Side By Side: ObamaCare vs. RomneyCare

OHPCenter.org spotted this nice side-by-side comparison of Romneycare and Obamacare from a left-of-center advocacy group.

Rhoads: Fact-Checking Romney on Individual Mandate

In the 1/28/2012 Daily Caller, Jared Rhoads of the Center for Objective Health Policy does some much-needed "Fact-checking Mitt Romney on the Massachusetts individual mandate".

Here is the opening:

During Thursday night's CNN debate -- the final such event before the Florida primary on Tuesday, January 31 -- Rick Santorum attacked Mitt Romney over the individual mandate contained in the health reform legislation passed by Romney as governor of Massachusetts.

Santorum said that Romney's mandate requires individuals to buy an insurance policy "as a condition of breathing." He called it a top-down model that is "no different than Barack Obama’s mandate."

Romney objected to it being called a "top-down model" and contested that the logic behind the individual mandate in Massachusetts is that "if you don't want to buy insurance, then you have to help pay for the cost of the state picking up your bill." He noted that under federal law, hospitals are required to treat certain patients regardless of whether the patients have insurance. Romney then followed with, "... [W]e said, no more, no more free-riders. We are insisting on personal responsibility. Either get the insurance or help pay for your care. And that was the conclusion that we reached."

Rhoads analyzes the real truth behind Romney's disingenuous claims.

In particular, Romney employs a faulty concept of "responsibility" to justify government infringements on individual freedoms.

For a proper analysis of genuine personal responsibility in this context, read the full text of "Fact-checking Mitt Romney on the Massachusetts individual mandate".

Blog for Surgery Center of OK

Readers of this blog might also enjoy the blog by Dr. G. Keith Smith for the "Surgery Center of OK".

Dr. Smith's tagline: "I blog about free markets in medical care and pricing."

Here's an extended excerpt from his latest post, "Another 'not making a profit' story":

A nurse with whom I am acquainted told me the following story this morning. A relative of hers was recently diagnosed with breast cancer and a course of chemotherapy was advised. She has a high deductible insurance policy (good for her!) but just after the holidays is a little short on cash. After having received the news of her diagnosis and just having received her first round of chemo, she was told by the cancer treatment facility (owned by a LARGE health system in Oklahoma employing oncologists) that she must show up with no less than $495 at her next appointment or the deal was off: no more chemotherapy for her.

Now those of you that know me or read this blog know that I'm a fan of the free market. TANSTAAFL (there ain't no such thing as a free lunch). Here at the Surgery Center of Oklahoma, we charge for what we do and we make a profit. We just happen to charge about a fifth as much as our hospital friends who claim to "not make a profit." I continue to be amazed and shocked at the strong-arm money grubbing that characterizes these "not for profit" health systems (big hospitals). Come on! Seriously, this woman receives a diagnosis during the holidays of breast cancer and she is shoved against the wall for money? You think my characterization of this is unfair? This shakedown mentality isn't limited to the poor, either. Just ask Garth Brooks.

There's more. The oncologists, previously independent physicians with their own chemotherapy center, were free to make allowances for hardship prior to their sell out to the hospital for which they now work. The fees for their services are now higher than before by virtue of their affiliation with the "hospital system" and their old cancer treatment center is now abandoned. This is important to understand for those of you who think that physician-owned facilities represent a conflict of interest for the owners and that price gouging will be the inevitable result.

The opposite is actually true. Physicians who own their own facilities must also own and claim responsibility for the billing practices of the facility in addition to that of their private office.

This "accountability of ownership," as I like to call it (economists would refer to this as a lack of moral hazard, I think) represents a powerful deflationary effect on prices charged patients. Then there is the compassion factor. The physician-owned facility and its staff (including the billing and business staff) can't aggressively shake patients down for money without tarnishing the image of the physician...

Read the rest of the post for how his facility deals with this issue, "Another 'not making a profit' story".

I thought the discussion of reputation effects and accountability for the physician-owned medical facilities were especially interesting and worth wider circulation.

In medicine as in the rest of the modern economy, the enlightened self-interest of an honest provider of goods and services is the customer's best guarantee of good quality.

(Note: I've only begun looking into the various posts, so this isn't a blanket endorsement of everything on the website. But I am looking forward to exploring it in more depth.)

WSJ Debate on ACOs

The 1/23/2012 Wall Street Journal features this extended debate on the pros and cons of Accountable Care Organizations (ACOS): "Can Accountable-Care Organizations Improve Health Care While Reducing Costs?"

(If the direct link doesn't work, just Google the title of the article).

There's lots of information here, which I am still digesting.

Orient on Quitting Medicare

The 1/25/2012 Washington Times has published Dr. Jane Orient's OpEd, "Uncle Sam exacts penalty for quitting Medicare".

Federal rules make it extremely difficult for physicians and patients to privately and voluntarily contract for medical services outside of the Medicare system, even when they both wish to.

A good step towards the eventual privatization of medicine would be loosening such onerous Medicare restrictions. Patients and physicians could reap some benefits now, while we work to phase in other free-market reforms.

Par8o: Why EMR is a Four Letter Word to Most Doctors

Hint: It's all about the control.

EMRs (electronic health records) can be excellent tools when developed in a free market in response to physician and hospital needs. EMRs can also act as impediments to good patient care when imposed in a top-down fashion by government fiat.

CO Considering Repealing Health Insurance Exchange

Last year, the state of Colorado agreed to establish a health insurance exchange, after much political debate. This year, state Senator Tim Neville has introduced a bill to repeal last year's bill creating that exchange.

Although I won't be able to testify in person at the hearing on this bill, I was invited to submit a written statement in support of Senator Neville's bill:

Statement to CO Senate Health and Human Services Committee Supporting SB12-053

Paul Hsieh, MD
Co-founder, Freedom and Individual Rights in Medicine (FIRM)

I'm writing to support Senator Tim Neville's bill, SB12-053, "Repeal SB 200 Healthcare Exchange".  Establishing the exchange last year was a mistake.  As a practicing physician concerned about the medical freedom of Colorado patients, I'm glad to hear the state legislature is considering repealing the earlier bill and rectifying last year's error.

The fundamental problem with the state exchanges is that they serve as a vehicle for implementing the federal ObamaCare legislation at the state level.  Rather than facilitating a free market in health insurance, the exchanges would effectively put health insurance under the control of the federal government.  This would allow them to dictate what policies would look like and how doctors would manage their patients covered by exchange-provided insurance.

As Twila Brase of the Citizen's Council for Health Freedom notes, "State-established Exchanges may not write rules that conflict with or prevent implementation of federal rules issued by HHS under the law."  In other words, by creating our own state exchange in Colorado, we did not give ourselves greater flexibility and freedom from federal law, but rather surrendered to it.

Some negative consequences include the following:

1) Federal law will encourage employers to "dump" employees onto the state exchanges.

As reported by Minnesota Public Radio News and Kaiser Health News: "A loophole in the federal health care overhaul could allow employers to game the system by getting their sicker employees to opt into buying coverage on the health insurance exchanges, according to two University of Minnesota law professors.  They say the loophole could have dire consequences for the financial health of the exchanges..."

Hence, the exchanges will become a "budget buster" for the taxpayer-subsidized exchanges.

2) Coverage decisions would be mandated by Washington

For example, the federal government has empowered the USPSTF (United States Preventive Services Task Force) to determine what sorts of preventive care are or are not considered "cost effective".  In 2009, the USPSTF recommended restricting screening mammography to women over 50 (and only at 2 year intervals), despite the proven medical benefits of the current practice of screening women starting at age 40 at yearly intervals.

Under ObamaCare legislation, the USPSTF will set the de facto standards for what preventive services will or will not be covered by government insurance such as Medicare.  These criteria will inevitably also be applied to determine which private plans may be offered on the state exchanges.  Coverage decisions would be made by bureaucrats in Washington, DC.

3) Mandated benefits would drive up costs for patients

In Massachusetts, insurance prices on their state exchanges have risen much faster than the national average because pressure from special interest groups has resulted in mandatory coverage of services, whether or not patients actually need or desire such coverage.  Since 2006, special interests in Massachusetts have successfully lobbied to include 16 new benefits in the mandatory package (including lay midwives, orthotics, and drug-abuse treatment), and their state legislature is considering 70 more.  The decisions over what services will or will not be covered by exchange insurance plans have become fierce "political footballs" to the detriment of patients.  This will likely occur in Colorado as well.

Fortunately, states have a method of fighting back against this unwarranted federal control of health care.  In a recent editorial, Sally C. Pipes (president of Pacific Research Institute) and Dr. Hal Scherz (President of Docs4PatientCare) note the following:

The feds have further stipulated that people can only access billions of dollars in tax credits and subsidies earmarked for the purchase of policies by shopping in the state-run marketplaces.  If a state refuses to set up its own exchange, Obamacare allows the federal government to come into the state and set one up.

But here's the rub. The text of the law stipulates that only state-based exchanges -- not federally run ones -- may distribute credits and subsidies.  Without the federal cash, consumers won't patronize the government-run exchanges -- particularly with all the cost-inflating mandates they impose on insurers who wish to participate.

In other words, the federal government needs the acquiescence and active co-operation of the states to make the government-run exchanges work.  Hence, state governments can block this key feature of ObamaCare simply by refusing to establish a state exchange.

In conclusion, state-run exchanges under ObamaCare will harm patients and taxpayers.  For these reasons, other states such as Florida and Louisiana have already declined to establish their own state exchanges.  Colorado can join them by passing SB12-053, thus correcting last year's mistake.  Passing SB12-053 would be an important step in protecting essential medical freedoms for Coloradans.

=====

References:

"Don't get mugged by a politically controlled insurance exchange"
Brian Schwartz, Denver Post, 5/6/2011
http://www.denverpost.com/recommended/ci_18002925

"State Health Insurance Exchanges Will Impose Federal Control"
Twila Brase, Citizens’ Council for Health Freedom
http://www.cchfreedom.org/pdf/Policy_Insights-Insurance_Exchange.pdf

"Study: Employers Could Dump Sickest Employees On Public Health Care"
http://www.kaiserhealthnews.org/stories/2011/november/30/employers-dump-sickest-employees-public-heath-care.aspx

"Mass. health care costs outpace nation"
Boston Globe, 6/14/2011
http://www.boston.com/Boston/whitecoatnotes/2011/06/mass-health-care-costs-outpace-nation/DFCgMwvVZtunS7TIAn44BN/index.html

"Rejecting health-care exchanges"
Pipes and Scherz, Charleston Post and Courier, 12/29/2011
http://www.postandcourier.com/news/2011/dec/29/29pipes/

The idea of repealing a prior bad law should be proposed more often. I'm glad our state legislators are seriously considering this idea. Perhaps this will be the beginning of a larger trend!

Medicaid Coercion

Christopher Conover discusses, "Medicaid Coercion":

[S]tates face a relatively simple (albeit stark) choice when it comes to Medicaid. They can either accept the new Medicaid spending required under the ACA or they can reject the "deal" offered by Congress, in which case they must forego all federal funding of Medicaid.

States are caught between a rock and a hard place as state spending (and budgets) explode out of control. Conover concludes:

The problem with salami tactics like those encouraged through federal matching programs such as Medicaid is that eventually we will run out of salami. It's very generous for the federal government to offer 90 percent matching in perpetuity for those newly eligible under the ACA. But it is not at all clear Uncle Sam is in a position to fund this promise, especially in light of the fiscal tsunami posed by Medicare in the decades ahead.

If you live by federal money, you die by federal money.

Snopes Disputes Neurosurgery Rationing Claim

On November 26, 2011, I posted about proposed "HHS Restrictions on Neurosurgery" based on a neurosurgeon claiming to receive a briefing from Obama administration officials.

The Snopes.com website states that the American Association of Neurological Surgeons has investigated this issue and determined that anonymous caller was likely not a neurosurgeon and that the call "contained several factual inaccuracies". More here.

CO High Risk Pools and D4PC Response

The 1/16/2012 Denver Post reported, "Colorado high-risk health insurance pool runs up claims twice the U.S. average".

Docs4PatientCare made the following observation:

One year into a 4 year plan, Colorado is just one of a dozen states who have already burned through the federal funds allocated to set up this program. It's deplorable that even before the poorly designed Obama healthcare law is implemented, the bureaucracy claiming it will cover the "uninsurable" is already over budget and asking for a federal bailout.

If this administration understood the healthcare marketplace and truly wanted to provide these high risk patients with affordable medical insurance options, they would unleash the power of the national marketplace by changing the rules that currently [prevent] these patients from "pooling" their risk and using the resulting "purchasing power" to shop across state lines.

Pipes and Scherz: Rejecting Health Insurance Exchange

In the 12/29/2011 Charleston Post and Courier, Sally Pipes (Pacific Research Institute) and Dr. Hal Scherz (Docs4PatientCare.org) discuss "Rejecting health-care exchanges".

They note:

Obamacare instructs states to set up health insurance exchanges where consumers and small businesses can look for coverage starting in 2014. The exchanges would effectively put health insurance -- and the delivery of care -- under the control of the feds, who would dictate what policies would look like and how doctors would treat patients with exchange-provided coverage.

The feds have further stipulated that people can only access billions of dollars in tax credits and subsidies earmarked for the purchase of policies by shopping in the state-run marketplaces.

Pipes and Scherz explain how states can fight back against ObamaCare by choosing not to create such exchanges:

If a state refuses to set up its own exchange, Obamacare allows the federal government to come into the state and set one up.

But here's the rub. The text of the law stipulates that only state-based exchanges -- not federally run ones -- may distribute credits and subsidies.

Without the federal cash, consumers won't patronize the government-run exchanges -- particularly with all the cost-inflating mandates they impose on insurers who wish to participate.

Some states have already rejected the role of abetting the federal government in imposing ObamaCare on unwilling residents. Let's hope more follow suit.

(Read the full text of "Rejecting health-care exchanges".)

Quick Links: Herd Medicine, CO Risk Pools, Government Growth

Dr. Richard Fogoros discusses, "Herd Medicine". Soon, it will be considered ethically obligatory to sacrifice a few patients for the "cost effectiveness" of the herd.

The Denver Post reports more problems with the Colorado high-risk pool.

At PJMedia, Bryan Preston explains "How ObamaCare Grows Government While Reducing Access".

Hsieh PJM OpEd: SOPA, Guns, and Freedom

The 1/19/2012 edition of PJMedia has just published my OpEd, "SOPA, Guns, and Freedom".

I open with the following question:

Q: What does the proposed SOPA (“Stop Online Piracy Act”) legislation have in common with gun control?

A: Both would punish the innocent for the bad acts of a guilty few.

Click through to read more on how this applies to SOPA, gun control, freedom, and limited government.

This piece isn't directly related to health care policy, but I do briefly discuss how ObamaCare is yet another example of this dangerous statist mindset.

For more detailed discussion on how SOPA could have "broken the Internet", technically-minded readers might enjoy Paul Vixie's article from 1/11/2012, "Refusing REFUSED". Because of the intense political pressure from anti-SOPA advocates, some legislators have proposed a modified version of SOPA that they claim will avoid some of these technical problems.

PJMedia also published the following technical analysis on 1/14/2012, "SOPA and PROTECT-IP: A Line-By-Line Analysis of the Bills We Must Kill".

Diana has more links and information about SOPA in her recent webcast on this topic, "SOPA and Online Piracy".

(Note: This OpEd was written the day before the 1/18/2012 "blackout" and subsequent political events.)

Update: Thank you, Instapundit, for the link!

Hsieh RCM OpEd: Why Is Creating Value Good, Profits Bad?

The 1/17/2012 edition of Real Clear Markets has just published my latest OpEd, "Why Is Creating Value Good, Profits Bad?"

It's not directly related to health care policy, but rather the broader theme of defending the virtue of the profit motive in a free, capitalistic society. (I do use insurance as an example of how value is created). Here is the opening:

"Profit" is a dirty word. Profit-seeking businessmen are stock villains in Hollywood movies. "Occupy Wall Street" protestors demand, "People not profits" (whatever that means). Companies reporting healthy profits are automatically assumed to be exploiting customers and can only atone for this by "giving back" to their communities. "Making a profit" has an unsavory, morally suspect taint.

Yet simultaneously, Americans have a far more positive view of the concept of "creating value." The mainstream press lauds visionary businessmen who "create value," such as the late Steve Jobs of Apple. The business literature routinely emphasizes the importance of "creating value." So many organizations wish to be seen as "creating value" that it has become a business cliche, like "best practices" and "thinking outside the box."

But in a free society, "creating value" and "making a profit" are just two sides of the same coin...

(Read the full text of "Why Is Creating Value Good, Profits Bad?")

Those who earn honest profits by creating value should be proud of this fact.

I'd like to thank attorney-blogger Doug Mataconis for providing the Tweet which I cited later in the OpEd, as well as pointing me towards the Wall Street Journal piece on Bain Capital that I cited.

Quick Links: Squeezing Doctors, Insurers, Patients

Dr. Craig Koniver explains why, "Doctors are forced to choose between really small or super big".

Government controls are squeezing out traditional small private practices. A few doctors will survive by running "concierge" practices. The rest will join large "Accountable Care Organizations", where they'll have to practice according to standardized "cost effectiveness" guidelines.

The 1/12/2012 New York Times reports, "U.S. Seeks Rollback of a Health Insurer's 'Excessive' Rate Increase".

The government will determine what benefits insurance companies must offer, who they must accept, and how much they can charge. Over time, insurance companies will become the equivalent of heavily regulated utilities -- "private" in name only. Or they'll be squeezed out of business altogether, leaving us with only a government "single payer" option.

The Atlantic reports, "5% of Americans Made Up 50% of U.S. Health Care Spending". Furthermore, "In 2009, the top 1% of patients accounted for 21.8% of expenditures."

As the government assumes greater control over health spending, it will place tremendous pressure on physicians to minimize spending for that top 5% (and especially for that top 1%). But don't call it rationing.

Hsieh DP LTE on ACOs

The 1/15/2012 print edition of the Denver Post has published my LTE, "Accountable care organizations would backfire". This was in response to their 1/9/2012 story, "Medicare reform rewards doctors for better, cheaper care".

My LTE was as follows:

"Accountable care organizations" would backfire

In theory, "accountable care organizations" should encourage physicians to provide cost-effective, "integrated" care. In practice, they will reward physicians for limiting care.

Suppose you see your ACO doctor for a severe headache. He briefly examines you then says, "You don't need a MRI scan of your head; just take two Tylenol and call me in the morning." Can you be completely sure he is acting in your best medical interest? Or might he be unduly influenced by the bonus he receives for reducing the number of MRI scans performed by the ACO?

ACOs make doctors accountable -- but to Medicare bureaucrats, not their patients.

Paul Hsieh, Sedalia

Catron: The Thelma And Louise Party

In his latest American Spectator piece, David Catron discusses the seeming suidicdal tendencies of the Republican party.

From "The Thelma & Louise Party":

Barack Obama should be facing, as he himself phrased it, "a one-term proposition." His incompetence has reached depths that render the feckless Jimmy Carter positively Washingtonian by comparison, the sheer lawlessness of his administration evokes nostalgia for the merely corrupt Clinton years, and the state of the nation is worse by any objective measure than it was in on the day he took office.

The GOP should be well positioned to send the President into retirement. Instead, the party's nomination process has become a bloody battle in which the candidates are viciously attacking one another rather than Obama, denouncing core conservative principles rather than the failures of big-government, and seems to be on the verge of producing a "winner" who has no prayer of defeating the incumbent.

Catron then runs down the many serious problems revealed by candidates such as Perry, Gingrich, and Romney. I especially liked this discussion:

[Romney] obviously can't go after the President on Obamacare. Even if Romney hadn't provided the prototype for Obamacare while governor of Massachusetts, his company's acquisition of a for-profit hospital chain whose largest revenue stream comes from the pocket of the American taxpayer makes it impossible for him to attack the President's big-government approach to health care.

Romney can't even point out that Obamacare's insurance mandate is unconstitutional without being reminded that it is based on a virtually identical requirement that he signed into law in the Bay State. That the Massachusetts mandate was enacted at the state level, and is therefore constitutional, will be lost on all but a few voters. Thus, Romney can't criticize ObamaCare's most offensive feature without looking like a cheap flip-flopper.

2012 should be a GOP landslide. But Obama may have a legitimate shot at relection due to the weakness of the GOP field.

(Read the full text of "The Thelma & Louise Party".)

Rock Vs. Hard Place

Surgeon-blogger "Skeptical Scalpel" notes "Not news: Shorter hospital lengths of stay = higher readmission rates".

This illustrates the two jaws of the trap being set for physicians attempting to practice under upcoming Medicare guidelines. If you allow your patients to stay too long in the hospital, you'll be penalized for wasting valuable societal resources.

But if you discharge patients too early, you'll be penalized for having an unacceptably high readmission rate.

The bureaucrats will claim, "We're not trying to tell doctors how they should practice. We merely want to give them incentives for practicing good medicine." But in reality, they're setting rules that will make practicing good medicine increasingly difficult. And ultimately, it will be patients who pay the price.

Goodman: Why The Doctor Won't See You

At the 1/7/2012 Townhall.com, John Goodman explains, "Why The Doctor Won't See You".

The health "reform" in Massachusetts has led to near-universal "coverage", but patients are waiting longer to get actual appointments to see physicians. In other words, coverage does not equal care.

Goodman notes:

Turns out that more people are currently seeking care in hospital emergency rooms and at publicly funded community health centers than there were before the reform! As one academic study concluded, in Massachusetts you have the same people seeking the same care at the same places you had before. Health reform has mainly meant shuffling money around from one bureaucracy to another.

(Read the full text of "Why The Doctor Won't See You".)

The problems in Massachusetts under RomneyCare are just a preview for what the rest of the US can expect unless we repeal ObamaCare.

The Most Famous Urology Lecture of All Time

Another piece that's not directly related to health policy, but what the heck -- I'm on vacation this week!

Laurence Klotz: "How (not) to communicate new scientific information: A memoir of the famous Brindley lecture" (BJU International Volume 96, Issue 7, pages 956–957, November 2005)

Here's the opening:

In 1983, at the Urodynamics Society meeting in Las Vegas, Professor G.S. Brindley first announced to the world his experiments on self-injection with papaverine to induce a penile erection. This was the first time that an effective medical therapy for erectile dysfunction (ED) was described, and was a historic development in the management of ED.

The way in which this information was first reported was completely unique and memorable, and provides an interesting context for the development of therapies for ED. I was present at this extraordinary lecture, and the details are worth sharing. Although this lecture was given more than 20 years ago, the details have remained fresh in my mind, for reasons which will become obvious...

(Read the full text of "How (not) to communicate new scientific information: A memoir of the famous Brindley lecture".)

My wife Diana was laughing throughout while reading the article.

One of my friends remarked on Twitter, "A colleague of mine, now a professor of urology at Stanford, was at this lecture as a young resident. His story was hilarious."

Quick Links: CER, Concierge Medicine, Covert Rationing

Benjamin Zycher, "Obamacare inhibits medical technology"

Dr. John Kihm: "Myths about concierge medicine"

Dr. Rich Fogoros: "The ACP Further Elaborates On 'Parsimonious Medical Care'".

Amazing Emergency Auto-Appendectomy

This isn't directly related to health care policy. But it's an incredible story in the British Medical Journal about a Russian surgeon who had to perform an emergency appendectomy on himself because he was the only physician at the Antarctic base:

"Auto-appendectomy in the Antarctic: Case Report" (BMJ 2009;339:b4965)

The incident occurred in 1961 but was only reported in the English medical literature in 2009. There are some graphic images which may be borderline NSFW, depending on your workplace.

All I can say is, "Wow". (Via Rory H.)

Update: The original link appears broken, but here's a cached version at The Internet Archive.

Turner: Big Brother Is Watching Your Doctor

In the 1/5/2012 Forbes, Grace-Marie Turner describes how "Big Brother Is Watching Your Doctor".

As she notes, one of the most ironic features of the new push for "comparative effectiveness research" (CER) is that it will pressure physicians into one-size-fits-all medicine at a time we are just beginning to develop the ability to tailor medical care for patients based on their individual characteristics:

These tailored medicines have little or no place in a one-size-fits-all world with mega government studies trying to determine which treatments work for the majority of people. The outliers who would respond exceptionally well to a particular drug will find that their doctor is afraid to recommend it for fear of going outside the government guidelines.

Newer drugs, particularly the biologics that can be tailored to an individual’s particular genetic code, are unlikely to be on the government's recommended lists.

This kind of rationing of care will be hard to detect and document as doctors simply don’t discuss, and may not even know about, a new drug or treatment that could save a patient's life. And when there is no market for these drugs, the companies that will produce them will find they simply cannot get the funding for future research and development of these new medicines.

(Read the full text of "Big Brother Is Watching Your Doctor".)

CER and other related government initiatives could strangle such promising innovations before they ever take hold, much to the detriment of millions of Americans.

Scott Atlas Book

Dr. Scott Atlas, who is both is a senior fellow at the Hoover Institution and a professor of radiology at Stanford University Medical Center has a new health policy book out, In Excellent Health.

Here's the description:

The real facts on America's health care dilemma

Medical care in the United States has been loudly and repeatedly derided as inferior in comparison to health care systems in much of the developed world and even in some relatively undeveloped nations. In Excellent Health offers an alternative view of the much maligned state of health care in America, challenging the statistics often cited as evidence that medical care in the United States is substandard and poor in value relative to that of other countries. Rather than relying on purely subjective judgments about equity and fairness, the book provides extensive, detailed evidence with which to answer the paramount question when considering quality of health care: "Where would you rather be when you are sick?"

Drawing from research in scientific and medical journals, the author defends both the quality of and access to medical care in the United States compared to numerous countries with nationalized systems often held up as models for health system reforms. He then suggests a logical and complete reform plan designed to maintain choice and access to excellence and facilitate competition. His proposal offers a series of key improvements in the three critical areas of the health care puzzle -- tax structure, private insurance markets, and government health insurance programs -- that will reduce health costs and maintain essential support for America's most vulnerable citizens, seniors and low-income families, without jeopardizing the exceptional health care quality and access in the United States.

I haven't read the book yet, but based on the free preview pages available here, it looks quite informative.

(Link via OHP. BTW, I used Dr. Atlas' excellent book on neuroradiology as one my texts during my radiology residency.)

Par8o Blog

The new physician referral service Par8o.com has a blog. I look forward to reading more of their commentary!

Hsieh PJM OpEd: The Truth About RomneyCare

The 1/7/2012 PJMedia has published my latest piece, "The Truth About RomneyCare".

Here is the opening:

Now that Mitt Romney has shown himself politically vulnerable after Iowa, more people are taking a closer look at his claims about the "RomneyCare" health care plan he helped create as Massachusetts governor. In this interview from April 2010 which recently recirculated last month, Romney attempts to draw some distinctions (as well as acknowledge similarities) between his RomneyCare plan and the national ObamaCare plan.

One of the alleged virtues of RomneyCare over ObamaCare is that Romney's plan does not contain "price controls," whereas ObamaCare does. But how does this stack up against reality?

I then discuss several forms of price controls that have already been (or will soon be) implemented in Massachusetts, and their consequences.

(Read the full text of "The Truth About RomneyCare".)

Quick Links: Ethics, 5 Dates, GOP

Dr. Rich on "social justice" and "The ACP's New Ethics Manual".

Washington Post: "Five health reform dates to watch in 2012"

Dr. Marc Siegel, "ObamaCare, the GOP and You".

Rhoads: Health Wonk Review

Jared Rhoads of The Center for Objective Health Policy is hosting the latest Health Wonk Review.

Check it out!

John Lewis On ObamaCare

Duke University classics professor John Lewis recently passed away after his struggle with cancer. He was a dynamic and inspiration speaker as well as a gentleman, a scholar, and a friend.

In his honor, here's a lecture he gave on health care in 2010, "Morality -- Not Costs -- As the Proper Basis for Health Care Reform":



RIP, John. You'll be missed.

(Please also see Ari Armstrong's remembrance, "John David Lewis Fought For The Future".)

Physician Exit Strategies

As more physicians find clinical practice unsatisfying (whether due to ObamaCare or other factors), many are considering switching fields.

At the KevinMD.com website, Dr. Franz Wiesbauer has posted this, "Advice for doctors who want to change careers".

No one knows (yet) how many physicians will choose to leave clinical medicine as ObamaCare is phased in. But we know it worsen the anticipated physician shortage. And it won't be good for American patients.

ObamaCare and Racheting History

Harvard physicist Mike Stopa makes some interesting observations in this 12/23/2011 American Thinker piece, "Obamacare and the Ratchet Theory of History".

In particular, he nicely rebuts the Lawrence Tribe argument that regulating "inactivity" is constitutionally legitimate because those who fail to purchase health insurance are choosing to become free riders on the rest of us:

In addition to being simply incorrect, this argument is ahistorical as well as insulting.

Until quite recently in American history, most people, when they became ill, went to a doctor, and, upon receiving a bill for the doctor's services, they paid it. Nowadays, most people who choose not to buy health insurance do so not because they are poor, but because they are young. They are betting (and usually the odds are in their favor) that they will stay relatively healthy. But still, in most cases, when such people get sick, they pay their doctor. To say that their intention upon not buying health insurance is to bilk the rest of us is to fail to realize that most people in America take their financial obligations seriously.

The most pertinent fault of Tribe's argument, however, is to establish a chain whereby the regulated activity, in some cases, is causally linked with an undesirable economic consequence. It is not failing to buy insurance that causes economic damage -- it is failing to pay the doctor's bill. Thus, an ultimately statistical argument is being used as a moral arbiter of behavior...

(Read the full text of "Obamacare and the Ratchet Theory of History".)