Monday, December 31, 2012

Catron: Court Updates

David Catron discusses some under-the-news-radar updates on recent ObamaCare court decisions in the American Spectator. Here's the opening to his piece, "MSM Gives Us the Mushroom Treatment on HHS Mandate":
In December, there were five federal court decisions relating to Obamacare. Chances are, however, that you will have heard about only one of them...
He also discusses why the one getting all the press is probably the least significant one.

(Read the full text of "MSM Gives Us the Mushroom Treatment on HHS Mandate" for more details.)

Wednesday, December 26, 2012

Hsieh Forbes OpEd: The Battle Of The Narrative

My latest piece is now up at Forbes, "The Battle Of The Narrative: How Ordinary Americans Can Fight ObamaCare".

Here is the opening:
The 2012 election ensured that ObamaCare will not be repealed anytime soon. But opponents continue to fight back. 26 state governments have declined to establish insurance “exchanges.” 40 lawsuits are still pending against various aspects of ObamaCare. Ordinary Americans may not be able to directly affect these battles. But they can play a key role in the all-important battle of the “narrative.”

As the problems of ObamaCare inevitably emerge, the big question will be whether they will be blamed on the residual free-market elements of our health system or on the new government controls. This will be the battle of the “narrative.”
I discuss how ordinary Americans can take part in this battle for their health freedom.

(Read the full text of "The Battle Of The Narrative: How Ordinary Americans Can Fight ObamaCare".)

Tuesday, December 25, 2012

Merry Christmas

Merry Christmas! (Note: Posting may be lighter than usual for the rest of the week due to the holidays.)

Monday, December 24, 2012

Private Health Care in Sweden

The Guardian reports on, "Private healthcare: the lessons from Sweden" (12/18/2012).

A couple of excerpts:
During an hour-long presentation to the Guardian, St Göran's chief executive, Britta Wallgren, says the 310-bed hospital, serving 430,000 people, outperforms state-owned rivals inside and outside the country.

She says emergency patients see a doctor within half an hour, compared with A&E waits of up to four hours in the NHS. "We took an A&E department that dealt with 35,000 patients a year and now treats 75,000," Wallgren says. "As admissions grow and we have an increasingly elderly population so must our performance improve."

Capio stresses that St Göran has low levels of hospital-acquired infections, and patient surveys record high levels of public satisfaction. It has also produced year-on-year productivity gains – something the state cannot match. Thomas Berglund, Capio's president, says the "profit motive works in healthcare" and companies run on "capitalism, not altruism".
One patient who opposed the private sector used it nonetheless:
"I am one of those Swedes who do not agree that private hospitals should exist," says Christina Rigert, 62, who used to work as an administrator in the hospital but resigned "on principle" when it was privatised a decade ago.

Now back as a patient after gastric band surgery, she says: "The experience was very good. I had no complaints. There's less waiting than other hospitals. I still do not think there should be private hospitals in Sweden but it's happening."
Note that she attacked it, even while benefiting from it.

The system is not perfect.  But it is an encouraging step in the right direction for Sweden.

Now there is an potential reverse argument some might make along the lines of, "Limited government advocates don't think government program X should exist, but they still take advantage of that service while opposing it.  So they're also being hypocritical!" (For instance, roads, schools, libraries, Post Office, Social Security, etc.)

But one key distinction is that these government programs typically use force "crowd out" (either directly or indirectly) the private options, thus leaving ordinary citizens with limited or no choice except to use the government option.

In contrast, introducing private health options into a socialist system adds choice rather than reducing it. And if over time the private choices "crowd out" the government option, I consider that a feature not a bug.

(Read the full text of "Private healthcare: the lessons from Sweden".  H/T: Dr. Matthew Bowdish.)

Friday, December 21, 2012

Binik-Thomas: Obamacare and My Daughter

Justin Binik-Thomas discusses "Obamacare and My Daughter".

An excerpt:
In May, we were blessed with a beautiful baby girl. Three of her fingers were fused together.  We understand that it will become an issue later as she grows if untreated, but there is no pain or concern in the short term. She has full control of both hands, and is able to manipulate objects and feed herself, just as any six month old would do.

There will certainly be appointments before and after treatment that include the specialist and the primary care physician. Both offices are reporting that access to doctors is becoming more difficult. Both offices are reporting decreased options for medical services and for drug therapies. There is now a two-week wait for the doctor, because most patients require two appointment slots — one for discussing existing problems and one for discussing new problems. There is a six-month wait for non-urgent visits at the specialist. Since laws do not become simpler with time, it is a certainty that wait time for medical staff will increase as new regulations are rolled out.

We have met with various medical professionals to discuss treatment options. There were several possibilities discussed, and we were able to weigh these options for the best fit: Zoe’s surgery is scheduled for the day after Christmas.

We knew that surgery was likely in the near future and chose to select a top-notch full coverage insurance plan this year.

The hospital informed us that this is a fairly new operation perfected over just the last five years. However: this surgery will “cease to be available in two years for insurance patients due to ObamaCare.” This is a quote from the flustered nurse at the hospital.
Related video interview: "ObamaCare and Your Kids: How ObamaCare Limits Health Care for Children".

Under ObamaCare, the treatment of choice for his daughter would be amputation rather than reconstructive surgery.

Just don't call it rationing. (Via Instapundit.)

Thursday, December 20, 2012

Atlas: Doctors Soon Won't Accept Medicare

In the 12/18/2012 Forbes, Dr. Scott Atlas explains that "Let's Be Honest -- Medicare is Insolvent And Doctors Soon Won't Accept It".

A few key take-home points:
Medicare is spiraling into bankruptcy, owing to both the demographics of America and the realities about health care.

An increasing proportion of doctors are already not accepting Medicare patients, and the primary reason is low payment for services.

There's an enormous difference between having insurance and achieving access to medical care.
Politicians can pat themselves on the back for guaranteeing "coverage", but their dictates cannot guarantee that patients receive actual medical care.  Coverage does not equal care.

Dr. Atlas also offers some partial reforms that can help in the interim while we continue the battle for free-market health care solutions.

(Read the full text of "Let's Be Honest -- Medicare is Insolvent And Doctors Soon Won't Accept It".)

Wednesday, December 19, 2012

Specialist Shortages

The 12/16/2012 Los Angeles Times reports, "Healthcare crisis: Not enough specialists for the poor".

As always, politicians can promise theoretical "coverage".  But they can't guarantee that patients will receive actual medical care.

It won't be long before the problems in California's government-run Medi-Cal program (which is their name for Medicaid) spread to the rest of the country.

Monday, December 17, 2012

Catron: Kathleen the Terrible

David Catron's latest piece for American Spectator discusses the arrogance and corruption of HHS secretary Sebelius.

From his piece, "Kathleen the Terrible":
Even as her Hatch Act violation came to light, she launched a program that illegally postponed Obamacare’s cuts to Medicare Advantage until after the recent election. And it hardly needs to be said that her behavior since November 6 contains no hint of moderation. Since then, Sebelius has put in place a legally dubious pay-to-play program for selecting which health carriers can ply their wares in Obamacare’s insurance exchanges, and it has been discovered that a crucial contract involving the exchanges was awarded to a company that employs a former Sebelius underling who ran the very agency that awarded the contract.
Such cronyism is a predictable result of the ObamaCare law, which gives the Secretary enormous "discretion" in implementing the law.

For more details, read the full text of "Kathleen the Terrible".

Majority of States Opt Out of ObamaCare Exchanges

In the 12/14/2012 Investors Business Daily, David Hogberg notes "26 States Decline ObamaCare Exchange".

Here's the opening:
The federal government will likely be involved in running the ObamaCare exchange in at least 30 states, 26 of which expressly declined to establish state exchanges. One health-policy expert refers to it as an "administrative nightmare" for the Department of Health and Human Services.
The article also notes that the federal government didn't expect to have to run any exchanges themselves.  I doubt this next step into government-run health insurance will go smoothly for them. (Via Instapundit.)

Sunday, December 16, 2012

McGuff and Adalja on Mandatory Flu Vaccination For MDs

ER physician Dr. Doug McGuff explains, "A physician takes his flu vaccine under protest".

Dr. Amesh Adalja offered a different take in "Universal Flu Vaccination of Healthcare Personnel: A Patient Safety Issue" and in this short letter, "Flu vaccine: Should it be mandatory?"

In a free market, many of these potentially divisive issues would be easily handled by freedom of contract between physicians and hospitals.

Friday, December 14, 2012

Young Vs. Old Doctors?

If you're a patient, should you see a younger doctor or an older doctor?

Slate discusses the pros and cons here: "Is It Better To See a Younger Doctor or an Older Doctor?"

In short, young doctors might be more familiar with the latest developments and technique.  But older doctors might have more experience with unusual or tricky cases.

(The article is also careful to note that broad statistics might not apply to specific individual young or old physicians.)

The other twist is that young doctors appear to cost "the system" more, although the exact reasons aren't clear.  It may be because they tend to order more tests to make up for their lack of clinical experience.  Or perhaps some of them are seeing the sicker, more challenging patients.

(Note the Slate article suggests the opposite, namely that older doctors create higher costs.)

The policy implications aren't immediately clear to me, but I thought this might be interesting to those thinking of selecting a new physician.

In my Forbes piece from last month on protecting yourself from ObamaCare, I do note:
[I]f you’re approaching Medicare age (65) and your current doctor will retire in a few years, consider switching to a younger doctor now. Many doctors no longer accept new Medicare patients, and this problem will worsen with anticipated Medicare payment cuts. However, most doctors will continue seeing their current patients even after they turn 65. But if you wait until after age 65 to look for a new doctor, you may have a hard time finding one.

Thursday, December 13, 2012

Democrats Oppose Medical Device Tax

The 12/12/2012 Washington Examiner notes, "Democrats urge delay for 'job-killing' Obamacare tax".

It would have been nice if they had listened to the many people who warned about this issue earlier.

Some related pieces:
Joshua Lipana, "Medical Device Tax: Immoral and Impractical" (TOS Blog, 12/10/2012).

Paul Hsieh, "The Deadly Tax on Medical Innovation" (PJ Media, 4/11/2010)

Wednesday, December 12, 2012

Adalja on Organ Markets

Dr. Amesh Adalja explains, "To Save Lives, Allow Individuals To Sell Their Organs" (Forbes, 12/12/2012).

He also reminds us that the current ban on organ sales is a bipartisan idea:
In 1984, President Reagan, with the acquiescence of the Republican-controlled Senate and Democrat-controlled House, signed the National Organ Transplant Act (NOTA), banning the sale of human organs.
Fortunately, some groups like the Institute for Justice have begun to chip away at the ban by helping to win a lawsuit permitting compensation for bone marrow donors.

It's time to build on this success.

Quick Links: Patients, Resistance, Taxes

Forbes has recently published a pair of good analyses.

Sally Pipes: "Obamacare's Cruel War On Patient-Centered Healthcare" (12/10/2012).

Grace-Marie Turner: "A Resistance Movement Rises Against ObamaCare" (12/10/2012).

Meanwhile, the New York Times reports, "New Taxes to Take Effect to Fund Health Care Law" (12/8/2012).

Tuesday, December 11, 2012

ObamaCare Privacy Nightmare

In the 12/6/2012 USA Today, Parente and Howard warn of a "Potential ObamaCare privacy nightmare".

In particular:
ObamaCare's federal exchange, however, will be very different from these earlier efforts or emerging private exchanges such as In order to determine eligibilty for health insurance subsidies, the new exchange has to bring together information about you and your family from the Treasury Department and IRS, the Department of Homeland Security, the Department of Justice, as well as your Social Security number — all coordinated by the Department of Health and Human Services.

The data gathering is sensible, in the abstract. Similar information is collected when you apply for a mortgage. But when the constantly updated information is combined in a central data hub, the potential for abuse is staggering. For one thing, the hub will have all the details needed to steal identities and fraudulently access credit.
This centralized collection of medical and financial data will be a tempting target for malicious hackers.  Or for malicious government officials.

(Read the full text of "Potential ObamaCare privacy nightmare".  Stephen T. Parente is a finance professor at the University of Minnesota. Paul Howard is director of the Manhattan Institute's Center for Medical Progress.)

Monday, December 10, 2012

The Lobbyist Feeding Frenzy Expands

The 12/5/2012 New York Times describes the accelerating lobbyist feeding frenzy in anticipation of new ObamaCare rules. In particular, lobbyists are working hard to have their particular pet items included in the state-level "essential health benefits" that all insurers must sell (and that consumers subject to the individual mandate will be forced to purchase).

From the article, "Interest Groups Push to Fill Margins of Health Coverage":
Most of the roughly two dozen states that have chosen their essential benefits — services that insurance will have to cover under the law — have decided to include chiropractic care in their package. Four states — California, Maryland, New Mexico and Washington — included acupuncture for treating pain, nausea and other ailments. It is also likely to be an essential benefit in Alaska and Nevada, according to the Department of Health and Human Services...

According to proposals that the states have submitted to the Department of Health and Human Services, insurance plans will have to cover weight-loss surgery in New York and California, for example, but not in Minnesota or Connecticut. Infertility treatment will be a required benefit in New Hampshire, but not in Arizona. 

Over all, the law requires that essential health benefits cover 10 broad categories, including emergency services, maternity and newborn care, hospitalization, preventive care and prescription drugs. But there is room for variation in those categories. Whether insurance will pay for hearing aids, foot care, speech therapy and various medications will vary significantly by state.
In other words, consumers will be compelled to purchase services they may neither need nor want, based on the political clout of special interest groups.  If a lobbying group can get the state government to compel coverage of their specific desired medical condition, it's like hitting the lottery,

This dynamic has already occurred in Massachusetts, under their system of mandatory insurance.  As a result, insurance costs have risen steeply for ordinary consumers.

To make matters worse, low-cost health plans without such mandatory benefits have been forbidden by the federal government:
Gov. Dave Heineman, Republican of Nebraska, chose an insurance plan with a high deductible as his state’s benchmark, reasoning that such lower-cost plans were popular in the state. But the Obama administration recently informed him that the plan did not meet the requirements of the law, he said.
We may or may not be able to stop the law from going into effect.  But as insurance costs go up, we must remember to place the blame squarely on the shoulders of the government, and not unfairly blame the private sector.

Friday, December 7, 2012

Thursday, December 6, 2012

Quick Links: ACO Spread, Device Tax, Rate Shock

Bruce Japsen notes: "Obamacare's Accountable Care Approach Reaches 1 in 10 In U.S." (Forbes, 11/26/2012):
The new analysis from consulting firm Oliver Wyman released Monday says the growth of accountable care organizations, or ACOs, has reached up to 25 million to 31 million patients, growing beyond the 2.4 million patients in the government's voluntarily program for seniors  covered by the Medicare health insurance program for the elderly to patients in private and employer-sponsored health plans.
If patients don't like their ACO, there's always this alternative: "Medical tourism booms in Costa Rica".

Reuters: "IRS finalizes new tax for medical devices in healthcare law" (12/5/2012)

Kaiser Health News: "State Insurance Officials Raise Concerns About 'Rate Shock' For Young People" (12/4/2012).

Wednesday, December 5, 2012

A Free Speech Victory Against the FDA

The 12/3/2012 New York Times reports, "Ruling Is Victory for Drug Companies in Promoting Medicine for Other Uses".
Under the Food, Drug and Cosmetic Act, which gives the F.D.A. the authority to regulate drugs, selling a “misbranded drug,” or one that is intended to be used for purposes not listed in the label, is illegal. Doctors, on the other hand, are free to prescribe a drug for any use. The agency has argued that off-label promotion of drugs is evidence that a sales representative or company intended to sell misbranded drugs. 

In its decision, the court said this view violated the First Amendment and cited as precedent a 2011 Supreme Court decision, Sorrell vs. IMS Health. In that case, the high court, citing freedom of speech, overturned a Vermont law restricting pharmaceutical companies from using prescription data for marketing purposes. 

“The government clearly prosecuted Caronia for his words — for his speech,” the majority wrote, concluding later “the government cannot prosecute pharmaceutical manufacturers and their representatives under the F.D.C.A. for speech promoting the lawful, off-label use of an F.D.A.-approved drug.” 
Let's hope this good ruling is upheld! (Via Virginia Postrel.)

Tuesday, December 4, 2012

MedCottage Innovation

This sounds like a potentially helpful innovation for many elderly Americans and their families: "MedCottage: An 'American Solution' for Eldercare".

As Ross England describes in his blog post for The Objective Standard:
[T]he MedCottage, is a pre-fabricated, modular, and portable “three-room apartment equipped like a hospital room. There are safety rails, lighted floorboards, and a wall with a first-aid kit and defibrillator machine.” Nicknamed the “Granny Pod,” the MedCottage “runs its water, electric, and waste disposal systems off the care-giver’s home systems.”
Dupin created the MedCottage to provide an alternative for caregivers whose parents need more constant care but who, for various reasons, aren’t willing or able to resort to professional nursing homes...
For more information, see the MedCottage webpage.

Monday, December 3, 2012

Central Planning Failures

So how are the various central-planning government medical initiatives working out?

"Patient Centered Medical Homes (PCMH)" -- not so well.

In the 11/30/2012 Forbes, Leah Binder notes "A Healthcare Plan That's Failing":
A troubling study in the Annals of Internal Medicine analyzes patient-centered medical homes (PCMH), and shows essentially no cost savings and minimal if any impact on clinical outcomes. This is the latest in a series of analyses notable for their consistent conclusions that the financial impact of PCMH is -- at best -- nonexistent or inconclusive.
How about electronic medical records?

The 11/30/2012 edition of Colorado Public Radio describes, "Colorado Docs' Difficult Digital Transition:
Wilkerson: We were told by sales people that we would make more money because we’d be more efficient, and you’d be able to see more patients,  We’d be able to bill faster, get the money in the bank at the push of a button. And none of that panned out.

Reporter: Wilkerson says they were told the practice would be able to see 25% more patients, meaning: more income. But she and her partners found they actually had to cut back on the number of people they could see.

Wilkerson: For the first couple months we were really probably only seeing 50%, and then tried to rampup to 75%. I’d say I never got above 80-85% of what I’d seen before, just because it’s time consuming.

Reporter: That meant Wilkerson and her partners were taking an unexpected financial hit, right after they’d borrowed $200,000 to buy the medical records software and the computers to run it.
And ObamaCare rules driving doctors out of private practice and into becoming hospital employees?

Two quotes from the 12/1/2012 New York Times article, "A Hospital War Reflects a Bind for Doctors in the U.S." contrast the theory with practice.

Here's the theory:
Many policy experts praise the shift away from independent practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better able to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law
But here's how it works out in actual practice:
Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.
The utopian visions of central planners failed to work for the economies of the Eastern Bloc countries.  There's no reason to think it will work for American health care. 

(CPR link via Ari Armstrong.  NYT link via Dr. Donald Palmisano.)

Saturday, December 1, 2012

Catron: Could Obamacare Go the Way of McCain-Feingold?

In yesterday's American Spectator, David Catron asks "Could Obamacare Go the Way of McCain-Feingold?"

He lays out his hope that repeated legal challenges could chip away at ObamaCare in much the same that repeated legal challenges eventually undercut the McCain-Feingold campaign finance restrictions.

I hope he's right.