Accountable Grocers

Hey -- if Americans aren't getting enough value for their food dollars spent, maybe we need a system of government-managed "Accountable Grocers"!

Great post by Dr. Beth Haynes.

Wolf on Obamanomics

Dr. Milton Wolf's latest OpEd at the Washington Times makes the crucial point that, "Obamanomics is shovel-ready".

My favorite passage is when Wolf debunks President Obama's shamefully ignorant fallacy of blaming ATMs for unemployment:

Mr. Obama, meet Ned Ludd. In the early 1800s, the Luddites -- named for Ned Ludd, an alias used to conceal their leaders’ true identities -- sabotaged factories for fear of new technology. Their mistake was a belief that jobs themselves are prosperity when, in fact, it’s the products and services of those jobs that create prosperity. The government could hire people to dig holes and other people to fill them back in, but America would be poorer for the wasted effort. In reality, new technologies, from the advent of the wheel to today’s nanotechnology -- including the ATM and the iPad -- increase efficiency, which frees people for more important endeavors. This is the precise mechanism that improves mankind's standard of living.

(Read the full text of "Obamanomics is shovel-ready".)

Whether it be in health care or the broader economic realm, the current administration's policy of stifling innovation and replacing it with government make-work projects merely shunts precious capital and resources from productive to unproductive venues. In essence, it squanders the lifeblood of any healthy economy.

Hsieh PJM OpEd: "Why the 'Unexpected' Keeps Happening"

The 6/29/2011 edition of PajamasMedia has just published my latest OpEd, "Why the 'Unexpected' Keeps Happening".

Here is the opening:

If an irresponsible teenager repeatedly crashed his car into a tree whenever he had a few beers, we would never say his accidents were "unexpected." Rather, they would be foreseeable consequences of driving while drinking. Similarly, we shouldn’t let journalists get away with describing as "unexpected" the foreseeable negative consequences of bad government policies.

Blogger Glenn Reynolds recently highlighted numerous examples of the media’s increasingly frequent use of "unexpected" to describe bad economic news. Unemployment "unexpectedly" rose despite federal "stimulus." Home sales "unexpectedly" fell despite taxpayer bailouts. ER visits unexpectedly rose in Massachusetts despite RomneyCare. Similarly, the Pundit Press blog has rounded-up dozens of examples of such "unexpected" developments since January 2011...

Read the full text of "Why the 'Unexpected' Keeps Happening" for the answer!

Obama Administration Cancels "Secret Shopper" Program

Breaking news: The Obama Administration has just canceled the controversial "secret shopper" program intended to learn if doctors treat privately insured patients differently from those with government insurance:

"White House dumps 'secret shopper' survey of doctors"
By SARAH KLIFF 6/28/11 5:57 PM EDT, Politico.com

From their official statement:

After reviewing feedback received during the public comment period, we have determined that now is not the time to move forward with this research project. Instead, we will pursue other initiatives that build on our efforts to increase access to health care providers nationwide...

Good riddance to a bad idea!

Snooping Shoppers and the End Game of ObamaCare

In his 6/27/2011 Forbes blog post, Avik Roy discusses the latest NYT story about government "secret shoppers". Roy's take-home point:

...[D]octors won't take federally-sponsored snooping lying down. Instead, more and more of them will drop out of Medicaid, and increasingly Medicare, rather than subject themselves to the onerous hassles and financial burdens of staying involved—only to face a federal audit for doing so. Doctors will avoid setting up shop in inner cities, where a higher proportion of patients are in these programs. In turn, access to care for those patients will get worse, not better, in a system that is already a humanitarian catastrophe.

The endgame for Obamacare’s proponents will necessarily involve compulsion: forcing doctors to see Medicaid and Medicare patients, despite penurious reimbursement rates, or revoking their licenses to practice medicine.

(Read the full text of Roy's post as well as the original NYT article.)

Roy is very likely correct. Last year, the Massachusetts legislature state legislature considered forcing doctors to accept government-controlled insurance rates as a condition of retaining their state medical licenses (regardless of whether or not the doctors lost money on each patient) -- in effect, creating a "physician mandate". (That law did not pass.)

Supporters of government health care will view a national equivalent as a logical next step to "fix" the problems of ObamaCare.

Calls for such a "solution" may increase as more patients with private insurance start experiencing similar problems as reported in this 6/27/2011 San Francisco Chronicle article, "Doctors Reject Insured Patients on Low Payments, Study Says".

If the government imposes a "physician mandate", expect a mass exodus of physicians out of the American medical system.

Quick Links: MA, AMA, Sweden

The 6/22/2011 Boston Business Journal reports that MA Attorney General Martha Coakley is demanding more price controls on health insurance. This is in addition to the proposed "global payments" (which are the 21st-century version of HMOs). For her, the solution to problems created by prior government controls is more controls. (Via Scott K.)

Dr. Mark Neerhof of Docs4PatientCare discusses why, "Obamacare Makes AMA Irrelevant to Doctors". His article gives many reasons why I'm not a member of the AMA.

Carl Svanberg debunks many of the American leftist myths about health care in his home country of Sweden at, "The Right To Wait".

Schwartz OpEd on SCHIP

The 6/26/2011 Boulder Daily Camera has published Brian Schwartz's latest OpEd on the Colorado SCHIP program (State Children's Health Insurance Program), "The poor keep their money for luxuries".

In response to CO governor Hickenlooper's decision to veto bill asking the SCHIP parents to pay more, he notes "Maintaining current fees would not only be an injustice to taxpayers, but also an insult to eligible parents. The fees imply that parents value enjoying life's amenities more than their own children's health."

Eventually, these programs (can and should) be privatized. But as an interim step, having parents assume more responsibility for their children's medical expenses (even if it means they must forgo various other discretionary expenses) would lessen the burden on taxpayers and would be a step in the right direction.

(Read the full text of "The poor keep their money for luxuries".)

From the Massachusetts Trenches

On 6/21/2011, the Boston NPR station (WBUR) had an interesting report on how "payment reform" is affecting Massachusetts doctors "in the trenches".

Here's an excerpt from their story, "Payment Reform: Panacea Or Debacle? A View From Middle Massachusetts":

...[T]he dominant message I take from Dr. Glazier is one of concern. It’s not kneejerk resistance to change. It's a view from the medical trenches that says: "I honestly don't see how what you're proposing is going to contain costs. But I do see some very real dangers." Here are seven of his top concerns, lightly distilled:

Some of the dangers he cites include:

1) Global payments don’t get the patient involved in containing costs.
2) No one even knows how much things cost.
3) The problem with risk-sharing is the risk.
4) Without full information, how can we take full risk?
5) How do you operationalize it?
6) Benchmarking is everything.
7) More consolidation to come.

Each of these seven points is covered in more detail in the full article, "Payment Reform: Panacea Or Debacle? A View From Middle Massachusetts".

Again, the problems in Massachusetts serve as a canary-in-the-coal-mine for the rest of the United States.

(Via @Lucidicus.)

Quick Links: HSAs, IPAB, Propaganda

Americans for Tax Reform note, "HSAs Increasingly Popular Despite Attacks from Obamacare".

In the 6/20/2011 Washington Times, Dr. Daniel Palmisano notes that the IPAB rationing board is becoming increasingly unpopular with both Democrats and Republicans in Congress. Read his OpEd, "Nailing Obamacare's rationing board".

The 6/20/2011 LA Times reports that our tax dollars will be used to fund another round of pro-ObamaCare commericials. (Via David Catron.)

Wolf OpEd: The FDA's One-Man Death Panel

Dr. Milton Wolf has a great new OpEd in the 6/22/2011 Washington Times, "The FDA's one-man death panel".

In his piece, he nicely summarizes the controversy over the FDA's decision to slow down the approval of the anti-cancer drug Avastin. Then he makes this crucial broader point:

The FDA, despite its intentions, drives up the costs of medicines and often dries up the supply chain altogether. America is currently facing a shortage of about 246 drugs - a record high. This doesn't happen by accident. Consider the alarming conclusions reached, not by the supposedly evil pharmaceutical companies, but by physicians and pharmacists at last year's Drug Shortages Summit.

A joint report by the American Society of Anesthesiologists, the American Society of Oncology, the American Society of Health-System Pharmacists and the Institute for Safe Medication Practices sounded the alarm: "Several drug shortages have been precipitated by actual or anticipated action by the FDA." They note that the "cost and complexity" of the FDA's "regulatory barriers" to providing new and even existing medicines is a "disincentive" to suppliers. Additionally, the "lengthy and unpredictable" approval process limits manufacturer's ability to develop reliable production schedules.

The Obama doctrine to keep the government’s "boot on the neck" of private-sector companies is not just limited to Big Oil. A nanny state that won't trust you to choose your own light bulbs certainly won't approve of even a life-saving medication until every bureaucrat has had his say in triplicate. Americans have landed on the moon and mapped the human genome and yet we suffer from the self-imposed scientific stagnation created by the FDA.

(Read the full text of "The FDA's one-man death panel".)

For more information on how ordinary Americans can submit input to government officials on the Avastin issue, visit Dr. Wolf's website.

Quick Links: Colvin, Conko, WSJ

Geoff Colvin of Fortune asks, "Why can't we fix Medicare once and for all?" (H/T: Dr. Beth Haynes.)

In particular, Colvin notes that we have the choice between the Brute Force approach and the People Aren't Dummies approach. The first has failed, and it's time to try the second. (Note: I don't necessarily agree with his endorsement of the Ryan plan).

In the 6/20/2011 Wall Street Journal, Greg Conko of CEI writes, "There's No 'Average' Cancer Patient". The FDA's reliance statistics and collectivized health measures jeopardizes individual patients. (H/T: Tom Bowden.)

As Conko notes:

The weakness of the FDA's reasoning here is that averages ignore that individual patients respond differently to treatments. Particularly with life-threatening illnesses, where the downside of any treatment is relatively small, average or median survivability too often masks the fact that some patients respond very well.

The 6/19/2011 WSJ editorial also describes, "The Accountable Care Fiasco". The basic premise behind ACOs is that government micro-management can guarantee good health care.

(As I noted in my recent TownHall piece, this is just the latest incarnation of the "central planner fallacy" applied to modern health care.)

Hsieh TownHall OpEd: Obama's Health Care Fallacy

The 6/20/2011 TownHall.com has published my latest OpEd, "A Doctor Exposes Obama's Health Care Fallacy".

My theme is that Accountable Care Organizations (ACOs) represent the latest incarnation of the failed "central planner fallacy" as applied to American health care. Here is the opening:

Suppose President Obama proposed reviving the faltering American economy by creating a federal "Department of Technology" to encourage Silicon Valley technology companies to merge into large consortiums. Bureaucrats would then tell these companies what products they should produce and sell.

Most Americans would consider that approach ridiculous. They know that innovations such as iPads and smartphones were created by entrepreneurs competing in a free market, not by government central planners. Yet the Obama administration is committing the same error by pushing doctors and hospitals into government-supervised "Accountable Care Organizations"...

(Read the full text of "A Doctor Exposes Obama's Health Care Fallacy".)

Thanks to Dr. Hal Scherz and to Dan Rene of Docs4PatientCare for helping to arrange this!

The FDA and Drug Shortages

At Marginal Revolution, Alex Tabarrok discusses the FDA and drug shortages.

Although the problem is multifactorial, FDA policies are making the shortages worse.

(John Goodman also discusses some of these issues in his 6/19/2011 TownHall OpEd, "Deadly Regulations".)

The Noose of Government Clinical Guidelines

Dr. Doug Perednia discusses, "How physicians not adhering to clinical guidelines may be punished".

As he notes:

If the Justice Department investigation is, in fact, going to target clinicians based upon their adherence to guidelines, the American healthcare system is headed down a very slippery slope. Government regulators and prosecutors will, of course, contend that they're simply looking for "waste, fraud and abuse", and that looking for non-adherence to guidelines is a reasonable screening tool when looking for criminals. But let's not kid around. Any such policy is going to have a chilling effect on treating patients as individuals rather than statistically average widgets. You may need a test or procedure as a part of good medical care, but your doctor is going to be too scared to order it if her record of "guideline compliance" is at stake.

Think about it. For the first time your doctor may have a real choice to make if your medical condition doesn't happen to fit neatly into some academic cookbook. Adhere to the guideline and commit malpractice, or violate the guidelines and risk jail time.

Using guidelines in this way is unscientific, unethical and just plain wrong.

In other words, the federal government is going to claim that it knows better than your doctor whether you should have a certain test or treatment. And it will base that determination on statistical data which may or may not apply to your particular case.

We have been warned.

Quick Links: Cronyism, Courts, Concierge Care

In the 6/13/2011 Forbes, Daniel Mitchell notes how "Obamacare Waiver Process Is Like Scene From Atlas Shrugged". Corruption and cronyism!

In the 6/14/2011 Wall Street Journal, David Rivkin and Lee Casey explain "Why ObamaCare Is Losing in the Courts".

This 5/13/2011 Fox News piece asks, "Concierge Health Care: Worth the Hefty Price Tag?" (Via @aapsonline.)

Quick Links: Medicaid, Markets, MA, Doctors Leaving

The 6/15/2011 New York Times used "secret shopper" techniques and found that Medicaid patients are having a more difficult time seeing doctors. Again, "coverage" does not equal actual care. (Via Tyler Cowen.)

John Goodman demonstrates numerous ways that the free market encourages private entities to offer affordable (or even free!) health services.

The 6/14/2011 Boston Globe reports "Massachusetts health care costs outpace nation".

UPI reports, "More physicians leaving private practices".

Mayo Clinic Opposes ACOs

The 6/10/2011 Minneapolis Star Tribune reports that, "Mayo opposes key health reform provision". In summary, the Mayo Clinic "says it already is accountable to patients without the government's proposed oversight system."

Here's an excerpt:

The Mayo Clinic says it will not be part of a critical piece of national health care reform under the government's proposed rules.

The prestigious Rochester clinic is raising questions about accountable care organizations, or ACOs, which are supposed to be updated -- and better -- versions of health maintenance organizations. Approved as part of the 2010 health care law, they are designed to improve care and cuts costs by over half a billion dollars a year.

But Mayo says the proposed regulations from the federal Centers for Medicare and Medicaid Services (CMS) conflict with the way it runs its Medicare operations, which treat about 400,000 patients a year...

Among the clinic's biggest concerns is the government's demand that patients be included on oversight boards that judge performance. Mayo doesn't do that now and is not eager to change.

"You don't have to have a [patient] on the board to make [treatment] patient-centered," Wood said.

(Read the full text of "Mayo opposes key health reform provision".)

Government ACO rules presume that bureaucrats know better how to run their operations better than doctors and hospital administrators whose own reputations are profitability are at stake. This is just another example of the central planner fallacy applied to health care. (Link via D4PC.)

Michael Cannon argues a similar point in his 6/3/2011 piece in Kaiser Health News, "ACO Debacle Exposes Obamacare's Fatal Conceit". (Via PatientPower.)

McArdle on High Risk Pools

In her 6/2/2011 blog post for The Atlantic, Megan McArdle asks a interesting question: "Why Hasn't Anyone Signed Up For the High-Risk Health Insurance Pools?"

She notes that ObamaCare supporters repeatedly argued that the law was necessary because millions of Americans were supposedly uninsurable because of "pre-existing conditions". Part of ObamaCare legislation included setting up government-sponsored "high risk" pools to enable these people to obtain insurance coverage that they could not otherwise find in the current mixed (semi-regulated/semi-free) economy.

Yet very few have chosen to do so, despite the relatively affordable subsidized prices.

It's almost as if the Obama administration had exaggerated the extent of the problem for political purposes!

There is a genuine problem of some Americans having a difficult time obtaining insurance, due to our current perverse system of tying insurance to employment (an artifact of government regulations going back to World War 2). But this problem cannot be solved by further regulations. Rather we need free-market insurance reforms.

For a discussion on how a free market would help those with pre-existing conditions, see my article in the Fall 2009 issue of The Objective Standard, "How the Freedom to Contract Protects Insurability".

ObamaCare Problems: Counting The Ways...

The 6/8/2011 Investor's Business Daily describes how "ObamaCare's Many Flaws Could Doom It".

The many problems they cite include:

* Millions of private employers will drop their worker coverage.
* Cost estimates keep rising
* The ACO concept to save money is meeting serious opposition
* The IPAB payment board is facing serious opposition
* The "high risk pools" are a flop
* The waivers

(Read the full text of "ObamaCare's Many Flaws Could Doom It".)

More and more Americans are catching on that this is a bad idea.

Hsieh PJM OpEd: Dude, Where's My Freedom?

The 6/11/2011 PajamasMedia has published my latest OpEd, "Dude, Where's My Freedom?"

My theme is that ongoing forms of "gun control", "health control", and "travel control" are just examples of a broader "freedom control".

Here is the opening:

Benjamin Franklin once warned Americans that “they who would give up an essential liberty for temporary security, deserve neither liberty or security.” Yet in the seemingly unrelated areas of health care and physical security, our political leaders are embracing this folly with predictably bad results...

(Read the full text of "Dude, Where's My Freedom?")

I'd like to thank JaredR and VickyG for pointing me to some of the links I used.

And thank you, Glenn Reynolds, for the Instapundit link!

Lucidicus Interviews Sally Pipes

Jared Rhoads of the Lucidicus Project has posted their recent interview with Sally Pipes, "Sally Pipes on doctors, students, and activism".

One excerpt:

With many negative aspects of the PPACA now coming to light, doctors are now beginning to see the impact on their practices and are getting engaged.

I think it is important to note that America does not have a free market in its health care system today. Fifty percent of health care is in the hands of government through Medicare, Medicaid, SCHIP, and the VA system. It does concern me greatly that a growing number of doctors in the academy and hospitals favor a single-payer system. The medical schools where our young students are training for a future in medicine either as primary care doctors or specialists are being indoctrinated by their professors who constantly tell them that a government-run system would bring about affordable, accessible, quality care for all.

It was this realization in 2008 that medical school students were not hearing any alternative to this type of system that emboldened me to found the Benjamin Rush Society. It is patterned after the Federalist Society but for medical students and doctors instead of law students and lawyers. It is a chapter based organization with affiliates at over 20 medical schools around the country—from Duke to Harvard; from Stanford to George Washington University. The chapters hold debates and seminars on issues of importance on issues that should be important to them. Topics range from "How do you achieve affordable, accessible, quality health care?" to "Are pharmaceuticals too expensive?" to "Is universal coverage the responsibility of the federal government?" Our goal is to have a chapter at every medical school in the nation.

These debates are very informative for students. We find that about 65 percent of students in the pre-vote tend to support a greater role for government. Following the debate, some gains have been made, with about 60 percent supporting our position. There is still much to be done if we are going to save a health care system that empowers doctors and patients. It is worrying that 49 percent of newly graduating specialists are now working for hospitals rather than going into private practice. In recent polls, 45 percent of doctors have said that unless ObamaCare is repealed, they will seriously consider getting out of the practice of medicine. This has serious implications for all of us who will at some point need medical care.

(Read the full text of "Sally Pipes on doctors, students, and activism".)

Pipes is absolutely correct. The key to the health care debate will be education -- of doctors, medical students, and patients. Activists like Sally Pipes deserve tremendous credit for their work in this arena.

Catron: Obamacare Has Another Rough Day in Court

In the 6/10/2011 American Spectator, David Catron has a nice wrapup of the latest legal proceedings in Atlanta over ObamaCare, "Obamacare Has Another Rough Day in Court".

Here's an excerpt:

Chief Judge Joel Dubina pointed out that there is no precedent for the claim that Congress is permitted to impose such a mandate by virtue of the Constitution's commerce clause: "I can't find any case like this.… If we uphold the individual mandate in this case, are there any limits on Congress's power left?"

Judge Stanley Marcus was also unequal to the task of finding a precedent for this arrogation of power by the federal government: "I can't find any case… telling a private person they are compelled to purchase a product in the open market.... Is there anything that suggests Congress can do this?"

Judge Frank Hull asked whether Congress could pass a similar law requiring Americans to buy certain types of cars or energy-saving devices to comply with federal energy policy.

(Read the full text of "Obamacare Has Another Rough Day in Court".)

These judges are asking exactly the right questions and addressing the fundamental issue of freedom vs. government compulsion.

The battle is a long ways from being won. But the latest courtroom proceedings are potentially encouraging for those who value freedom and individual rights.

Haynes: The Changing Character of Medicine

The 6/9/2011 edition of PajamasMedia has published another fine OpEd from Dr. Beth Haynes, "The Changing Character of Medicine: Are We Headed in the Right Direction?"

One crucial excerpt:

When you are ill, do you go to your physician to receive a government (or industry) derived practice guideline? Or do you want your physician to be able to apply his independent judgment to your individual situation? Which kind of doctor is more likely to be willing to rely on his own judgment in service of your individual best interests? One steeped in the ethics of social justice, beholden to a third-party for payment? Or a physician whose livelihood is directly related to and primarily dependent upon the quality of care he provides to you, the patient?

What if you have an unusual illness, or even a common illness for which a new but not yet thoroughly tested and approved treatment is available? Which physician would be more likely to suggest and/or support an innovative treatment? A doctor whose job depends on keeping the politicians or administrators happy, or the physician whose primary loyalty is to you?

(Read the full text of "The Changing Character of Medicine: Are We Headed in the Right Direction?".)

Dr. Haynes is asking the questions that all Americans should be asking.

Wolf: Why Obama Is Wrecking Medicare

Dr. Milton Wolf has a new OpEd in the 6/8/2011 Washington Times, "Obamacare wrecks Medicare by design, but why?"

He observes that (1) Medicare is increasingly unsustainable and that (2) current Obama administration policies seem designed to drive the American health care into a government-run single-payer system:

In the few remaining years Medicare has left, dispirited doctors are already fleeing the program in droves - and medicine altogether - leaving behind helpless patients. Democrats’ only plan is to maintain the crumbling status quo: Plunder Medicare, chase more doctors away with an additional 30 percent cut in reimbursement next year, and then watch from the bleachers as Americans are turned into medical refugees desperate for any salvation.

The president's intentions are chillingly clear: "I happen to be a proponent of a single payer universal health care program. ...That's what I'd like to see." Obamacare is a major step in that direction. "I don't think we're going to be able to eliminate employer coverage immediately," he says, but he can envision it "a decade out, or 15 years out, or 20 years out."

The current system of employment-based health insurance has many problems. But destroying the remnants of the semi-private insurance system and replacing it with a government monopoly insurer isn't going to make things better.

As one wag noted, "If you don't like health insurance companies now, think of how much better our customer service will be when you have to buy it from us."

(Read the full text of "Obamacare wrecks Medicare by design, but why?".)

ObamaCare Put Through The Wringer

Jay Bookman of the Atlanta Journal Constitution described the recent proceedings of the ObamaCare legal challenge at the 11th Circuit Court of Appeals today.

One excerpt:

Provisions of the federal Affordable Care Act, also known as ObamaCare, "may violate the constitution of Ayn Rand, but they do not violate the Constitution of the United States," acting solicitor general Neal Kumar Katyal told a three-judge panel of the 11th Circuit Court of Appeals Wednesday.

Conversely, attorney Paul Clement, representing Georgia and 25 other states, framed the issue of mandated purchase of health insurance as an issue of liberty.

"Can the federal government compel an individual to take part in commercial activity in order to better regulate that individual?" he asked the judges.

(Read the full text of "ObamaCare gets put through judicial wringer".)

I'm encouraged that the fundamental issue of liberty vs. government compulsion is being discussed in such frank terms. I'm also encouraged that the statists are identifying Ayn Rand as their explicit philosophical opposite.

The more that Americans understand Rand as providing a philosophical defense of liberty and individual rights, the better off we'll be in the long run.

(H/T: Beth Haynes and Sasha Volokh.)

Update: Ilya Shapiro has a nice report from the courtroom as well.

(And fixed a typo in the original title!)

Quick Links: Schwartz, Harsanyi, Pipes, Turner

The 6/2/2011 Denver Post has published Brian Schwartz's letter criticizing Governor Hickenlooper's veto of Colorado Senate Bill 11-213.

David Harsanyi reminds us, "Let's Not Forget About Obamacare":

Rationing boards. Political favors. Lies. Coercion. Broken promises. Precedents that can force us to buy about anything. It might not be socialism, technically speaking. But really, what's not to like?

(Read the full text.)

As Vermont proceeds with its "single payer" plan, Sally Pipes at Forbes (6/6/2011) describes, "Single-Payer Health Care Systems, Multiple Health Care Disasters".

In the 6/7/2011 Wall Street Journal, Grace-Marie Turner notes, "No, You Can't Keep Your Health Insurance". The end-game for many ObamaCare supporters is to drive private insurers out of business, leaving patients to the tender mercies of a government monopoly insurer.

Goodman Dissects Evidence-Based Medicine

John Goodman does a nice job dissecting the many problems with the current concept of "evidence based medicine".

Often, the purported "evidence" is shaky. Or subject to commercial bias. Or applicable only to a subset of patients. Or simply lacking.

Yet doctors will be increasingly pressured to follow "evidence based" government practice guidelines (or risk not getting paid), even if that's not the appropriate care for the individual patient.

And note how the term "evidence based medicine" is carefully crafted to cast aspersions on any doctors who stray from those guidelines -- not-so-subtly implying that they are disregarding evidence or failing to practice according to sound scientific principles.

So beware the double-speak of "evidence based medicine".

(Read the full text of Goodman's post, "Cookbook Medicine". Link via Donna R.)

Quick Links: Lucidicus, ACOs, Government Power

Neil Weikel has a nice interview with Jared Rhoads of the Lucidicus Project.

I also highly recommend Jared's recent blog post, "Moral arguments on the rise in healthcare".

The 5/27/2011 Washington Post reports that a 5-year trial of ACOs really did not save much money. But it did increase the bureaucracy.

The 6/2/2011 Washington Times discusses "ObamaCare's Unlimited Power":

As Judge James L. Graham asked acting Solicitor General Neal Katyal, "Where ultimately is the limit on congressional power?" The question sounds rhetorical but is not.

Haynes on Paying for the Cake You Want to Eat

Dr. Beth Haynes of the Black Ribbon Project and Docs4PatientCare has a new OpEd in the 6/2/2011 PajamasMedia, "Medicare Reform: Paying for the Cake You Want to Eat".

Here is the opening:

Since Medicare and Medicaid became law in 1965, people have been told: "You can have your cake and eat it too." You can have the medical care you need and not have to pay for it. (You may think you are paying for Medicare with your payroll taxes, but in fact those taxes cover less than 1/3 of your projected health care costs.)

For decades, Medicare and Medicaid have been paying for health care with no one facing the difficult question: "Is what we are purchasing worth the cost?" Not the doctors, nor the "beneficiaries" -- and especially not the politicians. Doctors get income; patients get health care; politicians get votes -- all with the carefree ease of paying for it with other people's money while simultaneously ignoring the debt looming larger and larger behind the proverbial curtain.

(Read the full text of "Medicare Reform: Paying for the Cake You Want to Eat".)

As Dr. Haynes notes, the crucial issue will be "Who decides?"

As long as we attempt to "guarantee" universal health care for any group of Americans (such as senior citizens), the government will attempt to control what medical care it will pay for (and what care patients can receive). The end result will be Canadian and UK-style rationing.

Hence, if we want to restore control over these decisions back to senior patients and their physicians, we need to phase out and eventually privatize Medicare. That will be the only way out of our current Medicare mess.

Hsieh CSM OpEd: "Obamacare's Big Brother: Accountable Care Organizations"

The June 2, 2011 edition of the Christian Science Monitor has published my latest OpEd, "Here comes Obamacare's Big Brother: Accountable Care Organizations".

My theme is that the federal government's proposed new model of Accountable Care Organizations (ACOs) is dangerous because it will corrupt the doctor-patient relationship and stifle genuine health delivery innovations. Here is the opening:

Suppose President Obama declared he would tackle rising food prices by forcing everyone to eat at government-supervised restaurant chains. Small restaurants would be nudged to merge with national ones. Bureaucrats would monitor menu items and prices. Restaurants would record orders in a central database to ensure meals adhered to federal nutrition guidelines.

Most Americans would be outraged at such infringements of their basic freedoms. Yet this is precisely the approach the Obama administration is taking by pushing doctors and hospitals into government-supervised Accountable Care Organizations (ACOs).

(Read the full text of "Here comes Obamacare's Big Brother: Accountable Care Organizations". This piece will appear in both the online edition as well as the weekly print edition.)

For more on how Dr. Brian Forrest uses "direct pay" and price transparency to achieve such remarkable results in his small clinic in Apex, NC, see this eye-opening video:



Here's a related shorter news video covering much of the same material:



I'm honored to once again appear in the pages of the Christian Science Monitor. My earlier two CSM pieces were:

"Health Care in Massachusetts: A Warning for America" (9/30/2009)
"Universal Healthcare and the Waistline Police" (1/7/2009)

Economic Sense and Nonsense

Sally Pipes makes some good legal and economic arguments against ObamaCare in her 5/30/2011 Forbes piece, "The Administration's Argument For Obamacare Makes No Sense".

In particular, she notes:

...[U]pon careful inspection, the Obama team's argument for the constitutionality of the individual mandate amounts to little more than "because we said so."

She also discusses how the claim that ObamaCare will lessen the cost-shifting are faulty. Rather than fixing that particular problem, ObamaCare will simply make things worse.

These are not necessarily the most fundamental problems with ObamaCare, but they are important ones. And I'm glad they're being addressed by analysts like Sally Pipes.

Hospitals Skeptical About ACOs

The 5/30/2011 New York Times notes, "Medicare Plan for Payments Irks Hospitals". In particular, hospitals are expressing increasing skepticism about new rules for so-called Accountable Care Organizations (ACOs) intended to encourage them to save money by "integrated care".

A couple of excerpts:

This plan has drawn fire from hospitals, which say they have little control over services provided after a patient’s discharge — and, in many cases, do not even know about them. More generally, they are apprehensive about Medicare’s plans to reward and penalize hospitals based on untested measures of efficiency that include spending per beneficiary...

Charles N. Kahn III, president of the Federation of American Hospitals, which represents investor-owned companies, said he supported efforts to pay hospitals according to their performance. But he said the administration was "off track" in trying to hold hospitals accountable for what Medicare spends on patients two or three months after they leave the hospital.

"That's unrealistic, beyond the pale," Mr. Kahn said.

(Read the full text of "Medicare Plan for Payments Irks Hospitals".)

The push towards government-supervised ACOs represent a top-down "central planner" approach towards health care, with government carrots and sticks used to incentivize hospitals to follow government "quality" guidelines.

This approach ruined the Eastern Bloc economies during the Cold War. Why should we expect it to do any better for American health care?