Quick Links: ACO Skepticism, Vermont, Devices

Politico reports that, "Health reform rule spooks providers". (5/24/2011)

In the 5/21/2011 Wall Street Journal, David Gratzer writes, "Vermont Gives the 'Public Option' a Clinical Trial". He explains why the prognosis is not good.

The Hill reports, "Two-thirds of small medical device makers are turning to Europe first to get approval for their products". (Via Dr. Beth Haynes.)

Drug Innovation Continues—For Now

As a small piece of good news, the June 2011 Atlantic magazine has an interesting story, "The Rise of Backyard Biotech".

The article describes how, "Powered by social networking, file sharing, and e-mail, a new cottage industry is bringing niche drugs to market."

We now finally have the tools (including software) to make such niche drugs commercially viable -- a giant step towards the goal of "personalized medicine" where tests and treatments can be tailored closely to fit your individual genome, medical condition, etc.

In many ways, these new drug development ventures are like the small technology startups that led to such innovation and prosperity in the 1990s. However, the pharmaceutical industry is much more heavily regulated than the technology industry.

Would we have seen the same technology boom if there had been a Federal Technology Agency that had regulated Silicon Valley as strictly as the FDA currently regulates the drug industry?

As I noted in my 2010 piece, "The Deadly Tax on Medical Innovation", one of the worst aspects of such regulations is that, "we will never know what new technologies could have been developed and how many lives they could have saved -- an example of Frederic Bastiat's principle of the seen and the unseen. As with any exponential process, small changes in the rate of growth will have a dramatic effect on the final total after twenty years."

And the Center for Medicine in the Public Interest has written a detailed paper describing how new "comparative effectiveness" research could seriously hamper new drug development, resulting in loss of 81 million life years and $4 trillion dollars.

Let's hope that the pace of drug innovation can still outpace the regulatory "drag".

Quick Links: Lewis Video, Barone, Neerhof

The video of the John Lewis lecture, "Setting Doctors Free", can be viewed here:



Michael Barone notes, "Obama skirts rule of law to reward pals, punish foes". (5/24/2011, Washington Examiner)

Dr. Mark Neerhof of Docs4PatientCare asks, "Who will be in charge of your health care?" (5/24/2011, Washington Times)

Quick Links: IBD, Turner, EMTALA

The 5/20/2011 Investor's Business Daily reviews the growing problems with the UK National Health Service and asks, "Why should the U.S. adopt a government system that will develop the same deadly problems?"

In the 5/22/2011 Washington Examiner, Grace-Marie Turner notes that the proliferation of ObamaCare waivers means that, "What's really being waived here is the rule of law".

We need to repeal the law and give everyone a waiver.

In his 1/27/2011 piece, "Repeal EMTALA!", Washington Post blogger Ezra Klein notes that it was Ronald Reagan who signed into law EMTALA, requiring ERs to accept all comers without consideration of payment. And that this would set the stage for a universal insurance mandate.

As with the massive expansion of Medicare under Bush2, we must remember that Republicans can be quite willing to inappropriately expand government power for many of the same reasons as Democrats. (Link via Scott K.)

FDA vs. Freedom

Mark McCarty of Medical Device Daily discusses the shenanigans and power-lust behind some of the FDA advisors.

Here's an excerpt from his 5/23/2011 post, "FDA advisory committees: Self-indulgence and the case for dismissal":

In a more recent advisory hearing, however, two panelists did a nice job of making themselves candidates for the Advisory Committee Hall of Shame. This hearing dealt with a treatment for a terminal cancer that would be approved only for patients whose disease twice failed to respond to other therapies, so it was not a light-hearted discussion. These patients are almost guaranteed to die within six months.

One panelist asked whether the treatment had been tested on healthy subjects, an absurd proposition on the face of it. As an example, it's not easy to get a healthy patient to climb into an MRI machine given how tight the spaces are, and one also suspects that it's just about impossible to get healthy subjects to volunteer for a CT scan for the sake of science, thanks to the recent flap over radiation dosing. The therapy under consideration is as yet utterly unfamiliar to the general public, so what are the chances? The balance of the panel declined to remark on the remark, and fortunately for all, this panelist let it drop.

But the development at this panel that really stuck with me was the vote by one panelist that the treatment in question -- we're still talking about a treatment for a twice-refractory, incredibly lethal cancer, mind you -- passed the test for safety and for efficacy, but this member of the panel nonetheless had the nerve to decree that the risk-benefit ratio was not up to par.

(Read the full text of his post, "FDA advisory committees: Self-indulgence and the case for dismissal".)

Remember, these are the people deciding whether you'll be permitted to benefit from potentially life-saving drugs and medical technology.

(Link via Vicki G.)

John Lewis Lecture-Webcast Tomorrow

Tomorrow, Professor John Lewis will be giving a special lecture available for free as a live streaming webcast: "Health Care Reform: Setting Doctors Free".

Here is more information from Lin Zinser (founder of FIRM, now at the Ayn Rand Center for Individual Rights):

John Lewis will close our first season of the Chicago Speaker Series, with his talk, "Health Care Reform: Setting Doctors Free." Tuesday, May 24, at 6:30 pm. If you're in the Chicago area, please come. Invite your Chicago friends to attend. If you can't make it live, livestream!!!

"Government medicine treats doctors as cogs in a giant machine, run from Washington, as if treating patients required no independent thought or action. Twenty-eight states have filed suit against Obamacare, claiming it is unconstitutional. But it is much worse than that. It is a moral assault on free people, and an attack on human life itself."

John Lewis has a unique perspective on this issue, both as an advocate for individual rights and as a cancer patient. Don't miss this hard-hitting lecture on the deepest evil of government medicine.

* * * * *

Hyatt Regency Hotel
151 E. Wacker Drive
Chicago, Illinois 60601

Tuesday, May 24, 2011

Doors open: 5:45 p.m.
Talk begins: 6:30 p.m.
Q & A: 7:15 p.m.

* * * * *

This event is free and open to the public, but it requires an RSVP. Please email events@aynrandcenter.org to reserve your seats.

The talk and Q & A will be livestreamed for free through the Ayn Rand Center Facebook page:
http://www.facebook.com/AynRandCenter

* * * * *

Speaker Information:

John David Lewis is a Visiting Associate Professor in the Philosophy, Politics, and Economics Program at Duke University, and a senior research scholar in history and classics at the Social Philosophy and Policy Center, Bowling Green State University. He has taught at the University of London and Ashland University, and is a fellow of the Anthem Foundation for Objectivist Scholarship. He has a PhD in classics from the University of Cambridge. He is an outspoken proponent of free market medicine.

Diana and I recently heard him give a version of this talk here in Denver, and it is superb. I highly recommend it to anyone interested in this topic.

Wolf On Waivers

In his latest OpEd in the Washington Times, Dr. Milton Wolf lays bare the sordid mess of ObamaCare waivers and political favoritism. As he notes, "Selective enforcement of the law is the first sign of tyranny."

Read his piece, "Obamacare waiver corruption must stop".

Quick Links: Exodus, UK, MA

More and more doctors, providers, insurers, and states are trying to escape from the restrictions of ObamaCare.

The 5/14/2011 Indianapolis Business Journal reports, "Reform could create more 'boutique' doctors". This is one way doctors can opt out of the government-controlled system. (Via S.K.)

The Heartland Institute reports, "UK's NHS Seeks to Limit Care for Smokers, Obese".

There's been extensive commentary about Mitt Romney's defense of the Massachusetts plan. One of the best pieces is from Jeff Jacoby in the 5/18/2011 Boston Globe, "Romney's steadfast stand for a bad idea". (Via Jeff P.)

Specifically, Jacoby notes that RomneyCare didn't end the free-rider/cost-shifting problem; instead it made the problem worse.

Doctors Town Hall Audio and Video

On 5/14/2011, the AAPS and Americans for Free Choice in Medicine held a special "Doctors Town Hall".

Experts in free market health care reform from around the country gave talks, including:

Sally Pipes, Pacific Research Institute
Yaron Brook, PhD, Ayn Rand Center for Individual Rights
Art Astorino, MD, President of AFCM
Cristina Rizza, MD
Wayne Iverson, MD, AAPS CA Coordinator
Marcy Zwelling, MD, President, American Academy of Private Physicians
Jeffrey Singer, MD, Co-Founder US Health Freedom Coalition

You can watch videos and download MP3 files of their presentations here.

The Independence Institute on CO and MA

The Independence Institute recently published two analyses of state-level health care issues.

On 5/17/2011, Health Policy Solutions published Brian Schwartz's OpEd, "Parents should value children’s health more than sweets and booze".

Schwartz discusses numerous problems with the Colorado "Child Health Plan Plus" government welfare plan, including the perverse incentives and the crowding-out of private charity.

At the John Goodman NCPA blog on 5/18/2011, Linda Gorman asks "Is RomneyCare Different from ObamaCare?"

Gorman discusses some of the under-reported waste and mismanagement in Massachusetts under the Romney plan.

America does not need either of these plans expanded to the national level.

WaiverMania

Mark Hemingway describes how those with the right political connections somehow seem to have a leg up in obtaining waivers from ObamaCare: "Over Half of All Obamacare Waivers Given to Union Members". Just a coincidence, I'm sure.

The 5/17/2011 Daily Caller notes, "Nearly 20 percent of new Obamacare waivers are gourmet restaurants, nightclubs, fancy hotels in Nancy Pelosi's district". Just another coincidence, I'm sure.

As of this week, the total number of waivers granted is 1372.

The 5/15/2011 New York Times similarly reports, "Nursing Homes Seek Exemptions From Health Law". (Via Brian Schwartz.)

The 5/16/2011 Washington Examiner discusses a crucial problem with these political-based exemptions in "Beyond irony: Nursing homes need waivers from Obamacare":

When government controls an industry, the health of firms within it inevitably becomes dependent on their influence in Washington and state capitals. Competition in a regulated industry is typically focused on hiring well-connected K Street lobbying firms, targeting the "right" congressmen on key committees for hefty campaign contributions and knowing which bureaucratic levers to pull in order to ensure a favorable "business environment."

What is best for patients becomes an afterthought when bureaucratic formulas determine what care is provided and how, instead of private firms competing with each other to offer needed services at affordable prices while making enough profit to stay in business.

(Via @TOSJournal.)

Mona Charen makes a similar point in "Wielding waivers as weapons":

The danger of waiver power is that it will be used differentially, giving one private entity a competitive advantage over another. The company denied a waiver can bring suit -- but litigation is expensive and slow.

Additionally, companies may fear government retaliation: "It is no accident that it is often public-interest groups or patient groups that take on the FDA, for instance. It is simply too risky for a pharmaceutical company with multiple applications before the agency to challenge one action if it is vulnerable to a government-induced slowdown on another," writes [Professor Richard] Epstein.

Finally, Kaiser Health News reported on 5/16/2011 that 9 more states are seeking exemptions from onerous ObamaCare insurance regulations.

This list includes New Hampshire, Nevada, Florida, Kentucky, Louisiana, North Dakota, Georgia, Kansas and Iowa. Nevada did just recently receive a partial waiver.

(This is in addition to the exemption already granted to the state of Maine.)

As Dr. Milton Wolf once asked, "If Obamacare is such a great law, why does the White House keep protecting its best friends from it?"

Hsieh Cited in IBD on Medicare Rationing

The 5/16/2011 Investor's Business Daily quoted me in their article, "Will Congress Kill 'Death Panel 2.0'?" Here's the relevent excerpt:

While IPAB defenders say the law specifically bars rationing, critics argue that cutting provider payments would have that effect.

They say IPAB-imposed payment cuts could accelerate doctors' exodus from Medicare, restricting seniors' access to care. In 2009, 13% of family doctors said they didn't participate in Medicare, up from 6% in 2004, according to the American Academy of Family Physicians.

"Its power to set payments to doctors and hospitals would give it de facto rationing power," Paul Hsieh, a Denver-based physician, noted in his IPAB analysis.

(Read the full text of "Will Congress Kill 'Death Panel 2.0'?")

The "IPAB analysis" they are referring to is my PajamasMedia piece from 4/22/2011, "We Call It 'Rationing,' Obama Calls It 'Medicare Independent Payment Advisory Board'".

I'm honored and delighted to be cited by such a high-profile outlet as Investor's Business Daily, and I'd like to again thank PajamasMedia (including editors David Steinberg and Aaron Hanscom) for providing such a friendly outlet for my work.

(See the full list of my PajamasMedia writings.)

Pushback Against ACOs

The American Medical Group Association (AMGA) has issued a strong statement warning that government plans for ACOs are "unworkable".

In the popular press, this is being (more-or-less accurately) portrayed as groups like Mayo Clinic, Cleveland Clinic, and Geisinger saying that they would not be able to participate in the proposed plans:

"Mayo Clinic, other premier medical groups call Obama plan on health care quality unworkable", Washington Post (AP), 5/12/2011.

The current administration has repeatedly tried to sell ACOs as a way to replicate the Mayo Clinic-type models nationally. But if even the Mayo Clinic states that they could not work under the proposed ACO guidelines, this could cast significant doubt about the idea.

More information:

AMGA online statement to members, 5/11/2011:
"AMGA Expresses Concerns about Accountable Care Organization Proposals to Donald Berwick, MD, CMS Administrator"

AMGA's letter letter to Medicare administrator Berwick (PDF)

Two From Haynes

Dr. Beth Haynes of the Black Ribbon Project asks, "What do Medicare, the Housing Bubble and the Chinese High Speed Rail have in Common?"

She also reports on the amicus brief filed by Docs4PatientCare, the Benjamin Rush Society, and the Pacific Research Institute against ObamaCare in the current FL vs. HHS court battle.

I'm very glad someone like Dr. Haynes is now a Senior Health Policy Analyst for Docs4PatientCare. You can learn more about her work at the Black Ribbon Project main website.

Today's Canadian Horror Story

This Canadian patient was told he must wait 12-18 months for spinal surgery, at the risk of developing paralysis. (Via @DaveSolsberg.)

Maybe he'll find another doctor who can help him "work the system" and get the surgery sooner. Or maybe not. Stuart Browning once noted that some Canadian doctors have been pressured by hospital administrators not to perform too many surgeries -- at the risk of losing some of their already-limited operating room time. (Unfortunately, the original link is now off-line.)

Fortunately, the US is not yet in such dire straits. Yet.

Hsieh PJM OpEd: Massachusetts is the Canary in the Coal Mine

PajamasMedia has just published my latest OpEd, Massachusetts: The Canary in the Coal Mine for ObamaCare.

My theme is that the ongoing failure of the "universal health care" plan in Massachusetts serves as a clear warning to the rest of America.

Here is the opening:

Five years ago, Massachusetts adopted its "universal health care" plan, which served as the template for President Obama's subsequent national health care legislation. However, Massachusetts' problems of rising health costs and worsening access foreshadow similar problems for the rest of America — as well as how to avoid them.

The Massachusetts Medical Society recently reported that the state law has resulted in "longer patient wait times [and] continued difficult access to primary care physicians." The average wait time in Massachusetts to see an internal medicine physician is now 48 days — double the national average. Over half of primary care practices are no longer accepting new patients. Fewer physicians are accepting the state-run Commonwealth Care and Commonwealth Choice insurance plans. So although Massachusetts politicians frequently boast that they have increased "coverage," many patients cannot find doctors to provide them with actual medical care.

Meanwhile health costs continue to skyrocket out of control, both for the state government and for privately insured patients...

(Read the full text of Massachusetts: The Canary in the Coal Mine for ObamaCare.)

Mitt Romney is expected to give a major speech later today in which he attempts proclaim his supposed opposition to ObamaCare while still defending his health care policy record as governor of Massachusetts.

I'm glad PajamasMedia has given me this opportunity to highlight the ongoing problems in that state. Romney appears to be trying to have it both ways here -- claiming that it might be ok for states to impose mandatory insurance, but not the federal government. For more, see his own recent OpEd in USA Today.

It would be one thing if he repudiated the principles of his failed state plan and acknowledged that it was a mistake. But the fact that he can't (or won't) do so is an ominous sign.

As the Wall Street Journal recently noted, he may as well be "Obama's Running Mate".

I'm also glad I could highlight Jared Rhoads' recent post, "How long until the Physician Mandate?", Diana's video on "Cookie Cutter Medicine", and Milton Wolf's OpEd, "My Cousin Barack Obama and Our ObamaCare Family Feud".

State Updates: MA, CA, CO

The 2011 report by the Massachusetts Medical Society notes that RomneyCare has resulted in, "Longer patient wait times, continued difficult access to primary care physicians,and gaps in physician acceptance of government coverage". (Via Scott K.)

The natural next question from Jared Rhoads, "How long until the Physician Mandate?"

Also in Massachusetts, an insurance company is being penalized $760,000 for selling policies that don't abide by the various state mandates.

(Or as Jared Rhoads noted on Twitter: "MA AG to insurance company: "STOP SELLING INSURANCE POLICIES THAT PEOPLE WANT! #governmentknowsbest")

John Graham's 5/6/2011 OpEd in the Orange County Register summarizes the main problem with the proposed new California law to impose Massachusetts-like controls over California's health insurance companies: "Politicians can't control health care costs". (Via Dr. Richard Armstrong of D4PC.)

Colorado Republican Amy Stephens continues to push for a state-run health insurance exchange, characterizing the government system as "free market", and calling opponents of her bill "anarchists". With "friends" like this... (Via Ari Armstrong.)

Wolf FoxNews OpEd on Genuine Health Reforms

Fox News has published the latest OpEd from Dr. Milton Wolf, "My Cousin Barack Obama and Our ObamaCare Family Feud".

In this latest piece, he zeroes in on the basic problem with ObamaCare:

The fundamental flaw at the core of ObamaCare is the mistaken belief that the government can spend your dollars more effectively than you can. This tragically pessimistic belief views all Americans with suspicion as either incompetent or unrighteous but either way in need of big-government control.

He also offers some genuine free-market reforms, including:

1) Tax Fairness. Allow Americans to purchase their own insurance without a tax penalty.
2) End state insurance and licensing monopolies
3) Eliminate frivolous lawsuits

(Read the full text of "My Cousin Barack Obama and Our ObamaCare Family Feud".)

I find it especially noteworthy that he's willing to tackle an issue that will be unpopular with many doctors -- namely the government licensing requirements that give doctors an unfair state-sanctioned monopoly. Dr. Wolf's proposed reform would be a good step in the direction of true health care freedom for all Americans.

(In fact, economics professor Shirley Svorny makes a good case in this paper that all government medical licensing can and should be completely eliminated and replaced with private credentialing systems: "Medical Licensing: An Obstacle to Affordable, Quality Care".)

Catron: Obama On Drugs

David Catron's latest AmSpec piece discusses the latest bad idea from the Obama Administration -- price controls on drugs. Here's an excerpt from, "Obama On Drugs":

Because Medicare is by far the largest single purchaser of pharmaceuticals in the market, "leveraging" its "purchasing power" is merely euphemistic language for "we will dictate drug prices."

Like all price-control schemes, this would inevitably lead to shortages. If Medicare forces the drug companies to sell their products at rates that fail to cover costs, these companies will simply stop manufacturing those drugs. To counter this inconvenient reality, the supporters of Obama's approach to "cost control" point to the Veterans Health Administration (VA), which has negotiated directly with pharmaceutical companies for years. What such people usually fail to mention is that the VA covers far fewer drugs than does Medicare...

Furthermore, reducing the profit motive for drug companies will reduce (and ultimately kill) innovation in future drugs.

On this point, Catron notes:

This point is dismissed by progressive "experts" like Maggie Mahar, who sneers, "[This] is an old argument. Innovation is already slowing at drug companies as fewer new 'game-changing' drugs are approved each year." That this reduction in approvals may say more about bureaucratic inertia at the FDA than drug company creativity seems not to have occurred to her.

Ironically, one of the most eloquent rebuttals to this progressive talking point has been made by fanatical Obamacare supporter Andrew Sullivan, who credits profit-driven innovation for saving his life: "I was told in 1993 that I had a few years to live. I write this 16 years later with a stronger immune system than I have ever measured before."

Sullivan is, of course, referring to the discovery that he was HIV positive. Yet, despite his affinity with the positions of people like Mahar, Sullivan readily understands what saved him: "America's much-maligned healthcare system did this. Without this vast and free market in medical care and pharmaceuticals, without the potential for making large amounts of money... the innovation of treatments and regimens would never have occurred at the pace it did."

(Read the full text of "Obama On Drugs".)

During the 2009-2010 health care debates, the drug industry wanted a "seat at the table" to help influence legislation in their favor. Instead, like with the medical device industry, they found that they got served as one of the courses.

That kind of political betrayal is the predictable consequence of trying to make deals with the devil, rather than standing up in a principled fashion for one's right to produce and trade free from government interference.

(David Catron also blogs regularly at HealthCareBS.)

Schwartz DP OpEd on Insurance Exchanges

Congratulations to Brian Schwartz for his latest OpEd in the 5/6/2011 Denver Post, "Don't get mugged by a politically controlled insurance exchange".

Here is the opening:

Say a street thug breaks your nose, robs you, and then offers to "help" by driving you to the hospital. Would you accept? Of course not. But some Colorado legislators are accepting - by supporting the Washington-controlled health insurance exchange in Senate Bill 11-200.

Insurance exchanges seem appealing because they give employees more health plan options and relieve employers of insurance-related administrative costs. Policies bought through an exchange are also portable, so changing or losing your jobs does not mean losing your health plan.

But creating an exchange run by Washington empowers politicians to "fix" problems resulting from bad policies they have preserved...

(Read the full text of Denver Post, "Don't get mugged by a politically controlled insurance exchange".)

Schwartz is absolutely right. We don't need yet another government bureaucracy to give people better access to affordable health insurance. Instead, we should eliminate the current policies that keep prices high, for instance by repealing mandatory benefits and allowing customers to purchase insurance across state lines.

The best way to lower prices is to respect and protect the freedom of consumers to purchase (and insurers to offer) the products and services according to their best judgment. It's worked in every other sector of the American economy -- we should let it work for health insurance as well.

Diana Hsieh on Cookie Cutter Medicine

My wife, Diana Hsieh, talks about her experience with hypothyroidism, and why she doesn't want the "cookie cutter medicine" being pushed on us by ObamaCare and other government meddling in medicine:

Perednia On Clinical Guidelines

The concept of clinical practice guidelines is one of the key cornerstones of ObamaCare. The theory is that there is "too much variation" in how individual doctors practice around the country. Hence, in the name of preserving quality and "cost effectiveness", physicians will be increasingly pressured by the government to follow clinical practice guidelines.

Dr. Doug Perednia addresses this issue in his essay, "Dangers of strict adherence to clinical guidelines", which draws extensively from an earlier essay by cardiologist Dr. Rich Fogoros, "The Abuse of Implantable Defibrillator Guidelines".

Dr. Perednia makes a couple of key take-home points:

1) Clinical guidelines often do not capture the reality of "in the trenches" medicine. Patients are all individuals, and frequently do not present as described in the textbooks. Hence, adherence to clinical guidelines will often mean that patients won't receive certain treatments that are actually medically appropriate for their particular individual circumstances, because they fall outside of the theoretical guidelines.

2) Many of the guidelines are based on very questionable evidence, even though bureaucrats will insist on calling them "evidence based" practices. And deviating from these guidelines will be falsely characterized as practicing "non evidence based" medicine, even when it is medically appropriate.

(Read the full text of "Dangers of strict adherence to clinical guidelines".)

Of course, clinical guidelines per se are not automatically wrong. When they are solidly grounded in medical science, they can be valuable practice aids -- when properly used by a physician who integrates them with the specific facts of the specific patient he or she is treating. But they should not be used as a substitute for the independent rational judgment of the practicing physician. That's why medicine is a combination of science and art -- not merely following "cookbook" protocols.

As Dr. Perednia emphasizes, "Strict adherence to standardized guidelines ought to raise a red flag." That's a sign that a doctor has abdicated his own judgment and his own mind to his bureaucratic masters -- at his patient's expense.

The fundamental problem with the current ObamaCare push towards "clinical guidelines" is that it's just another variation of the fallacious central-planner mindset that ruined the economies of the Eastern Bloc countries:



Just as those European central planners believed that bureaucrats could know better than you how to spend your own money, today's medical bureaucrats believe they know better than the actual treating physician as to what medical care you should (or should not) receive.

Only this time, you won't just be risking getting bad automobiles. Rather, you'll be risking your life.

Government Health at the VA

In the 5/3/2011 Forbes, Sally Pipes discusses how the government controls costs for the Veterans Administration medical system.

Here's an excerpt from, "A Plan That Leads Health Care To Nowhere":

The government purchases far more drugs than any other entity. So it can effectively dictate the price it will pay. Such price controls may seem like an effective way to cut spending--but they'll actually reduce the supply of available drugs. Pharmaceutical firms will simply stop selling their wares if the government forces them to take a loss on every transaction.

Consider the drug benefit administered by the Department of Veterans Affairs. The VA pays about 40% less for prescription drugs than Medicare Part D, so many pundits have held it up as an example of how the feds can effectively rein in drug spending.

But the VA has only been able to deliver those savings by covering fewer drugs.

Health care economists Austin Frakt, Steve Pizer and Roger Feldman recently compared the VA's drug benefit with Medicare Part D at the request of the Department of Veterans Affairs and the Robert Wood Johnson Foundation. They found that the average Medicare Part D plan covered 85 percent of the nation's 200 most popular prescription drugs -- while the VA formulary covered just 59% of those drugs.

That makes sense. The more comfortable benefit managers are saying "no," the more success they'll have demanding low drug prices. Patients, of course, will bear the downside--fewer choices.

Price controls will also discourage research into the next round of innovative therapies. Developing just one new medicine costs a drug company nearly $1.5 billion dollars. If investors fear that Medicare will refuse to cover new, expensive treatments, then they'll simply refuse to fund the research and development needed to create new drugs.

(Read the full text of "A Plan That Leads Health Care To Nowhere".)

Hence, the effect of the central-planning approach is the immediate restriction of benefits available to those receiving government health care, and the strangling of future innovation that could benefit us when we're sick and in need of new treatments.

We've already seen this play out in other countries like Great Britain, where access to new drugs is limited by government policy. Will this be our future here in the US?

NPR on ER Crowding

The 4/28/2011 edition of National Public Radio (!) reports that health care "reform" will make ER crowding worse.

Patient may still have theoretical coverage. But their primary doctors will send them to the ER if they are unable or unwilling to see them. ER overcrowding will occur -- not from the uninsured patients, but those with "coverage".

Again, this illustrates the principle that "coverage" does not equal actual medical care.

Just as ER visits increased in Massachusetts despite (or arguably because) of that state's reform, the same is likely to occur in the rest of the US under ObamaCare. (See also this related 2010 Boston Globe story.)

Time to kiss those promised cost savings goodbye...

Doctor and Drug Shortages

In the 5/1/2011 New York Post, Michael Tanner explains "Doc holiday: Behind the coming physician shortage".

The 5/1/2011 Washington Post reports, "Shortages of key drugs endanger patients"

Could it be that government policies are the cause of both shortages?

And the 5/2/2011 Wall Street Journal describes how, "The Administration targets a drug CEO in a troubling precedent".

I'm sure that punishing producers will help with the shortages. Just like it worked in Atlas Shrugged!

It looks like the Administration has decided that, "The beatings will continue until morale improves"...

Lucidicus: Is Healthcare a Fundamental Human Right?

Jared Rhoads of the Lucidicus Project recently responded to a question on the popular Q&A site Quora.com, "Is healthcare a fundamental human right? Should it be?"

I really liked his answer, so I'm reposting it here in its entirely with his permission:

Jared Rhoads, Director, The Lucidicus Project

Healthcare is not a right. A right cannot grant a good or service to one person by imposing an obligation upon another person to provide it. In other words, you can't declare something a right for one man if it creates a slave out of another.

If you object that "slave" is too a strong word to use in this context, remember that rights are moral absolutes. It makes no difference whether a man is forced to provide for the entirety of his neighbor's care, or whether he only is forced to provide only for part of his neighbor's care because "society's" resources are pooled. It is still an obligation that is imposed upon one person to satisfy the alleged right of another.

It doesn't even make a difference whether the man who is taxed to provide healthcare for others could also someday be eligible to receive healthcare for himself by the same system. To confiscate money, property, or effort today and promise a benefit tomorrow is still a violation of rights.

The only fundamental right that exists is the right to one's life. Essentially, this means the right not to be interfered with as you go about living your life. The only thing that others are "required" to do is leave you alone, which is not the same as an obligation to provide healthcare, food, clothing, or anything else no matter how much or how little of a necessity it is.

The right to life does not mean the right to be kept alive by others, to be kept healthy by others, or to be cured by others when you are sick. It means that you are left free to pursue your own life and health to the best of your ability, based on what you can accomplish yourself and what you can gain from others by trading with them voluntarily. (Seeking charity does not violate the rights of others, assuming it is given voluntarily.)

Some people like to carry on about which goods and services individuals should be forced to provide each other through government programs. Healthcare is a popular one. Retirement pensions are another. Education is yet another. The list is long.

But the question of whether these things are rights in the precise sense of the word, is not debatable. They are not. Rights are determined objectively, not by governments or the United Nations. When someone wishes to institute a new "right" to a good or service, what they are actually trying to do is sell you on the proposition that it is worth violating the one real right (the right to life) of some people in order to appropriate something else for others.

It is not in anyone's long-term interest to live in a society like that.

8:4 on Fri Apr 29 2011

(More about the Lucidicus Project.)

Last Chance: Let the FDA Know You Support Freedom For Genetic Testing

Sorry about the short notice, but I just learned about this myself. Submission deadline for comments is tomorrow(!)

The FDA is giving the general public one last opportunity for comment on whether it should clamp down on consumer genetic testing. These are tests where patients can have their own DNA analyzed to see if they might be at risk of developing certain diseases in the future, sold by companies such as 23andMe.com.

Here's the Wired story on the proposed regulations (and public comment period):
"Last chance: let the FDA know why you want direct access to your own genome", Wired, 4/29/2011

Here's the direct link to submit a comment to the FDA.

If you want some background, here's my PajamasMedia piece from last year:
"Should You Be Allowed to Know What's in Your DNA?"

I've already submitted the following short comment:

As a practicing physician, I want my patients to be as well-informed as possible about their bodies and their medical conditions. I fully support the rights of patients to learn about their genome free from government interference.

Such information could be invaluable in helping patients prevent or mitigate bad outcomes from genetic diseases or diseases with genetic predispositions.

Patients have both the responsibility and the right to be able to manage their own health according to their best judgment. Consumer genetics would be a powerful tool in assisting them make these important personal decisions.

Thanks to everyone who has already submitted a comment! The price of freedom is eternal vigilance.