bastiat pointed out many years ago in "What Is Seen and What Is Not Seen", we must not focus only on the immediately visible jobs that are destroyed by ObamaCare. We must also consider the jobs that would never be created by businessmen who choose not to expand.

Instead of letting ObamaCare kill our economy, Congress should kill ObamaCare.

People Can Handle the Truth About Their DNA

In the January 17, 2011 New York Times, John Tierney reports that ordinary Americans are able responsibly handle the information provided by personal DNA testing services. Here's an excerpt from, "Heavy Doses of DNA Data, With Few Side Effects":

In two separate studies of genetic tests, researchers have found that people are not exactly desperate to be protected from information about their own bodies. Most people say they'll pay for genetic tests even if the predictions are sometimes wrong, and most people don’t seem to be traumatized even when they receive bad news...

Although they were offered sessions, at no cost, with genetic counselors who could interpret the results and allay their anxieties, only 10 percent of the people bothered to take advantage of the opportunity. They apparently didn't feel overwhelmed by the information, and it didn't seem to cause much rash behavior, either...

"The medical field has been paternalistic about these tests," says Peter J. Neumann, the lead author of the study, who is director of the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center. "We've been saying that we shouldn't give people this information because it might be wrong or we might worry them or we can't do anything about it. But people tell us they want the information enough to pay for it."

(Read the full text of "Heavy Doses of DNA Data, With Few Side Effects".)

I took a similar position in my PajamasMedia piece from July 2010, "Should You Be Allowed to Know What’s in Your DNA?"

One of the core principles of medical ethics is to respect and preserve patient autonomy. The FDA should not interfere with a patient's right to use personal DNA testing to learn medically important information about himself that could help him treat, mitigate, or prevent bad diseases. And ethically responsible physicians should support -- not thwart -- their patients who wish to benefit their lives in such fashion.

Criminalizing Independent Physician Practices

Physician-blogger "Dr. Rich" talks about how government rules are "Criminalizing Independent Physician Practices".

In particular, the Federal Trade Commission is using antitrust rules to punish physician groups that negotiate better prices with insurance companies in what the government considers a too aggressive fashion. This trend will accelerate under ObamaCare, as the Justice Department starts getting involved in such cases (not just the FTC.)

The end result:

...[U]nder Obamacare all doctors are to be driven into federally-sanctioned organizations that will operate strictly under government directives. The current parlance for such an organization is the "Accountable Care Organization."

The ACOs will be run by administrators who (theoretically) will become expert at navigating the morass of rules and regulations now being conjured up under Obamacare. These administrators will interpret the rules and regulations in such a way as to determine The Way It Must Be Done, and then will pass The Way It Must Be Done down to the ACOs' clinical chiefs (doctors who perhaps used to practice medicine, and maybe still do, a little, but who are now mainly brevet administrators), and the clinical chiefs will finally pass the restrictive rules of engagement down to the doctors who will actually take care of the patients.

These doctors, struggling in the trenches, will attempt assiduously to follow those rules without exception, if they would like to keep their jobs as well as avoid a federal fraud rap. The patients, of course, will get whatever they get, but always with official assurances that whatever it is they get, it will be of the highest quality.

(Read the full text of "Criminalizing Independent Physician Practices".)

When independent private practices are driven out of business by ObamaCare, all that will be left will be "Accountable Care Organizations" which will be accountable to the government -- not the patient.

ObamaCare must be repealed.

Quick Links: Medicaid, Mandates, FDA

In the 1/15/2010 Boulder Daily Camera, Brian Schwartz writes, "Colorado Medicaid reform: federal matching funds promote waste".

(Eventually, Medicaid and Medicare should be phased out entirely. But there are good intermediate steps we could take towards that goal.)

John Graham of the Pacific Research Institute warns, "The End of the 'Individual Mandate' Is Not the End of Obamacare".

(Hence, Americans should continue the pressure on Congress for a complete repeal of ObamaCare.)

In response to the latest FDA regulations on painkillers such as Vicodin and Percocet, Stella Zaiwistowski argues, "You don't ban cars because people drive them off cliffs".

(Read her whole post, especially for her discussion of free-market alternatives to more cumbersome FDA regulations.)

ObamaCare's Ticking Time Bomb

In the 1/16/2011 Washington Examiner, Tim Carney explains that the future costs of ObamaCare are the ticking time bomb.

As with the Massachusetts plan, supporters' first priority was to expand coverage -- and control costs later.

And if the recent history of other states (such as MA and TN) are a guide, when the bills for ObamaCare come due to the federal government, they will (1) attempt to shift the blame onto "greedy" insurance companies and (2) start imposing price controls.

The end result will be a collapse of the mixed partially-private-partially-socialized system, and a full government takeover of American health care.

(Read the full text of, "Tick, tick, tick: The cost of Obamacare is a time bomb". Link via @TOSjournal.)

End of Medicare?

Carla Fried asks the provocative question, "Is 2011 The Beginning of the End for Medicare?"

Here is an excerpt:

As the red bars in the chart below show, it is Medicare and Medicaid, not Social Security, that looms as the biggest federal budget buster in terms of its growing demand on federal dollars.

...[T]he bottom line is that all Americans — not just Boomers getting ready to sign up for Medicare — must recognize Medicare is the really big federal deficit elephant in the room. What we're all paying into the system through payroll deductions is in no way close to the amount of Medicare benefits we will consume.

Medicare in its current form is unsustainable. The only real question is whether it will crash-and-burn in a dramatic fashion or whether it will be phased out with a fiscal equivalent of a "controlled landing".

But younger Americans should start planning now for neither Medicare nor Social Security being there when they retire.

Catron: Some Vitriolic Rhetoric About Repeal

David Catron has a new piece in today's AmSpec, "Some Vitriolic Rhetoric About Repeal".

In particular, he warns Republicans that they should not let the Democrats use the Tuscon murders to derail their efforts to repeal ObamaCare. Here's an excerpt:

The repeal effort will presumably begin moving forward again next week, and the debate will no doubt be more restrained than might have been the case before Tucson. The Republicans will certainly be less aggressive in their rhetoric. The Democrats will, in turn, see this as weakness and attempt to exploit the gesture, just as they have exploited Tucson. They will brand as "vitriolic" every floor speech in favor of repeal and repeatedly demand that the GOP water down its agenda.

House Republicans would do well to ignore these tricks. They know that Tucson had nothing to do with the health care debate or any other political exchange. And the Democrats know it as well. In fact, according to a CBS poll taken early in the week, even the public gets it. The survey showed that "57 percent of poll participants said the country's harsh political tone was unrelated to the shooting." So, there really is no excuse for the GOP to wave the white flag on repeal.

(Read the full text of "Some Vitriolic Rhetoric About Repeal".)

Catron is absolutely right. The Republicans need to "stick to their guns" (so to speak) on this issue and not capitulate.

Again, this highlights the importance of having the moral confidence that repealing ObamaCare is right.

Rhoads: Let's Petition with Conviction

Jared Rhoads of the Lucidicus Project has a new OpEd out, "Let's petition with conviction".

In his piece, he makes the following critical point about the Morris petition to oppose ObamaCare:

Republicans need to stop hinting that they support individual rights -- if indeed they do -- and instead come out and uphold rights as a matter of firm, moral conviction.

I used to think that Republicans did stand for individual rights on principle, but that they shied away from moral arguments because they deemed it better public relations to be "big-tent," inclusive, neutral. Well, over the past two years, the Tea movement has demonstrated that pro-individualist moral sentiments are popular and effective. We are still waiting for the Republicans to catch up.

(Read the full text of "Let's petition with conviction".)

Basically, Republicans (and other would-be defenders of limited government) have to stop ceding the moral high ground to the Left. Unless they fully grasp that individual rights and limited government are good (and must be defended as such), they'll ultimately lose.

Let's hope enough Republicans are listening...

Quick Links: Free Riders, MA, Privacy Breaches

Greg Scandlen talks about free riders in "Revisiting the Individual Mandate":

There is not yet a proposal that would end “free-ridership.” ObamaCare will continue a large number of people who are uninsured and getting free services, including illegal immigrants and people who simply don’t pay their bills. For all of the contortions and intrusions, the current law would at best reduce the problem, not solve it.

Further, virtually all of the expansion in coverage under ObamaCare is subsidized, either by free care under Medicaid or subsidized care under the Exchanges. If consuming, but not paying for, health services is free-riding, isn’t this institutionalized free-ridership?

Sally Pipes asks, "Has Massachusetts Experience Put ObamaCare On A Path To Repeal?" (IBD, 1/12/2011.)

The 1/11/2011 Denver Post reports on electronic security breaches in Colorado leading to the disclosure of private medical information of over 100,000 Medicaid patients.

As more hospitals and doctors' offices start adopting mandatory electronic medical records, how many more such incidents will we see?

Are CO Insurers Bailing?

Brian Schwartz notes that Colorado health insurance companies are quietly shifting out of the sector -- both into other branches of insurance (e.g., worker's compensation and life insurance) as well as moving into non-insurance products.

Read the details at, "Health insurance takeover alert: Insurers selling different products".

One natural question is whether this is their form of contingency planning for an eventual government takeover of health insurance. If the insurance companies are worried, we should be as well.

Rubin's Question

In the 1/9/2011 Washington Post, Jennifer Rubin discusses the latest arguments about the costs of ObamaCare.

Here's the key question from "Now ObamaCare debate moves to the real world":

If the bill is vastly more expensive than advertised, causes great upset to consumers and negatively impacts care, shouldn't we repeal and replace it?

Rubin is absolutely correct -- we need to repeal and replace it. And in this process, the debates about the numbers (i.e., costs, deficits, etc.) are important.

But the key political driver behind the support for universal health care has never been economic but rather moral. Supporters of government-run health care simply believe it's "the right thing to do" on the grounds that a need to health care entitles one to an alleged "right" to health care -- even if it must be "guaranteed" via creating a huge new government program.

Hence, to effectively challenge ObamaCare, one must address the underlying issue as well -- namely, should government compel one man to pay for another's health care solely because the other man needs it? Or should government leave people alone to act as they wish -- to let them freely donate (or not) according to their own values and priorities to help others in need via private charity?

The "right thing to do" is not a government that redistributes wealth but one which protects individual rights, including the right to own and dispose of one's property as one wishes.

As Thomas Jefferson noted:

A wise and frugal Government, which shall restrain men from injuring one another, shall leave them otherwise free to regulate their own pursuits of industry and improvement, and shall not take from the mouth of labor the bread it has earned.

President Jefferson, not Obama, correctly understood what was "the right thing to do".

Squeezing Your Medical History Into 7 Tweets?

Can your doctor fit your medical history into 7 "Tweets" (1000 characters)?

As more physicians start adopting government-mandated Electronic Medical Records (EMR), they will be faced with such challenges. Dr. Danielle Ofri reported her frustrations with her EMR system in her 12/30/2010 New York Times piece, "The Doctor Vs. The Computer".

Here's an excerpt:

Estimating my patient's surgical risk and planning for his operative care is not a straightforward process. After our physical exam, I sit down to write a detailed evaluation, because I want the surgeons and anesthesiologists to fully understand the complexity of his situation.

As I type away, I feel like I'm doing the right thing, explicating my clinical reasoning rather than just plugging numbers into a formula. I'm midway into a sentence about kidney function when the computer abruptly halts.

I panic for a moment, fearful that the computer has frozen and that I've lost all my work -- something that happens all too frequently. But I soon realize that this is not the case. Instead, I've come up against a word limit.

It turns out that in our electronic medical record system there is a 1,000-character maximum in the "assessment" field. While I've been typing, the character number has been counting backward from 1,000, and now I've hit zero. The computer will not permit me to say anything more about my patient.

I go back and remove excess articles: the, a, an. Then I try to gain a few characters by using abbreviations: DM for diabetes mellitus, CRF for chronic renal failure. Still, I am over the limit.

A new trick dawns on me. Maybe if I cut back on my descriptions of the clinical problems I’ve already assessed, then I can gain enough characters for his cardiac status and operative assessment.

I nip and tuck my descriptions of his diabetes, his hypertension, his aortic valve stenosis, trying to placate the demands of our nit-picky computer system. Nevertheless, I am still unable to fit a complete assessment into the box.

In desperation, I call the help desk and voice my concerns. "Well, we can't have the doctors rambling on forever," the tech replies.

I want to retort with something snarky, like I hope that his next critical illness clocks in at less than 1,000 characters, but I hold my tongue. Instead I focus on eliminating verbs and prepositions, wondering just how skeletal my text can become...

(Read the full text of "The Doctor Vs. The Computer".)

Dr. Ofri did finally manage to squeeze her patient's medical assessment into the 1000-character limit -- roughly 7 Tweets (Twitter posts). And she did so without compromising patient care, although it took a great deal of work on her part.

Her specific 1000-character limit was undoubtedly set by her particular EMR vendor (as opposed to the federal government). But the fact that hospitals and medical offices will be de facto required to purchase some government-approved EMR system under ObamaCare rules is unlikely to make vendors more responsive to customer preferences. After all, how good will customer service be in an industry when you have to buy one their products?

Welcome to ObamaCare...

Wolf: Buck Up and Stop Obamacare

Dr. Milton Wolf has a new OpEd in the January 8, 2011 Washington Times entitled "Buck up and stop Obamacare".

In it, he has a very simple message for the GOP:

Republicans won this year's historic landslide election primarily by virtue of not being Democrats. The year of the Tea Party was 2010, and the GOP is the beneficiary - for now. It's not often that fate - or, in this case, the Tea Party - grants you a second chance for a rendezvous with history. Now is the time to earn it.

...A word of caution here: America is not clamoring for Obamacare Lite. Congressional Republicans should not fall for the Democrats' trap of tinkering around the edges of Obamacare because doing so accepts the underlying fundamental flaw that the government takeover of the health care system is acceptable. After all, even Mr. Obama wants to fiddle around with removing unpopular provisions, such as the 1099 rule that forces ordinary Americans to become tax snitches for the state. Don't fall for it. Make them lie in the bed they made.

(Read the full text of "Buck up and stop Obamacare".)

If the GOP doesn't listen to the Tea Party voters who put them into power in the House, they'll quickly learn the meaning of Dr. Wolf's warning phrase, "46-12-4".

(Related story: "GOP: Dance With The One Who Brung You".)

Hsieh RCM OpEd: "A Defense of High-Frequency Trading"

The January 7, 2011 RealClearMarkets published my OpEd, "A Defense of High-Frequency Trading".

This piece is not directly about health care, but rather the critical economic infrastructure that makes health care innovation possible -- namely, efficient capital markets. I contrast the recent reporting in Wired vs. the New York Times on "flash trading" (high speed computer stock trading), and rebut three fallacious concerns raised by the NYT -- its supposed "unfairness", the loss of human control, and the difficulties it creates for government regulators.

Here is the opening:

Wired magazine and the New York Times both recently published detailed stories on "flash trading" -- the increasing use of high speed artificial intelligence algorithms in the financial markets. Both asked the same question: Will flash trading help the markets by improving efficiency -- or will it destroy them?

But while both stories covered the same basic facts, they took strikingly different approaches. Wired discussed the technology in a generally balanced fashion, whereas the New York Times adopted a more alarmist attitude, including emphasizing the problems the technology would create for government regulators.

However, the concerns raised by the Times against flash trading are variations of fallacies frequently raised against free markets. Hence, identifying and rebutting those fallacies will help one better appreciate and defend flash trading in particular, as well as market capitalism in general...

(Read the full text of "A Defense of High-Frequency Trading".)

I'd like to thank Wendy Milling for helping me get this published at RCM, and Ari Armstrong, Brian Schwartz, and Jimmy Wales for their helpful feedback on an earlier draft of this piece.

Catron: Bringing the Bureaucrats to Heel

In his latest piece at AmSpec, David Catron discusses the importance of "Bringing the Bureaucrats to Heel".

Whether it be strangling Medicare Advantage or restricting access to drugs like Avastin or technologies such as personal genetic testing, the bureaucrats will be looking for ways to restrict our freedoms. As Catron notes, the FDA is even sticking its nose into international cycling!

(Read the full text of "Bringing the Bureaucrats to Heel".)

And with a divided Congress, President Obama will be relying more than ever on executive orders and the regulatory apparatus to impose his agenda on the American people. Hence, the importance of keeping our eye on what they're doing.

While you're at it, check out Catron's blog, Health Care BS. I especially liked his recent post, "End-Of-Life Counseling Meets the Death Panel"

Hsieh WashTimes OpEd: Best Health Care Political Pull Can Buy

The January 6, 2011 Washington Times has published my latest OpEd, "Best Health Care Political Pull Can Buy".

My theme is that unless ObamaCare is repealed, it will foster the wrong kind of health care competition.

Here's an excerpt:

When President Obama signed his health care plan into law, he promised it would foster "choice and competition." Nine months later, Americans can count this as another Big Lie. Obamacare has instead reduced competition in the marketplace for health services...

Yet while Obamacare is suppressing genuine marketplace competition for medical services, it is also spurring a more sinister facsimile of competition -- for political favors...

(Read the full text of "Best Health Care Political Pull Can Buy".)

I'd like to thank the organization Docs4PatientCare.org for helping to facilitate publishing this article -- especially Dr. Hal Scherz and Dr. Richard Armstrong.

And I'd like to thank Diana Hsieh, Ari Armstrong, and Brian Schwartz for their help in editing my early drafts of this OpEd.

Update: Thank you, Instapundit, for the link!

Quick Links: 2011, Dead Hospitals, Repeal

The Christian Science Monitor has a list of new ObamaCare provisions in effect for 2011, "Health care reform 101: What will kick in Jan. 1?"

(Short summary: More rules and regulations doctors, patients, and insurers. Plus a few small benefits thrown to some Medicare providers and recipients to sugar-coat the rest of the bitter pill.)

ObamaCare will end the construction of 45 new physician-owned hospitals.

The ObamaCare Repeal Bill is 2 pages long.

Hsieh PJM OpEd: "Will the GOP Walk the Walk On The Constitution?"

PajamasMedia has just published my latest OpEd, "Will the GOP Walk the Walk on the Constitution?"

My theme is that not only should the GOP pay lip service to the Constitution, they must defend in action the principles of individual rights and limited government. Defunding "ObamaCare" would be a good start.

Here is the opening:

Now that the Republicans have won control of the House of Representatives, they've chosen to demonstrate their respect for the U.S. Constitution in two important ways.

First, they plan on reading the full text of the Constitution on Thursday, January 6, 2011, one day after swearing in John Boehner (R-OH) as the new speaker of the House. Second, they've promised that every new bill will contain a statement citing the constitutional authority for the proposed law.

But while these are important symbolic steps, the real test will be whether the GOP-controlled House will defend the Constitution with deeds and not just words -- especially on high-stakes issues like health care. In other words, will the GOP "walk the walk" as well as "talk the talk" on the Constitution?

(Read the full text of "Will the GOP Walk the Walk on the Constitution?")

Hat tip to Brendan Casey for the quotes from Nancy Pelosi and George Washington.

Scandlen on American Style Death Panels

Greg Scandlen has a new blog up entitled, "Real Health Reform: Our Money, Our Health, Our Choice".

Here's his superb analysis on the 4-step approach to "Death Panels American-Style". The 4 key steps are:

1) Health information technology -- which doesn't save money, but does let the government know what doctors are doing.

2) Comparative effectiveness guideliens -- in which the government decides which treatments "work" and which treatments "don't work".

3) Practice incentives -- in which the government rewards doctors who follow those guidelines, and punishes those who don't.

4) End of life counseling -- in which the doctor denies care to patients.

As Scandlen notes, the end-of-life counseling is not the first step but the final step towards de facto death panels:

End-of-Life Counseling will pay physicians to deliver the bad news to the patient -- "I'm afraid your breast cancer is quite advanced and there isn't anything further we can do. How can I help you get your affairs in order?"

Now, notice the physician is not explaining there IS something that can be done, but the government decided to not pay for Avastin because it costs too much. Or any of the other life-enhancing treatments that would be available if not for federal intervention. No, Medicare would not pay the doctor to deliver this information because it might upset the patient.

We have been warned.

(Read the full text of "Death Panels American-Style" and check out the rest of Scandlen's blog as well. Link via IBD.)