Bigger Picture Views from Catron, Ferguson, Hennessey

It's easy for me to get too enmeshed in the details of health care policy, so I like occasionally post links to OpEds and essays taking more of a big-picture view of government and society.

David Catron has a piece in the 10/31/2011 American Spectator, "The Left Has Become Comfortably Dumb".

Niall Ferguson has a piece in the 10/30/2011 Daily Beast, "America's 'Oh Sh*t!' Moment". The teaser asks, "Has the U.S. deleted the very things that made it great? Niall Ferguson on how America can avoid imminent collapse." (Via Hanah V.)

This pair of 2/22/2011 videos from Keith Hennessey shows why all the current political debates are just tinkering at the margins of a much bigger fiscal problem (via Paul L.):



And Part 2:

ObamaCare Issues Before the Supreme Court

SCOTUS blog discusses "the five petitions that the Justices will consider Nov. 10, the issues each seeks to raise, the lower court involved, and the petitioners".

Here are a couple of quick useful summaries of the relevant issues, including the individual mandate, severability, Medicaid burden on states, etc.:

"Obama healthcare law issues before high court", Vicini, Reuters, 10/25/2011.

"High court zeroes in on health care", Haberkorn, Politico, 10/23/2011.

Massachusetts Hardship

The 10/18/2011 Boston Herald discusses continuing problems with Massachusetts' "universal" health care system based on mandatory insurance.

Lauren and Nick Destito are being told by the state that the health insurance plan they've purchased is not acceptable, and are being punished for it despite their current financial hardships.

From the article, "Health-Care Agency Sick":

...[T}he state must establish if her family could afford other, better insurance, and that affordability is determined "not, unfortunately, from your perspective but from the state agency's view."

In other words, the state decides how much health insurance you can afford -- not you.

After that stunner, [state insurance hearing officer Irene] Herman asked Destito detailed questions about her income and expenses right down to costs of clothing, heat, food, phones. She also said the state would need documentation on her mortgage and medical bill arrears as well as what her insurance does and does not covers.

"This is outrageous," [state representative Dan] Winslow interjected. "Bankruptcy isn't enough? Unemployment isn't enough? Buying insurance isn't enough when it's bought from a licensed broker in Massachusetts?..."

(Read the full text of "Health-Care Agency Sick".)

Whenever the government imposes mandatory insurance, it must necessary specify what constitutes an acceptable (or unacceptable policy). And if you don't spend your own money in a fashion the state deems appropriate, you'll pay the price.

Because ObamaCare is closely modelled after the Massachusetts plan, residents of the other 49 states may soon have to learn this the hard way.

(Via D4PC.)

Wolf On CLASS

Dr. Milton Wolf's latest Washington Times OpEd discusses, "CLASS-less Democrats: Obamacare collapsing en route to Supreme Court".

He discusses the inevitable failure of the unsustainable ObamaCare CLASS program, intended to "guarantee" long-term care for patients. Because it was based on transparent accounting gimmicks (including "count[ing] 10 years of CLASS incoming revenue but just five years of expenses"), it could never possibly work.

Wolf then makes this broader point:

the CLASS Act is nonviable for the same reason that the rest of Obamacare is nonviable: There simply isn't enough of other people's money to pay for it. Obamacare is propped up by the individual mandate, which forces would-be free Americans to purchase far more health insurance than they need as an obvious means to transfer wealth. Because Obamacare doles out welfare goodies to families earning up to $88,500 a year -- imagine that -- a whole lot of wealth needs to be transferred. The individual mandate, as currently adjudicated in federal court, has been ruled unconstitutional. If the Supreme Court resurrects the mandate, it's likely an even higher court -- the voters -- will strike it down.

(Read the full text of "CLASS-less Democrats".)

Reality always wins in the end, despite politicians' desires to fudge it. American voters just need to remind them of that fact come 2012.

Quick Links: Secret DNRs, PSA

David Catron links to this 10/25/2011 Telegraph article, "Elderly patients condemned to early death by secret use of do not resuscitate orders".

Here in the US Dr. Rich discusses, "Some Implications Of the New PSA Recommendation".

Just don't call any of this "rationing".

Hospital Bill From 1960

One of my friends just send me this copy of a hospital bill from 1960. This was for a relative of hers who had delivered a baby and subsequently stayed 5 days in the hospital. (I've obscured the patient's name to preserve her privacy.)

Here's the breakdown:

Hospital (5 days, $21 per day) = $105
Newborn care (5 days, $9 per day) = $45
Routine special services = $9
Delivery room = $45
Anesthesia = $25
Telephone = $1.05

Total = $230.05

(Click on image below to see full size.)

This bill was from Hartford Hospital, a high-quality hospital in Hartford, CT.

In contrast, the typical cost today for an uncomplicated vaginal delivery is $9,000 to $17,000 (without insurance).

Of course, patients with private insurance would have a smaller out-of-pocket cost.

The figure cited for today also include professional fees, which weren't included in 1960 hospital bill. On the other hand, most mothers today don't stay in the hospital 5 days after the delivery but rather only 1-2 days. And today, the baby is typically billed separately for services he or she receives, in the range of $1,500 to $4,000 (as opposed to the $45 in 1960), which should increase today's total.

The only item on the bill that hasn't increased by a factor of 25-100x is the telephone charge.

Some food for thought when thinking about medical inflation.

(Via Hannah K.)

The Mandate Both Is and Is Not a Tax

The Obama administration is trying to have it both ways in arguing to the US Supreme Court about the individual mandate -- claiming that it both isn't yet is a tax.

The administration does want the court to hear the case sooner, rather than later.

However, "a federal law known as the Anti-Injunction Act prevents courts from blocking taxes before they take effect". Hence, in order to get the SCOTUS to hear the case the Obama administration has to claim that the individual mandate is not a tax. Yet, in their supposed defense of the mandate's constitutionality, they argue that it is a tax.

ObamaCare supporter and law professor Tim Jost acknowledges that this strategy is "transparently contradictory". (Read the full text of "Tax law could hinder quick Supreme Court decision on healthcare mandate", The Hill, 10/23/2011.)

The Obama administration reminds me of the desperate defense attorney who tries to simultaneously claim, "My client wasn't even in town when the victim was shot -- and my client shot in self-defense!"

(Via @aapsonline.)

Rhoads: What We Can Learn From Failures Like The CLASS Act

Jared Rhoads of the Lucidicus Project has a nice OpEd at the 10/20/2011 American Thinker, "What We Can Learn From Failures Like The CLASS Act".

In particular, he discusses wrong ways of thinking about the CLASS act failure, such as Robert Reich's contention that it failed because it wasn't sufficiently coercive.

Instead, Rhoads offers this as the correct lesson:

If you are a policy expert in the throes of designing a new program, and at any point during that process you realize that it cannot work if it is voluntary -- that it must rely on the use of coercive force to "make the numbers work" -- then take that as a signal that what you have concocted is immoral. Scrap what you have and start over. You're violating individual rights.

(Read the full text of "What We Can Learn From Failures Like The CLASS Act")

Quick Links: Residents, Exchanges, Creeping Socialism

29% of medical residents (doctors in training) said they would chose to go into another field instead of medicine, up from 18% in 2008. (Via @ohpcenter.)

PatientPowerNow: "Private health exchange to compete with politically-run government exchanges".

Dr. Robert Sewell discusses, "Creeping Socialized Medicine". (Via Dr. Richard Armstrong.)

Haynes: False Dichotomy Between ObamaCare or 'Let Them Die'

Dr. Beth Haynes has an OpEd in the 10/18/2011 TownHall.com, "False Dichotomy: ObamaCare or Let Them Die".

She analyzed a recent exchange during one of the GOP presidential debates and makes a point that too few in the mainstream press are making -- namely, that there is a false alternative between ObamaCare and "letting patients die":

The logical fallacy... is that our only choices are to either (1) force hospitals and doctors to provide care and citizens to purchase insurance, or (2) "Let Them Die." This erroneously limited view fails to consider the existence of humane, liberty-preserving alternatives. It also ignores the history of increasingly intrusive government actions which have seemingly left us with only these two equally unacceptable choices: government coercion or Let Them Die.

Dr. Haynes discusses the many ways in which government intervention in the marketplace has driven up costs and limited the ability of Americans to receive affordable health care and health insurance.

She also makes this crucial point:

This false alternative, Government Control or Let Them Die, arises from a misplaced confidence in government and the erroneous belief in a fixed quantity of available healthcare resources. It is bolstered by the lingering remnants of the Marxist belief that profit-seeking requires exploitation and that because physicians know more than patients, an "asymmetry of knowledge" leaves patients too vulnerable and incompetent to make their own healthcare judgments. These errors are held by Democrats and Republicans -- which results in both parties crafting "solutions" that require ever more government involvement in the provision and funding of healthcare.

But a system of voluntary exchange creates wealth by increasing the availability of resources. Competition drives affordability by increasing efficacy and decreasing cost. Profits are not the result of exploitation but simply the reward justly earned for providing patients with what they want, while losses are the correcting and cleansing consequence of failing to do so in a cost-effective manner.

Dr. Haynes offers both the right diagnosis and the right treatment for our current health care problems. Let's hope more Americans start listening.

(Read the full text of "False Dichotomy: ObamaCare or Let Them Die".)

Wolf On Liberalism

Dr. Milton Wolf has a new piece in the Washington Times, "Liberalism's Unwashed Last Stand".

Today's OWS protestors are engaging in the First World equivalent of "magical thinking" -- as if demanding free goodies at others' expense will make it happen. Of course, this game only "works" as long as someone else is willing to foot the bill.

But as the protestors in Greece are learning, this can't go on forever -- either because those paying bills can't (or won't) continue indefinitely. The only real question is how it ends.

Similarly, the entitlement state in the US will end sooner or later -- the only question is whether it will be a semi-controlled landing or a catastrophic crash. Of course, the issue involves all manner of entitlements, ranging from health care to business subsidies to "crony capitalism".

Fortunately, more Americans are waking up to the issue. The OWS protestors openly declaring, "I want more handouts" are helping to make the issues clearer to most ordinary Americans, without as much of the prior sanctimonious window dressing.

(Read the full text of "Liberalism's Unwashed Last Stand".)

Federal Government: All Your Data Are Belong To Us

In his latest 10/17/2011 AmSpec column, David Catron discusses yet another aspect to ObamaCare that hasn't gotten much media attention lately -- the impending loss of medical privacy.

Here's an excerpt from, "We'd Like to Know a Little Bit About You for Our Files":

The new regulation, a copy of which can be found here if you have the intestinal fortitude to wade through 27 pages of excruciating bureaucratese, requires insurance companies to submit detailed health information about their patients to the HHS mother ship.

And the "information collection requirements" (ICRs) set forth in this Byzantine edict will not be limited to federal programs like Medicare, or even to carriers involved in Obamacare's insurance exchanges. As the rule matter-of-factly phrases it, ICRs will apply to "all health insurance issuers both inside and outside of the exchanges" and affect carriers "in the individual and small group markets." The new regulation includes several alternatives for gathering and reporting your health data, but opting out is not among the choices offered.

(Read the full text of "We'd Like to Know a Little Bit About You for Our Files".)

Given the poor track record of the US government in keeping other supposedly-confidential information secure, this should alarm every American concerned about their medical privacy.

The government's response to such concerns is: "Protecting an individual's personal health information continues to be among CMS's highest priorities." That's basically a fancy way of saying, "Trust us, we're from the government and we're here to help you."

Plus, this data is precisely the sort of tool the government needs in order to impose practice guidelines on physicians -- namely, the ability to see which doctors are adhering to the government's standards of "appropriate care" and which doctors are exercising too much independent judgment and straying from government guidelines. Of course, this is framed in terms of guaranteeing equal care for all. But in reality, such "equal care" means equally bad care for all (unless you're politically connected).

To paraphrase an old internet meme, the government is saying "All your data are belong to us!"

Government Failure, Private Sector Success

The Obama administration has pulled the plug on the unsustainable CLASS program, which was a part of ObamaCare legislation intended to guarantee long-term care to patients.

As Philip Klein noted, this means "Half of Obamacare's deficit reduction wiped out":

As Obamacare's critics noted at the time, Democrats' deficit reduction claims were based on a series of accounting gimmicks. One of the most obvious was the inclusion of the Community Living Assistance and Support Services Act, a program that was slated to collect five years of premiums before paying out any benefits. Though it was unsustainable over time, on paper it produced surpluses during the Congressional Budget Office's 10-year budget window.

At the time of final passage, the CBO found that the health care law would reduce deficits by $143 billion, and $70 billion of that was attributable to the CLASS program.

In contrast, a friend reminded me of this older story from the 2009 Wall Street Journal, on medical tourism for heart surgery.

Their story, "The Henry Ford of Heart Surgery", describes the success that Dr. Devi Shetty has had in creating hospitals that cater to heart surgery patients from around the world. If ObamaCare is fully implemented in the US, such overseas facilities will become increasingly attractive to Americans unable to get such care here at home.

And BTW, Dr. Shetty's work has earned him The Economist's 2011 award for business-process innovation.

Continued Deterioriation of UK Health System

This 10/13/2011 report from The Commentator describes how the, "Latest horrific report on NHS standards must give UK pause for thought about its socialist medical system".

The horrors of poor patient care in the UK NHS are eye-opening.

But as always, the real challenge is persuading Americans that such problems aren't amenable to more tweaks (or increased funding), but are inherent in any socialized medical system.

Wolf on Jobs and Capitalism

Dr. Milton Wolf gives a nice tribute to Steve Jobs (and a moral defense of capitalism) in his latest 10/11/2011 Washington Times OpEd, "Steve Jobs, billionaire capitalist".

I especially liked how he contrasts the virtues of capitalism and the pursuit of rational self-interest as against the irrational pursuit of supposed self-interest as exemplified by Gordon Gecko in Wall Street.

(Read the full text of "Steve Jobs, billionaire capitalist".)

Under capitalism, people are free to engage in voluntary trade with one another to their mutual benefit. The government's role is to protect honest people from the initiation of force or fraud, but otherwise leave them alone. Because transactions cannot be compelled, they occur when both parties deem it to be in their mutual interest. Hence, capitalism encourages individuals to engage in "win-win" trades with one another.

To the extent we have allowed it to operate, capitalism has brought incalculable benefits to us -- and should be praised as moral and virtuous. Furthermore, long-range success in a capitalist society comes from cultivating and practicing life-affirming virtues such honesty, integrity, and rationality.

Good for the body and good for the soul -- what more could one ask for/

Quick Links: Romney, Essential Care, 2012 Scenarios

In the 10/4/2011 Forbes, Avik Roy asks "Is Mitt Romney Committed to Repealing Obamacare?"

One troubling passage: "...[I]n many settings, Romney did not argue for full repeal, but merely for repealing 'the worst aspects of Obamacare'". I guess he's ok with just eliminating "the worst aspects" of statism.

The federal government is preparing to decide what counts as "essential" medical care. Of course, if the government can declare some care as "essential" it can also declare some care as "not essential".

4 possible political scenarios for ObamaCare in 2012.

Wolf: The President Vs. Math

In Dr. Milton Wolf's latest Washington Times OpEd, he gives President Obama a much-needed remedial math lesson.

(Not directly related to health care -- but as David Catron has noted, we've seen similar Obama administration math failings through the health care debate.)

Pipes: Don't Blame Doctors For High Health Care Costs

In the 10/10/2011 USA Today, Sally Pipes notes, "Don't blame doctors for high health care costs".

She debunks the recent Columbia study attributing high American health costs to physician salaries, and instead points out numerous confounding factors that haven't been taken into account.

Read the whole thing.

Frezza on Drug Shortages

In the 10/7/2011 Forbes, Bill Frezza discusses "How To Create Shortages In An Abundant World", with special attention to the worsening shortages of various critical drugs.

Hint: It has to do with government interference in the free market.

Update: As some readers have correctly pointed out, the FDA isn't the only source of the shortages, but it is a significant contributing factor.

Dr. Lee Hieb Explains How Regulation Hurts Patients

The Black Ribbon Project has posted this video, "Dr. Lee Hieb explains how regulation hurts patients":



She makes a couple of critical points:

Government-run medicine necessarily sacrifices the individual to the collective.

It compels one person to pay for another's health care -- which is no longer charity but immoral once it bcomes compulsory.

Here's the short summary from AAPS:

Government over-regulation increases costs, decreases quality, and limits access to medical care says orthopaedic surgeon, Dr. Lee Hieb. She is President of AAPS, http://aapsonline.org. In her talk at the Doctors Town Hall in Nashville on August 6, 2011, she gives real world examples from her experience as a physician running a private practice. Only true free market solutions will decrease costs, increase quality and improve access to care.

Health IT Takes More HITs

Here are a couple of recent stories about health IT (HIT) problems at home and abroad.

This 9/29/2011 article reported on "Healthcare Breaches: A New Top 5":

With the announcement of a health information breach affecting 4.9 million patients in the Defense Department's TRICARE healthcare program, there have now been five incidents that have each affected at least 1 million individuals since the HIPAA breach notification rule took effect.

As more and more Americans' medical data is stored in the de facto mandatory electronic medical record systems under ObamaCare, we can expect more such privacy breaches in the future.

The 9/22/2011 Telegraph reported on the UK national electronic medical records system boondoggle, "Dismantling NHS computer scheme could cost more money".

Basically, the UK system has to be scrapped because it "was unworkable while costs had increases and deadlines were missed":

Andrew Lansley, the Health Secretary, said: "Labour's NHS IT Programme let down the NHS and wasted taxpayers' money by imposing a top-down IT system on the local NHS, which didn't fit their needs..."

Roger Goss, co-director of the pressure group Patient Concern said: "Thank goodness politicians have decided to stop money being poured into a huge bottomless pit.

"Now we must pray that they don't sanction pouring it into endless incompatible regional pits."

(Via Docs4PatientCare.)

Let's hope the US doesn't make the same mistake(s).

Catron: The Supreme Arbiter of Your Liberty

Now that the ObamaCare legal challenge is finally going to the US Supreme Court, what might we expect?

In today's AmSpec, David Catron has a nice detailed analysis of Justice Kennedy, the likely swing vote, at "The Supreme Arbiter of Your Liberty".

His conclusion:

Kennedy's record, then, is not merely incoherent. It also suggests that he believes the Constitution gives the federal government very broad powers via the Commerce Clause. If the Court upholds the individual mandate, it will increase federal power over your day-to-day life to a much greater degree than did even the Raich ruling. Whereas the latter regulates an activity, growing pot, Obamacare's mandate regulates something you are not doing. As constitutional law professor Randy Barnett explains it: "[T]he statute speciously tries to convert inactivity into the 'activity' of making a 'decision.' By this reasoning, your 'decision' not to take a job, not to sell your house, or not to buy a Chevrolet is an 'activity that is commercial and economic in nature' that can be mandated by Congress."

In other words, if the Supreme Court acquiesces in Obamacare's specious justification for the mandate, it means that there are no real limits to federal power. And this is where your personal liberty will be intimately affected by Justice Kennedy's view of the mandate. If Congress can order you to buy insurance, it can order you to do anything. As U.S. District Judge Roger Vinson put it last year, "If they decided everybody needs to eat broccoli because broccoli makes us healthy, they could mandate that everybody has to eat broccoli each week." Assuming the Court does grant the DOJ's petition, the only man standing between you and that kind of tyranny is a 75-year-old swinger from Sacramento, California. Anthony Kennedy could well be the ultimate arbiter of your personal liberty.

But read the whole thing.

Hsieh TU OpEd: Don't Blame Capitalism for High Health Insurance Costs

On 10/4/2011, The Undercurrent published my latest OpEd, "Don't Blame Capitalism for High Health Insurance Costs".

My theme is that rising health insurance costs are due to statism, not the free market. Here is the opening:

Suppose Congress passed a law requiring that all restaurant meals include broccoli and okra, whether the customer wanted them or not. Restaurants must also charge the same price for all meals, regardless of whether the customer ordered a small salad or a large steak. And they must serve free meals to children up to age 26 whenever their parents purchased a meal.

As meal prices rose, most Americans would understand that this was caused by the government regulations, not the free market. Today, similar laws are driving up the price of health insurance -- and it's equally important not to unfairly blame capitalism for the problems caused by the government.

(Read the full text of "Don't Blame Capitalism for High Health Insurance Costs".)

I'm glad The Undercurrent published this to coincide with their Capitalism Awareness Week project. You can still watch some of their earlier lectures and debates held this past week at college campuses across the country.

Many thanks to Noah Stahl and Ben Bayer for their helpful editorial suggestions. For more on The Undercurrent, check out their website.

More Problems in Vermont and Massachusetts

The 10/2/2011 Kaiser Health News discusses Vermont's move towards a "single-payer" (i.e., government-run) medical system.

Note that some leftists are complaining that the proposed new Vermont system does not regulate medicine enough(!):

Himmelstein [Dr. David Himmelstein, a professor at the City University of New York's School of Public Health and a proponent of a national single payer system] said that the law should be more explicit about not having copayments and deductibles and make a greater commitment to global budgeting, in which providers pay for a patient's healthcare with a set fee for the year.

In other words, a government-set ceiling on how much money could be spent each year on a patient's care. Just don't call it "rationing".

The 10/1/2011 Boston Herald discusses, "Health costs, Massachusetts-style". Their conclusion:

Those of us in Massachusetts, long accustomed to double-digit rate increases, have only one thing to say to the rest of the nation: We could have told you so!

(Via @TOSJournal.)

The Massachusetts Medical Society reported on 10/3/2011 of critical shortages in 8 medical specialties in Massachusetts, including dermatology, family medicine, general surgery, internal medicine, neurosurgery, orthopedics, psychiatry, and urology.

These shortages are not only affected the rural portions of Massachusetts but suburbs such as Cambridge, Newton, Wellesley, and Arlington. (Via @Lucidicus.)

Colorado Medical Privacy

...is in jeopardy.

Read the details at this post from the Independence Institute, "Spotlight on your private medical records".

Please also see this related article by Dr. Richard Reece in the 9/27/2011 Technology Review, "Why Doctors Don't Like Electronic Health Records".

Wolf: Bending Obamacare's Honesty Curve Downward

Dr. Milton Wolf's pen is on fire with another OpEd in the 9/30/2011 Washington Times, "Bending Obamacare's Honesty Curve Downward".

In his piece, Wolf dissects several of the broken promises and outright lies made by ObamaCare supporters, including:

ObamaCare will control costs
ObamaCare would reduce the number of uninsured
ObamaCare would reduce the federal budget deficit

Wolf is quite blunt in his assessment:

We did not get here because of simple distortions or exaggerations or even misrepresentations. Obamacare is the product of statements known by their makers to be untrue and meant to deceive -- lies...

The Obamacare lies are mounting: You could keep your current insurance. You could keep your doctor. The plan would cost less than a trillion dollars. Medicare would be protected. There would be no health care rationing. No one earning less than $250,000 per year would see an increase in his taxes. Tax credits would alleviate the burdens placed on small businesses. The plan would create 4 million new jobs, 400,000 almost immediately. Americans would love Obamacare once they saw what was in it.

The crumbling of Obamacare is now so unmistakable that its supporters have become the dog that didn’t bark. It's difficult to find anyone outside the administration who is still willing to defend it publicly.

(Read the full text of "Bending Obamacare's Honesty Curve Downward".)

Let's make sure that ObamaCare meets its well-deserved end come 2012.