Hsieh PJM OpEd: Screening For Terrorists vs. Screening For Cancer

Today's PJMedia has published my latest OpEd, "Screening For Terrorists vs. Screening For Cancer".

My theme is that the seemingly contradictory policies of the government of terrorist screening vs. cancer screening actually demonstrate a common theme.

Here is the opening:

As the holiday travel season approaches, millions of American air passengers will become painfully reacquainted with Transportation Security Agency (TSA) screening measures. Passengers must submit to either medically unnecessary X-rays or intrusive gropings.

Yet in the realm of health care the federal government has adopted a new policy of discouraging routine screening tests for many cancers. Although these two policies may seem superficially contradictory, they demonstrate an underlying common theme of the government seeking ever-greater control over our bodies and our freedom.

In particular:

Our government currently tells air travelers, "Submit to our screening despite the dubious effectiveness, bodily invasion, and needless emotional distress" while simultaneously telling patients, "Don't undergo cancer screening because it might lead to further bodily invasion and emotional distress."

Despite this seeming contradiction, in both cases the government is really saying, "We'll decide who can do what with your body." The American founding fathers would never have imagined that the federal government would someday presume to restrict citizens' medical or travel freedoms in such a fashion.

(Read the full text of "Screening For Terrorists vs. Screening For Cancer".)

Wolf Bids Farewell To Berwick

Dr. Milton Wolf has a new OpEd in the 11/28/2011 Washington Times, "Bye-bye, Berwick".

As Dr. Wolf notes, ObamaCare has been so politically toxic for the Obama administration that their choice to head Medicare, Dr. Donald Berwick, had to step down after his recess appointment expired. Berwick is, of course, an unapologetic supporter of UK-style medical rationing. Wolf cites some representative quotes from Berwick in which he makes his position perfectly clear.

As Wolf notes:

Politically, White House operatives had little choice but to jettison the toxic Dr. Berwick, ironically for simply saying aloud what they themselves privately think.

(Read the full text of "Bye-bye, Berwick".)

President Obama has now chosen to nominate Berwick's second-in-command, Marilyn Tavenner, to take over Medicare. For more information on what to expect from her, see this piece in the 11/26/2011 American Thinker "Obama's Problematic New Nominee for Top Medicare/Medicaid Post". Meet the new boss, same as the old boss.

The names may change, but the battle for health care freedom continues...

Catron Dissects A Newt

In his latest American Spectator OpEd, David Catron takes a closer look at Newt Gingrich's health care policies. It's not a pretty sight.

In his piece "Newt's Health Problems", Catron notes:

Gingrich praised many of Donald Berwick's ideas, based on bad study on medical errors.

Gingrich supported government-financed end-of-life counseling.

Gingrinch has supported an individual insurance mandate.

(Read the full text of "Newt's Health Problems".)

Gingrich may be an articulate intelligent politician with some good idea on some issues. But don't mistake him for a principled defender of free-market health care reforms.

ACOs May Raise Costs and Lower Quality

In his 11/21/2011 Forbes blog post, Avik Roy wrote about recent comments by FTC commissioner J. Thomas Rosch on the ObamaCare "Accountable Care Organziations".

In particular, Rosch warned that net result of ACOs could be "higher costs and lower quality health care -- precisely the opposite of its goal" (emphasis Rosch's, not mine.)

His remarks can be found on page 15 of this transcript of his 11/17/2011 speech before the American Bar Association’s Antitrust Fall Forum.

ACOs represent the government creation of large consortiums of doctors and other medical providers, which may exert near-monopoly power in many markets. The various government financial carrots and sticks tilt the playing field away from smaller private practices which have otherwise thrived in the American medical marketplace for many years.

By driving small private practices out of business, the subsequent problems created by these de facto monopolies (or quasi-monopolies) should be attributed to the government, not a non-existent free market.

(Note: This should not be construed as an endorsement of the legitimacy of "antitrust" laws.)

HHS Restrictions on Neurosurgery: Just Don't Call It Rationing

An Illinois neurosurgeon discusses upcoming new guidelines from the Obama administration restricting how doctors can deliver medical care.

A few key points with respect to neurosurgery procedures:

Patients over age 70 with government insurance will receive "comfort care", but not the full range of aneurysm treatment, stroke therapy, etc.

Patients are referred to as "units", not patients.

Various devices currently approved by the FDA for "humanitarian use" and widely regarded by surgeons as medically safe and appropriate for clinical use will likely have that approval withdrawn to save money.

According to this surgeon, this information is straight from Obama administration HHS officials, although not yet published.

The physician summarizes the issue quite nicely:

You know, we always joke around -- 'it's not brain surgery' -- but I did nine years after medical school, I've been in training ten years, and now I have people who don't know a thing about what I'm doing telling me when I can and can't operate.

(Read the full blog post, "Neurosurgeon Briefed by HHS". Link via @SonoDoc99.)

Anyone who's read Atlas Shrugged will recognize the similarity between this surgeon's observations and this quote from the fictional Dr. Hendricks (also a neurosurgeon):

Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I could not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward...

Many Americans (including my own and Diana's parents) are over 70 years old yet in reasonably good health. They'd likely be denied life-saving neurosurgical care in the near future if these guidelines take effect.

But just don't call it rationing.

Note: There isn't any official confirmation from HHS on this, so we're still awaiting further information one way or another. It may also be that unfavorable publicity from the original story may lead HHS to reconsider these proposed guidelines.

Quick Links: Life Expectancy, ObamaCare

Avik Roy debunks, "The Myth of Americans' Poor Life Expectancy" (Forbes, 11/23/2011). A few key points:

If you measure outcome based on how well you do after you get sick, the US comes out on top.

Deaths from car accidents and homicides are unrelated to the quality of the US health system, and unfairly skew US statistics.

America doesn't have one health care system, but three.

Jeffery Anderson discusses, "What Else Is Wrong with Obamacare?" (PJMedia, 11/22/2011). It's not just the individual mandate.

Happy Thankgiving!

Happy Thanksgiving, everyone!

Regular posting will resume after the holiday.

Get Ready For the Feeding Frenzy

The Obama administration is now working on what services should be included in the government's mandatory insurance package (the so-called "Essential Health Benefits Package").

As part of this process, HHS (the federal Department of Health and Human Services) has been holding a series of "Listening Sessions" around the country to solicit public opinion on this issue.

I received an interesting report from someone who attended (via teleconference) the 11/18/2011 Denver "listening session". He was kind enough to give me his permission to post this excerpt from his summary and analysis:

Speakers included individuals and representatives of various organizations and companies. I would say that in the two-hour meeting, representatives of health care organizations and related service/medical device providers accounted for more than 95% of the total time. It became immediately clear that for many this was a well-orchestrated lobbying effort.

(Footnote: I am not one who condemns lobbying by individuals, companies or organizations so long as it isn't accompanied by graft or other corrupt activities. Lobbying in its pure sense should be protected free speech.)

The handful of individuals who spoke appealed primarily for expanded benefits for people afflicted with autism and phenylketonuria (a condition I had never heard of.) These speakers were parents of children (including adult children) for whom the burden, expense and heartache of dealing with the afflicted ones has become overwhelming.

Organizations whose representatives spoke today included groups that provide research, support, technologies and care in a wide range of areas. They all made well-scripted pitches for their causes to be deemed "essential" when the government mandates are imposed upon insurance plans. Nearly every one argued that the cost of their services, when utilized early, would produce much greater savings in the future.

Organizations and companies making their "pitches" are too numerous to list, but here's a glimpse of what was proposed:

* Expanded services for Autism and PKU
* Expanded care for mental and behavioral health
* Expanded pediatric vision care
* Expanded services to reduce pediatric injuries and obesity
* Expanded coverage for orthotics and prosthetics
* Expanded coverage for chronic disease management
* Expanded testing for STDs
* Expanded coverage for arthritis and psoriasis
* Coverage for foster care for Autistic developmentally disabled persons
* Expanded coverage for chronic pain
* An emphasis on "consumer satisfaction" with their health care coverage
* Coverage for "eating coaches"
* Expanded coverage for physical therapy
* Provisions for nutrition counselors
* Coverage for medical nutrition therapy, especially for the African-American population
* A heightened emphasis on utilization management
* An emphasis on flexibility
* Expanded coverage for maternity, newborn care and "reproductive rights" (abortion)
* An expanded emphasis on Latina healthcare needs
* Coverage for "medical foods"
* Expanded coverage for HIV testing
* Expanded coverage for hemophilia
* Expanded coverage for chiropractic care

Proponents of these services would benefit greatly if their services and products are deemed "essential" by the government. Hence, the virtual "feeding frenzy" that these listening sessions seem to be. (Why not? If your product or service can be declared "essential", you've hit the jackpot. And, would anyone care to take bets on how many corrupt members of Congress are secretly investing in some of these companies or organizations?)

Note as well the political "angle" for African-Americans and Latinas. Draw your own conclusions about that.

There may be perfectly viable cases to be made for some of these therapies being cost-effective preventive care. Others may simply be opportunists seeking to benefit from more "crony capitalism" with big money rolling in from insurance companies.

Politicians who are pushing for making insurance companies pay for more "essential benefits" will ever-so-predictably scream bloody murder when premiums rise to cover these services. These are the very politicians who will come to our "rescue" by advancing the notion that the government can provide all of them for "free", and gullible Americans will sadly believe them.

So, there you go. Remember this as the government takeover of American healthcare advances. It may not be the pure, noble and virtuous thing the politicians want you to believe it is.

Similar lobbying took place in Massachusetts after that state imposed its individual insurance mandate:

In the three years since Massachusetts enacted its individual mandate, providers successfully lobbied to require 16 specific types of coverage under the mandate: prescription drugs, preventive care, diabetes self-management, drug-abuse treatment, early intervention for autism, hospice care, hormone replacement therapy, non-in-vitro fertility services, orthotics, prosthetics, telemedicine, testicular cancer, lay midwives, nurses, nurse practitioners and pediatric specialists.

The Massachusetts Legislature is considering more than 70 additional requirements.

Unless ObamaCare is repealed, we should expect a similar special-interest feeding frenzy at the national level.

Fogoros Explains Drug Shortages

Dr. Rich Fogoros cuts through the Obama administration smoke and discusses, "What's Really Causing The Drug Shortages".

In short, it's price controls. Here's an excerpt:

In general, truly persistent shortages will only occur when the product-makers cannot increase the price they get for their finished product sufficiently to keep up with a rising cost of production. In this case profit margins shrink or even become negative, and the incentive to expand production, or even to stay in that business, disappears. This is a true shortage – the demand is still there, and customers are willing and able to pay the price being asked, but the product-makers are no longer able to supply the product at that price. Unless the mismatch between the cost of production and the price of the finished product is repaired, the product shortage becomes persistent or even permanent.

Such a persistent cost/price mismatch does not occur in a free market. It occurs when some Central Authority acts to control prices (often, to be sure, while simultaneously acting to increase the cost of production). A Central Authority can cap effective price a product-maker can get for his/her product by implementing overt or hidden price controls; by increasing marginal tax rates high enough to push the product-maker’s risk/reward calculation to favor inaction; and by instituting windfall profit taxes that do the same thing.

Furthermore, Dr. Fogoros explains how changes in the law in 2005 have had a predictable effect leading to ever-worsensing drug shortages that have now hit a crisis in 2011. For this reason, the Obama administration's proposed "solutions" will not alleviate the problem, because they do not address the root causes. The basic laws of supply-and-demand cannot be overruled by political fiat.

(Read the full text of "What's Really Causing The Drug Shortages".)

Kurisko on Canada and ObamaCare

Dr. Lee Kurisko discusses "Why Obamacare Will Be Worse than Canadian Healthcare":



Dr. Kurisko is a radiologist who used to practice in Canada before he relocated to the US.

One of his key themes is the "fatal conceit" of the central planners in both Canada and the US who think they can devise top-down health care "systems" more efficiently than the marketplace. Of course, the inevitable result is shortages.

Another is the difference between genuine insurance (to protect against expensive but rare unforseen problems) and the current US system of inefficient 3rd-party prepaid care masquerading as insurance.

Dr. Kurisko also discusses a variety free-market reforms as an alternative to ObamaCare.

Catron On Aaron and Rationing

In the 11/18/2011 American Spectator, David Catron discusses "A Rationing Advocate to Head Social Security Advisory Board?"

From his article:

Henry J. Aaron, the President's nominee for Chair of the Social Security Advisory Board... is an unapologetic admirer of Great Britain's notorious socialized medical system, the National Health Service (NHS). Why? Because NHS administrators unabashedly practice the dark art of health care rationing.

Aaron, a Senior Fellow in Economics at the Brookings Institution, is unable to imagine any route to cost control that doesn't involve government coercion. In a 2005 Brookings white paper titled "Health Care Rationing: What it Means," he represents the NHS as a system that has come to grips with what he sees as the inescapable necessity for rationing. Predictably, he rejects any alternative involving the market: "The key to efficient market outcomes is that prices reflect costs of production. The market for health care does not operate that way." In other words, Aaron believes health care is a unique universe in which the market mysteriously fails to function and therefore can't be relied upon to contain costs. It never seems to have occurred to him that the market's alleged failure might be the result of government meddling...

(Read the full text of "A Rationing Advocate to Head Social Security Advisory Board?")

At least now they're being explicit in their calls for medical rationing.

Curious how just a short while ago, opponents of ObamaCare who warned that it would lead to rationing were accused of hyperbole and paranoia.

(Note: I'm pro-choice on abortion. But the references to abortion politics in this piece are tangential to the author's primary point.)

Quick Links: Mandate Trap, Adverse Selection, Kopel

Dr. Rich Fogoros warns, "Republicans Blithely Enter The Individual Mandate Trap".

Hence, the GOP must stand for free-market reforms, not just oppose the individual mandates.

Greg Scandlen discusses adverse selection vs. moral hazard.

David Kopel asks, "Will the Necessary & Proper clause save Obamacare?" (He thinks not.)

Killing Small Medical Practices

Walter Russell Mead discusses how ObamaCare is killing small medical practices in his 11/15/2011 blog post, "Big Oil, Big Pharma, Big Obama?"

Mead notes:

The rise of enormous, super-empowered HMOs closely tied to government regulations suggests we are headed further in the direction of building a corporatist, medico-industrial complex whose powerful lobbies will fight reforms, abuse monopoly powers and further congeal the American health care system into an unmanageable and unaffordable form that will undermine living standards while providing ever-less-satisfactory care.

He also wonders whether this is a deliberate policy or a so-called "unintended consequence". (Read the full text of "Big Oil, Big Pharma, Big Obama?".)

I offered my own thoughts on this topic in my 7/11/2011 PJMedia piece, "The Coming Collectivization of American Health Care":

The Obama administration regards this collectivization of medical providers as a desirable outcome, not merely some "unintended consequence." As Obama health advisor Nancy-Ann DeParle wrote last year in the Annals of Internal Medicine, the new law will "accelerate physician employment by hospitals and aggregation into larger physician groups" and "physicians will need to embrace rather than resist change." Translation: "Doctors should get with the program -- or else!"

Furthermore, such collectivization is merely a continuation of a much older strategy. Jonah Goldberg's book Liberal Fascism described how the Roosevelt administration sought similar consolidations of American agriculture and business during the New Deal. As Goldberg noted:

[If] you want to use business to implement your social agenda, then you should want businesses themselves to be as big as possible. What's easier, strapping five thousand cats to a wagon or a couple of giant oxen?

Similarly, it will be much easier for the federal government to regulate 100 large ACOs than 10,000 small private practices.

(Read the full text of "The Coming Collectivization of American Health Care".)

Regardless of whether this is a deliberate policy or not, the end result will be the same: the stagnation of American medicine as doctors are increasingly compelled to practice according to the dictates of their bureaucratic masters, rather than according to their independent minds.

Quick Links: Kagan, Jobs, Rationing

Doug Mataconis has a nice roundup of information and links on the question, "Should Justice Kagan Recuse Herself From Health Care Reform Case?"

Mark Perry describes another effect of the medical devices tax: "Obamacare Destroys 1,000 Jobs at Stryker Corp". (Via Kelly V.)

Jeffery Anderson writes, "Obama Nominee for Social Security Board Favors Rationing Health Care". At least they're no longer hiding their true intentions. (Via Dr. Matthew Bowdish.)

Catron Discusses SCOTUS

David Catron has a nice follow-up piece on the issues the US Supreme Court will tackle when it hears the ObamaCare challenges.

More information at, "Supreme Court Agrees to Hear 'Frivolous' Obamacare Case".

His breakdown of how much time will be allotted to each critical subissue (the individual mandate, severability, "commandeering", etc.) was especially interesting.

SCOTUS To Hear ObamaCare Challenges

The big news is, of course, that the US Supreme Court will hear ObamaCare challenges this session. Here are a couple of representative pieces:

"Supreme Court to Hear Challenge to Obama Health Care Law", FoxNews, 11/14/2011.

"Obama Health Care Law Case Reaches Supreme Court", Huffington Post, 11/14/2011.

More analyses and prediction from SCOTUS watchers are sure to follow!

Palmisano on CER and Rationing

In this 11/11/2011 New Orleans Times-Picayune OpEd, Dr. Donald Palmisano explains why we should "Beware use of data to ration health care".

In particular, he describes how federally-funded "comparative effectiveness research" (or CER) will be used as a stepping stone to government medical rationing. One excerpt:

How exactly would this work? Take rheumatoid arthritis, for example. If tests done on rheumatoid arthritis drugs A and B revealed that Drug A was effective for 80 percent of patients, while Drug B was only effective for 20 percent, the government could refuse to cover Drug B for patients, leaving 20 percent of patients no choice but to purchase the drugs themselves or go without treatment.

At the last minute, language was inserted into the legislation to alleviate growing public concern that CER could be used for rationing. However, at a time when lawmakers are desperate to find cost savings in health care, I believe that the law eventually could be manipulated to meet the needs of these lawmakers.

This is not a far-fetched idea. In fact, CER data is already used for just this purpose in England, where the National Health Institute routinely denies patients treatments that CER has determined insufficiently cost effective.

In other words:

Although the authors of the report seemed to understand that CER is not meant to be used for rationing, they nevertheless recommend that services included in the essential health benefits package should be "cost effective, so that the gain for individual and population health is sufficient to justify the additional cost to taxpayers and consumers."

It is only a matter of time before cost-cutting bureaucrats turn to CER results as an excuse to cut health care costs.

(Read the full text of "Beware use of data to ration health care".)

The other half of the rationing piece is the widespread use of government-mandated electronic health records (EHRs). That way, physicians who stray too far from government CER guidelines can be punished for failure to deliver "appropriate" care. Even if few physicians are actually punished, the threat of punishment will be enough to keep most physicians in line with government controls.

Those Americans who still value their medical freedom still have time to act to protect it. But time is running short. Once these programs (CER and EHRs) are fully implemented over the next few years, it will be much harder to undo them.

Private vs. Public Health Care in the UK

A current UK resident posted this short report of private vs. government-run health care onto Facebook. He has given me his permission to repost it here. (I'll refer to him by his initials "OMM".)

Two days ago, while in London, I visited a private (non-NHS) drop-in medical clinic to check on a sore and aching eye. The medical doctor, a nice Indian woman, examined me for two minutes and then advised me to go to an eye clinic. The reason why was that only at the eye clinic could they rule out a serious, but unlikely, eye condition. Since her brief examination was ”so little,” in her own words, and since she weren't prescribing anything, she wouldn’t charge me for the consultation. Instead, she gave me a free map and explained how I could get to the eye clinic. She also advised me to bring some food.

The eye clinic was not private. The first thing that met me was a line and no-one behind the counter. After a little while, a man came, and after another little while, it was my turn. The man did not look at me, but mechanically typed my name, date of birth, and address, and then said – pointing to a crowded waiting room with wooden chairs – that there was a three hour waiting time today. I asked if I could go to a cafe in the meantime. No, he said, I had to remain in the waiting room until they called my name.

After two hours, someone said ”OMM” loud. I jumped up, and was taken to another room where a nurse asked me what was the problem. I answered. 20 minutes later, someone said ”OMM” again. I was taken to another room and a new nurse asked the exact same question. I answered again.

10 minutes later, I met with a medical doctor. He complained that he had insufficient equipment and that the light in his office (which he shared with two other doctors) did not work properly.

After some tests, he concluded that I probably just have conjunctivitis, and prescribed some eye drops.

When I got out of the clinic, I noticed that on the prescription it read ”Use every 2 days.” I thought the doctor had said ”2 times a day,” so I went back in and asked. And, yes, he had written it down wrong. He meant two times a day.

The closest counterparts we have in the US to the British National Health Service is the Veterans Administration medical system. Most medical students who have rotated through a VA hospital know how bureaucratized and inefficient they can be compared to a decent private hospital. The last thing we need is for all of American medicine to become like a bad VA Hospital (or the UK NHS).

Public vs. Private Initiatives In the US

One of the latest "new" ideas proposed by government health policy gurus to reduce costs is through "bundled payments". Doctors and hospitals would get a fixed amount to take care of a patient's health problems. In theory, this should increase efficiency and reduce unnecessary tests and procedures. But this is simply a variation of the HMO-style "capitation" system that many Americans rejected during the 1980s.

The 11/7/2011 Wall Street Journal health blog reports on results from this latest attempt, "Study Raises Questions About 'Bundling' To Pay Doctors".

They note:

...[A] new study published in Health Affairs raises questions about the feasibility of bundling. The researchers, from the Rand Corporation and the Harvard School of Public Health, looked at three sites that were trying to implement a bundling methodology developed by the nonprofit Health Care Incentives Improvement Institute. (The method is called Prometheus.)

The short version of their findings: the efforts moved along slowly. In two to three years of trying, none of the providers or insurers actually made or received a bundled payment, or even implemented a contract to start them. That "lagged months or years behind their planned milestones," notes the study, which reflected results up to May of this year.

Of course, setting hard payment caps in the form of "bundling" will reduce costs, but by creating incentives to ration and/or deny care.

Meanwhile in the private sector, NPR reports, "Wal-Mart Plans Ambitious Expansion Into Medical Care".

These "retail health clinics" have proven successful in providing patients will affordable access to decent primary care services. As is typical, the profit-driven private sector is meeting the needs of patients in away that the government central planners do not and cannot.

Catron SCOTUS Update

In his latest American Spectator piece, David Catron gives a nice rundown of upcoming US Supreme Court action with respect to ObamaCare.

For details, see "Supremes About to Decide Which Obamacare Cases Make the Cut".

Quick Links: Montana, Ralston, Benjamin Rush

The Heartland Institute asks, "Canadian-Style Health Care Coming to Montana?"

In the 11/4/2011 Orange County Register, Richard Ralston of AFCM asks, "Richard Ralston: Who do you trust: doctors or the feds?"

In the 11/3/2011 Forbes, Avik Roy asks, "Can the Benjamin Rush Society Bring Free-Market Ideas to Medical Schools?" (Via Scott K.)

Price Controls in New York State

Doug Ross describes, "Obamacare-style price controls succeed in New York: 'tens of thousands' to lose their health care coverage"

If a business (such as insurance) cannot operate in a particular location due to onerous government regulations, it's entirely rational for them to withdraw.

The key is to make sure we place the blame where it belongs -- on the government -- and not on the free market.

Hsieh PJM OpEd: In Praise of Capitalist Inequality

The 11/6/2011 PJ Media has published my latest OpEd, "In Praise of Capitalist Inequality".

My theme is that the economic inequality that the "Occupy Wall Street" protestors oppose is not something to be condemned, but to be celebrated. Here is the opening:

For several weeks now, the Occupy Wall Street protestors in New York City and around the country have been demanding "economic justice," which includes a mishmash of leftist goals including universal health care, forgiveness of student loan debt, and higher taxes on the wealthy. To the extent the OWS protestors have a unifying theme, it's that capitalism is bad and that redistributing wealth to reduce "inequality" is good.

The Irish socialist playwright George Bernard Shaw once wrote, "A government that robs Peter to pay Paul can always depend on the support of Paul." The Occupy Wall Street protestors demanding government redistribution of wealth from the richest Americans ("the 1%") to themselves ("the 99%") would certainly agree. But as some of them are starting to learn, if their ideas were actually put into practice they'd end up being the Peters, not the Pauls.

Already, some of the OWS protestors are finding their ideas coming back to bite them...

And as to the dirty little secret that motivates many who want to "redistribute" (i.e., steal) others' wealth, read the full text of "In Praise of Capitalist Inequality".

Quick Links: ObamaCare Surprise, PSA Screening

In the 10/27/2011 Washington Examiner, Diana Furchtgott-Roth discusses "Another unpleasant surprise from Obamacare".

Basically, new ObamaCare rules will create enormous incentives for employers to offer unaffordable health insurance plans to their workers, so the workers' families can qualify for government-subsidized plans on the new exchanges. The ObamaCare rules will also discourage marriage.

In the 10/28/2011 Medical Progress Today, Paul Howard discusses "The PSA debate: to screen, or not to screen?"

He raises the following good point:

It is true that the PSA test has a high number of "false positives" that can drive men who don't have cancer, or don't have life-threatening cancers, to get biopsies or treatments that may have serious side effects but not actually save lives. But this is like saying that the first generation of cell phones was ridiculously expensive, clunky, and didn't work very well -- and so we shouldn't invest in better cellphones since the early ones were so crappy.

Since we don't adhere to that philosophy in technology markets, relatively cheap, fast, and powerful smartphones now rule the world.

Medical technology is benefitting from the same underlying forces that drove the telecommunications and computing industries into producing incredibly rapid, consumer-friendly innovations.

For instance, take a new biomarker test from the San Diego company Gen-Probe, which is under review by the FDA. Unlike PSA, which is produced by inflamed prostate tissue (which may or may not be cancerous), Gen-Probe screens urine for a prostate cancer antigen (PCA3) which is "overproduced in more than 90 percent of patients with prostate cancers."

Depending on how the FDA approves the test, it could be used as a second line screen for patients with unusual PSA readings, allowing doctors and patients to make better decisions about when to seek a biopsy or leave well enough alone.

That's what we really want, right? More confidence that we're seeking treatment when we need it, and it might save lives, and less treatment when we don't. And the PCA3 test isn't the only promising technology in the pipeline.

As always, by stifling current technology through regulatory mandates, we may never know the downstream benefits of future improvements -- the classic issue of "the seen vs. the unseen".

Finally, blogger Glenn Reynolds notes:

EARLY CANCER DETECTION: Suddenly, it's not good for you after all...

Many people are concerned that the new "science" that has led to a sudden about-face on testing, coincident with the passage of ObamaCare, is driven by costs rather than patient welfare. This may be unfair, but one of the hazards of politicizing the health care system is that suspicions of, well, politicization of the health care system become unavoidable.

Amerling on the Danger of Practice Guidlines

Dr. Richard Amerling gives a detailed analysis of the problems with so-called "practice guidelines".



The many problems he identifies include:

1) They wrongly promote "cookbook" care that glosses over individual variations in patients.
2) They are too often based on faulty or biased data.
3) They are too often obsolete by the time they are codified.
4) If current political trends continue, physicians can be held accountable for failing to adhere to these guidelines, even if that is the correct care for their particular patient.

In short, they remove the practicing physicians mind from clinical care -- the most essential aspect of high-quality medicine. Instead, they create the "illusion of knowledge" while stifling genuine innovation. Interestingly enough, he shows how faulty guidelines can result of both inappropriate undertreatment and inappropriate overtreatment of patients.

Dr. Amerling illustrates these points with real-world examples from his specialty of nephrology. His summary of how such practice guidelines are playing out in Europe is especially disturbing (timestamp 26:15).

Watch the full video at: "Practice Guidelines: More Harm Than Good?"

More information on Dr. Amerling:

Richard Amerling, M.D. is a nephrologist practicing in New York City. He is an Associate Professor of clinical medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence.

Wolf on Repealing ObamaCare

Milton Wolf has another strong OpEd in the 11/3/2011 Washington Times, "Save America: Repeal Obamacare".

He lays out numerous current and future problems of ObamaCare and offers a number of practical steps that move us closer to genuine free-market solutions. Here are a few excerpts:

There's more Congress can do immediately. Members of the supercommittee -- the extraconstitutional select bipartisan deficit-reduction panel -- can save about $2 billion in the current budget year by withdrawing early Obamacare implementation grants. Taxpayers should not be forced to pay for a law that, as currently adjudicated, is unconstitutional...

States should rescue their patients from Medicaid. This welfare program, as administered by Washington, has become an undeniable second-class health care system, and Obamacare expands it enormously... Survival rates for Medicaid patients are worse than those of private insurance patients. No surprise. Sadly -- and take a moment to ponder this -- survival rates for many ailments, including some of the most common cancers, are worse for Medicaid patients than for uninsured patients. Only Washington could create an insurance plan whose use is a worse fate than being uninsured. It’s called Medicaid...

States also have it within their power finally to kill the artificial and destructive health care insurance state boundary rules. With two identical families living across the street from each other, one could see insurance premiums tripled compared to the other's premiums because of these rules. Stop protecting the insurance companies. Health care compacts between two states would force companies to face competition from across the state line... States should eliminate well-meaning but harmful regulations that prevent carriers from providing affordable mandate-lite policies. And federal and state tax penalties that discriminate against individual policies should end.

(Read the full text of "Save America: Repeal Obamacare".)

Dr. Wolf offers both a good diagnosis and a good prescription for our health care problems. But it will be up to ordinary Americans to act.

WSJ: The Bush-Obama Drug Shortages

The 11/3/2011 Wall Street Journal explains how government interventions have created "The Bush-Obama Rx Shortages".

Here is the opening:

This week President Obama finally confronted a major U.S. health-care disgrace—the growing shortages of lifesaving drugs, especially anticancer therapies. For some reason the White House lumped its executive order with its "we can't wait" campaign against House Republicans, but the pity is that we will have to wait, because the only genuine fix is a liberal anathema: market prices...

The problem is compounded because Food and Drug Administration rules cause pointless delays. It takes as long as two and a half years to receive FDA manufacturing approval for a generic, so other drug makers can't ramp up production if a company cancels a product line due to these disincentives or even if the fragile supply chain for sterile injectables is contaminated and manufacture is delayed.

(Read the full text of "The Bush-Obama Rx Shortages".)

Adding yet more regulations and price controls to the current system won't solve the problem of shortages.

(Via Dr. Evan Madianos.)

Fougner on Defensive Medicine

Dr. Art Fougner has a nice discussion of defensive medicine and how it harms medical care in this country.

Here's an excerpt from his piece in the 10/28/2011 "Weekly Update" for the Medical Society for the State of New York:

I'm Dr. Art Fougner and I'm a recovering obstetrician.

Defensive medicine consists of office visits, lab tests, imaging studies, and procedures that have less to do with patient care and more to do with chart care. Defensive medicine measures are primarily used not to ensure patient health, but to safeguard against a potential medical malpractice suit.

Defensive medicine is pervasive. In the September 2011 issue of the Archives of Internal Medicine, Sirovich, et al noted that 83% of primary care physicians admit to defensive practices and concluded, "the extent to which fear of malpractice leads to more aggressive practice (so-called defensive medicine) has been hotly debated; based on our findings, we believe it is not a small effect.”

In the ACOG 2009 survey, more than two-thirds of the OB/Gyns made changes to their practice because of liability concerns— 11% of OBs stopped delivering babies; 1.5% retired. In 2009, seven New York Counties did not have a board-certified obstetrician.

In a 2005 survey, Studdert found that 93% of physicians practice defensive medicine.

I submit that number is a low-ball estimate...

(Read the full text for additional discussion by Dr. Fougner of the costs of defensive medicine.)

As a radiologist, I see this every day. ER physicians, primary care doctors, and specialists order many imaging tests that they don't want to (and don't feel are medically necessary) because of the fear of malpractice lawsuits if they don't order a test and the patient turns out to have a rare-but-dangerous condition.

Given the current medico-legal climate, that's an entirely rational response by these doctors. Why should they risk their careers in order to save the hospital (or the 3rd party payors) a few dollars if they'll risk legal penalties for doing so?

Genuine free-market health care reform (as opposed to ObamaCare) will have to include rational tort reform as part of the solution.

Wolf Challenges OWS

In his latest Washington Times OpEd, Dr. Milton Wolf issues a bold challenge to former Obama aide Van Jones and the Occupy Wall Street movement.

From "My challenge to Occupy Wall Street":

...[T]here actually may be honest common ground between the seemingly diametrically opposed Tea Party and Occupy forces: Government bailouts are wrong. Tea Partyers recognize the destructive nature of the bailouts and conclude that they must end; in fact, all corporate handouts should end. Occupiers also recognize the destructive nature of the bailouts, but - curiously - agitate not for the end of bailouts but instead, that they get their own piece of the action.

If there’s any honesty in the Occupy Wall Street movement, even a shred, I call upon its protesters to join me, to join Tea Partyers, and demand the end of all forms of corporate welfare. No more bailouts. No more subsidies. No more targeted tax breaks, loan guarantees or loopholes. No more stimulus spending, protective tariffs or favoritism. No more waivers. No more more allowing the government to pick and choose winners and losers. No more plundering the 99 percent to enrich the well-connected 1 percent.

If we want politicians to quit peddling favors, we have to take away their inventory.

(Read the full text of "My challenge to Occupy Wall Street".)

As he notes, the issue is tyranny vs freedom. Or autocracy vs. the free market.

Dr. Wolf was also gracious enough to quote something Diana once said on Twitter, "Crony capitalism is capitalism just like sea horses are horses."

I don't know if the OWS crowd will take him up. But I hope they do!

CEI: Stifling Medical Device Innovation

The Competitive Enterprise Institute has a new paper out, "Stifling Medical Device Innovation".

I haven't read the full paper yet, but here's an excerpt from the opening:

The United States has long been the home to cutting-edge innovations in the medical device industry, a remarkable private enterprise success that has improved or extended the lives of millions of people. However, increasingly burdensome regulatory policy is driving pioneering research and development to Europe and to the rest of the world. Nevertheless, the U.S. Food and Drug Administration (FDA) and self-styled public health advocates are engaged in an assault on the primary regulatory pathway through which new products reach the market. This could lead to further erosion of U.S. leadership in this important field.

You can read the full paper here (PDF format).