Vecchio Video Series on ObamaCare

Dr. Jill Vecchio, the head of the Colorado chapter of Docs4PatientCare (and a fellow radiologist!), has recorded an informative set of videos on ObamaCare and what it means to all Americans.

One important point: the current system is not a free-market but rather a mixed system with some free-market elements but also enormous amounts of government regulation. Forthcoming additional government controls to be imposed by ObamaCare will not solve our current problems but rather make them worse. In contrast, there are many good free-market reforms that would lower our costs and improve our health care quality.

Part 1 -- Coverage:



Part 2 -- Costs, section A:



Part 3 -- Costs, section B:



Part 4 -- Employers and Exchanges:



Part 5 -- Doctors and Patients:



Part 6 -- Constitutional Issues:



Part 7 -- Real Health Care Reforms:



(Note: Overall I found these extremely informative.)

Why Hospitals Are Employing Doctors

Why are more doctors giving up private practice and seeking instead to become hospital employees?

This article in the 2/26/2012 Pittsburgh Tribune-Review discusses why, "Hospitals woo physicians away from private practices".

From the physician's point of view:

...[S]ome physicians tire of running a business and sell their practices to a hospital system for "the sigh of relief that they can just take care of patients," said Dr. Leo McCafferty, president of the Allegheny County Medical Society and a Shadyside plastic surgeon with an independent practice.

Being employed by a hospital can be good when government mandates make remaining in private practice more difficult.

A hospital offers a consistent paycheck even when government reimbursements for Medicare and Medicaid are cut back, experts say. Billing and negotiating with insurance companies is complicated. And health systems have the money to invest in electronic record systems, which the government mandates.

"It's difficult for solo doctors and smaller groups to incur the expense of creating infrastructure to meet the goals of the government," [Dr. Frank] Civitarese said.

Yet from the hospital's perspective, physicians are still a cash cow:

Each doctor can bring millions of dollars annually to a health system, according to a 2010 study by Merritt Hawkins, a physician search and consulting company in Irving, Texas.

On the low end, a pediatrician can generate more than $850,000 a year for a hospital while earning a salary of $171,000, the study shows. On the high end, a neurosurgeon can be worth more than $2.8 million in hospital revenue while earning $571,000 a year. In the middle are family practice doctors, which earn $173,000 on average but can generate more than $1.6 million a year for a health system.

(Read the full text of "Hospitals woo physicians away from private practices".)

Of course, hospital-employed physicians are generally expected to keep their patient within the system that employs them, which may or may not necessarily be in the patient's best medical interest.

Hospital-employed physicians thus serve two masters -- their patient and their employer. This has the potential to create conflicts of interests for physicians (depending on the exact terms of their employment contract). Whether this will ultimately compromise patient care remains to be seen.

(Link via Donna Rovito.)

UK Holding Back Cancer Drugs

The 2/25/2012 Telegraph reports, "New cancer drugs being held back to save Government money, says GlaxoSmithKline boss".

From the article:

GlaxoSmithKline chief executive Sir Andrew Witty warned that... governments were now seeking to go further in an effort to achieve even bigger savings -- and he highlighted Britain's decision to delay new cancer treatments.

"The bit I'm much more frightened about is that what's now beginning to become clear is that, in addition to price reductions, governments are delaying the approval of innovative new drugs," he said.

"So a second way they can save money, they think, is 'Let's just not buy the next round of innovation'.

"Cancer in the UK is a good example where we're seeing oncology drugs being systematically delayed from introduction and reimbursement.

The net result:

He warned that drug companies may soon no longer find it worthwhile to seek approval for their products in Britain.

"The regulation is such in this country that it is not worthwhile for the drug companies making the effort of actually negotiating with our regulatory authorities for the sale of their products in the UK. It is a complete loss-leader for them – waste of time," he said.

"We are going to have a situation in the UK where drugs are not available for our patients. It is a disaster. Someone just needs to sort this out."

(Read the full text of "New cancer drugs being held back to save Government money, says GlaxoSmithKline boss".)

Besides showing the pernicious effects of government control over over drug development, the article also demonstrates one of the problems with government-mandated "cost effectiveness" restrictions.

In a free market, some innovations are going to cost a lot in the beginning. Remember how expensive first-generation DVD players were? Or the first home computers?

But as early adopters start buying these products, they create an increasingly-robust market which then creates economies of scale which drives down the price -- making them increasingly affordable to later users.

Imagine if a government agency had stopped DVD manufacturers from selling (and early adopters from buying) their products on the grounds that they were too expensive and insufficiently "cost-effective". This would have short-circuited the market forces at the outset, thus depriving later consumers of the ability to purchase these items at future lower prices.

The big question is how long it will be before US regulatory agencies start doing the same thing as is already happening in the UK? And will American patients take this lying down, or will they stand up against it?

Wolf: Is This Still America?

Robert Heinlein once wrote: "The human race divides politically into those who want people to be controlled and those who have no such desire."

In his latest Washington Times OpEd, Dr. Milton Wolf shows which half is in charge of this country: "Is this still America? Control freaks assault the land of the free".

Read the whole thing.

Gorman Critiques HA on Massachusetts

Linda Gorman of the Independence Institute critiques a recent Health Affairs article praising the RomneyCare plan in Massachusetts.

In "What Were They Thinking at Health Affairs?", she debunks several misleading arguments from the Health Affairs piece.

Gorman notes:

Unfortunately, in several cases the authors fail to inform readers that their results are contradicted by other, possibly more reliable, sources of information. They also neglect to put some of their results in proper context. Some examples:

* Failing to mention that although the nonelderly adults in the telephone survey samples reported a drop in emergency department (ED) use from 2006 to 2010, data from other reputable sources suggest that total ED visits have risen.

* Failing to mention that the "strong and sustained gains in the share of nonelderly adults in Massachusetts who reported their health as very good or excellent" are similar to the gains reported by all American adults.

* Misrepresenting the historical record with the claim that the "Massachusetts 2006 health reform initiative did not tackle the high cost of health care in the state." Readily available sources clearly show that reform proponents expected it to reduce health care costs.

* Asserting that "access to health care in the community is better than it was in 2006," without reporting on evidence that contradicts this conclusion.

* Inappropriately limiting the definition of "affordability" to out-of-pocket expenses, while ignoring higher premiums, fees, and taxes.

* Concluding that the survey evidence "is suggestive of important improvements in the effectiveness of the delivery of health care in the state" and implying that this is due to RomneyCare despite noting, three times on one page, that "our data did not allow us to isolate the impact of reform from that of changes in other factors during the study period."

RomneyCare supporters are still trying to spin the Massachusetts plan as a success. Fortunately, not everyone is buying that spin.

Online Markets In Medical Care

John Goodman discusses the growing online market for medical services in his 2/25/2012 TownHall.com piece, "Can Health Care Be Bought and Sold on eBay?".

Services such as MediBid allow patients to find elective services such as knee replacement at discounts of up to 50%. In effect, this marketplace allows patients to engage in a domestic equivalent of "medical tourism".

Unfortunately, Goodman notes that this sort of innovation is being threatened by ObamaCare regulations -- yet another reason to repeal ObamaCare.

Oregon Pseudoephedrine Legal Fail

This is not a surprise: "Oregon's Prescription Requirement for Cold Medicine Has Little Effect on Meth".

From the article:

Since 2006, the state of Oregon has had the strictest pseudoephedrine laws in the country. The popular decongestant, a common additive to over-the-counter cold and allergy medications, is also used to make black market methamphetamine. As meth use soared and volatile homemade meth laboratories proliferated in the early 2000s, many states began to put restrictions on the sale of the drug.

The most common such restriction was to move the medications behind the counter, and require customers to show identification before purchasing them. But Oregon was the first state to require a doctor's prescription to purchase cold and allergy medication....

However, the law has done little to restrict the production of illegal drugs, while imposing unnecessary burdens on legitmate users of pseudoephedrine:

A trip to the doctor requires a fee for an office visit, transportation costs and missed time from work, all of which can be especially burdensome on parents. The Cascade report points out that the hassles associated with visiting a doctor likely cause many patients to seek less effective treatment or no treatment at all, resulting in a longer recovery and lost productivity.

One 1992 study published in the Journal of Law and Economics found that the increasing availability of over-the-counter cold and allergy remedies prevented 1.6 million annual doctor visits. That number would likely be much higher today if all states had Oregon's law, resulting in higher health care costs, lost productivity, and lost time for doctors who would be spending time with sneezy patients that they could be spending with those suffering more serious illnesses.

The article also describes other "unintended consequences" of the anti-pseudoephedrine campaign.

(Read the full text of "Oregon's Prescription Requirement for Cold Medicine Has Little Effect on Meth".)

The Myth of Runaway Health Spending

In the 2/17/2012 Wall Street Journal, J D Kleinke addresses, "The Myth of Runaway Health Spending".

The rise in health spending is commonly trumpeted as a reason for more government controls.

However, the NCPA notes the following take-home points from Kleinke's piece:

* Health care spending increased continuously since the 1970s, consistently outstripping inflation and economic growth.

* This trend continued into the last decade, with the 7 percent rate of growth in 2000 rising to more than 9 percent by 2002.

*However, this trend has since turned negative with the rate dropping almost every year since 2002, reaching a low of less than 4 percent in 2009.

It is crucial, in reviewing this trend, to note that the downward pressure existed long before the recession began -- this lends credence to the belief that the ingredients that drove down spending are independent from the economic situation as a whole. Specifically, a number of developments in the early 2000s are largely responsible for the gradual reduction.

* A number of expensive medicines that were developed in the 1980s and 1990s, such as drugs for mental illness, HIV, cancer, heart disease and schizophrenia, have since become generic and are much cheaper.

* Greater information channels exist for communicating health care options and preventative measures.

* Market forces have slowly permeated the health care industry with higher deductibles, new copayments, and Health Savings Accounts allowing participants to have a hand in controlling their own health care spending.

The current system is mixed, with both free-market and statist elements. We should not blame the free-market elements for problems caused by government controls. And indeed, it has been the free-market elements that have kept costs at least partially under control, as happens in the rest of the economy.

TPPF on Medical Loss Ratios

The Texas Public Policy Foundation has a new paper on the problems with Medical Loss Ratios.

They do a nice job describing the various "unintended consequences" of the MLR mandates, including how they will destabilize the state’s small group and individual insurance marketplace. The paper is worth reading for a short summary of this issue.

ObamaCare Regulations Now Up To 1,147,271 Words

ObamaCare Watcher notes, "1,147,271 Words of Obamacare Regulations Published So Far—270% as Long as the Text of the Statute":

If you thought that Obamacare was long, it is only a fraction of the length of the regulations.

Obamacare contains over 700 directives for HHS and other agencies to implement Obamacare.

We went through and counted all of the Obamacare regulation documents published so far. We found that the number of pages in regulations are already 114% as long as the number of pages in the Obamacare statutes! The statutes contain 961 pages compared to 1,093 pages of regulations.

But regulations published in the Federal Register are published in small font, three columns wide.

What is more telling is the word count comparison. The Obamacare statutes together contain 425,116 words. Compare that to 1,147,271 words published so far in Obamacare regulation documents. The regulations are 270% as long as the statute itself.

The 1.1 million words in Obamacare regulations published so far are only a fraction of the regulations yet to come...

(Link via David Catron.)

This is just a manifestation of a much broader problem as outlined in the latest issue of The Economist, "Over-regulated America". The Economist is more sympathetic to ObamaCare than I would be, but it does note the following tidbit:

Every hour spent treating a patient in America creates at least 30 minutes of paperwork, and often a whole hour.

Quick Links: Med Students, Responsibility, UK

The 2/16/2012 LA Times reports, "Med school admission tests change to reflect new care realities".

In short, medical schools will place lower priority on the hard sciences and greater emphasis on sociology, psychology, and ethics. Of course, the big question is what kind of ethics will future physicians be expected to follow? (Hint: "The Wisconsin Protests and the New Medical Ethics".)

In the 2/14/2012 Orange County Register, Richard Ralston of AFCM urges, "Restore true personal responsibility to health care".

The 2/17/2012 Daily Caller notes, "As Obama pushes new regulations, UK eyes privatizing its health care".

Book: What Problem Does the Individual Mandate Solve?

In the 2/15/2012 Forbes blog, Robert Book asks, "What Problem Does the Individual Mandate Solve?"

He notes that individual mandate is supposed to solve the so-called "free rider" problem. However, it exempts (or subsidizes) many who arguably fit that description, and is instead imposed on those who aren't actually free riders.

Scherz: Unequal Protection Under the Health Care Law

Dr. Hal Scherz of Docs4PatientCare has a new OpEd in the 2/15/2012 American Thinker, "Unequal Protection Under the Health Care Law".

Government-run medicine is supposed to take money out of the equation and give people theoretically "equal" access to care without financial bias. Of course, as we've seen in other countries such as Canada, this merely results in preferential treatment based on political "pull".

One of my colleagues who practiced in Canada before he moved to the US tells me of occasions where they would turn on the normally-closed MRI scanner during the evening to squeeze in a politically-connected VIP, even though ordinary Canadians with similarly-urgent medical problems had to wait weeks for their MRI scans.

Similarly, the US Preventative Services Task Force is now trying to clamp down on medical procedures they consider "unnecessary", such as screening mammograms for women between age 40-50 and prostate screening (PSA tests) for men. As Dr. Scherz notes, President Obama just had his PSA test recently -- but ordinary Americans are being told they shouldn't get one.

Sure, we're all "equal" under ObamaCare. But some will be more equal than others.

(Read the full text of, "Unequal Protection Under the Health Care Law".)

Quick Links: MD Shortages, Insurance Costs, Drugs Development

Dr. Patrick Hisel discusses, "Why the physician shortage is a perfect storm".

A couple of excerpts:

The Government’s answer is always to grow itself. Now its plan is to start planting the seeds to force physicians to see Medicare patients in order to maintain their license (definition: serfdom). This will lead to an even further disillusioned physician workforce and more attrition...

The best and brightest will choose other careers that don’t involve government-fettered patient care. Or they will simply choose to do something with their lives other than practice medicine.

MIT economist Jonathan Gruber, consultant for both RomneyCare and ObamaCare, admits that "that the price of insurance premiums will dramatically increase" under ObamaCare. (Daily Caller, 2/11/2012. Via Dr. Art Fougner.)

Megan McArdle explains, "New Drugs Cost Even More Than You Think". If we keep making it harder for industry to develop new drugs, we won't have many of them soon. (Forbes, 2/10/2012. Via Dr. Matthew Bowdish.)

Armstrong: Obamacare Grants Doctors Liberty to Withhold Care

Dr. Richard Armstrong of Docs4PatientCare has a new OpEd in the 2/15/2012 Washington Times, "Obamacare grants doctors liberty to withhold care".

He dissects the new Orwellian language in which government controls over physicians are now a new form of "freedom". Here's an excerpt:

The law promotes a “new” model, the Accountable Care Organization (ACO), in which an entity that covers a specified number of Medicare patients is given a fixed pot of money. This is quite similar to the HMO capitation systems that caused tremendous backlash in the early 1990s. In both, if the doctors can provide care for less than what is in the pot over a defined period, they get to share the leftovers. If, however, the doctors overspend the pot, they are financially liable for the consequences. With sleight of hand and fanciful re-packaging, Dr. Emanuel attempts to convince physicians that this gallows for private practice somehow improves and enhances autonomy. Nice try, but doctors have been fooled once, which is quite enough.

In particular:

Either consciously or subliminally, the message is the same: The less you spend on patient care, the more you gain financially. This is the reality of the ACO model and the "new ethics" of government cost control in medicine, courtesy of the Affordable Care Act. Shouldn't economic and professional decisions be transparent in medicine, where doctors and patients make joint decisions based upon available resources, not some underlying, unspoken financial advantage for the physician to offer the patient less.

This system rewards doctors for denying care, while pretending to the patient (and themselves) that they're merely practicing "efficient" medicine and "parsimonious care".

I highly recommend reading the full text of "Obamacare grants doctors liberty to withhold care".

Rhoads: Concierge Physicians Now Being Targeted By Regulators

Jared Rhoads of the Center for Objective Health Policy notes, "Concierge physicians now being targeted by regulators".

Here is the opening of his OpEd:

According to a new rule that was passed in October and took effect on January 1st, concierge physicians in Oregon are now required to register their practices with the state's insurance department.1 To comply, concierge physicians and other doctors on retainer must share their business plan, financial history, and practice information with the state, submit marketing materials for review, and disclose any past bankruptcies going back 25 years.

The legislation was proposed by the state's insurance division. Insurers complained that, since concierge practices take a fee up front in exchange for care to be provided later, the practices are in the business of managing risk not unlike insurers. Their portfolio of clients, for example, cannot be allowed to exceed the capacity of the practice to provide the service promised. (That is, in the judgment of some unelected bureaucrat.)

(Read the full text of "Concierge physicians now being targeted by regulators".)

More and more physicians are seeking to escape the government-controlled insurance system by forming "direct pay" or "concierge" practices, so that they can practice medicine on their terms, for the mutual benefit of patient and doctor alike. Patients receive better care at reasonable prices, and doctors are able to practice according to their best medical conscience.

These independent practices thus pose a huge threat to government bureaucrats wishing to control how American medicine is practiced. The state of Oregon has taken the next step in attempting to herd doctors back under government control. The battle over concierge medicine could become the next big front in the fight for American health care freedom.

Related:

"Oregon requires concierge physicians to register with insurance department", American Medical News, 2/1/2012.

"Myths about concierge medicine", Dr. John Kihm, 1/9/2012.

Nursing Director Asks Staff To "Take Some Risks"

A reader who prefers to remain anonymous sent me an excerpt from a recent memo issued by a Clinical Nursing Director to his/her staff at a major American university medical center.

It reads:

...I need your help! I need the whole team to help own the '[Department] Checkbook.' The whole hospital is currently looking at ways to increase revenue and decrease expenses. We did not meet our targets for the 1st quarter of 2012 and have to make it up over the next 3 quarters. This is effecting [sic] every division of the hospital and not just nursing.

I am 100% confident that we can work together over the next couple of months to meet our goals. This means we are going to need to take some risks. What those risks are and when they are is dependent on the team. We are not always going to get everything right -- but we need to trust in every member of the team that we are trying to do the right thing.

It's not entirely clear what the Nursing Director means by "take some risks".

But the natural question is whether this means the hospital will jeopardize patient safety or well-being to meet their revenue targets. And whether "not always going to get everything right" refers to any aspect of patient care.

I don't have any more information other than what's in this excerpt, so there could be a totally reasonable explanation for this.

And even if there is a reasonable explanation for this particular memo, patients should remain wary of any purported health care "reform" which pits doctor' and hospitals' financial interests against their medical well-being.

Wolf: Time For A Romneycare Mea Culpa

Dr. Milton Wolf has a new piece in the 2/10/2012 Washington Times, "Time for a Romneycare mea culpa".

It's time for Romney to repudiate RomneyCare. Given how he's been so "malleable" on all his other views, it's puzzling that he refuses to change his mind about his failed Massachusetts health care plan. If he becomes the GOP nominee, he is thus unable to muster any effective rhetorical or philosophical opposition to ObamaCare, which is

The fact that Romney still can't "close the deal" with GOP voters should be a warning sign to him.

(Note: I have severe concerns about Gingrich and Santorum, but for different reasons than Romney.)

Roy: Conservatives and the Individual Mandate

In the 2/7/2012 Forbes blog, Avik Roy has an extremely informative post, "The Tortuous History of Conservatives and the Individual Mandate".

Basically, conservatives have been split on this issue. Many supported it on the grounds that it was enforcing "individual responsibility", although others correctly opposed it as an infringement of individual freedom. Over time, many former supporters did eventually change their minds. Others, like Ann Coulter, now seem to favor it -- at least if imposed by state governments rather than the federal government.

Roy's piece is long, but worth reading in its entirety.

I wrote about the problems with the pro-mandate conservatives in this piece for the Fall 2008 issue The Objective Standard, "Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America":

Nor does mandatory health insurance promote "personal responsibility," as [some] conservatives claim.

Personal responsibility presupposes that an individual has the freedom to make his own decisions and enjoy (or suffer) the consequences thereof. Personal responsibility presupposes that if a patient wants to pay a willing insurer more money now in exchange for the assurance of lower future costs if he becomes ill, then he is free to make that choice.

Similarly, personal responsibility presupposes that if he chooses not to purchase health insurance and later incurs a $10,000 medical bill, he will be held accountable for it even if he has to sell his car, borrow money from his family, or rely on charity. When the government forbids an individual from making such choices about his health insurance, it makes personal responsibility in this area impossible.

Armstrong On Birth Control Mandates

In The Objective Standard blog, Ari Armstrong discusses why "Not Only Catholics Should be Angered by Birth Control Mandates".

I especially liked this segment:

True, the government should not force Catholics to fund birth control against their religious beliefs. But the government should not force anyone to fund any type of insurance coverage against their wishes. The government should not force people to buy insurance that covers birth control, acupuncture, maternity leave, or any other good or service. Such mandates violate the rights of insurance companies and their clients to freely negotiate terms, and they drive up the costs of premiums.

Insurance mandates not only violate Catholics' freedom of religion; they violate everyone's freedom of conscience and everyone's freedom to use their own resources as they judge best. To be genuinely "pro-choice," one must respect people's choices across the board—including their choice of religion or philosophy, their choice of whether to buy insurance and if so what kind, and their choice of how to dispose of the fruits of their labor.

(Read the full text of "Not Only Catholics Should be Angered by Birth Control Mandates".)

Update: Ari Armstrong pointed me to how the Obama Administration may try to use waivers to make this political hot potato go away, "Obama May Waive Away Contraception Uproar".

Quick Links: Amicus Briefs, BC Mandate, Liberty, Virtual Clinics

Sally Pipes: "Amicus Briefs Give A Supreme Condemnation Of ObamaCare" (Forbes, 2/7/2012).

CBS News: "Catholic League Poised To Go To War With Obama Over Mandatory Birth Control Payments"

Dr. Jane Orient: "Shall We Take the Liberty of 'the 1%'?"

Mark Perry: "Virtual Retail Clinics". (Via Kelly V.)

Washington State ER Medicaid Trap

The 2/7/2012 Seattle Times reports, "State Medicaid to quit paying for ER visits deemed unnecessary".

From the article:

Medicaid officials say the program will no longer pay for any medically unnecessary emergency-room visits, even when patients or parents have reason to believe they're having an emergency...

They would apply to all adults and children on Medicaid, with no exceptions, such as someone being brought in by ambulance or from a nursing home, or when patients have neurological symptoms or unstable vital signs...

Under federal law, patients that show up at the ER cannot be turned away, at least not until the treating physician determines they are not having a medical emergency. But for many conditions (which includes neurological impairment or unstable vital signs), it can be unclear whether or not there is a true emergency until after a fair amount of skilled testing and evaluation.

As the article notes:

For Medicaid patients, Schlicher said, the plan suggests that even before heading to the ER, they should know what their ultimate diagnosis will be.

"If we don't know without an X-ray or CT scan, how can they know it?"

For doctors, the plan could place them in legal jeopardy, Schlicher said.

If they turn patients away, "it's not good care and it doesn't meet the legal standard," he said. "I can't tell any provider to commit medical malpractice, no matter how much the state wants us to do that."

So in essence, the state will compel ERs and doctors to render medical services to these patients, then penalize them economically if the government deems that the condition wasn't a real emergency.

Note the trap: The government tells doctors, "We don't want to tell you how to practice medicine. But we have to control what gets paid for, for the good of 'society'." Doctors no longer have genuine freedom to practice medicine as they see fit, and patients suffer as a result.

(Read the full text of "State Medicaid to quit paying for ER visits deemed unnecessary".)

Right now, this affects only Washington state. But don't be surprised if we start seeing similar proposals in the rest of the country.

(Seattle Times link via a reader.)

Herrick on the Medical Devices Tax

Devon Herrick of NCPA has a new short policy brief, "The Job-Killing Medical Device Tax".

He notes that the tax would (1) harm an industry working on slim profit margins, (2) destroy many jobs, and (3) raise health care costs.

This tax will also stifle many new innovations before they ever reach the market. As always, we'll never know about the lives that could have been saved by new devices that weren't developed (but could have been). For more on this, see my PJMedia piece from 2010, "The Deadly Tax on Medical Innovation".

Goodman: Worse Than Death Panels

In this 2/4/2012 TownHall piece, John Goodman explains why ObamaCare will be "Worse Than Death Panels".

In particular, he describes how rigid clinical practice protocols will be foisted on doctors and patients under the guise of "evidence based care". This will happen through the following steps:

1) The ObamaCare exchanges will only allow health insurance plans that cover "evidence based care". Over time, these will likely be the only plans that survive.

2) Because doctors will want to get paid, they'll have to adhere to care that follows government guidelines.

3) Doctors who follow these guidelines will have protection from malpractice suits, whereas doctors who stray will have to take their chances in court if anything goes wrong.

While "evidence based" sounds scientific, there are many problems with what is currently called "evidence based". Often these guidelines are based on inadequate, outdated, or biased data.

Another problem:

[E]ven where there are well established guidelines, they are inevitably written for the average patient. But suppose you are not average. Is your doctor free to step outside the protocols and give you care based on her training, knowledge and experience? Or will she be pressured to stick to the cookbook, regardless of how the patient fares? Health plans always say that doctors are free to step outside the guidelines if they have good reason for doing so. But if the doctor is forced to fill out multiple forms and jump through lots of hoops, many will conform to the guidelines even if that’s bad for you.

And finally, guidelines are too-often wrongly applied to patients for whom they were not intended:

For example, a large number of studies of patients with heart failure excluded elderly patients, even though most of the people who have this problem are elderly! If you are an elderly patient do you want your doctor to follow procedures that were based on studies of patients 30 or 40 years younger than you are? According to Don Taylor, a health policy analyst at Duke University, it is not at all unusual to exclude patients with characteristics and conditions from clinical trials who are then subjected to the guidelines after the trial is over.

In effect, these guidelines represent the "central planner fallacy" as applied to health care. Bureaucrats in Washington DC regard themselves are more qualified to decide what medical care you should receive than your doctor who actually knows your medical condition.

Is this the kind of health care you want?

(Read the full text of "Worse Than Death Panels".)

Catron On Coulter

David Catron offers his own takedown of Ann Coulter's attempted defense of RomneyCare in his 2/6/2012 American Spectator piece, "Who Castrated Ann Coulter?"

He makes many good points, but I especially liked this section:

...[Coulter] adds the irrelevant point that mandates are constitutional when enacted by states rather than by the federal government. This is true enough, but it misses what should be an obvious point. Health care consumers are less concerned with constitutional nuances relating to federal versus state powers than with the reality that they will be forced to buy insurance whether they wish to or not. That the mandate was passed by a state legislature rather than Congress will not render voters less inclined to resent such government interference in their private transactions.

(Read the full text of "Who Castrated Ann Coulter?")

The debate should be about protecting individual rights, not which level of government is best suited to violating them. Catron does a nice job exposing Coulter's many inconsistencies.

According to the FDA, Your Stem Cells Are Now Drugs

The latest news story on FDA overreach, "According to the FDA, Your Stem Cells Are Now Drugs".

Here's the relevant section:

The bizarre controversy revolves around the FDA's attempt to regulate the Centeno-Schultz Clinic in Colorado that performs a nonsurgical stem-cell therapy called Regenexx-C. It is designed to treat moderate to severe joint, tendon, ligament, and bone pain using only adult stem cells. Doctors draw your blood, spin it through a centrifuge, extract the stem cells and re-inject them into your damaged joints. It uses no other drugs. No drugs means no FDA oversight and that does not sit well with the administration.

The FDA has since argued that a) stem cells are drugs and b) they fall under FDA regulation because the clinic is engaging in interstate commerce. That's right, a process performed at the clinic using the patient's own bodily fluids constitutes interstate commerce because, according to the administration, out-of-state patients using Regenexx-C would "depress the market for out-of-state drugs that are approved by FDA."

This is stretching the claimed limits of government power into hyperspace. By that "reasoning", the government could regulate anything that might alter what sorts of medications you might purchase from out of state, such as an exercise machine. (Via Instapundit.)

Related: Michelle Minton of the Competitive Enterprise Institute describes the latest FDA overreach with respect to dietary supplements at her 1/31/2012 OpEd for The Hill, "The FDA has it dead wrong":

[T]he NDI draft guidelines released by the FDA this summer would create a de facto pre-approval process on virtually all supplements on the market, thus giving the agency carte blanche to pull any supplement off the shelf without the need to prove that it is unsafe.

As Minton notes, the FDA's efforts are a "rogue effort to unilaterally expand its authority". Fortunately, some in Congress want to rein them in, at least on this issue. Let's hope they are successful.

Wolf: Obamacare Is Worth Getting Angry About

Dr. Milton Wolf has a great new OpEd at the Washington Times, "Obamacare is worth getting angry about".

He makes many good points, but I wanted to highlight this passage:

For the first time in the history of our republic, our government has demanded that every American, upon the condition of breathing, be forced to enter a legal contract with government-approved corporations. Not even King George III dared impose such control. In truth, if a government can force you to patronize companies of its choosing, the fundamental relationship between the government and the individual is irrevocably changed. If it is allowed to stand, there will be no part of your life the government cannot control and no crony it cannot enrich -- with your money.

Isn’t that worth getting angry about?

(Read the full text of "Obamacare is worth getting angry about".)

I don't know whether or not Mitt Romney will be the eventual GOP nominee for the 2012 presidential race. But if he is, our best hope for moving the country in the right direction with respect to health care policy is for Americans to keep up the pressure, letting him know that we want ObamaCare repealed.

Thank you, Milton, for reminding us what's at stake -- it's not just our health care but our basic freedoms.

Armstrong: Our Dead American Medical Association

Dr. Richard Armstrong of Docs4PatientCare has a new OpEd in the 2/1/2012 Washington Times, "Our Dead American Medical Association".

In his piece, Dr. Armstrong highlights a couple of facts that aren't widely known by the general American public:

1) The AMA now represents only 15% of American physicians.

2) They make most of their money from a government-granted monopoly on medical coding, rather than from physician membership dues.

Hence, the AMA is far more beholden to the federal government than to physicians. Is it any surprise that the AMA decided to back ObamaCare despite deep opposition from regular practicing physicians?

And because the public perception is that the AMA "is the voice of American doctors", most people wrongly concluded that there was of a "consensus" of US physicians in favor of ObamaCare when that was not the case at all.

Fortunately, more US physicians are joining other groups that do genuinely represent their interests and their patients' interests, such as Docs4PatientCare.

(Read the full text of "Our Dead American Medical Association".)

Finally, one commenter made the following astute observation:

Most doctors don't dare practice medicine any more.

They must simply fit their patients into templates designed by actuaries and prescribe negotiated, unimaginative, and often dated protocols handed down from the ivory tower regardless of documented dismal success rates. Straitjacketed by the constant threat of malpractice the MD now merely represents a certificate of applied medicine and board certified means guaranteed not to stray from Conn's Current Therapy.

They don't have a license to practice medicine, they have a permit to follow a flow chart. It sickens me.

This is the future of American medicine unless ObamaCare is repealed and we adopt genuine free-market health care reforms.

Coulter And Her Critics

Conservative pundit Ann Coulter recently attempted to defend the Massachusetts "universal" health care plan in her 2/1/2012 column, "Three Cheers for RomneyCare!"

Almost immediately, critics posted rebuttals of her various bad arguments. Here are a few:

Philip Klein: "Coulter's shameful defense of Romneycare".

AllahPundit at HotAir.

Mark Levin: Video rebuttal. (Or download the MP3 version).

Ultimately, Coulter's arguments don't hold water. And plenty of people noticed it.

Quick Links: Ethics, Algorithms, Managed Care

John Goodman: "Money, Medicine and Ethics". (Via D4PC.)

Dr. Jeffrey Parks: "How algorithm driven medicine can affect patient care". (Rigid protocols are no substitute for the rational mind.)

Dr. Rich Fogoros: "Whatever Happened To Managed Care?"