Quick Links: Barr, Puzder, CER

Andrew Barr: "Obamacare, Europe and the Sophistries of Socialized Medicine". (Via @sonodoc99.)

Andrew Puzder: "Job Creation Is Price for New U.S. Health Law". (Via J.G.)

AP News: "New fee soon to be added to health insurance". To pay for the "comparative effectiveness research" used to limit your future access to medical care(!)

Hsieh: Who Will Your Doctor Work For Under ObamaCare?

The 12/30/2011 TownHall.com has published my latest OpEd, "Who Will Your Doctor Work For Under ObamaCare?"

The theme is that ObamaCare will pressure doctors to sacrifice their individual patients' welfare for a collectivist concept of "social justice".

Here is the opening:

Suppose you move to Las Vegas, and you hire a real estate agent to help you buy a house. She returns with several inappropriate choices -- all too expensive and too far from your work. She explains, "I know these aren't what you wanted. But you'd really help the struggling Nevada housing market by purchasing one of these."

Most people would fire her on the spot. Your real estate agent has a professional obligation to look out for your individual interests, not some nebulous "Nevada housing market." Yet under ObamaCare, your doctor will be increasingly pressured into sacrificing your individual medical interests for a nebulous "social justice"...

(Read the full text of "Who Will Your Doctor Work For Under ObamaCare?")

I'd like to thank Diana for her assistance editing an early version of this piece.

I'd also like to thank Dr. Hal Scherz, Dan Rene, and Docs4PatientCare for helping to arrange its publication!

Wolf: In Obama He Trusts

Dr. Milton Wolf has a new Washington Times OpEd, "In Obama He Trusts".

An excerpt:

Where once the American flag was hailed universally as the ultimate symbol of freedom, we who live under it have slowly but surely surrendered our liberties to an insatiable government. Consider our decline in just the past two generations. Our grandfathers, who stood against evil and shed their blood to stop it, never would have tolerated their own government becoming so totalitarian that it would dictate to them what car they should drive, what (if any) health insurance they should choose or even what light bulb they should buy...

The sum total of Mr. Obama's political philosophy, the unifying theme of his presidency, amounts to this: You cannot be trusted to live as a free American.

Dr. Wolf spells our more details of our steady erosion of freedom in, "In Obama He Trusts".

And he has this crucial warning for the Republicans:

The GOP should resist the temptation simply to become a cleverer version of autocrats who pull the same powerful levers of government but in different directions. Instead, they should become the party that embraces liberty.

Let's hope they heed his advice.

Dr. Wes On The Future

Physician-blogger Dr. Wes has some good insights on the future of American medicine in "A Look Ahead".

In particular, he highlights trends to anticipate under the growing centralization of health care such as loss of privacy, less contact with primary care physicians, and increasing reliance on algorithms.

Although some of these trends may be good if they had evolved in a free market context, in the context of ObamaCare they often represent market responses to external government compulsion.

The Coming Squeeze On Private Insurance

One of my friends here in Colorado received this letter from his health insurance company a few weeks ago.

This will just be the beginning of the shakeout in the private market due to "uncertainty brought on by the regulatory environment" (i.e., the slow strangling of the private insurance industry under ObamaCare):

Dear [name omitted]

We are writing to inform you of an important decision World Insurance Company ("World") has made regarding individually underwritten comprehensive major medical insurance in Colorado, which impacts your coverage.

This letter contains important information about the cancellation of your policy/certificate.

Like all companies, we continually monitor our business strategy to ensure a competitive presence in the rapidly changing insurance market. With the changes in the major medical insurance marketplace and the resulting uncertainty brought on by the regulatory environment, World has decided it is no longer able to provide the kind of major medical protection our customers have come to expect. During a recent review of World's overall businesses, the difficult decision was made to exit the individually underwritten comprehensive major medical insurance business in all of our existing markets.

You can click on the image below to see it full size.

Brian Schwartz also discusses this topic at, "State regulations force insurers out of market, Obamacare will make it worse".

Merry Christmas!

Merry Christmas! (Note: Posting may be lighter than usual next week due to the holidays.)

Quick Links: Mandates, Kagan, Bad Year

Brian Schwartz: "Feds won't add any insurance coverage mandates in exchanges -- for now"

Michael Ostrolenk: "Elena Kagan: The Justice Who Knew Too Much"

Paul Conner: "Obamacare's terrible, horrible, no good, very bad year"

Zycher on Medical Innovation

In the 12/21/2011 PJMedia, Ben Zycher of PRI discusses "Coal In Our Stockings: The Destruction of Medical Innovation".

In particular, he warns how "comparative effectiveness research" mandates will slow medical innovation as well as cause politicization of results. Patients will be the ultimate victims, deprived of treatments they could have received if the government interference hadn't existed.

Hsieh PJM OpEd on Gingrich and Personhood

PJMedia has published my latest OpEd, "Would a President Gingrich Ban The Birth Control Pill?"

My theme is that if Newt Gingrich wins the 2012 GOP nomination, it would introduce the controversial "fetal personhood" issue into the presidential race and potentially tip the election to Obama.

Here is the opening:

If history is any guide, Newt Gingrich's views on birth control, abortion, and the controversial "personhood" movement will be likely targets for Democrats if he wins the 2012 GOP nomination for President.

Gingrich recently signed the "Personhood Republican Presidential Candidate Pledge" which affirms that "unborn children" should be regarded as persons with full legal rights "from the moment of conception… without exception and without compromise." Gingrich signed the pledge after taking heat for an earlier statement stating that human life began after embryo implantation in the womb (which occurs a few days after fertilization). His campaign has since clarified: "Newt believes that human life begins at conception, that is, at the moment of fertilization." If enacted into law, this seemingly small distinction could have serious implications for the legality of many forms of birth control.

The "personhood" movement represents the most ideologically consistent endpoint of the anti-abortion movement. In their view, once a human sperm fertilizes an egg, the zygote deserves full protection as a legal "person" comparable to a born child. Under this standard, abortion would become illegal even in cases of rape and incest -- one of the goals of "personhood" advocates. However, recognizing fertilized eggs as legal persons would also have serious implications for issues other than abortion. As Ari Armstrong and Diana Hsieh describe in their 2010 paper, this includes potentially limiting women's ability to receive in vitro fertilization and physicians' ability to treat women with life-threatening ectopic pregnancies. But one of the biggest political issues would be the legality of many forms of birth control...

I'd like to thank both Diana and Ari Armstrong for their earlier writings on this topic, as well as giving me feedback on earlier drafts of this OpEd.

Pipes On Socialized Medicine

In her 12/19/2011 Forbes column, Sally Pipes reminds us that "The Ugly Realities Of Socialized Medicine Are Not Going Away".

In her critique of the UK National Health Service she notes, "The British healthcare system may 'guarantee' access to care -- but that doesn’t mean patients actually receive it."

In addition to the poor quality care and rationing, there are indiginities such as:

A report released in October by Britain's health regulator found that a stunning 20 percent of hospitals were failing to provide the minimum standard of care legally required for elderly patients.

As part of the study, inspectors dropped by dozens of hospitals unannounced. They found patients shouting or banging on bedrails desperately trying to get the attention of a nurse. At one hospital, inspectors identified bed-ridden patients that hadn’t been given water for over 10 hours.

The upcoming austerity measures will only amplify maladies like these.

The NHS is broken -- and not in some superficial way that a simple tweak would fix. The incentives are wrong. The government's main priority is keeping costs low -- not providing quality care. Patients can't choose how they receive their care -- it's one-size-fits-all medicine. And the entrenched NHS bureaucracy has no reason to improve efficiency.

For more details (and implications for the US), read the full text of "The Ugly Realities Of Socialized Medicine Are Not Going Away".

Bolick: Obamacare's Other Unconstitutional Provision

Clint Bolick of the Goldwater Institute discusses, "Obamacare's Other Unconstitutional Provision".

In particular, he addresses the many problems with the Independent Payment Advisory Board (IPAB):

Three features combine to make IPAB's regulatory power unprecedented: its decisions are largely uncontrollable by Congress, its actions are unreviewable by the courts, and -- amazingly -- the agency's existence is virtually unrepealable.

Ordinarily, the delegation of legislative power to regulatory agencies is accompanied by numerous safeguards. First, as a matter of separation of powers, courts require that the delegation of regulatory powers be guided and restricted by "intelligible standards." Second, most regulatory powers are exercised through the administrative rule-making process, which provides for public notice and comment. Third, both Congress and the courts can review the rules. Finally, of course, Congress can repeal the agency or change the delegation of power. None of those safeguards are present with IPAB...

One interesting point:

The law says that certain proposals are off-limits, including any that "ration health care, raise revenues or increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility requirements."

[However,] crucial terms such as "rationing" are undefined, and the requirements are confusing and contradictory. Elsewhere, the law directs IPAB to "protect and improve Medicare beneficiaries’ access to necessary and evidence-based items and services." So IPAB is not allowed to ration health care, but it must decide which services are "necessary and evidence-based" -- which, of course, is rationing.

(For more details, read the full text of "Obamacare's Other Unconstitutional Provision".)

As financial pressures mount on Medicare, this de facto rationing will occur even if IPAB bureaucrats claim it's not rationing.

Fortunately, there's growing opposition from members of both political parties to this radical empowering of IPAB. Let's hope it's enough.

Dorin: Why Your Doctor Will Not Be Happy Under ObamaCare

Dr. Adam Dorin discusses, "Five Reasons Your Doctor Will Not Be Happy Working Under the Yoke of Obamacare".

Specifically, he cites the following factors:

1. Technology Gone Wild
2. The Ghost of Donald Berwick
3. Medical Coding Monopoly
4. The Downgrading of the Medical Degree
5. Misrepresentation

(For more details on each point, read the full text of "Five Reasons Your Doctor Will Not Be Happy Working Under the Yoke of Obamacare".)

Renegade Doctor Doesn't Accept Insurance

Dr. Susan Rutten Wasson doesn't accept insurance, and it helps her practice better medicine.

From the article:

It's more a scene from the days of frontier medicine than from the modern health care system. And that's because Rutten Wasson, 42, is a throwback to a time before HMOs, electronic health records and hospitals with fountains in their lobbies. She sees patients the same day they call if she's not booked up, spends at least a half-hour per visit — compared to the more typical 15 minutes -- and usually charges only $50 for a consultation. She takes cash or check, but no insurance -- and sometimes accepts gratuities of a dozen fresh eggs or a pie.

"I have a few bottles of homemade wine in the fridge from patients," says Rutten Wasson. "In summer, I'll get pickles or tomatoes. I've received pork sausage, the kind that would convert a vegetarian."

Rutten Wasson is decidedly not a vegetarian. She and her husband raise sheep and chickens she butchers herself. "Occasionally, I have people pay me more than my fee because they think I've earned it. It's nice. I don't complain."

In an era of high overhead, ever more byzantine regulations and payment models, cuts to Medicaid and Medicare benefits, and large medical systems swallowing independent practices, Rutten Wasson relishes her straight-forward manner of practicing. Since many federal health care reforms -- such as those requiring electronic medical records -- are tied to Medicare, they tend not to apply to her.

Her practice serves as a critique of the modern health care system, the complexity of which has pushed some providers and clinics to find dramatic work-arounds, despite the fact that it can be tough to make a living outside the mainstream. A small but growing number of physicians practice "concierge medicine," charging patients annual retainers for basic medical care. A 2010 nationwide survey commissioned by a congressional agency pegged the number of concierge doctors at 756, up from 146 in 2005.

Walk-in clinics are another alternative. MinuteClinic, for example, started in Minnesota in 2000 and has spread to 26 states. At these clinics, nurse practitioners and physician assistants treat a menu of common illnesses and injuries and perform physicals for reasonable, stated fees, no appointment necessary. Exams typically run between $79 and $89...

(Read the full text of "Doctor as renegade—accepts cash, checks, eggs or pie, not insurance".)

The freedom from federal mandates will become increasingly valuable in the future to physicians like her.

Bach: When Care Is Worth It, Even if End Is Death

In the 12/12/2011 New York Times, Dr. Peter Bach discusses, "When Care Is Worth It, Even if End Is Death".

First, Dr. Bach lays out the "conventional wisdom" currently being promulgated by the cost-cutters:

You've probably heard that we spend a lot of money on patients who die. It's true: about one-tenth of the money spent on direct care goes to people who die each year. Among Medicare patients, the figure is much higher, about one-quarter.

You may be shocked by those statistics. What health care system would squander so many dollars on patients who don't benefit? Or maybe you’re saddened. No humane system would subject patients to painful interventions and procedures that serve no purpose.

The idea that we waste money on terminal patients has caught on; the simplicity of the conceit makes it appealing to policy makers. And the data to support it keep coming, because it is easy for researchers to measure how much is spent on patients before they die.

Then he points out the following "inconvenient truths":

Providing care means reducing the chance they may die -- not eliminating it. My supervisor noted this the moment he saw my patient...

Put another way, the policy conceit that spending money on patients who die is a waste overlooks the core purpose of health care -- to prevent or forestall illness, disability and death among patients at risk of those outcomes.

It also overlooks a key correlation in health care. When people get sicker, they need more intensive -- and expensive -- health care services. But when they get sicker, they are also more likely to die. When I met my patient, I took him to the intensive care unit, the second-most-expensive place per minute in any hospital. The other place he went, twice, was the operating room -- the most expensive place.

Healthy people, who are unlikely to die, are also very unlikely to find themselves in those settings. Thank goodness.

Thus, spending will always be concentrated on people who are the sickest. When one examines spending on patients who die, dollars will be concentrated there, too.

I am not saying that every health care dollar is well spent. But five carefully done studies have now shown that hospitals that spend more on caring for sick patients have better outcomes than those that spend less. So some of the spending is improving health.

(Read the full text of "When Care Is Worth It, Even if End Is Death".)

It's impossible to ascribe "value" for a health care dollar in the abstract. As author Ayn Rand once noted, the concept of "value" presupposes "to whom and for what". No government central planner can determine what is the appropriate value to a particular patient for a dollar spent on his health care.

One of the biggest problems with ObamaCare is that it presumes that health care "value" (and thus what constitutes "appropriate" vs. "inappropriate" care) can be best determined by bureaucrats, rather than by those whose very lives are at stake.

As a corollary, payment for health services is also the responsibility of those who wish to receive them. If someone desires health services because it would be of value to them, they should pay for it from their own funds, through contractually-promised voluntary agreements (such as private insurance or mutual-aid groups), or via private charity. They don't have the right to demand that others write them a blank check for services they deem valuable.

(NYT article link via Dr. Kathleen Brown.)

Quick Links: Agents, ERs, Exchanges

Nigam Arora describes how, "Obamacare Mandate Kicking Insurance Agents To The Curb".

This is yet another part of the squeeze on the private insurance industry. (Link via Dr. Art Fougner.)

In the Annals of Emergency Medicine, Wiler, et al ask, "Episodes of Care: Is Emergency Medicine Ready?"

Their conclusion: Despite the push for payment "reforms" in the form of "episodes of care", this will hurt ER departments and ER patients. Instead, they advocate retaining the current fee-for-service model. This is, of course, a very politically incorrect conclusion.

Robert Book describes, "Unreasonable Rate Review for Health Insurance". In particular:

So, the Exchange cannot exclude a plan because its premiums are too high, but it can take high premiums into account in decided whether or not to exclude it.

This is a recipe for arbitrary decisions by state and federal bureaucrats as to which health plans will be permitted.

Just another reminder that government-run health insurance exchanges will not be any sort of a "free market", but rather a pseudo-market where the government determines if the prices are "reasonable".

Study Ranks US First In Overall Health

Julian Pecquet of The Hill reports, "Study ranks US first in overall health".

This an interesting variance from the oft-cited study arguing that the US ranked 37th in the world, based on numerous fallacious arguments.

I haven't yet read the new study in detail, so I can't vouch for its methodology. But at least it gives more reason to doubt the reliability of the old "37th in the world" claims.

(Via @sonodoc99.)

Real World Effects of ObamaCare

One of my friends posted the following to Facebook, and she has graciously given me her permission to repost it here. She has asked that I refer to her as "Dr. Monica H.":

In Which I Detail How Obamacare Will Work for Me

Currently, I am a college professor at 3 campuses in the Denver area. I prefer not having administrative duties and would rather focus on teaching and research. Until we move (this is complicated), finding a FT job isn't likely, but I'm basically happy. I make what a full time faculty member makes, but that means I don't get healthcare because my work is split at multiple institutions, 2 of them community colleges. So I am responsible for my own healthcare, but I am OK with that, since I don't really use the traditional healthcare system for anything but very serious emergencies. I am not a big fan of medicine as it is practiced in this country, so I do most of my own lab testing and "alternative" treatment.

But never fear. My healthcare "problem" will be solved in 2014 when Obamacare kicks in. That's because the college has been told by the Feds that they must provide community college instructors who work more than 3/4 time (that's me) with health insurance. That would be me. I'm going to get health insurance! Yay, right?

How will the college respond to this? Likely by hiring more very part time instructors and taking work away from current instructors that teach nearly a full-time load. This is not speculation: I expect this to gradually be implemented over the coming 2 years, as detailed in an email I just received from the administration. This will be so they don't have to pay the insurance mandated by the federal government. I won't simply be able to spread out my work over 4-5 community colleges in response, because the new regulations apply to all community colleges in Colorado as a whole. In other words, the state won't view, say, Front Range CC and CC of Denver as two separate institutions when it comes to health insurance. It will view them as one. That means instead of teaching 4-5 classes per semester, I'll be limited to 1. The number of instructors will probably triple, depending on the department.

Yep, I'm sure on a salary 1/4 to 1/5 what I make now, I'll be ever so capable of paying for mandated insurance! Thanks, Obama!

A very practical example of the types of unanticipated effects of such legislation. For those of you who wonder why I'm no longer all that excited about the government thinking it knows best for me and every aspect of my life, this is why.

First, I very much appreciate this sort of "in the trenches" real-world report of how ObamaCare is hurting Americans. I hope more of our elected officials take heed of what their policies are doing to their constituents.

Second, many on the Left actively want Americans to be frustrated with private insurance industry under ObamaCare. That way they can say, "See, we tried it the 'free market' way and it failed; that's why we need a government 'single-payer' system". (Of course, the failure would be due to government policies that destroyed the free market, not the free market itself.)

Finally, these perverse effects of ObamaCare will affect many people all across the economic spectrum by making it harder for employers to offer full-time jobs to willing employees. For more details, see the following from James Sherk of The Heritage Foundation: "Obamacare Will Price Less Skilled Workers Out of Full-Time Jobs".

Here's a critical image:

Quick Links: Gingrich, Dumping, Autonomy

Jared Rhoads of the Center for Objective Health Policy discusses "Newt Gingrich: 3 hits and 3 misses on transforming healthcare".

Dr. Michael Hurd offers his own analysis at, "Gingrich on Health Care".

At best, Gingrich is a very mixed bag with some good ideas and some bad ideas masquerading as "reform".

Jeffrey Anderson notes, "Under Obamacare, Employers Will Likely Engage in 'Targeted Dumping' of Employees".

Dr. Ken Murray describes, "How Doctors Die":

It's not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What's unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Many doctors choose to decline aggressive end-of-life treatment -- as is their right. Of course, this is precisely the sort of decision that each person should be able to make for themselves -- not the government.

Three Major Cognitive Errors Physicians Make

This isn't directly related to health policy, but I thought it was a darned good read: "Three major cognitive errors physicians make".

The authors, Jerome Groopman and Pamela Hartzband, describe the "Three 'A' errors" of "Anchoring", "Availability", and "Attribution Error".

Read the whole thing.

Quick Links: MLR, HSA, Concierge Medicine

At his 12/6/2011 Forbes blog post, Avik Roy offers his own take on the new MLR insurance rules.

Roy argues that it won't destroy the private insurance market and lead to a government-run "single-payer" system. Rather, "they will usher in a new era of private insurance monopolies and significantly drive up the cost of health insurance, things that neither liberals nor conservatives should cheer."

Meanwhile, at the 12/7/2011 Investor's Business Daily, David Hogberg warns that the MLR rules may mean that many Americans may no longer be able to use Health Savings Accounts (HSAs) for their medical expenses.

On 12/5/2011, CNN Money discusses, "Concierge medicine: The doctor will see you now".

More patients and physicians are finding this model attractive. The patients get better care and physicians get to practice better medicine in a more satisfying manner.

A Liberal Speaks Out on Kagan and Recusal

In Slate, Eric Segall gives "A Liberal's Lament on Kagan and Health Care".

A key excerpt:

So far it appears that only Republicans and conservatives want Kagan to recuse herself from hearing the case, while liberals and Democrats take the opposing view. I have been a liberal constitutional law professor for more than 20 years, and a loyal Democrat. I believe the Affordable Care Act is constitutional and that it would be truly unfortunate for the country (and the party) if the court strikes it down. I also recognize that there is a much greater chance of the court erroneously striking down the PPACA if Kagan recuses herself. That said, I believe that as a matter of both principle and law, Kagan should not hear the case...

I am not arguing that Supreme Court justices should recuse themselves any time they are called upon to hear a case involving a law supported by the president for whom they once worked. But this situation is far more complicated than that. This isn't just about parsing the words of the recusal statute for plausible defenses; it's about the appearance that a Supreme Court Justice with a conflict of interest is sitting on a major case. This is the perfect storm of events that should require Kagan’s recusal.

(Read the full text of "A Liberal’s Lament on Kagan and Health Care".)

Via Dr. Matthew Bowdish and @D4PCCO.

Catron On Economic Illiteracy

David Catron's latest American Spectator piece notes that, "Democrat Economic Illiteracy Has Consequences".

After citing some examples, he observes:

It is precisely this kind of ignorance that led so many Democrats to believe Obamacare would somehow render health care less expensive. One of the first items covered in any introductory economics course is that the price of any good or service will rise if the quantity demanded increases without an accompanying increase in the available supply of that commodity. Nonetheless, it held no message for the average Democrat that the supply side of the equation was ignored by "reform," though it increased the number of patients in the health system as well as the range of services to which they are entitled.

Of course, the law of supply and demand keeps working regardless of whether or not policy makers recognize that fact. To paraphrase Ayn Rand, they can evade reality, but they cannot evade the consequences of evading reality.

Although Catron concentrates mainly on Democrats, plenty of Republicans fall prey to economic illiteracy as well.

(Read the full text of, "Democrat Economic Illiteracy Has Consequences".)

The Fight Over Necessary Care

The 12/4/2011 Forbes describes how, "CMS Tightening the Screws on Unnecessary Procedures in Florida and 10 Other States".

There are more articles such as this one ("The Doctor's Dilemma -- What Is 'Appropriate' Care?") arguing that physicians should abandon "the primacy of patient welfare" in favor of "collectively caring for a defined population within a fixed annual budget."

Of course, what counts as "necessary", "appropriate", or "essential" will be driven by ferocious political lobbying. If you have political "pull", then your favored medical treatments will be considered "necessary"; if you don't, then you're out of luck.

But just don't call the politically-driven granting (or restricting) of "necessary" care, "rationing".

Quick Links: Waste, Special Interests, Spending

Jaan Sidorov: "Retrospective Vs. Prospective Identification of 'Wasteful' Medical Care".

It's easy to declare something as "waste" when it didn't work out in retrospect. But if the patient lives, they certainly don't regard their survival as "waste".

Brian Schwartz: "'Thanks Obamacare' for special-interest politics & higher insurance premiums".

John Goodman: "Do We Really Spend More and Get Less?"

Gottleib on Drug Shortages

Scott Gottleib recently testified in front of Congress on, "The causes of drug shortages and proposals for repairing these markets".

Although the problem is multifactorial, he groups them into three major:

The first are regulatory challenges that have made the manufacturing of these products safer and more reliable, but also in some cases more challenging and expensive.

The second are mechanisms that make prices sticky, limiting profitability and precluding new investment in additional supply and better and more efficient manufacturing.

The third and final category is market structures that prevent firms from branding their products, and reflecting by how they price them, legitimate improvements in manufacturing that allow drugs to be produced more reliably and in scalable facilities.

Hence, the best way to alleviate these shortages is not more government regulations but rather free market reforms.

For more details, read the full text of "The causes of drug shortages and proposals for repairing these markets".

Quick Links: Opting Out, Cookbook Medicine, MLRs

Kaiser Health News and OPB discuss the growing trend of doctors opting out of accepting health insurance. (Via @AAPSonline.)

Many doctors find this lets them to practice better medicine. The big question is how long they will be allowed to do this by the government or whether they will be compelled to take patients with insurance under ObamaCare. (This was proposed in Massachusetts to address the problem of long waits, but did not become law.)

Dr. David Gelber discusses how, "Rigid regulation can become detrimental to patient care".

We can expect to see much more of this "cookbook medicine" as payments to hospitals and physicians becomes increasingly linked to adhering to government-specified "quality" measures under ObamaCare. People will choose to adhere to these "quality" guidelines, even if it harms patient care.

The 12/2/2011 Kaiser Health News reports, "Final Medical Loss Ratio Rule Rebuffs Insurance Agents". The effect of these insurance regulations will be to make private health insurance less available to the public.

Here's a related story from Forbes, "The Bomb Buried In Obamacare". (Note: I don't endorse his glee at the impending end of private health insurers.)

Old Boss, New Boss

Now that Dr. Donald Berwick is out as head of Medicare, what do we know about the new director, Marilyn Tavenner?

David Catron has a nice rundown at his latest American Spectator piece, "Donald Berwick's Replacement".

She apparently has some "issues" of her own. Plus she has stated a clear sympathy with Berwick's policies and similar hostility to reducing the level of government in medicine.

Don't expect much to change under the new boss.

Wolf on Romney

Dr. Milton Wolf's latest piece in the Washington Times deals with GOP presidential candidate Mitt Romney. He debunks the myth of Romney's "electability".

Here's an excerpt from "Candidate in the Cross Hairs":

At the core of Mr. Obama's failed presidency are the two intertwined, evil strands of DNA, Obamacare and Obamanomics, and with them the era of failed bailouts, high unemployment, government takeovers, crony payoffs and a downgraded America. Luckily for Mr. Obama, his two chief vulnerabilities -- Obamacare and jobs -- are the very ones most easily neutralized should he face Mr. Romney.

Obamneycare: Mr. Romney's Massachusetts Romneycare is the forebear of Obamacare. Both are premised on the notion that the governing class may force its subjects into government-knows-best health-insurance servitude. Mr. Romney will continue in vain to deny the similarities between Obamacare and Romneycare, but there isn't enough hair gel in the world to straighten that hairdo. Every minute spent trying is a lost minute.

Jobs: Mr. Romney, founding partner of Bain Capital, acknowledges laying off workers but has claimed that his business ventures have, on net, created jobs. I believe him. I also appreciate the economic benefit of "creative destruction." But this matters little in campaigns. Perception becomes political reality. Mr. Obama’s counter for his own abysmal jobs record -- 2 million lost -- will be to showcase every person who was ever laid off by Mr. Romney. Recall the dagger in the heart of Mr. Romney's 2008 campaign, Mike Huckabee’s simple statement, "I want to be a president who reminds you of the guy you work with, not the guy who laid you off."

(Read the full text of "Candidate in the Cross Hairs".)

There are many Tea Party supporters and advocates of limited government who view Romney as just a watered down version of Obama. If the GOP nominates Romney, they'll turn off many of those potential supporters. Running on a platform of "I'm still bad, just not quite as bad as the other guy" is hardly a winning formula.

(Side note: Curious how Dr. Wolf's metaphor of "cross hairs" has failed to elicit the self-righteous rhetoric about violence and civility that we've seen when similar metaphors were used against Democrats. It's almost as if there were some kind of media double-standard or something...)

Frezza: Science in Thrall to the FDA

In the November-December 2011 issue of Bio-IT World magazine, Bill Frezza of the Competitive Enterprise Institute describes, "Science in Thrall to the FDA".

He describes how FDA regulations hamper medical innovation at a time we need it most. From his article:

A report recently released by the Milken Institute -- "The Global Biomedical Industry: Preserving US Leadership" -- documents how the wheels of progress have been slowly grinding to a halt as the FDA raises the bar for drug approval. The length of time required to complete clinical trials over the past decade is up 70%. The median number of procedures required per trial is up 50%, as is the total work burden per protocol. Meanwhile, volunteer enrollment and retention has been driven down by 21% and 30% respectively. And, of course, new drug approvals are down 50%. Keep this up and it won't be long before clinical trials follow U.S. manufacturing to China, with other elements of the pharmaceutical industry trailing closely behind.

Even as trials drag on with preliminary information kept blinded, new laboratory developments that could improve results are banned due to an insistence on maintaining rigid conformity to outdated protocols. In what other industry does this happen? The calls for "adaptive trials" that might be more suitable in an age of personalized medicine remain unheeded. And the shameful spectacle of denying Americans access to drugs that are approved and available in Europe and elsewhere defies justification.

Frezza also offers steps to move us in the direction of greater freedom:

But there are modest steps we can take in the meantime. How about carving out one or more FDA-free Enterprise Zones where doctors, scientists, and volunteer patients can make their own decisions unfettered by the heavy hand of regulators? Imagine an experimental terminal-illness wing of the Cleveland Clinic where informed consent was the only law. How hard would it be to draft enabling legislation?

Defenders of the FDA's prerogatives would fight such proposals tooth and nail. But what kind of nanny state arguments can be made against conducting such a policy experiment when anyone who objects doesn’t have to be treated? Breakthroughs that emerge would still have to pass through the FDA gantlet before they would be generally available. The difference is that researchers could continue making improvements while treating volunteers during this long process.

If we fail to arrest the regulatory assault on medical progress in the U.S., sooner or later out-of-the-box solutions like the one described above will pop up—elsewhere. And American patients will follow. The price of a plane ticket is trivial compared to the cost and consequences of cancer.

Sick patients will naturally seek the freedom to pursue their best medical interests. A proper government will respect that desire by reducing the regulatory obstacles, not reinforcing them.

(Read the full text of "Science in Thrall to the FDA".)

Why The AMA Supported ObamaCare

In his 11/28/2011 Forbes blog post, Avik Roy discusses, "Why the American Medical Association Had 72 Million Reasons to Shrink Doctors' Pay".

The "money quote" (figuratively and literally):

When the AMA gets twice as much from the government as it gets from its own members, we can hardly be surprised that the AMA today is more a tool of Washington's interests than those of doctors. This is why the AMA decided to support Obamacare...

(Read the full text of "Why the American Medical Association Had 72 Million Reasons to Shrink Doctors' Pay".)

This is one of many reasons I'm not a member of the AMA.