McGuff on Fitness, Health, and Liberty

Dr. Doug McGuff (a practicing ER physician and a nationally-known expert on fitness and exercise) gave a nice lecture to The 21 Convention on "Fitness, Health, and Liberty".

I'm honored that he incorporated a lot of material from the FIRM website and I'd like to thank him for his excellent talk!



In particular, I liked how he shows how controls breed controls.  The government consistently doubles-down on bad laws by adding more bad laws, rather than repealing earlier ones.

He also discusses several practical tips to stay healthy and to minimize reliance on an increasingly government-controlled medical system.

Additional links:

• Download the full powerpoint from this presentation (free).
• Download the full length MP3 of this presentation.

(Dr. McGuff is a partner with Blue Ridge Emergency Physicians, P.A. Dr. McGuff Lives in Seneca, South Carolina with his wife of 25 years, and their Children Eric and Madeline.  He is the best selling co-author of Body by Science and The Body by Science Question and Answer Book.  For more information, please visit BodyByScience.net.)

Quick Links: UK, FL, 2013

From the UK: "Cystic Fibrosis sufferer denied 'chance of life' drug by NHS".

From Florida: "Health Law's Promise Of Coverage Not Resonating With Miami's Uninsured"

Grace-Marie Turner: "The Avalanche Of New Obamacare Rules Will Come In January, 2013" (Forbes)

Advice From Dr. Madianos

Dr. Evan Madianos offers, "Advice from Your Friendly Local Radiologist: Vote to Repeal ObamaCare".

Quick Links: Takeover, Taxpayers, Wales

From Patient Power Now: "Ten Reasons ObamaCare is a Government Takeover of Health Care"

Viard: "Both Parties Defend Medicare, None the Taxpayer" (Real Clear Markets).

I look forward to the day when the debate is over how to phase out Medicare, not how to save it.

Wales Online: "Lack of doctors in Wales causing NHS systems to 'break down'" (via Dr. Art Fougner and Dr. Richard Amerling.)

Quick Links: Bankruptcy, EMR, Sicker

Sally Pipes, "Medical bankruptcy: Fact or fiction?" (The Hill, 10/23/2012)

(Her conclusion: "The overwhelming body of research shows that medical costs play little or no role in the vast majority of U.S. personal bankruptcies."  Plus she notes that Canada has a nearly-identical bankruptcy rate as the US, despite the fact that Canadians have "free" government-provided health care.)

Dr. Anne Marie Valinoti,  "Physician, Steel Thyself for Electronic Records" (WSJ, 10/23/2012).

Dr. Charles Willey, "Government Meddling In Health Care Has Only Made Us Sicker" (IBD, 10/24/2012)

Star Trek Preview of ObamaCare

This short clip from Star Trek: Voyager shows a Federation doctor horrified at the health care policies enacted on this planet:



Fortunately, this is just science fiction -- right? (*nervous tug on collar*)

Unfortunately, not.  Proposed medical rationing schemes in the US bear an eerie similarity to the Star Trek episode.

From my recent Forbes piece, "Get Ready for ObamaCare's Medical Rationing":

...Dr. Ezekiel Emanuel, has already laid the intellectual groundwork for overt rationing in a 2009 Lancet article, “Principles For Allocation of Scarce Medical Interventions.” Dr. Emanuel is a former White House health care advisor and the brother of Rahm Emanuel, President Obama’s former chief of staff.

Dr. Emanuel proposes rationing based on a combination of factors including patient age, expected “quality adjusted life years,” and the patient’s “instrumental value” to “society.” Given that the government would be making (and paying for) these rationing decisions, value to “society” will become “value as determined by the government.”

Such rationing completely inverts the relationship between the individual and the state. Rather than the state existing to serve the individual, the individual’s existence is sustained at the discretion of the state. This is the opposite of the American founders’ intention that the government be the people’s servant, not their master.

(Read the rest of the piece for more rationing proposals advanced recently in the New York Times.)

It will be up to the American voters next month to determine if this stays science fiction -- or becomes fact

UK Death Rates

In the 10/21/2012 TownHall.com, Daniel Mitchell notes "Wanna Die? Try Government-Run Healthcare in the United Kingdom".

Here is the opening:

I’m not a fan of the American healthcare system. It suffers from huge inefficiencies because of problems such as third-party payer, which is caused by government programs such as Medicare and Medicaid along with a system of tax code-driven over-insurance in the supposedly private sector.

But regardless of how much I grouse about the damage government causes in the United States, I can say with considerable confidence that the government-run system in the United Kingdom has even larger problems...

Mitchell cites recent articles on the higher death rates for patients caused by the government-run health system in the UK.

Such problems wouldn't develop overnight in the US if ObamaCare is fully implemented.  But we would move more quickly in that direction.

ObamaCare and Jobs

Robert Samuelson discusses "ObamaCare: Rhetoric Vs. Reality".

He opens with:

Just recently, the Internal Revenue Service issued an 18-page, single-spaced notice explaining how to distinguish between full-time and part-time workers under the Affordable Care Act ("Obamacare"). The difference matters, because the ACA requires employers with 50 or more full-time workers to provide health insurance for those workers. At the same time, no company has to buy insurance for part-time employees, defined as those working less than 30 hours a week.

As a result, the IRS has issued a complex set of rules to let employers know who does (or does not) count as a full-time employee for the purposes of the law.

Many employers are now shifting workers from full-time to part-time status:

Employers have a huge incentive to hold workers under the 30-hour weekly threshold. The requirement to provide insurance above that acts as a steep employment tax. Companies will try to minimize the tax. The most vulnerable workers are the poorest and least skilled who can be most easily replaced and for whom insurance costs loom largest. Indeed, the adjustment has already started.

Some may call these "unintended consequences".  But they are completely predictable consequences of increasing government regulations.  No one should be surprised by them, including the legislators who passed the law.

It will be up to us to hold them accountable.

(Read the full text of "ObamaCare: Rhetoric Vs. Reality".  Link via Dr. Art Fougner.)

Ohio Doctor Speaks Out

The 10/19/2012 Daily Caller reports, "Ohio doctor running newspaper ads criticizing Obamacare ahead of election".

First, I'm glad to see more physicians speaking out and telling their patients how ObamaCare will affect them.

Second, Dr. Naffah's article is pretty darned good.  You can read it for yourself here. (Note: It's easier to read if you click on the "full screen" icon after the "+" and "-" icons on the top toolbar)

Third, he has given "blanket permission" for others to recirculate that ad in their own localities. If anyone is interested in contacting Dr. Naffah directly he can be reached at avamarnaffah@aol.com.

(Thanks to Dr. Evan Madianos for making contact with him!)

Scherz On Disincentives

In his 10/19/2012 TownHall piece, Dr. Hal Scherz of Docs4PatientCare asks a good question: "Obamacare may be around, but will your doctor?"

In particular, he notes that ObamaCare will increasingly reward doctors for cutting costs and skimping on care to patients.

Under IPAB, ACOs, "bundled payments", and the other new regulations, doctors will be encouraged to not practice medicine, rather than to practice medicine.  For instance:

Obamacare creates a template which will result in the elimination of the private practice of healthcare. This will occur through Accountable Care Organizations (ACOs) which are large hospital systems employing physicians, ostensibly to facilitate the integration of care and to control costs.

Sadly, ACOs are akin to the HMOs of the 1990s, only much worse. The payment for an episode of care comes into the ACO as a single bundled payment and the institution determines how the money is divided. The patient no longer is the first priority of the doctors, but rather, it is satisfying the needs of their boss- the ACO. Doctors will be incentivized to save money- doing less, not more for their patients. Currently, less than 50% of doctors are self-employed and this number will drop sharply under Obamacare.

Under these pressures, many doctors will quit or retire early.  Others will just ramp down their efforts, working fewer hours.  We'll see fewer doctors willing to put in the extra effort staying late in the medical library consulting a journal to nail a difficult diagnosis or fine tune a patient's treatment protocol.

Instead, more and more doctors will develop a clock-puncher mentality, like we see at the local DMV office.  After all, why should they make that extra effort for you, the patient, when their bosses don't want them to?

If you don't want that kind of doctor taking care of you in a few years, the time to speak up is now.

(Read the full text of "Obamacare may be around, but will your doctor?")

Adalja on 3rd Party Payor System

Dr. Amesh Adalja (clinical faculty at University of Pittsburgh) has a new Forbes OpEd, "Let's End The Enslavement Of Healthcare Providers".

He discusses the problems of our current 3rd-party payor system, noting the following key points:

1) The 3rd-party payor system "sets up is a conflict between those who pay for healthcare (i.e., insurance companies and taxpayers) and those who consume healthcare. If healthcare is a cost or a liability to a third party, the tendency is to seek to reduce costs. Hence, the policymaker’s view that healthcare consumption is a drain on the economy."

2) The current system is an artifact of WWII-era government regulations, not the free market.

3) Instead of doubling down on the current system (as ObamaCare does), we need to transition to free-market solutions, such as Health Savings Accounts (HSAs).  Dr Adalja notes:

"[H]ealth insurance would be utilized solely for catastrophic health events for the majority of individuals (e.g., major surgeries, chemotherapy, long hospitalizations, etc.), and routine healthcare transactions would be between provider and patient. This devolution of power back to the two transacting parties would result in increased physician autonomy, patient empowerment, and a drop in the prices charged for healthcare services as the absence of a third party would eliminate much overhead while allowing more flexibility in price structure."

4) I especially like his identification of the fundamental problem:

"The pervasiveness of the viewpoint of healthcare as a right—it is even included in the U.N.’s Universal Declaration of Human Rights -- is the root cause of all our healthcare woes. It has created an ever expansive footprint for government, disintegrated the provider-patient relationship, and suspended the operation of the free enterprise system in healthcare."

(Read the full text of "Let's End The Enslavement Of Healthcare Providers".)

Medical School Dean Promotes Herd Medicine

From East Carolina University medical school:

Dr. Libby Baxley, senior associate dean for academic affairs at the Brody School of Medicine, echoed Berwick's recommendations for changing the way doctors treat patients and said that would mean changing the way medical students are taught.

"We have to go beyond the traditional education … of the care of the individual and have our students think about populations," she said.

This is another example of what Dr. Rich Fogoros calls teaching "herd medicine".

More and more students are being taught this "new medical ethics".  As I wrote last year:

In traditional medical ethics, a doctor’s primary responsibility is to tell his patients the truth and to treat his patients according to his best honest judgment, skill, and ability.

But a new form of medical ethics is being taught in medical schools that tells doctors to place the needs of “society” ahead of individual patients. At best, it forces doctors to juggle the truth and the interests of their patients alongside “social” considerations. At worst, it will give them license to sacrifice their professional integrity (and their patients’ interests) in the name of “society”...

But what will happen under a new generation of doctors who have been taught that the individual patient’s welfare must be balanced with “social” considerations — such as the cost to the government or to “society”?

Suppose you see one of these newly trained doctors at the local Accountable Care Organization because you are suffering from the worst headache of your life. He performs a brief physical exam, then tells you that according to the new ACO practice guidelines, you don’t need a MRI scan of your brain — just take two Tylenol and call him in the morning. Can you be 100% sure that he’s truthfully advising you in your best medical interest? Or might he be compromising your medical interests to satisfy the ACO bean counter who will reward him based on how many MRI scans he saves the organization?

The new medical ethics allows doctors to salve their consciences by telling themselves that restricting care to patients serves the greater “social” good. Most people have a powerful (and natural) need to believe that the work they are doing is morally worthwhile.

Very few people can knowingly work in a fashion they believe to be ethically wrong. The new code of medical ethics gives doctors the internal psychological moral “cover” they need to allow themselves to continue practicing according to government guidelines. It allows them to act as agents of medical rationing, while telling themselves that “I’m just being socially responsible” — the 21st-century medical version of, “I was just following orders.”

Medical educators are heading down a dangerous road.

Update: Dr. Fogoros posted: "How to get the "Open Wide and Say Moo!" audiobook for free (a pre-election special).

(ECU link via John D.)

Behind The Entitlement Mentality

ER physician-blogger "Birdstrike" posted an interesting essay onto KevinMD.com, "To the patients who resent greedy doctors".

He was responding to an earlier comment made by "Johnathan Blaze":

Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are.  Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.

Dr. "Birdstrike" then makes a few observations in return, including:

In the field of emergency medicine, there are only a few situations where the physician can truly walk in a room and walk out a few minutes later absolutely certain he saved a life.  One is an emergency intubation (making a non-breathing person breath again) and another is cardioversion/defibrillation (restart a non-beating heart.)  It doesn’t always happen every day, but it is what emergency physicians and other critical care providers are paid to do. 

To be an emergency physician is a paid position.  It is not a volunteer position.  It stands to reason that emergency physicians would be paid at least as much as for a life saved as for the aforementioned goods and services, correct?  Let’s break down what a true life-saver gets paid to save an entire life, not just the hip, the breasts, the fingertip or the shoes.

What an emergency physician actually gets paid to save a life:

1. Emergency intubation: $112  (CMS payment for CPT 31500) or,
2. Cardioversion/Defibrillation: $131  (CMS payment for CPT 92960)

Even if one combines cardioversion with a $226 charge for critical care services provided (CMS CPT 99291) the total charge is still only $357. Therefore, according to the United States Center for Medicare and Medicaid Services, your life is worth $357, or at least that’s what they’re willing to pay emergency and critical care physicians to save it.

But I was especially intrigued by this:

I am not an economist, nor a philosopher, but this all seems to follow a theory of sorts, that I have observed...

The extent to which the value of a service to an individual approaches infinity (such as a human life saved), is the extent to which a person expects it to be provided to them for free.  [Emphasis mine. --PSH]

Any charge for this infinitely valuable service will not be considered a very fortunate undercharge.  Instead, the extent to which there is any charge at all for the infinitely valuable service, is the extent to which the receiver of the service will harbor undue resentment toward whomever profited any amount from providing it...

It is for this reason that the emergency physician that expects to be paid $15,000 for a life saved is wrong, yet the plastic surgeon is right to charge, and is happily paid by his “customers” $15,000 for a beauty enhancement service.

I think he has put his finger on a key element of the entitlement mentality.

If something is an important need (including a legitimate need such as a life-saving medical procedure), some people become extremely emotionally uncomfortable at the thought that they won't just get it automatically.  Even though the universe doesn't owe them (or anyone else) an automatic survival, they want someone to provide it.

And if they've been taught all their lives that others must morally provide for them as an automatic moral obligation based solely on their need, then anyone who fails to do so is shirking that supposed moral duty.  This implicit visceral premise comes to a head in life-and-death situations, such as emergency medicine.

Of course, people can and should take advantage of voluntary risk-sharing economic arrangements (such as true insurance), charity, and other voluntary measures to protect themselves against unforseen catastrophes, medical and otherewise.  And given our modern technology, such risk-protections are becoming more robust and affordable all the time.

But given our nature as human beings, elimination of all risk is metaphysically impossible.  And the universe truly does not "owe" us any kind of survival.  Compulsory social arrangements, such as socialized medicine, are an attempt to try to get around that basic unavoidable fact of reality -- and are doomed to fail.  But in the process, they destroy the freedoms necessary for individuals to actually protect themselves from risks as best possible.

Kristof's Failed Attempt To Defend ObamaCare

In the 10/12/2012 New York Times article "A Possibly Fatal Mistake", columnist Nicholas Kristof attempted to defend ObamaCare, citing the unfortunate story of his friend Scott Androes who chose not to purchase health insurance, didn't receive a PSA screening test, and then developed prostate cancer.

I feel sorry for Kristof's friend Scott, and I hope he pulls through. 

But Kristof notes:

Let’s just stipulate up front that Scott blew it. Other people are sometimes too poor to buy health insurance or unschooled about the risks. Scott had no excuse. He could have afforded insurance, and while working in the pension industry he became expert on actuarial statistics; he knew precisely what risks he was taking. He’s the first to admit that he screwed up catastrophically and may die as a result. 

Kristof supports the mandatory insurance of ObamaCare as a form of government-paternalism, which will compel others like Scott to act for their own good (as deemed good by the government).

But one piece of information that Kristof failed to mention in his NYT piece is that under ObamaCare, ordinary people like his friend Scott will have an increasingly difficult time getting a routine PSA test.

The USPSTF (US Preventive Services Task Force) is seeking to end routine PSA screening for prostate cancer on the grounds that it is not sufficiently cost effective, the false positives could harm patients, etc.  Under ObamaCare, the USPSTF guidelines will likely become the de facto standards for what services would or would not covered by insurance companies. 

Also note that the President was able to request and receive a PSA test when turned 50 last year. 

It's curious how getting a PSA test is supposed to be a bad choice for American men (so bad that we shouldn't even have the option), but it was apparently ok for the President to get one.

For more on this, see my Forbes piece from 7/5/2012: "Is President Obama's Prostate Gland More Important Than Yours?"


(Also, Nick Gillespie at Reason.com offers his own related critique of Kristof's argument.)

Atlas on Doctors and ObamaCare

Dr. Scott Atlas (a neuroradiologist as well as a health policy analyst at Stanford) discusses "What Do Actual Doctors Think About Obamacare Now?"

Short answer: Most of them think it will be detrimental to patients and detrimental to the practice of medicine.  And various doctors' organizations that have been supportive of ObamaCare are not representative of physicians as a whole.

One noteworthy excerpt:

...America’s doctors know about the scandalous deficiency of access in centralized systems, countries where government’s officials themselves circumvent restrictions when their own personal care is at stake.

Like when England’s NHS spent more than 1.5 million pounds to pay for thousands of its own staff members to leapfrog their own waiting lists in 2009; or when Italy’s Prime Minister Berlusconi chose to have his heart pacemaker surgery at the Cleveland Clinic in 2006, rather than in Italy; or perhaps when the Canadian Prime Minister of Newfoundland and Labrador, Danny Williams, traveled to the US in 2010 to circumvent Canada’s restrictive system for his own heart valve procedure, because, as he explained, “This was my heart, my choice and my health,” and “I did not sign away my right to get the best possible health care for myself when I entered politics.”

Perhaps America’s doctors see the repeated behind-the-scenes maneuvers by our political leaders in the US, frankly by some of the strongest advocates for more government control of US health care when they or their families are sick.

Like when President Obama, an on-the-record supporter of single- payer systems (“I happen to be a proponent of a single payer universal health care program”on June 30, 2003), was asked pointedly in 2009 to promise that he would not seek out-of-plan help for his wife or daughters if they became sick and the public plan he was then proposing limited their options, the president refused, and instead replied, “If it’s my family member, if it’s my wife, if it’s my children, if it’s my grandmother, I always want them to get the very best care.”

Time and time again, these same outspoken advocates of nationalized health systems for the rest of us, like the late Senator Edward Kennedy of Massachusetts, have exercised their personal freedoms unique to our system for the latest diagnostic tests, the most sophisticated surgical techniques, the most innovative medical therapies, the newest drugs, and the best doctors in the world – right here, in America, where those choices were uniquely available – when confronted with their own personal illnesses.

(Read the full text of "What Do Actual Doctors Think About Obamacare Now?"  Link via Dr. Evan Madianos.)

Proposed Limits in NY State

As states prepare to implement ObamaCare, they have to define their "essential benefits plan" for residents.

According to Dr. Susan Berry, "the state of New York has requested that annual doctor visit limits be substituted for lifetime and annual dollar limits in health care plans."

The law does not allow insurers to set a dollar cap on how much patients can receive per year.  Hence, the state of New York has requested the ability to instead limit number of doctor visits.

In other words, the government would decide whether or not you've seen the doctor too many times.

Just don't call it rationing.

UK Patient Abuse

The 10/6/2012 Telegraph reported, "Patients starve and die of thirst on hospital wards".

Some of the statistics of the patient mistreatment in the government-run NHS system are appalling.

From the article:

* as well as 43 people who starved to death, 287 people were recorded by doctors as being malnourished when they died in hospitals

* there were 558 cases where doctors recorded that a patient had died in a state of severe dehydration in hospitals

...In many wards nurses were dumping meal trays in front of patients too weak to feed themselves and then taking them away again untouched.

A report by the Health Service Ombudsman last year condemned the NHS for its inhumane treatment of the most vulnerable.

Leftists like to argue that government-run medicine would ensure "compassionate" care for all.   But the UK stories show that comparisons with the DMV may be closer to the truth.

Reynolds On The Price of "Free" Health Care

Glenn Reynolds (aka "Instapundit") has an OpEd in the 10/9/2012 USA Today on the price of "free" health care.

Here's the opening of his piece, "Do you want your goat scruffy or shiny?":

According to a West African proverb, "a goat owned in common always starves." This pithy phrase captures a key truth of human behavior: People are a lot better about taking care of things that belong to them than they are about taking care of things that don't.That's a lesson that applies to more than goats...

Reynolds notes that it applies to "community bicycles".  And to collectivized health care:

You can also see this phenomenon in medicine. The dermatology office where my family goes has two sides. One does the work that's covered by insurance: Stuff that's mostly "free," in the sense that it's largely paid for by someone else.

The other side does the stuff that's paid for out of pocket and isn't covered by insurance. Guess which one is nicer? Guess which one makes it easier to get an appointment? And, most interestingly, guess which one has the newest, and fastest-advancing, technology? Thanks to ObamaCare, we're heading toward the world of "scruffy bike" medicine. Is that where you want to go?

On the one hand, the scruffy bikes are free, sort of. At least, you don't have to cough up any cash each time you use them. But you pay in other ways.

First, they're, well, scruffy. Second, they're not always available, meaning that you have to wait, or do without. Waiting is a kind of payment, too, since time is money. (Time is probably more important, actually, when you're waiting for a hip replacement, or chemotherapy, than when you're waiting for a bike).

The result is cronyism, inefficiency, and waste.

Fortunately, we're not stuck with this system.  But we'll have to decide in a few weeks.

(Read the full text of "Do you want your goat scruffy or shiny?")

Adalja on Repealing EMTALA

Dr. Amesh Adalja, a Clinical Assistant Professor at University of Pittsburgh School of Medicine, discusses why we should repeal the EMTALA law that forces ER's to provide emergency care to all individuals seeking care irrespective of ability to pay.

Here is an excerpt from his 10/8/2012 Forbes piece, "Universal Health Insurance Mandates, And The Emergency Care Myth":

To concretize what EMTALA does to a healthcare facility, transpose the law to the restaurant setting. If a hungry person goes to a restaurant and orders a cheeseburger and is unable to pay, restaurant personnel are completely free to withhold the sandwich and, if this is a frequent occurrence, to refuse entry of the person into the building. These actions are a clear exercise of the individual rights of the restaurant owner to do commerce with whom she wishes on a voluntary basis with terms mutually agreeable to both parties. This common sense, market-based approach in which one is expected to pay for the things one needs is forbidden from occurring in the healthcare realm, and those who violate EMTALA are subject to heavy fines.

One other consequence of EMTALA, also not often mentioned, is that it creates a moral hazard. If a person knows that, because of EMTALA, they will not be refused emergency care despite being unable to afford it, what is their incentive for obtaining insurance? While a person is still legally liable for the hospital charges, many hospitals eventually “forgive” the unpaid debt with minimal repercussions for the individual.

What EMTALA has predictably created is a situation in which emergency care has become viewed as a right to be provided by healthcare facilities irrespective of the fact that to do so nullifies the rights of providers. In creating this false right, EMTALA also fuels the animus of certain individuals against purchasing their own health insurance because the law created an emergency care safety net that is always available.

Basically, government mandates create moral hazard and "cost shifting" which is then used to justify yet more government mandates (such as the individual mandate to purchase insurance).  As always, controls breed controls.

Instead of piling on more government controls, we need to repeal and unwind them.  I'm glad that Dr. Adalja is putting EMTALA on the table for discussion.  Let's hope policymakers listen to him.

(Read the full text of "Universal Health Insurance Mandates, And The Emergency Care Myth".)

Quick Links: Exodus, Kryptonite

American Medical News: "Will a “silent exodus” from medicine worsen doctor shortage?"

(I know many doctors thinking of reducing their hours/workload as the downsides of clinical practice worsen.  Not all of them are doing so for overtly political reasons.  But they are responding to incentives created by the politicians, such as new paperwork requirements, decreased reimbursements, etc.  AMN link via Jared Rhoads.)

Anders Ingemarson: "Pre-existing conditions: Healthcare Kryptonite".

(Note: Although I support the rights of insurers to set prices and conditions in a free market, it's also important to note that they themselves have often lobbied for special favors from the government.  So insurers are often a mixed bag morally.)

Catron Shines Light on AARP

David Catron notes how the AARP is trying to have it both ways on ObamaCare.

When ObamaCare was being debated in Congress, they put their full lobbying muscle behind the bill (even though many rank-and-file members were deeply skeptical.)   When Paul Ryan spoke before them discussing the need to repeal ObamaCare, they repeatedly booed him.

But now that Obama's  political future seems more uncertain, they're distancing themselves from him.  Following last week's debate in which Obama cited AARP statistics supposedly supporting his position, the AARP rushed to issue a statement that they were "nonpartisan".

In other words, the AARP's strategy seems to be

"We love you, Obama", when it suits them.
"Hey, we're non-partisan", when it doesn't.

For more details, read Catron's latest piece in American Spectator, "AARP Stands by as Obama Gets Mugged by Reality".

Depending on how the next few debates go, we'll see if any more fair-weather friends of Obama declare themselves.

Will on IPAB and Rationing

In the aftermath of last week's debate, the issue of the ObamaCare IPAB board for Medicare rationing has resurfaced.

Supporters of IPAB are again claiming that the IPAB won't ration care. But in his 10/4/2012 column, George Will debunks this claim:

Beginning in 2014, IPAB would consist of 15 unelected technocrats whose recommendations for reducing Medicare costs must be enacted by Congress by Aug. 15 of each year. If Congress does not enact them, or other measures achieving the same level of cost containment, IPAB’s proposals automatically are transformed from recommendations into law. Without being approved by Congress. Without being signed by the president.

These facts refute Obama’s Denver assurance that IPAB “can’t make decisions about what treatments are given.” It can and will by controlling payments to doctors and hospitals. Hence the emptiness of Obamacare’s language that IPAB’s proposals “shall not include any recommendation to ration health care.”

By Obamacare’s terms, Congress can repeal IPAB only during a seven-month window in 2017, and then only by three-fifths majorities in both chambers. After that, the law precludes Congress from ever altering IPAB proposals.

Because IPAB effectively makes law, thereby traducing the separation of powers, and entrenches IPAB in a manner that derogates the powers of future Congresses, it has been well described by a Cato Institute study as “the most anti-constitutional measure ever to pass Congress.”

I'm glad George Will is emphasizing this point.

It's true that the IPAB won't directly tell individual doctors and individual patients what specific treatments they can or cannot receive. But it can set the prices so that a hospital can no longer afford to offer a specific service. For instance, if they say "Yes you can offer a PET-CT scan for detecting metastatic ovarian cancer, but you can only charge $100" (instead of $1000), then no one will offer that service and no patient would receive it.

It would be like the government telling grocers, "We won't ration food and we won't restrict what food consumers can purchase. But you must now all sell steaks for $1." 

Pretty soon, no one would sell steak at a loss and no one would be able to buy steaks either.

Madianos and Vecchio Speak Out For Freedom

Dr. Evan Madianos has some suggestions to the Romney campaign on how to promote real free-market health care reform.

Dr. Jill Vecchio has a new website which includes her videos and the text of her numerous radio commentaries on health care policy.

I'm encouraged to see more activist physicians speaking out for health care freedom.  Please go check them out!

Insurance Is the Problem

Dr. David Mokotoff writes, "Why health insurance is the problem and not the solution" (KevinMD.com, 10/6/2012).

He does a nice job explaining how the current employer-based 3rd-party payor system is an artifact of bad goverment policies and creates perverse economic incentives.

RomneyCare For The States?

Mitt Romney clarified his position on health care at the 10/3/2012 debate. and his current position (still) leaves much to be desired.

As Peter Suderman notes, "Romney Would Repeal ObamaCare Only to Pass It Again At the State Level".

If you're a "glass half full" person, it's an improvement from a nationally-mandated status quo. If you're a "glass half empty" person, it means the battle is not yet won.

But perhaps his advisors would be willing to look more closely at the Docs4PatientCare "Physician's Prescription for Health Care Reform". That would be a good place to start moving America in the direction of real free-market health reform.

Catron and Wolf on Biden

Now that the first Presidential debate is over, pundits are looking forward to October 11 Vice-Presidential debate between Joe Biden and Paul Ryan.

To get you ready, here are some observations from David Catron and Milton Wolf.

David Catron writes in the 10/1/2012 American Spectator, "Joe Biden Escapes from the Attic... Again".

Dr. Milton Wolf paid tribute to VP Biden in this 9/6/2012 Daily Caller video:



As Ari Armstrong noted last night on Twitter: "Thank God the Dems can now fall back on Biden."

Quick Links: Choosing Doctor, Refusing Insurance

A couple of informative links, both via Dr. Matthew Bowdish.

WSJ: "Finding the Best Doctor for You" (9/24/2012).

NYT: "When Doctors Stop Taking Insurance" (10/1/2012).

One interesting question is how the government will respond as more doctors start opting out of the government-insurance complex.

Hsieh Forbes OpEd: Get Ready For Obamacare's Medical Rationing

Forbes has just published my latest OpEd, "Get Ready For Obamacare's Medical Rationing".

I discuss the latest PR campaign in the New York Times to "sell" overt medical rationing to the general public.

 If the ObamaCare advocates are confident enough to use the "R-word" now, they're almost certainly going to implement these ideas in a 2nd Obama term.

BTW, I am now a regular monthly columnist for Forbes, with my own dedicated page -- woohoo!

Physicians Quitting?

Dr. Matthew Bowdish alerted me to another ominous survey, "6 in 10 Physicians Would Quit Today".

As always, it's hard to know if that exact number is precise.  I've seen similar surveys citing percentages ranging from 40-80% (!)   A lot may depend on how exactly the question is framed, and what a physician means when he or she says they are "considering" quitting.

But from numerous informal conversations with my colleagues, I can say there are significant numbers of physicians seeking an "exit strategy" from clinical medicine. Many more are hoping to just "hold on" until their kids get through college, etc.

Now there are some who argue this will be a non-issue, because there will always be plenty of young people eagerly applying to medical school. But I contend this analysis is mistaken.

There's already a projected shortage of doctors looming over the next 10 years, so any unanticipated early retirements will make things worse. This will translate into longer waits for patients.

Yes, new trainees entering the pipeline will partially make up for this shortfall. But we'll see a different kind of person choosing to enter medicine. There will be fewer of the fiercely independent types that I knew in medical school, and more of the types willing to submit quietly to bureaucratic decrees.

One contributing factor will be the "new medical ethics" being taught to many students, which explicitly states that a good doctor doesn't merely just advocate for his or her patient's best interests but should also balance the needs of "society". This gives them the moral fig leaf to help obey government edicts to deny care. They'll believe that restricting care is "the right thing to do".

Also, doctors employed by hospitals or managed by "Accountable Care Organizations" (as opposed to private practice) will be less incentivized to work hard, stay late, and put in that extra 5% of time/energy that can make the difference between nailing a difficult diagnosis vs. giving up and just following the cookbook treatment protocol.

In 10-15 years, there may be close to the same number of doctors "on the ground", but there will be a quality difference that might be hard for patients to discern but will be clear to doctors.

(For more on this, see my earlier PJ Media piece "The Wisconsin Protests and the New Medical Ethics" and related TownHall piece "Who Will Your Doctor Work For Under ObamaCare?")

Personal DNA Testing

NPR raises concerns about inexpensive personal DNA testing: "Will Low-Cost Genome Sequencing Open 'Pandora's Box'?"

For the record I fully support this concept, as I discussed in 2010: "Should You Be Allowed to Know What’s in Your DNA?"

The City Without Medicine

The 9/22/2012 reports, "Valencia: A Spanish city without medicine".

The government-run medical system can no longer purchase medicines due to a combination of government fiscal irresponsibility and/or corruption. As a result:

Paula guides me into that back room that exists in all pharmacies, where the prescription drugs are kept. The problem is, now, there are not many drugs left.

"Look, this drawer is usually full," she says, pointing to where the suppositories are kept. Now there are only two packets."

She opens the fridge. "Look," she says, "we are down to our last packs of insulin. We just have no money to buy the stock."

I ask: "What happens if several people come in on the same day for insulin?" She makes two fingers walk along the back of her wrist. "They have to go around the neighbourhood to see if anybody else has it. It is the same with drugs for heart disease, stroke, anti-retrovirals."

Fortunately, this could never happen here in the US.  Or could it...?

Hsieh PJM OpEd: The Harms of Medical Licensing Laws

Today's PJ Media has published my latest OpEd, "How Medical Licensing Laws Harm Patients and Trap Doctors".

My twin themes are that (1) Government licensing of doctors is both morally and economically wrong, and (2) the interaction between current licensing laws and upcoming ObamaCare laws will harm both patients and doctors in unanticipated ways.

This piece is adapted from a short talk I recently gave on Milton Friedman and medical licensing. I don’t agree with Friedman on some important issues, but he was excellent on the issue of occupational licensure.

I also cite economist Shirly Svorny and Dr. Milton Wolf for their proposals to move us in the right direction.