Monday, April 30, 2012

Nice List Of Free Market Health Reforms

If the US Supreme Court overturns ObamaCare (or if Americans elect officials committed to repealing it), we will need to be ready with some positive free-market health care reform to propose in its place.

Fortunately, there are many people working on this issue. One nice compilation of positive reforms can be found in this article by D. Eric Schansberg, "Envisioning a Free Market in Health Care" (Cato Journal, Winter 2011).

Some of the specific categories of reforms he covers include:
Ending the Subsidy for Employer-Provided Health Insurance
Allowing "Health Status Insurance" for Pre-Existing Conditions
Health Savings Accounts
Reducing Insurance Regulation
Privatizing Medicare, Medicaid, and the Veterans Administration
Allowing Markets in Vital Organs
Tort Reform
Undo FDA Regulations
Eliminate Certificates of Need (CONs)
Freedom in Labor and Service Markets
The article covers each of those topics in more detail.  Schansberg also cites some good examples where employers in our current semi-free market have implemented market-oriented health plans -- including Safeway, Whole Foods, and Wendy's.

There can be reasonable disagreements about the details of each point (including how quickly to pursue each subgoal and by which exact means). But his list covers pretty much all the major categories of reforms. And they would all be good steps towards the eventual goal of a fully free market in health care.

(Read full text of "Envisioning a Free Market in Health Care".  Link via NCPA.)

Friday, April 27, 2012

Roy: How Obamacare Will Make Health Savings Accounts More Costly

In his 4/27/2012 Forbes blog post, Avik Roy explains, "How Obamacare Will Make Health Savings Accounts More Costly".

It hinges on how the Obama administration defines "actuarial value".

Given the nature of HSA's (which are designed to allow consumers to pay larger amounts than in conventional insurance premiums in exchange for greater control over how that money is spent), this will make HSA's "actuarial value" look artificially low via these government yardsticks.

Read the whole piece for more details, including why this moves us in the wrong direction away from free-market reforms.

Schwartz CPR Interview on the Colorado Trust

Brian Schwartz recently appeared in this Colorado Public Radio piece, "Health Care Ads: Public Interest, or Advocacy?"

Schwartz discussed the Colorado Trust and its advocacy of greater government involvement in health care, offering a free-market counterpoint. You can listen to the audio or read the transcript.

Related: "Don't Trust the Colorado Trust" by Brian Schwartz, Boulder Daily Camera, 3/31/2012

Thursday, April 26, 2012

Universal Health Care = Policing Your Diet

AFP reports, "Hungary to punish diabetics if they don't stick to diet":
Hungarian diabetics who fail to stick to their diet will be deprived of more modern treatments from July, under a government decree published Monday aimed at cutting health spending.
This is the logical outcome of government-run health care: "Because we have to pay for your health care, we have to control what you can eat or drink".

(For more on this, see my OpEd in the 1/7/2009 Christian Science Monitor, "Universal healthcare and the waistline police".)

Scherz On Tort Reform And Liability

Dr. Hal Scherz of D4PC has a new OpEd in, "Trial Lawyers and Insurance Cos are True Beneficiaries of Medical System".

One of his key takehome points is that ObamaCare fails to address a critical cause of skyrocketing health costs -- "defensive medicine" and the dysfunctional tort system.

The system doesn't just affect the relatively few patients injured by negligent physicians. Instead, everyone pays in the form of higher costs from unnecessary tests and treatments.

I do a lot of emergency radiology, so I've spoken at length with good ER doctors who are essentially compelled to order extra x-rays, MRIs, and CT scans that aren't medically necessary -- but legally necessary to protect themselves from frivolous lawsuits.

And this problem extends to nearly every specialty in medicine.

Fixing the broken legal system would go a long ways towards helping reduce health care costs, without compromising quality.

Tuesday, April 24, 2012

Catron: Obama Snookering Seniors Before Election

David Catron has a new American Spectator piece, "Obama's Latest Plan to Snooker Seniors".

He describes the fiscal games the Obama Administration is playing to ensure that seniors don't feel the pain of politically-unpopular cuts to the Medicare Advantage program until after the November election.

The vehicle is a sham "demonstration project" of dubious legality. For details, see Catron's piece and this related New York Post article, "An $8 billion trick?"

Update: Related piece by Avik Roy, "The Obama Campaign's $8 Billion Taxpayer-Funded Medicare Slush Fund".

Haynes On Affordable Health Care

Dr. Beth Haynes of the Black Ribbon Project recently gave this short talk to the Silicon Valley Tea Party Patriots (4/15/2012).

She discusses how freedom of choice will create abundance and affordable access to health care:

(Note: Dr. Haynes told me that the video clip omitted her acknowledgement to Alex Epstein and the Center for Industrial Progress for guidance/inspiration on this talk, so she asked that I include it in this blog post.)

Monday, April 23, 2012

Barnett Rebuts Cost-Shifting Myth

Randy Barnett has a nice discussion on, "The Myth That the Individual Mandate Addresses Cost Shifting by the Uninsured, Part 2: 'Bronze Plans' Are Not the Same As Catastrophic Coverage".

Based on his discussion, it appears that some of the Supreme Court justices understand these economic issues. Let's hope enough of them do.

Perry: Mayo Clinic Offers Insurance For Canadian Patients

Mark Perry notes, "U.S.-Based Mayo Clinic Offers Three Medical Insurance Programs for Canadian Patients".

From his blog post:
The Mayo Clinic in Rochester, MN, has introduced two new insurance programs. That wouldn't be very newsworthy except that the insurance programs aren't being offered to Americans, they're being offered to Canadians, who already have access to "free" medical care in their home country...
According to the Mayo Clinic, 25% of the international patients they serve every year are from Canada. And why is an American hospital/clinic serving so many Canadians?
According to this news report about Mayo's insurance programs for Canadians, "the publicly funded health system in Canada decreases the choices available to patients, and can also result in delayed diagnosis and treatment. That's why, within the national system, it's good to offer choices for those who need diagnosis confirmation or even treatment for serious illness."
Curious how the Mayo Clinic recognizes the problems in Canadian health care that apologists like Michael Moore fail to mention...

Saturday, April 21, 2012

Why Science Whistleblowers Are Ignored

The 4/20/2012 Wall Street Journal highlighted a little-known but widespread problem in cancer research in their article, "Lab Mistakes Hobble Cancer Studies But Scientists Slow to Take Remedies".

(If the article link doesn't work, you can paste the title into a Google search window to get access to the full piece.)

Basically, hundreds of cancer cell samples in scientific laboratories are either contaminated or misidentified -- which casts doubt on the reliability of any subsequent scientific results. The WSJ piece notes:
Cancer experts seeking to solve the problem have found that a fifth to a third or more of cancer cell lines tested were mistakenly identified -- with researchers unwittingly studying the wrong cancers, slowing progress toward new treatments and wasting precious time and money.
Even worse, the more conscientious scientists warning about this problem are being ignored by their colleagues:
...[R]esearchers who yelled loudest were mostly ignored by colleagues fearful such a mistake in their own labs would discredit years of work.
Leaders in the field say one of the biggest obstacles to finding a cancer cure may not be the many defenses nature affords malignancies, but the reluctance of scientists to address the problem.
Dr. John Masters, a professor of experimental pathology at University College London, warns that such misidentification of tumor cells (and unwillingness of senior scientists to address this problem) could have serious downstream impact on medical care for patients:
But when seeking cancer treatment for a specific tumor, he said, such mistakes "are an utter waste of public money, charity money and time." Worse, he added, "It may be causing drugs to be used which are inappropriate for that particular type of cancer."
Masters put his finger on the core issue:
The whole ethos of science is to strive for the truth and produce a balanced argument about the evidence. Yet, all this crap is being produced.
These scientific and ethical problems with cancer research are just part of a bigger problem in biomedical research.

The New York Times recently reported on the alarming rise of inaccurate (or sometimes outright fraudulent) results being published in respectable medical journals, which then required retraction once the errors (or misconduct) were discovered. The two medical journal editors investigating this phenomenon "reached a troubling conclusion" that there was a much broader "dysfunctional scientific climate".

One critical question is how much government funding of science is contributing to this problem. As Bill Frezza wryly noted on Twitter: "$5B/yr to unaccountable tenured academics. What could go wrong?"

University of Tennessee law professor Glenn Reynolds (aka Instapundit) similarly noted, "There's lots of government money. That leads to corruption."

Forbes columnist David Shaywitz shows how this corruption plays out in the university science labs:
...[T]here's often a circular quality to academic research, where a particular model system, or particular enzyme, or particular brain region, or particular analytical approach becomes very trendy, and then it takes on a life of its own.
He concludes:
At the end of the day, I suspect that the problem involves some combination of the law of small numbers, the appeal of narrative, the structural advantages of reinforcing dogma, and the difficulties of publishing negative results that might challenge it, especially if the dogma was advanced by senior leaders in the field who tend to play critical roles in reviewing papers for high-profile journals and in selecting which new research gets funded.
While the process may ultimately be self-correcting (and I certainly believe that science "works"), the cycle time for this can be a lifetime (literally -- in some cases I've heard it said you need to wait for someone to pass away before contrary ideas can truly gain traction).
As a result, scientific dissenters and whistleblowers raising inconvenient questions about the integrity of the published results are too easily ignored or branded as troublemakers.

One of the reasons that many Americans no longer trust politicians' pronouncements about "global warming" (or "global climate disruption" as it's now called) is because they've seen how a similar dynamic has seemingly led to unsound scientific and policy conclusions. Americans are rightly skeptical of politicians' claims that "the science is settled".

It's bad enough if government funding helps promotes bad climate science. But if government funding is also contributing to the corruption of American biomedical research, then American patients may pay the ultimate price in the form of lives lost due to flawed or ineffective medical treatments.

(Related post: "Bad Science, Bad Medicine?", 4/18/2012.)

Wolf on Mandates, Sebelius, and Kansas

Dr. Milton Wolf has a new OpEd in the 4/20/2012 Washington Times, "Kathleen, I’ve got a feeling you’re still in Kansas".

He notes that too often both Republicans and Democrats favor mandated insurance benefits, even though such compulsory spending hurts innocent people. He offers some informative contrasts between highly-regulated health insurance and less-regulated auto insurance:
Kansans are allowed to purchase car insurance directly from any provider across the country, and you won’t find state mandates that force your auto insurance company to cover windshield-wiper blade replacements or oil changes. You also won’t find tax penalties that coerce you into buying auto insurance through your employer rather than on your own, but that’s another story.
So which is more effective at keeping costs lower and serving Kansans - the big-government health insurance mandates or the auto insurance free-market approach? Is there a single person who believes we have an auto insurance crisis in America?...
State mandates, by their very nature, eliminate competition. It’s ironic that supporters of mandates don’t realize - or perhaps they do - that their approach creates oligopolies within each state where only a few large companies can operate and artificially drive up prices. The free-market approach, on the other hand, opens the door to innovative companies like Geico and Progressive, which have revolutionized auto insurance.
Every state faces this dilemma between destructive but poll-driven big-government mandates and demonstrably effective free-market reforms...
(Read the full text of "Kathleen, I’ve got a feeling you’re still in Kansas".)

Insurance companies get a bad rap from the public. Some of it is deserved, if they fail to live up to their contractual obligations -- but that's not "greed", that's fraud.

In a free market, honest insurance companies provide a valuable service, allowing customers to share risk on mutually agreeable terms. Some people will want lean "catastrophic only" coverage with lower premiums, whereas others may wish a more "gold plated" plan that covers more services (but has correspondingly higher premiums).

The beauty of a free market is that it allows prospective insurance customers to find other like-minded people to voluntarily share the risks they want, without compelling others to do so against their will.

For more on this, see: "How the Freedom to Contract Protects Insurability" (The Objective Standard, Fall 2009).

Thursday, April 19, 2012

Quick Links: Discounted Surgery, Canadian Laundry, Faux Transparency

Economist Mark Perry discusses a nice innovation, "Markets in Everything: Market-Based, Deeply-Discounted Surgery for Cash, Payable in Advance". (Via Kelly V.)

Canadian health care update: "Hospital tells patients to do own laundry". (Via Dr. Art Fougner.)

Drs. Scherz and English of Docs4PatientCare: "Obamacare: We Need a Earmark to Treat that Disease". Faux "transparency" will be a vehicle for stealth rationing.

Wednesday, April 18, 2012

Bad Science, Bad Medicine?

The 4/16/2012 New York Times published a disturbing article, "A Sharp Rise in Retractions Prompts Calls for Reform".

Basically, they discussed the alarming rise of inaccurate (or sometimes outright fraudulent) results being published in respectable medical journals, which then require retraction when the error (or misconduct) is discovered.

As they investigated the source of the problem, two medical journal editors,
...reached a troubling conclusion: not only that retractions were rising at an alarming rate, but that retractions were just a manifestation of a much more profound problem -- "a symptom of a dysfunctional scientific climate”...
Although the system of peer review is supposed to minimize this from happening, the article notes the following factors making the problem worse:
* "[S]cience has changed in some worrying ways in recent decades — especially biomedical research, which consumes a larger and larger share of government science spending"

* "To survive professionally, scientists feel the need to publish as many papers as possible, and to get them into high-profile journals. And sometimes they cut corners or even commit misconduct to get there."

* "The higher a journal's impact factor, the two editors found, the higher its retraction rate."
That last item is especially eye-opening. In other words, some of the most prestigious journals (such as The New England Journal of Medicine), have the highest retraction rates. Yet these are supposed to be the most authoritative sources for "clinical practice guidelines".

This leads to the following disturbing conclusions:

1) As Glenn Reynolds notes, "There's lots of government money. That leads to corruption."

2) This bad science will be used to set "clinical practice guidelines" for physicians. This goes under various names such as "evidence based medicine". But the guidelines are only as good as the science -- which is becoming demonstrably less trustworthy.

3) Under Obamacare there will be an increasing push for doctors to adhere to these "practice guidelines", or face financial penalties. So in other words, government-funded science and government-mandated medical practice standards will increasingly foist bad treatments onto an unsuspecting population.

Let's hope that ObamaCare is overturned by the Supreme Court (or repealed by Congress) before it's too late.

Tuesday, April 17, 2012

Catron: Will the Supreme Court Let the Death Panel Stand?

In the 4/16/2012 American Spectator, David Catron asks, "Will the Supreme Court Let the Death Panel Stand?"

In particular, he notes that if the Supreme Court strikes down just part of ObamaCare (such as the individual mandate), then the de facto IPAB rationing board could still wreak havoc for America's elderly patients.

Catron observes:
...IPAB will in theory only propose Medicare cuts, but its recommendations will take effect automatically unless Congress and the President intervene with some alternative to its recommendations. This means that the welfare of patients will inevitably take a back seat to the political exigencies of the moment.

Indeed, the political dynamics of the 2012 election cycle are already dictating the actions or lack thereof by both the Republicans and the Democrats where IPAB is concerned. Knowing full well that the bill hasn't a prayer of going anywhere in the Senate, the GOP-controlled House of Representatives passed a measure repealing IPAB last month. And the President, who doesn't want to spend time talking about death panels in the run-up to November 6, has declined to appoint anyone to the panel.
IPAB thus creates the mechanism for de facto rationing, while giving elected officials a veneer of "plausible deniability" for those cuts.

(Read the full text of "Will the Supreme Court Let the Death Panel Stand?")

Monday, April 16, 2012

Hsieh RCM OpEd: "The Best Congress Money Can Buy?"

The 4/16/2012 edition of has published my latest OpEd, "The Best Congress Money Can Buy?"

According to NPR, a Congressman on a powerful House committee can raise up to an extra $250,000 in campaign funds from lobbyists because of his political power over the federal tax code or affected industries. In effect, this is the going "market rate" for his level of political influence.

To eliminate this corrupt "market", we shouldn't be trying to "limit money in politics". Instead, we should limit government, so that it can no longer interfere with a genuine free market.

Here is the opening:
What's the going market rate for a friendly Congressman?

Of course, it's illegal to bribe a legislator. But according to recent episodes of the NPR shows Planet Money and This American Life, Congressmen on powerful committees have a much easier time raising money for their campaign war chests than members of less-powerful committees. And this political clout can be measured in precise dollar amounts...
(Read the full text of "The Best Congress Money Can Buy?")

Sunday, April 15, 2012

Wolf: The Ghost of Kathleen Sebelius Lives

Dr. Milton Wolf asks, "What's the matter with Kansas? The ghost of Kathleen Sebelius lives".

In particular, he notes how short-sighted politics results in both liberals and conservatives supporting health care mandates, such as mandatory insurance coverage for autistic children, which drive up costs for everyone.

Liberals, of course, have no problems with forced redistribution of wealth to appease favored constituencies. Unfortunately, conservatives too often go along, either so they don't appear "heartless" -- or because they believe in similar forced redistributions (differing perhaps only in their preferred recipients).

Dr. Wolf correctly notes:
As the government health insurance mandates expand, the cost of insurance to Kansas families increases. This is unavoidable. The statists solution to the problem they've created is to impose still more mandates to help the people who were victimized by the first round of mandates. It's a vicious cycle but there's a better way.

Eliminate all insurance mandates. Allow Kansans -- free Americans -- to purchase whatever insurance they choose...
(Read the full text of "What's the matter with Kansas? The ghost of Kathleen Sebelius lives".)

When politicians play the game of doling out ever-increasing favors to their pet special interest groups, the end result will be political and economic bankruptcy. This is a losing game for all of America.

As "Joshua" the computer noted in the movie War Games: "The only winning move is not to play."

Saturday, April 14, 2012

Scherz: IPAB Is Real Life Computer Worm

In his 4/12/2012 column, Dr. Hal Scherz of D4PC discusses, "IPAB -- A Real Life Computer Worm Affecting Your Government".

One important point:
But do not be fooled into believing that [IPAB] will affect only Medicare. Private healthcare spending will be reduced as well. IPAB has been given the power to reduce ALL healthcare expenditures, including private insurance.

How might this occur? Once the state insurance exchanges are established, they will be under direct federal oversight and a variety of regulations will go into effect, including price controls. Additionally, private insurance rates follow Medicare rates in the market place, so actions by IPAB to reduce reimbursement will have an indirect effect on the private market.
He notes that if the Supreme Court does not throw out the whole of ObamaCare, then it will be up to Americans to vote for political leaders who will.

Friday, April 13, 2012

Why Obamacare Expands the Deficit

This topic has become a recent hot political item following the Mercatus Center report.

Here's the original author's response to the ongoing debate: "Why Obamacare Expands the Deficit: Charles Blahous Rebuts His Critics"

Thursday, April 12, 2012

Medicare Double-Counting

The Mercatus Center has posted a great video on the economic smoke-and-mirrors behind ObamaCare's Medicare numbers, "Health Care Bill: Double Counting Doubles the Crisis":

Of course, if a private businessman pitched a similar business plan to investors, he'd be thrown in jail for fraud. But it's apparently ok if the government does it.

(Via COHP.)

Wednesday, April 11, 2012

Positive Alternatives to ObamaCare

If ObamaCare is actually struck down by the US Supreme Court, it will be crucial for free-market advocates to have a positive alternative to propose.

Fortunately, there are many people working on precisely this issue. Here are a few that have been proposed:
Avik Roy, "The Tea Party's Plan for Replacing Obamacare".

Sally Pipes, "The Pipes Plan: The Top Ten Ways to Dismantle Obamacare". (Introduction viewable at Scribd.)

Docs4PatientCare, "The Physician's Prescription for Health Care Reform"
I don't necessarily endorse every element of all of these plans. But they all contain excellent ideas that would move us in the right direction towards a full free market in health care.

An in a free market, we'd see all sorts of innovations and improvements, such as affordable "concierge" medicine: "Concierge Doctors: They're Not Just for the Super-Rich Anymore".

Tuesday, April 10, 2012

IRS Getting The Goods

The Hill reports, "White House has diverted $500M to IRS to implement healthcare law".

In other words, the IRS is getting more goodies so that they can better get the goods on you if you don't follow the health care laws.

From the article:
The Obama administration has plowed ahead despite the legal and political challenges.

It has moved aggressively to get important policies in place. And, according to a review of budget documents and figures provided by congressional staff, the administration is also burning through implementation funding provided in the healthcare law.

The law contains dozens of targeted appropriations to implement specific provisions. It also gave the Department of Health and Human Services (HHS) a $1 billion implementation fund, to use as it sees fit. Republicans have called it a “slush fund."

HHS plans to drain the entire fund by September -- before the presidential election, and more than a year before most of the healthcare law takes effect. Roughly half of that money will ultimately go to the IRS.
Although we won't know how the Supreme Court will rule on ObamaCare until June, it's almost as if the Obama administration is trying to push through implementation of much of the law while they still can.

Or to borrow a cancer metaphor from David Catron, they're trying to get the bad law to "metastasize" as quickly as possible into as many nooks and crannies of Americans' lives in order to make it harder to undo in the future.

Radical excision of ObamaCare can't come soon enough -- either by the Supreme Court or at the ballot box. (The Hill link via Dr. Matthew Bowdish.)

Update: Investor's Business Daily offers their own observations in, "Army Of IRS Enforcers Can't Make ObamaCare Legitimate":
Cost: Half a billion dollars, paid for off-the-books by taxpayers through a massive $1 billion Health and Human Services slush fund that got tucked into the bill.

The only conclusion from this stealth move is that the Obama administration expects massive noncompliance from taxpayers with its unpopular mandate.

And that raises questions about its legitimacy as a law. Passed through trickery, bribery and without a bipartisan majority, ObamaCare is already on shaky ground...

When vast numbers of people refuse to obey a law, there's a problem with the law... ObamaCare ultimately boils down to the public's willingness to accept its mandate. That they haven't and that President Obama's only weapon of persuasion is to threaten them speak volumes about the law's viability.

Monday, April 9, 2012

UK Blues

A couple of stories from the UK:

"Surgery bans elderly patient over her carbon footprint" (Telegraph, 4/3/2012)

"Sentenced to death for being old: The NHS denies life-saving treatment to the elderly" (Daily Mail, 4/6/2012)

The US isn't in such dire straits yet. Let's hope we never get there.

Friday, April 6, 2012

Roy: Medicaid's Cruel Status Quo

In a 4/5/2012 Fox News OpEd, Avik Roy discusses "Medicaid's Cruel Status Quo".

As he notes, Medicaid patients have theoretical "coverage", but often lack ability to receive actual care. Even worse, ObamaCare "doubles down" by expanding Medicaid as its vehicle for increasing "coverage", thus making current problems worse.

Roy offers more details in his policy paper, "The Medicaid Mess: How Obamacare Makes It Worse".

Eventually, Medicaid can and should be privatized. Proposals such as "block grants" to states could be a helpful intermediate step, if they eventually lead to complete privatization. But ultimately, in a fully free society those who need medical care but cannot afford it should rely on private charity.

(Fortunately, in a fully free society health care costs would also be much lower, thus enabling many to afford basic care.)

Thursday, April 5, 2012

Legal Risks of Going Paperless

As more physicians and medical offices move (voluntarily or involuntarily) to electronic medical record systems, they should be aware of these "Legal risks of going paperless".

Wednesday, April 4, 2012

Cochrane: Free Market Reforms

In the 4/2/4012 Wall Street Journal, University of Chicago professor John Cochrane offers several constructive free-market reforms that would move the American health care system in the right direction.

He gives details in, "What to Do on the Day After ObamaCare".

Some ideas he discusses include:
* Eliminate preferential tax treatment of employer-provided health insurance
* Eliminate expensive mandated benefits
* "Premium support" for Medicare and Medicaid
* Eliminate legal barriers to training new physicians
* Eliminate anti-competitive "certificate of need" requirements for equipment
All of these would move us in the proper direction of more freedom and less government intrusion in health care. If ObamaCare is overturned by the Supreme Court, it's important that free-market supporters be ready to propose positive ideas as an alternative.

For more details, see the full text of "What to Do on the Day After ObamaCare".

(Note: "Premium support" for Medicare and Medicaid can should be a step towards full privatization of these programs, not another permanent government entitlement program.)

Tuesday, April 3, 2012

Scherz: Clinical Perspective on ObamaCare

Dr. Hal Scherz of Docs4PatientCare reviews, "Obamacare and The Supreme Court – the Clinical Perspective" (TownHall, 4/3/2012).

In particular, he warns what will happen if ObamaCare is not overturned by the Supreme Court:
All actions always have consequences -- whether intended or unintended. The result of Obamacare will be less doctors working, which means that the guarantee of increased access to healthcare is a false promise. Your insurance card will only provide a place in line. It means that the Patient Centered Outcomes Research Institute will decide what treatment you will get. It means that the Secretary of Health and Human Services will tell your doctor how to practice medicine.

On this current path, the private practice of healthcare will disappear within the next 10 years, as physicians sell their practices to hospitals, afraid that they can no longer afford to stay in business. More than 50% of doctors now work for hospitals. Obamacare suspends antitrust regulations so that hospitals can consolidate doctors’ practices into a single entity -- an accountable care organization (ACO). Under such an arrangement, the doctors work for the ACO and not for the patients.

There already are rumblings coming from Washington suggesting that physician licensure needs to be nationalized in an attempt to compel doctors to see patients on Medicare and Medicaid and avert the mass exodus that is expected when reimbursement rates are slashed in the coming years.
Such nationalization of the medical profession would be a disaster for patients and doctors alike.

(Read the full text of "Obamacare and The Supreme Court – the Clinical Perspective".)

HSAs At Risk?

Roy Ramthun asks, "Do Health Savings Accounts Have a Bullseye on their Back?"

Short answer: "Probably". But we'll know more soon.

Monday, April 2, 2012

Liberals And Conservatives Flip-Flopping On The Mandate

Avik Roy remembers how many liberals once hated the individual mandate.

And how many conservatives once supported it.

ObamaCare Without The Mandate

Andrew Sullivan asks, "What happens if the mandate is ruled unconstitutional but the rest of the law is left intact?" It's not a pretty picture. (Via Dr. Art Fougner.)

Avik Roy discusses a similar example, "Want to See a Health Insurance Death Spiral? Visit Washington State"

Schwartz: Don't Trust The Colorado Trust

In the 3/31/2012 Boulder Daily Camera, Brian Schwartz explains, "Don't trust the Colorado Trust".

Schwartz rebuts some of the fallacious "cost shifting" arguments they make in support of ObamaCare. In particular, the cost shifting from the uninsured is relatively small compared to the cost shifting caused by Medicaid, Medicare, and various mandated insurance benefits. Yet the Colorado Trust is in favor of all of these programs.

As he notes:
Don't be fooled. Mandatory insurance isn't about personal responsibility or reducing cost-shifting. It's about using politically-controlled health plans to advance political control of your medical care.
(Read the full text of "Don't trust the Colorado Trust".)