Bizarre Drug IP Incentives

Bizarre economic incentives in drug IP laws can create unusual "unexpected consequences".

Here are more details at this Freakonomics.com post, "Why Do Patent Holders Sometimes Pay Patent Copiers?"

Quick Links: HSA, Catron, PSA, MA

Brian Schwartz: "Insurance with HSAs gain popularity, but authorities want to ban them".

David Catron: "Another Obamacare Mandate Runs Afoul of the Courts" (American Spectator, 7/30/2012).

Medical News Today: "Study: No PSA Tests, Advanced Cancer Triples" (7/30/2012, via Dr. Art Fougner).

WBUR: "Mass. Aims To Set First-In-Nation Health Care Spending Target" (7/30/2012, via @OHPCenter). Yes, this is a proposal for the government to set a hard cap on overall medical spending. Just don't call it rationing.

Reminder: Lecture Tomorrow on Medical Licensing

Reminder: For those in Colorado, I'll be one of two speakers tomorrow at Liberty on the Rocks event on Milton Friedmam.

My talk will be 30 minutes, on "Milton Friedman and Medical Licensing".

The event is free, 5:30 pm to 7:30 pm, 31 July 2012.

Directions and details here:

Celebrate the Life of Dr. Friedman With LOTR!

To celebrate the philosophy of liberty and to honor Dr. Friedman on what would have been his 100th birthday, Liberty on the Rocks is hosting an educational event complete with networking, cocktails and appetizers, and rousing discussions from two local liberty advocates and experts.

The War on Drugs

What did Dr. Friedman think about the War on Drugs? Hear from local lawyer and liberty activist David K. Williams, Jr., who will share the views espoused by Milton Friedman on this critically important subject.

Medical Licensing

Throughout his career, Dr. Friedman was adamant about the need for ending medical licensing of doctors. Hear from local radiologist and liberty activist Dr. Paul Hsieh to learn about Milton’s view on this topic, and the economic and moral reasons behind his crusade.

RSVP to this FREE event today!  https://www.facebook.com/events/140634582739255/

Location: 

Independence Institute

727 E. 16th Ave., Denver, Colorado 80203

Thank you, Amanda Teresi-Muell, for organizing this!

Taxing Medical Innovation

More on the pernicious effects of the tax on medical devices: "Indiana company scraps plans for expansion over ObamaCare device tax". (Fox News, 7/27/2012).

Taxing medical innovation will cost jobs. And it will also cost lives, in the forms of devices that won't be invented, but could have.
 
For more on this, see my PJMedia piece from 2010, "The Deadly Tax on Medical Innovation".

NYT Notices Coverage Doesn't Equal Care

The 7/28/2012 New York Times reports, "Doctor Shortage Likely to Worsen With Health Law".

I was especially struck by the fact that they finally recognize that "coverage" does not equal health care:

[In the Inland Empire region of California,]President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now...

Experts describe a doctor shortage as an "invisible problem." Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

And by the way, which fields don't have a shortage?  The fields that are less regulated (and thus more free-market), namely plastic surgery and dermatology:

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. 

(Read the full text of "Doctor Shortage Likely to Worsen With Health Law".)

The government is trying to find ways to "fix" the problem, but their proposed solutions unlikely to solve the problem.

And given that their policies are driving many doctors to consider quitting medicine or retiring early, I don't forsee this situation changing in the near future.

Fogoros Book Complete

Dr. Rich Fogoros has completed all the chapters of his book, "Open Wide And Say Moo! – The Good Citizen's Guide To Right Thoughts and Right Actions Under Obamacare".

Here's the complete first draft.

Although I don't necessarily agree with all his points, he makes numerous excellent observations about the ominous new direction of American medicine, and what we can do to turn it around.  His book is thought-provoking and definitely worth reading.

IBD: Could ObamaCare Make The Uninsured Problem Worse?

John Merline of Investors Business Daily asks, "Could ObamaCare Make The Uninsured Problem Worse?" (7/25/2012)

In particular, the combination of a relatively weak individual mandate/tax, other insurance regulations (guaranteed issue, community rating), and economic incentives that will cause many employers to drop workplace coverage could drive up the number of uninsured Americans.

 In other words, further government regulations to "solve" a problem will actually make things worse.

Totally unsurprising. (Via Instapundit.)

PIA Interview On Surviving ObamaCare

Diana has uploaded the audio of my interview with her from last night:  

On Wednesday evening's episode of Philosophy in Action Talk Radio, I interviewed my own Dr. Paul Hsieh on "Surviving Socialized Medicine."

If you missed the live broadcast, you can listen to the audio podcast. You'll find that posted below, as well as on this episode's archive page: Talk Radio: 25 July 2012.

Talk Radio: Episode: 25 July 2012

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Follow Philosophy in Action

Wednesday Radio Interview: Surviving Socialized Medicine

On Wednesday evening (tonight), I'll be a guest on philosopher Dr. Diana Hsieh's live internet radio show, Philosophy in Action, to discuss "Surviving Socialized Medicine."

• What: Philosophy in Action Talk Radio: Surviving Socialized Medicine
• Who: Dr. Diana Hsieh, with Dr. Paul Hsieh, plus live callers
• When: Wednesday, 25 July 2012, 6 pm PT / 7 pm MT / 8 pm CT / 9 pm ET
• Where: Philosophy in Action's Live Studio

With ObamaCare confirmed by the Supreme Court, what can a person do to preserve his health under America's increasingly socialized system of medical care?

To join the live broadcast and its chat, just point your browser to Philosophy in Action's Live Studio a few minutes before the show is scheduled to start.

By listening live, you can call the show with your questions and experiences, as well as post comments and questions in the text chat.

If you miss the live broadcast, you'll find the audio from the episode posted here: Philosophy in Action Talk Radio: 25 July 2012.

Join us on Wednesday evening for an engaging discussion of "Surviving Socialized Medicine"!

Quick Links: Hentoff, Turner, Wolf

Nat Hentoff: "What Still Shocks Me About ObamaCare" (RealClearPolitics, 7/24/2012, via @sonodoc99)

Grace-Marie Turner: "How Much Is The Obamacare Mandate Going To Cost You?" (Forbes, 7/24/2012)

Dr. Milton Wolf: "Stop!! Obamatime!" [video] (Daily Caller, 7/23/2012).  Come for the satire, stay for the radiologist dance moves!

Hsieh PJM OpEd: Media Underplays Successful Defensive Gun Use

PJMedia has just published my latest OpEd, "Media Underplays Successful Defensive Gun Use".

My theme is that American journalists should report the whole truth about defensive gun use by law-abiding citizens rather than burying that fact.

Here is the opening:

On February 28, 2012, an angry 28-year-old gunman entered a medical office building in Colorado Springs and took three women hostage. After a three-hour standoff, the police shot him, and he died later that evening at a local hospital. The hostages were unharmed.

Yet the two largest newspapers in the state took two very different approaches in reporting the heroic actions of one of the clinic physicians, Dr. Jeff Ferguson, a legally armed civilian...

(Read the full text of "Media Underplays Successful Defensive Gun Use".)

On a personal note: The recent murders in Aurora, CO, were unspeakably evil, and my thoughts are with the victims and their families.  Some of the wounded are at the hospitals where I work and the doctors and medical staff are doing everything they can for them.  I want to offer my best thoughts for the patients' successful recoveries.

Catron: The IRS Illegally Expands Obamacare Tax Credits

In the 7/23/2012 American Spectator, David Catron describes how "The IRS Illegally Expands Obamacare Tax Credits".

As Catron notes, the feds will attempt an end-run around the law by distributing certain monies through federal "exchanges" even if the law as written only allows the states to do so.  This would nullify the attempts of various anti-ObamaCare governors to block the law at the state level by declining to establish state-run exchanges.

But even if the legal problems are clear-cut, we now know the courts will not likely uphold legal challenges to such actions. Instead, they'll likely defer to what they regard as the will of the legislature.

US Supreme Court Chief Justice made that very clear when he wrote: "It is not our job to protect the people from the consequences of their political choices."

Which means it really comes down to the voters in November.

Update: Catron notes that two Congressmen have introduced a bill to try to stop this maneuver.

Hsieh Lecture: Milton Friedman and Medical Licensing

I'll be speaking next week at Liberty on the Rocks on "Milton Friedman and Medical Licensing".

Save the date: 31 July 2012.

The event is FREE, 5:30 pm to 7:30 pm.

Directions and details here:

Celebrate the Life of Dr. Friedman With LOTR!

To celebrate the philosophy of liberty and to honor Dr. Friedman on what would have been his 100th birthday, Liberty on the Rocks is hosting an educational event complete with networking, cocktails and appetizers, and rousing discussions from two local liberty advocates and experts.

The War on Drugs

What did Dr. Friedman think about the War on Drugs? Hear from local lawyer and liberty activist David K. Williams, Jr., who will share the views espoused by Milton Friedman on this critically important subject.

Medical Licensing

Throughout his career, Dr. Friedman was adamant about the need for ending medical licensing of doctors. Hear from local radiologist and liberty activist Dr. Paul Hsieh to learn about Milton’s view on this topic, and the economic and moral reasons behind his crusade.

RSVP to this FREE event today!  https://www.facebook.com/events/140634582739255/

Location: 

Independence Institute

727 E. 16th Ave., Denver, Colorado 80203

Thank you, Amanda Teresi-Muell, for organizing this!

Quick Links: Minton, Cochrane, UK

Michelle Minton: "More FDA Control Does Not Mean More Safety" (CEI, 7/18/2012)

John Cochrane: "Forget About the Mandate. Let’s Fix Health Care" (Bloomberg, 7/12/2012)

UK update: "Thousands could lose their sight as NHS cuts cataract surgery by a quarter" (Daily Mail, 7/15/2012)

Civilian Responses to Active Attackers

[This is a bit off-topic for my usual health care blogging, but I'm exercising bloggers' prerogative.  --PSH]

If you ever find yourself in a mass-shooting incident, how can you safely respond?

My friend Ari Armstrong discusses this with his father Linn Armstrong (a firearms instructor here in Colorado) on what unarmed -- and armed -- civilians can do. For instance, unarmed civilians could throw their movie theater drinks and any available objects en masse at a shooter, thus disorienting him.

Here's the full blog post by Ari and the related video, "Civilian Responses to Active Attackers":




FWIW, my group practices at two of the big trauma hospitals in Denver that received casualties from the Colorado shooting, The Medical Center of Aurora (TMCA) and Swedish Medical Center.

I was off-duty that night, but when I came in early that morning I talked to one of the ER doctors at TMCA who helped treated these patients.  He and his colleagues were worn out after a long and busy night, but they did a terrific job under enormous pressure.

The Accelerating Collectivizing of American Medicine

The July 19, 2012 Washington Post reports, "Health-care law driving doctors away from small practices, toward hospital employment".

A few excerpts from the article:

During a hearing before the House Small Business Committee on Thursday, health-care professionals explained that the shift has already been picking up momentum in recent years, driven largely by growing regulatory and administrative burdens, rising malpractice costs and declining reimbursements from insurers -- all of which they say have hit small practices especially hard. Consequently, doctors are shying away from the traditional solo practitioner model in favor of employment at large hospitals...

Now there's an additional catalyst physicians say may expedite the decline of small practices -- the Patient Protection and Affordable Care Act, passed in 2010 and recently approved by the Supreme Court.

For starters, PPACA made Accountable Care Organizations -- referring to groups of providers that take responsibility for the care for an entire patient group -- an official part of the Medicare program this year, giving hospitals added incentive to scoop up physician partners.

"Because of bundled payments and other measures in the law, hospitals want to make sure they have enough primary care physicians, particularly, as well as specialists that they can have in their Accountable Care Organizations so they can participate," Dr. Jerry Kennett, senior partner at Missouri Cardiovascular Specialists in Columbia, Mo., told lawmakers.

But the law also comes with new regulations and non-compliance penalties that could further deter doctors from self-employment...

Bear in mind, this is not some "unintended consequence". From my July 2011 PJMedia piece, "The Coming Collectivization of American Health Care":

The Obama administration regards this collectivization of medical providers as a desirable outcome, not merely some “unintended consequence.”

As Obama health advisor Nancy-Ann DeParle wrote last year in the Annals of Internal Medicine, the new law will “accelerate physician employment by hospitals and aggregation into larger physician groups” and “physicians will need to embrace rather than resist change.”

Translation: “Doctors should get with the program — or else!”

Furthermore, such collectivization is merely a continuation of a much older strategy. 

Jonah Goldberg’s book Liberal Fascism described how the Roosevelt administration sought similar consolidations of American agriculture and business during the New Deal. As Goldberg noted:

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

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

Once doctors are herded into ACOs, they will become increasingly accustomed to simply following orders from ACO administrators (who in turn will be proxies for government health bureaucrats).

The New York Times recently reported that after physicians became hospital employees, they became much more accepting of government controls over health care than their counterparts in private practice...

If a physician freely decides to join a large multispecialty group practice (or become a hospital employee) based on his own best professional judgment and individual practice preferences, this is not necessarily bad. 

But when the government tilts the playing field to drive doctors out of small private practices into these more easily-regulated large entities, that's a different matter altogether.

As Dr. Jay Parkinson observes, this really means that "bureaucrats determine the business model of a doctor’s practice".

Under such a system, doctors lose the freedom to practice how they best see fit.  When that happens, patients lose the freedom to receive the care their doctors deems most appropriate.

Do we want that kind of medical system?

Employers and ObamaCare

As ObamaCare continues to be phased in, some are asking "Will your employer abandon health coverage under new law?"  (Via Dr. Art Fougner.)

Companies with more than 50 employees will be required to provide health insurance for their workers or else face financial penalties.

CNN reports, "Trying to duck health care's employer rules? Don't bother".

Perhaps companies already employing more than 50 people will have a hard time finding loopholes around the law.

But you can be sure that many companies who only have 45-49 employees will try pretty hard not to grow to the size where they exceed 50 and thus be subject to the law.

Given the tough economy, the last thing we need is further incentives for companies to not hire willing workers.

Krening: What ObamaCare Means to Me

Our friend (and cancer survivor) Hannah Krening discusses the patient's perspective on government-run health care at, "What ObamaCare Means to Me".(TOS blog, 7/18/2012)

Here's an excerpt:

Should my cancer return, will I have access to the expensive but vital drugs that boosted my depleted red and white blood cell counts and kept my chemotherapy and radiation treatments on schedule and thus more effective? What restrictions will my doctor face in prescribing treatment, and what restrictions will I face in obtaining it? No one knows.

Until government gets out of the health-care business and starts protecting rather than violating the rights of providers, patients, and insurers to contract voluntarily in a free market, my greatest fear is not that I might need treatment in the future—that I could deal with. My greatest fear is that if I do need treatment, I won’t be permitted to receive it.

(Read the full text of "What ObamaCare Means to Me".)

This could be you, your mother, your sister, or your wife.

Health Care Sharing Ministries

The 7/8/2012 USA Today highlighted, "Health care sharing ministries offer insurance alternative".

Basically, these are voluntary cooperatives in which members (typically of a shared religious affiliation) agree to help cover each others' medical costs in case one of them gets sick. The details vary from group to group, but overall:

In these ministries, members pay a monthly fee that gets dispersed to a member who needs help paying medical bills. Depending on the ministry, the money may go directly to the family in need or through the ministry.

Most of those who opt to belong lack affordable insurance through an employer. Ministry members must attest they are good Christians and live life accordingly.

Such mutual aid arrangements are an excellent idea. In a fully free society, we'd likely see more of such arrangments.

I also discussed these private arrangments in my article, "How the Freedom to Contract Protects Insurability" (The Objective Standard, Fall 2009):

In fact, many Americans have already formed private pools in which members voluntarily share each other’s health-care costs.

For instance, more than 100,000 American Christians are members of “health-care sharing ministries”—arrangements whereby members pay a monthly fee to the ministries, which in turn distribute that money to other members facing expensive medical bills. Such groups typically accept members who meet certain religious and lifestyle requirements regardless of preexisting medical conditions.

Unfortunately, these health-care sharing ministries currently cannot guarantee payments to their members, because the government would then treat them as insurance companies and subject them to myriad onerous state and federal regulations that specify what prices they may charge, what benefits they must offer, and which customers they must accept.

The only thing preventing individuals from creating their own contractually binding risk pools today is the government.

All Americans (religious or otherwise) should be left free to form such voluntary mutual aid societies as they see fit.

Quick Links: Armstrong, Catron, HSAs

Ari Armstrong: "No, Edolphus, Health Care is Not a 'Right' or a 'Privilege'" (TOS blog, 7/16/2012)

David Catron: "No, Professor Gruber, Obamacare Won't Boost the Economy" (American Spectator, 7/16/2012)

Paul Howard: "What happens to Health Savings Accounts (HSAs) now?" (Medical Progress Today, 7/12/2012).  Short answer: "Regulations are slowly strangling HSAs"

FDA Spies On Dissenting Scientists' E-Mails

The 7/14/2012 New York Times reports that FDA spied on its own scientists' e-mails as well as external critics of the agency:

While federal agencies have broad discretion to monitor their employees’ computer use, the F.D.A. program may have crossed legal lines by grabbing and analyzing confidential information that is specifically protected under the law, including attorney-client communications, whistle-blower complaints to Congress and workplace grievances filed with the government.

Sure, I trust them to protect my health.

(Via Instapundit.)

Scherz and Koriwchak: The Health Information Technology Boondoggle

Dr. Hal Scherz and Dr. Michael Koriwchak of Docs4PatientCare have a new TownHall OpEd, "The Health Information Technology Boondoggle".

When electronic medical record systems are selected by hospitals and physicians in response to clinical needs, based on free-market principles, they can be tremendously helpful in improving efficiency and patient care.

But when they are imposed by fiat by the government, they won't help doctors treat patients. It would be like the government telling you what kind of cellphone and data plan you must have, regardless of your actual needs.

But these health IT systems will help the government more closely track whether doctors are adhering to government practice guidelines.

Hence, they represent the next step in government control of American medicine.

More Under-The-Radar ObamaCare Provisions

So what else is in the ObamaCare law?

This 7/12/2012 piece from Kaiser Health News lists, "Ten Things You Didn't Know Were In The Affordable Care Act".

Two in particular that caught my eye:

New specifications on which sorts of advanced wheelchairs for Medicare must be rented vs. purchased.

States will have to specify in death certificates whether the deceased had diabetes or not.

I'm just glad the new regulatory overhead will be a minimal burden on honest Americans.

Doctors Bowing Out

Dr. Jordan Grumet describes how, "Doctors are quietly and incrementally bowing out".

An excerpt:

Physicians are looking for a way out. They are becoming businessman, social media entrepreneurs and commentators, writers, reformers, and career coaches. They are retiring early and cutting their hours. I spend less time in the clinic than ever before. Each year I replace some of my office time with non clinical revenue generating activities. The joy of patient care is being overshadowed by regulation. We are quietly and incrementally bowing out...

In the end, it will be American patients who suffer as a result.  

Related: This recent Daily Caller piece notes that, "83 percent of doctors have considered quitting over Obamacare".

Moreover, CNN reports that independent solo physicians are dying breed. 

Economic and political pressures are going to drive the remaining doctors into large group practices (or to become hospital employees), where their practice patterns can be more easily tracked by regulators via mandatory electronic medical records.  This will likely also accelerate the trend of some doctors bowing out of the new system.

Patient-Centered Health Care In Jeopardy

RealClearPolicy discusses how ObamaCare guarantees higher costs by outlawing the affordable health care revolution. (Via Stephen Bailey.)

Related: "Just Who Should Control Your Healthcare Spending?"

KevinMD Post: How Will ObamaCare Affect Prostate Cancer Screening?

The widely-read medical commentary website KevinMD.com has just reposted my OpEd, "How will ObamaCare affect prostate cancer screening?"

(It originally appeared at Forbes.com under the title, "Is President Obama's Prostate Gland More Important Than Yours?")

My theme is that you should enjoy the same freedom to make medical decisions as President Obama.

Or a snarkier version of the theme: "Medical freedom for me, but not for thee."

Here is the opening:

When President Obama turned 50 last year, he made an "informed patient request" for a PSA (Prostate Specific Antigen) test. This is the blood test routinely used to screen men over 50 for possible prostate cancer. The President received his PSA test. But under ObamaCare, you may not be able to.

Now that ObamaCare has been upheld by the Supreme Court, all of its major provisions will be in force, not just the controversial “individual mandate.” This includes government medical practice guidelines that will affect millions of Americans...

(Read the full text of "How will ObamaCare affect prostate cancer screening?" at KevinMD.com.)

Thank you, Dr. Kevin Pho, for reposting this piece. And thank you, Forbes, for allowing republication!

Doctors In Portugal Go On Strike

BBC news (7/11/2012) reports that Portugese doctors are going on strike under that country's government-run health system.

I'm just glad this could never happen here in the US.

Quick Links: UK, HSA, TX Medicaid

UK rationing update: "Hospitals 'letting patients die to save money'" (Telegraph, 7/8/2012).

Flopping Aces: "ObamaCare – Killing Health Savings Accounts", 7/8/2012. (Via Dr. Art Fougner.)

Medicaid update: Fewer Texas doctors willing to accept Medicaid (Fort Worth Star-Telegram, 7/8/2012)

Armstrong D4PC Congressional Testimony

Dr. Richard Armstrong, Chief Operating Officer of Docs4PatientCare, testified before Congress earlier today on the negative effects ObamaCare will have for patients and doctors.

Here's a downloadable PDF copy of his testimony, discussing how ObamaCare will harm the doctor-patient relationship.

Update: Here's the final version of Dr. Armstrong's testimony below (thanks to Dr. Beth Haynes):

Mr. Chairman, members of the committee, ladies and gentleman; it is an honor to speak with you today on behalf of Docs4PatientCare and thousands of practicing physicians nationwide who share our deep concern about the effects of the Affordable Care Act upon the practice of medicine and specifically upon our relationship with patients.

You have my written testimony and the attached information.  In the interest of time I will depart from the written documents.  In response to the question…how does this law affect the physician-patient relationship?  The answer is…it destroys it.

This has been developing for many years, but this law truly makes it crystal clear.  In fact, Dr. Donald Berwick, the former head of CMS has written that for this law to work…”the traditional physician-patient dyad must end.”

All of you on this committee see your doctor from time to time.  What do you expect from the visit?

You’d like a friendly compassionate doctor who will listen to you, examine you and talk to you.  The doctor will call on extensive training and experience to devise a plan that you both agree upon and understand.

Your doctor simply wants to do what their training has prepared them to do…listen to your history, do a physical exam, discuss the findings and recommend a plan.

Unfortunately, that is not how things are going in medicine.

To illustrate how things are changing, I’d like to share some stories.

Electronic medical records systems have been touted as a “cure” for many of the problems in our health care systems today.  Unproven and untested, these claims are simply not true.

During a recent sales demonstration at my hospital, the presenter, a physician’s assistant, took 30 minutes to demonstrate how to document the patient encounter with their system.  The process  was unfriendly to both patients and doctors.

One of our primary care physicians asked…”how do you propose that I do this in the 15 minutes that I normally have with patients?”

He answered….”The goal is to reach at least a level 3 visit.”

I’ll say that again…”The goal is to reach at least a level 3 visit.”

In other words, the billing trumps the medical care.

He added…”So, you have your nurse enter the history data, you fill in the physical exam data, make the plan and move on to the next patient.”

Really?   Where in these 15 minutes do you talk to the patient or listen to the patient…you, the doctor?

As a patient, how do you feel?  Did you develop a relationship or are you part of an assembly line?  I think that most of us know the answer and it should make us both sad and angry.

And then there is this account of a fellow physician’s recent experience taking her father to visit his new primary care doctor:

This is her story…

“I took my father, 80 years old and living independently,  to meet his new internal medicine physician yesterday.

I sent ahead a brief summary of his history, list of meds, and request that he do a physical exam, since it had been well over three years since it was done.

After introducing himself, he immediately announced that federal 'guidelines' no longer allow regular exams. An exam allows only listening to hearts, lungs, and bowel sounds (with patients sitting, mind you) - and does nothing else unless there was a specific complaint to justify it. I asked if anemia (which my father has) justified a rectal exam - he said no.  He of course quoted repeatedly the US Preventive TASK Force recommendations as one of the standards. He recited the statistics and the 'societal' cost arguments.  He had it down; a perfectly 'useful idiot'.

He said he only does 'evidenced based' medicine. In fact, he had just been to a conference to confirm the validity of his positions.  I did not engage him - it was not appropriate with my poor father sitting there listening to how he is too old for……well, anything.

Eventually, to pacify me, the doctor went through the motions of the rectal exam (after having to leave the exam room to get gloves and lubricant, which are of course, of no use to him).  I doubt he even knows how to do a rectal, since my Dad (who has had many) hardly felt it. “

Again, guidelines trump medical care.

This is the reality of Obamacare.  There is no care.  This law, supported by organized medicine, has been consistently opposed by Docs4PatientCare and AAPS.

Things do not need to be this way. We need not turn our doctors into government drones.  But, under a government controlled one-size-fits all plan, that is what we can expect and what we are witnessing nationwide…today.

Physicians are being buried under increasing financial and bureaucratic burdens.  Time is literally stolen from direct patient interaction, destroying the physician-patient relationship and fragmenting patient care.

This does not have to occur.  American physicians need to be free to do what they have been trained to do…excel at practicing medicine.

American patients need to be free to choose health insurance plans and medical treatments that suit their needs, not something coerced by a central authority.  This is simply impossible under the suffocating burden of the Affordable Care Act. 

Thank you for the invitation to speak with you today.  I’ll be happy to entertain your questions.

Catron: The States Can Still Kill Obamacare

In his 7/9/2012 OpEd at American Spectator, David Catron discusses how, "The States Can Still Kill Obamacare".

Basically, ObamaCare relies on the state-run "exchanges" for consumers to purchase their mandatory insurance (if they don't receive it through their workplace). But states aren't required to establish the exchanges.

Furthermore:

The federal government can set up its own exchanges, in theory, but Obamacare stipulates that Washington would then be required to pick up the tab as well. And, as [Cato analyst Michael] Cannon goes on to point out, "The Obama administration has admitted it doesn't have the money -- and good luck getting any such funding through the GOP-controlled House."

And it gets worse. If the federal government is forced to set up an exchange, it faces yet another huge problem. As Sally Pipes and Hal Scherz write, "The text of the law stipulates that only state-based exchanges -- not federally run ones -- may distribute credits and subsidies."

Thus, if a state refuses to set up an exchange, the feds have no real ability to do so either. The states have an opportunity, therefore, to shoot a poison arrow directly into Obamacare's Achilles' heel...

(Read the full text of "The States Can Still Kill Obamacare".)

Some states are already adopting this strategy.

But as Catron reminds us, ultimately the best way to kill ObamaCare will be at the ballot box in November.

Update:  David Catron notes that Texas has joined the list of states opposing ObamaCare in this fashion.

Get Ready For the Taxes

Gateway Pundit: "Lawyers Have Already Drafted 13,000 Pages of Regulations for New ObamaTax Law".

I just think of it as an opportunity for more patriotism! (H/T: Milton Wolf.)

Quick Links: Medicaid, Privacy, UK

Kaiser Health News: "States Balk At Expanding Medicaid" (7/2/2012). Due to a combination of politics and economics.

Boston Globe: "As records go online, clash over mental care privacy" (6/21/2012)

BBC: "NHS charging and rationing 'may be needed'" (7/3/2012). Hey, let's fix the UK national health system with more rationing. And making it no longer "free"!

Hsieh Forbes OpEd: Is President Obama's Prostate Gland More Important Than Yours?

Forbes.com has just published my latest OpEd, "Is President Obama's Prostate Gland More Important Than Yours?"

My theme is that you should enjoy the same freedom to make medical decisions as President Obama.

Snarkier version of the theme: "Medical freedom for me, but not for thee."

Here is the opening:

When President Obama turned 50 last year, he made an "informed patient request" for a PSA (Prostate Specific Antigen) test. This is the blood test routinely used to screen men over 50 for possible prostate cancer. The President received his PSA test. But under ObamaCare, you may not be able to.

Now that ObamaCare has been upheld by the Supreme Court, all of its major provisions will be in force, not just the controversial “individual mandate.” This includes government medical practice guidelines that will affect millions of Americans...

(Read the full text of, "Is President Obama's Prostate Gland More Important Than Yours?")

Stossel: Obama's SCOTUS Victory Speech Translated

John Stossel translates Obama's SCOTUS victory speech into plain English.

Read the whole thing. (Via Brian Schwartz.)

Happy Independence Day!

   Happy Independence Day!

   (Regular blogging will resume tomorrow.)

List of ObamaCare Taxes

For your reference, Americans for Tax Reform has compiled this handy list, "Full List of Obamacare Tax Hikes: Listed by Size of Tax Hike" (6/29/2012).

From their introduction:

Obamacare contains 20 new or higher taxes on American families and small businesses. Arranged by their respective sizes according to CBO scores, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, their effective dates, and where to find them in the bill.

Here's the PDF version.

More Doctors' Reaction To SCOTUS

I'm seeing more reactions like this post-SCOTUS: "A Surgeon Cuts to the Heart of the ObamaCare Nightmare".

Or this picture, which is worth 1000 words (from Dr. Meg Edison).

Another Doctor Squeezed by ObamaCare

A physician colleague posted the following on Facebook, as part of a discussion of rethinking his career in the wake of the Supreme Court ObamaCare decision. Basically, the new government controls will drastically limit his autonomy to practice, force him to fire people, and shatter his dreams of owning his own small private practice.

He has given me his permission to repost this lightly-edited excerpt:

We all go into medicine for different reasons. We all believe in 'helping people,' as we all wrote in our admissions essays. But we all also have enlightened self-interests in pursuing a career in medicine.

Some of those are related to money, to scientific inquiry, take part in an endeavor worthy of respect, etc. A big part of my decision to enter the Art was also to be able to take a bigger role in guiding my life's wishes, i.e. autonomy. 

As a lowly lab tech & employee, I was frustrated being at the mercy of others. I saw medicine as a way to take control of my own life. And I love it at present given all of its current faults. I can decide how much to work, what types of patients to see, how much time I spend on certain patients, etc.

But this bill directly attacks that autonomy in ways no individual insurance company could ever. ACOs [Accountable Care Organizations] with their care rationing incentives, bans on physician-owned hospitals (i.e., there will be no new Mayo Clinics or competition to Big Hospitals), meaningful use, gold-silver-bronze plans with dictated coverage, the IPAB [Independent Payment Advisory Board], etc., all centralize decision making authority away from doctors and patients and move that to government bureaucrats whose main concerns may be costs or graft.

While the rest of the world becomes more vibrant and flexible through decentralization, this Administration has 1) identified people like me (us) as the problem and not the solution, and 2) placed itself on the wrong side of history (and freedom) by centralizing perhaps the most important decisions people will be making about their lives and some of the most important recommendations that doctors can provide to them during their time of need.

So while I can morph to make sure I still make a decent wage, how do I maintain my self-respect in a setting that doesn't value my contributions?

Second, I would respectively challenge your notion that I've come a long way in all of this. 13 years ago I was living month-to-month with little savings and feeling trapped. Now, I am up to my ears in debt, essentially living month to month with no savings. I can't afford a home. I am just a couple of paychecks away from being homeless and defaulting on loans. And I don't have any great escapes that wouldn't negative impact my family (i.e., I'm still trapped). I knew that it would be tough before it would get better.

And while I'm now beginning to see the light at the end of the tunnel where I will get ahead of the game, I have an Administration that says I have to spend six figures on electronic medical records (which of my employees do I fire to buy an EHR [Electronic Health Record]?), that will filter some (and eventually all) of my payments through a big hospital system, that says I am the problem with medicine, that taxes me to death, that has frozen with regulations and taxes my small business from hiring above 50 employees so I can compete with larger providers, that outside of medicine claims that I am not paying my fair share, that's made it more difficult for me to get a loan, that will increase the costs of insurance for my patients, that will tax me as a specialist to shuttle more money to PCPs that will take worse care (if you believe the studies) of asthma & allergy patients than I do, etc.

Up to this point in my life, I've been an optimist because I felt that I could overcome any challenge. Now, I don't see how my dream of owning my own small medical practice is possible with what's coming down the pike.

So, do I employ a bunch of NPs [Nurse Practitoners] and essentially become an administrator, do I go off the grid and open a concierge IM [Internal Medicine]/allergy practice, or do I find something else to do?

(Note: The material in square brackets [ ] are my own insertions to clarify some of his abbreviations.)

I really hope my colleague doesn't decide to leave the profession, especially not after all his years of hard work, including college, medical school, residency, and fellowship.

But I wouldn't blame him if he did.

Reynolds on SCOTUS, ObamaCare, and Legitimacy

Glenn Reynolds (aka "Instapundit") has a piece in today's Washington Examiner, "The Supreme Court, Obamacare and 'legitimacy'".

He goes through the tortured history of ObamaCare (including how it was passed), then notes: "[A]t the end of the day, the legitimacy question rests not with the Supreme Court, but with Congress and the president."