Favorite Forbes and PJ Media Columns of 2013

As 2013 winds down, here are some of my favorite Forbes and PJ Media health care columns for 2013.

Thanks to everyone who shared these by e-mail, blogging, Facebook, Twitter, etc.  I'm looking forward to an equally productive 2014!

Forbes columns:

"Why Doctors Should Not Ask Their Patients About Guns" (1/22/2013)

"Is Concierge Medicine The Correct Choice For You?" (3/27/2013)

"How Much Will Your Life Be Worth Under Obamacare?" (8/28/2013)

"Why The Federal Government Wants To Redefine The Word 'Cancer'" (9/29/2013)

"The Only Obamacare Fix Is For Obama To Legalize Real Health Insurance" (11/17/2013)

PJ Media columns:

My 4-part series on "Big Medicine"

Part 1: "Your Future Under Obamacare: Big Medicine Getting Bigger" (9/4/2013)

Part 2: "How Big Medicine Will Affect Patient Care" (9/10/2013)

Part 3: "The Eyes of Big Medicine: Electronic Medical Records" (9/18/2013)

Part 4: "How Patients Can Protect Themselves Against Big Medicine" (9/26/2013)

"Will Tomorrow's Medical Innovations Be There When You Need Them?" (11/15/2013)

(Here is the full list of my pieces.)

Cochrane: What to Do When ObamaCare Unravels

University of Chicago professor John Cochrane has a nice OpEd in the 12/25/2013 WSJ, "What to Do When ObamaCare Unravels".

A key point:

Health insurance should be individual, portable across jobs, states and providers; lifelong and guaranteed-renewable, meaning you have the right to continue with no unexpected increase in premiums if you get sick. Insurance should protect wealth against large, unforeseen, necessary expenses, rather than be a wildly inefficient payment plan for routine expenses.

People want to buy this insurance, and companies want to sell it. It would be far cheaper, and would solve the pre-existing conditions problem. We do not have such health insurance only because it was regulated out of existence...

ObamaCare Problems In Guam

Washington Post: "Think your state has Obamacare problems? They’re nothing compared to Guam."

Supporting the Benjamin Rush Institute

If you enjoy the work of the Benjamin Rush Institute (including their debates, panel discussions, lectures, etc.), consider donating and/or becoming a member. I did!

(The Benjamin Rush Institute is a 501(c)3 non-profit organization, so donations should be tax-deductible.)

Hsieh Forbes OpEd: Obamacare Spends 'Other People's Money' To Make Healthcare Expensive And Scarce

Forbes has just published my latest OpEd: "Obamacare Spends 'Other People's Money' To Make Healthcare Expensive And Scarce".

I discuss 4 dangers of a health system based on spending 'Other People's Money'.  In other words, it's not just that the money will run out some day!

Those dangers include:

1) Doctors will be increasingly expected to save money “for the system”
2) This will further fuel the nanny state
3) Health benefits will become increasingly politicized
4) Sooner or later, government spending Other People’s Money means the government taking your money

I also discuss how to avoid these problems.

(And many thanks to Ray Niles for finding that great Walter Williams quote.)

Roy on ObamaCare Rule Changes

Avik Roy has a good round-up at Forbes on the latest ObamaCare rule changes and what they mean: "Utter Chaos: White House Exempts Millions From Obamacare's Insurance Mandate, 'Unaffordable' Exchanges".

A couple of key points:

* The previous "fixes" weren't working, but the proposed new "fix" to allow some people to purchase "catastrophic" plans also won't work.  Those "catastrophic" plans won't be much cheaper.

* The insurance marketplace is now in chaos because of unexpected rule changes.

But you should read the whole thing.

Catron on Insurers' Faustian Bargain

David Catron's latest piece for the American Spectator notes that "Insurance Companies Deserve Obamacare".

He reminds us that insurers:

...enter[ed] into a Faustian bargain with the White House whereby they agreed to promote Obamacare in return for potentially enormous profits from millions of new customers who will be herded to them by its exchanges. In 2012, the health insurers kept their part of the deal by spending $216 million to pimp Obamacare, but the president and his accomplices began double-crossing them as soon as it became politically expedient.

Most Americans won't shed too many tears for the insurers.

And Catron also notes that the current problems of ObamaCare will further fuel the push towards abolition of private health insurance altogether by advocates of a "single payer" system.

(FWIW, I covered some similar points in my March 2009 PJ Media piece, "Health Insurance Industry Sells Its Soul to the Devil".)

Updated D4PC Reform Proposal

Docs4PatientCare has published their updated 2013 health care reform proposal, "Physician's Prescription for Health Care Reform".

Overall, I agree with the broad outline of their proposals.  Their plan would definitely move American health care in positive direction.

(I would also include proposals to eventually fully privatize Medicare, Medicaid, and high-risk pools.  But their plan would be far superior to the status quo.)

USA Today on MRSA

USA Today has a detailed article on the growing problem of antibiotic-resistant bacteria: "Dangerous MRSA bacteria expand into communities".

We will be hearing much more about this issue in coming years.

Quick Links: Roy, NHS, Friedman

Avik Roy: "Government Takeover: White House Forces Obamacare Insurers To Cover Unpaid Patients At A Loss"

Telegraph: "Inspectors carrying out first spot checks of family doctors in England find maggots in treatment rooms and queues so long that patients brought in stools to sit on"

Classic Milton Friedman talk from 1978: "Economics of Socialized Medicine"



(I don't agree with Friedman on some issues, but he was very good on this topic.)

Adalja on Medicare and End-Of-Life Care

Dr. Amesh Adalja has a new column up at Forbes: "Medicare Has Chained Us Together, Reliant On End-Of-Life Government Rationing".

A few excerpts from his piece:

As 25-30% of Medicare spending occurs in the last year of life, end of life care has become a rising issue in health care policy debates. End of life scenarios often place the ICU physician in the position of persuading designated surrogates of the patient to—after consulting the patient’s living will and stated wishes—withdraw care and allow the patient to succumb to their illness...

The growing fiscal burden of the program, not surprisingly, raises concerns regarding the costs and efficacy of the treatments paid for by Medicare. End of life care often takes place in ICUs and employs expensive state-of-the-art technology. Yet, in certain contexts, these advanced therapies are unable to alter the course of illness. Family members of gravely ill patients may have religious, financial, or other reasons to continue care and when an unseen 3rd party is responsible for the bill, costs of care are not a factor...

It is the increasingly socialized atmosphere of medicine that has created this scenario that puts physicians in a financial stewardship position creating a conflict with their role as an advocate for their patients. In any system where government pays for end-of-life health care, it will inevitably have to decide who receives it or not. In a free market, in which individuals control their own health care spending, individuals make these decisions for themselves... 

But you should read the full text.

Medicaid Time Bomb

Michael Tanner discusses how, "ObamaCare created a Medicaid time bomb" (NY Post, 12/7/2013).

Wolf on Other ObamaCare Lies

Dr. Milton Wolf has a new OpEd in the Washington Times, "The President’s other Obamacare lies".

The controversy over ordinary Americans losing their health insurance is just the tip of the iceberg.  Some of the other issues he discusses is people losing their doctors, raising taxes, and transparency.

Read the full text for more details.

And if you want more information on his run for the US Senate (or wish to donate to his campaign), check out his website.

Adalja Blog: Tracking Zebra

Dr. Amesh Adalja has a new blog, Tracking Zebra, covering "Infectious disease, politics, healthcare, Pittsburgh, and related topics".

I've learned a lot about the growing danger of antibiotic resistant bacteria from his Twitter feed as well.

Coming Next: "Doc Shock"

After the "rate shock", will come the "doc shock".  Get ready for arguments that "narrower networks" and less choice over doctors will be good for you.

From Megan McArdle: "'Doc Shock' On Deck in Obamacare Wars". 

(Link via Matthew Bowdish.)

Inappropriate "Appropriateness"

Dr. Wes Fisher asks a good question, "What happened to doctors serving as advocates for their patients?"

In particular, he notes how doctors are being increasingly expected to adhere to externally imposed "appropriateness" criteria for treating patients -- which may or may not be what's actually right for the individual patient.

Of course, guidelines and criteria can be helpful adjuncts to experienced clinical judgment. But they cannot replace that judgment.  The issue will become increasingly important as physician payments (or penalties) are increasingly linked to how whether or not a physician adheres to (or strays from) those criteria.

In the worst case, these criteria create a serious conflict of interest for the physician -- will doctors do what's right for their patients?  Or will they adhere to the criteria, even at the patient's expense?

Current Legal Challenges to ObamaCare

The 12/2/2013 New York Times has a round-up of, "A New Wave of Challenges to Health Law".

Two of the key issues include:

* The subsidies for people purchasing insurance through federal exchanges
* Religious freedom questions

Benjamin Rush Institute Debate on Markets and Health Care, Dec 4

The Benjamin Rush Institute will be hosting a debate tomorrow (Wednesday, December 4) on Kenneth Arrow's ideas of uncertainty as applied to health economics.  The set of panelists looks very impressive!

Here is their announcement:

Debate: "50 Years of Uncertainty: Are markets unsuitable for healthcare?"

In celebration of the 50th anniversary of Kenneth Arrow's highly influential article "Uncertainty and the Welfare Economics of Medical Care," the Benjamin Rush Institute chapter of UTHSCSA School of Medicine is sponsoring a debate on whether or not healthcare is sufficiently different from other industries that it requires a significant role for government to correct intrinsic "market failures."

When: Wednesday, December 4th, 2013 6:00 - 8:00 PM

Where: University of Texas Health Science Center at San Antonio School of Medicine
Pestana Lecture Hall 3.104A, 7703 Floyd Curl Drive, San Antonio, Texas 78229

Who:

Avik Roy, graduate from Yale School of Medicine; Senior Fellow, Manhattan Institute, Forbes columnist
Dr. William Sage, MD/JD, Vice Provost for Health Affairs, University of Texas at Austin
Dr. Mark Pauly, PhD, Professor of Health Care Management; Professor Business Economics and Health Policy, Wharton School of University of Pennsylvania
Dr. Samuel Richardson, PhD, Assist. Professor of Public Affairs, LBJ School of Public Affairs

Local audience members can RSVP here.

For out-of-town folks BRI says, "Regretfully, the planned live-streaming will not be available. A video recording will be posted on the website as soon as possible."

More background information on the topic from BRI:

Fifty years ago in 1963, Kenneth Arrow wrote what became a landmark article in health economics, “Uncertainty and the Welfare Economics of Medical Care.”

Arrow’s analysis is deeply imbedded in the economic theory of welfare economics — which in turn is built upon the belief that it is possible to determine a socially optimal allocation of resources — frequently along the lines of Pareto optimality – and anything short of that optimal state is a “market failure.” Arrow contends that the lack of optimality in healthcare, and the market failures which lead to it, emanate from variant forms of uncertainty, manifesting as problems of risk, insurance and imperfect information.  He discusses ways that society attempts to circumvent market failures through the use of non-market institutions, such as government, professionalism, nonprofit status, and trust.

Arrow’s article quickly became required reading for anyone studying the economics of healthcare — and even today, his ideas continue to influence scholarly and popular dialogue. Anyone with a serious interest in tackling healthcare reform needs to be familiar with Arrow’s analyses, in particualr, the problems of adverse selection in insurance, and of asymmetric information, both in matters of insurance and in doctor-patient relationships.

To celebrate Arrow’s contribution to healthcare economics, the Benjamin Rush Institute is hosting a debate. We have gathered an exciting panel of scholars who are well versed in Arrow’s work. Dr. Sage edited and Dr. Pauly contributed to a compilation of essays on the 40th anniversary, Uncertain Times: Kenneth Arrow and the Changing Economics of Health Care. Avik Roy has written several op-eds critiquing the use of Arrow to justify government interventions.

Forcing Doctors To See Obamacare Patients?

In his 11/25/2013 Forbes column, Merrill Matthews asks a darned good question: "When Will The Government Start Forcing Doctors To See Obamacare Patients?"

Given the worsening doctor shortage and the influx of newly-insured patients under ObamaCare, something is going to have to give.  Some possibilities include:

1) More patients will get their care from mid-level providers such as Physician Assistants (PAs) and Nurse Practitioners (NPs), only seeing an MD when their condition is deemed sufficiently severe.

2) Patients will get "shared medical appointments", where multiple patients see one doctor at the same time.

3) Doctors will not be allowed to turn away patients with ObamaCare insurance (or government Medicare/Medicaid coverage).

We're not yet at that last step.  But some trial balloons have been floated in Massachusetts.  And a candidate for the Virginia state legislature recently made a similar proposal.

This gives rise to a natural question: Do you really want a doctor taking care of you who is doing so only because he's forced to by the government?

Don't expect this issue to go away.

Light Posting Notice

Because of the holidays, I'll be taking a break from blogging until after the weekend. Happy Thanksgiving, everyone!

Repealing ObamaCare?

The generally-liberal Chicago Tribune says it's time to repeal ObamaCare.

Pro-ObamaCare New Republic article warns: "Think Obamacare Can't Be Repealed? It Happened Once in Australia".

David Catron reminds us of some relatively recent US history in, "Obamacare Repeal a Fantasy?"

BRI: Obama's Not To Blame (Not Entirely)

I liked how Benjamin Rush Institute blogger Charlotte Monte put it: "Obama's Not to Blame! Well…Not Entirely".

Our current president has created many problems for American health care. But he is merely extending policies that go back many years (and caused by both major political parties).

She also notes:

Our health insurance system bears improving, especially since it was created by bad government intervention. The answer is not more government, but less. There exist viable, reasoned and intelligent solutions. It’s up to Americans to demand them.

Amen to that.

(And I greatly appreciated the link to my recent Forbes piece, "The Only Obamacare Fix Is For Obama To Legalize Real Health Insurance"!)

TOS Commentary From Armstrong

BTW, Ari Armstrong has been posting good analyses of the health care issue at the TOS blog.

Some of his recent posts include:

"What’s Your Best Line Exposing the Evil of ObamaCare?" (11/18/2013)
"Obama’s Answer to How Health Insurers Will Adjust to His Whim: Somehow" (11/15/2013)
"ObamaCare Ads Tout Keg Mishaps and Promiscuous Sex; Ignore Rights Violations" (11/14/2013)

The blog also has lots of cultural and political commentary on other issues, so go check them out!

Hsieh Forbes OpEd: Legalize Real Health Insurance

Forbes has published my latest OpEd, "The Only Obamacare Fix Is For Obama To Legalize Real Health Insurance".

My basic theme is that we need to legalize real "catastrophic-only" insurance, free of government mandates.  More broadly, instead of debating which new government entitlements to create, we should be vigorously debating which freedoms to restore.

Here is the opening:

The President has proposed a one-year “fix” to deal with the political fallout from his broken promise (or lie), “If you like your insurance plan, you will keep it.” Now it’s, “If you like your plan, you can keep it until after the 2014 mid-term elections. Maybe.”

But the problems with ObamaCare go much deeper than cancelled insurance. As surprising as it sounds, most Americans never had real health insurance to begin with — and were not allowed to by law. And the only cure for our current health insurance mess is to legalize real health insurance...

I discuss the history of how we got into our current mess and some concrete free-market reforms that would move us in the right direction. These include:

1. Eliminate the tax disparity between employer-provided health insurance and individually-purchased health insurance.

2. Eliminate all mandated benefits. Insurers should be free to offer to willing consumers inexpensive policies covering only catastrophic accidents and illnesses.

3. Allow insurers to sell policies across state lines.

(For more details, read the full text of "The Only Obamacare Fix Is For Obama To Legalize Real Health Insurance".)

If you like these ideas, please feel free to circulate the column to friends, family members, etc.

You can also send your elected officials a quick e-mail. Please feel free to use and/or modify the template below:

Dear [Congressman or Senator]:

As the current problems of the Affordable Care Act are becoming more apparent to Americans, we need to consider genuine free-market reforms.

I like the ideas in this recent Forbes article, "The Only Obamacare Fix Is For Obama To Legalize Real Health Insurance", including the following:

1. Eliminate the tax disparity between employer-provided health insurance and individually-purchased health insurance. This would uncouple health insurance from employment and restore a level playing field to the individual insurance market. Individuals could then purchase policies that they kept even when they changed jobs (just as they already do with their car and homeowners insurance).
2. Eliminate all mandated benefits. Insurers should be free to offer to willing consumers inexpensive policies covering only catastrophic accidents and illnesses. Insurers would remain free to offer richer policies that covered varying levels of elective procedures (but cost correspondingly more). Customers could purchase whatever levels of coverage they wished from willing insurers based on their own individual needs and circumstances.
3. Allow insurers to sell policies across state lines. State mandates create 50 separate state markets rather than a single national market. A family insurance plan costing $3,000 in Wisconsin might cost $10,000 in New Jersey because of state regulatory barriers. Allowing interstate competition would quickly drive down prices and help many working families on a tight budget.

From: http://www.forbes.com/sites/paulhsieh/2013/11/17/the-only-obamacare-fix-is-for-obama-to-legalize-real-health-insurance/

I hope Congress can discuss and debate these ideas as a way to truly fix our health care system.

[Signed your name, address, etc.]

Hsieh PJM OpEd: Will Tomorrow’s Medical Innovations Be There When You Need Them?

PJ Media has just published my latest OpEd, "Will Tomorrow’s Medical Innovations Be There When You Need Them?"

My basic theme is that we must protect the freedoms necessary for the advancement of medical technology.

I start with a pair of vignettes:

How much has American medicine changed in the past 30 years?

Let’s turn the clock back to 1983. A middle-aged man, Dan, is crossing the street on a busy midday Monday. An inattentive driver runs a red light and plows into Dan at 45 mph, sending him flying across the pavement. Bystanders immediately call for help. An ambulance rushes Dan to the nearest hospital. In the ER, the doctors can’t stabilize his falling blood pressure. They prep him for emergency surgery. The trauma surgeon tries desperately to stop the internal bleeding from his badly fractured pelvis but is unsuccessful. Dan dies on the operating table.

The surgeon gives Dan’s wife the sad news: “I’m sorry, but your husband’s injuries were too severe. We did everything we could. But we weren’t able to save him.”

Fast forward to 2013. Dan’s now-grown son Don suffers the same accident. But within minutes of his arrival in the ER, he’s sent for a rapid trauma body CT scan that shows the extent of the pelvic fractures — and more importantly, shows two badly torn blood vessels that can’t be easily reached with surgery.

An interventional radiologist inserts a catheter into the femoral artery in Don’s right leg. Watching live on the fluoroscopy screen, the radiologist skillfully guides the catheter through the various twists and turns of the arterial system and positions it at the first of the two “bleeders.” From within the blood vessel, he injects specially designed “microcoils” into the torn artery and stops the bleeding. He then guides the catheter to the second bleeder and repeats the procedure. Don’s blood pressure recovers. The surgeons now have time to repair Don’s pelvic fractures and other internal injuries.

The surgeons give Don’s wife the good news: “Your husband’s injuries were pretty bad. But we were able to fix everything. He’ll still have to go through recovery and physical therapy. But he should be back to normal in six months”...

For more, read the full text of "Will Tomorrow’s Medical Innovations Be There When You Need Them?"

(The material for the opening vignettes was drawn from a pair of excellent talks presented last month at the 2013 annual meeting of the American Society of Emergency Radiology. )

Update #1: A great example of medical innovation coming from unexpected places was this 11/14/2013 New York Times article describing how an Argentinian car mechanic saw a Youtube video on how to extract a stuck cork from a wine bottle and realized it could also be used to help extract babies stuck in the birth canal.

His idea will be manufactured by Becton, Dickinson and Company and has already undergone initial successful safety testing in humans. It could save the lives of many babies in Third World countries and also reduce the need for Caesarean section in industralized countries.  (Via Gus Van Horn.)

Update #2: For those interested in the real-life technology used in the fictional scenario I discussed, here's a nice medical slideshow from UCLA interventional radiologist Dr. Justin McWilliams, "Life-saving Embolizations: Trauma and GI bleeding"

Life saving embolizations from pryce27

Hsieh LTE in WaPo on ObamaCare Enrollees

The Washington Post published my letter-to-the-editor (LTE) on how the White House counts ObamaCare enrollees:

An Obamacare and income tax accounting

So the White House counts as Obamacare enrollees “those who simply picked a plan and put it in their online shopping cart” but have not yet paid for it. Do I then get to count as having paid my taxes if I’ve filled out my 1040 form but haven’t mailed in my check?

Paul Hsieh, Sedalia, Colo.

(My letter was in response to their 11/11/2013 article, "HealthCare.gov tally: 40,000 are signed up".)

Charlotte Monte Report on "Physicians Summit 2013"

Charlotte Monte of the Benjamin Rush Institute reports on the successful "Physicians Summit 2013" earlier this month.

From her post:

On November 1 – 2, over 60 physicians from across the country, including three Benjamin Rush Institute medical students, attended the 2-day Physicians Summit 2013 in Dallas, TX. The purpose of the Summit was to give information — factual and inspirational — to physicians seeking a better way to practice medicine other than under the thumb of the Affordable Care Act (“Obamacare”).

Throughout the event, attendees were presented with first hand accounts how doctors from Oregon to Florida are making a better life for themselves and their patients by not succumbing to Obamacare. They presented variations on the Direct Pay, or “Concierge” medical model, with many survival tips and techniques.

Other speakers provided advice about online reputation protection, marketing, innovation, entrepreneurial- and business-oriented thinking, and investment advice. Sponsors included offshore asset and precious metal investment account managers, health and wellness products, practice transition services, and non-profit doctor organizations who work together for positive healthcare policy...

She also reports that, "Plans are already underway for The Physicians Summit 2014, with more speakers, more sponsors and supporters." 

You can get more information about this and other events at the BRI Blog.

Balko on Forced Medical Procedures and the Drug War

This is a very eye-opening piece from Radley Balko: "Anal Probes And The Drug War: A Look At The Ethical And Legal Issues".

From the opening:

Last week, news wires, blogs and pundits lit up with the horrifying story of David Eckert, a New Mexico man who last January was subjected to a series of invasive and degrading drug search procedures after a traffic stop. The procedures, which included x-rays, digital anal penetration, enemas and a colonoscopy, were all performed without Eckert's consent.

[...other examples...]

These incidents raise troubling questions about how the criminal justice system and medical establishment could allow for such extreme and invasive measures based on such little suspicion for nonviolent drug offenses...

Read the full text for more thorough discussion of the relevant legal and medical ethics issues.

(BTW, Diana and I got to hear him speak in Denver on his book, Rise of the Warrior Cop: The Militarization of America's Police Forces.  If you get to hear him speak in person, it's worth going to.)

Chicago Tribune Speaks Out Against ObamaCare

I was pleasantly surprised to read this editorial from the liberal Chicago Tribune speaking out against ObamaCare and supporting free-market reforms.

From their piece, "Truth, consequences and Obamacare":

An essential first step: Accept that government doesn't know what's best for everyone. That people can decide what coverage they need and can afford. A strong marketplace offers choices for every wallet. Obamacare's rules curtail those choices. Why, for instance, should only people under age 30 be eligible to purchase lower-cost "catastrophic" insurance? Pinching Americans' coverage choices is one big reason this law doesn't work.

I wish they had spoken out sooner.  But it's a good start.

The FDA Prepares to Ban Trans-Fat

Michelle Minton of CEI has a new OpEd, "FDA Trans-Fat Ban Sets Stage to Target Sugar, Salt, and More".

In particular, she notes:

The de facto ban on trans-fat’s GRAS [Generally Recognized As Safe] status signals a sea change in the agency’s approach to food-safety regulation. Historically, the FDA has banned only additives and products that could be acutely dangerous to public health. FDA attempts to limit other ingredients, such as salt and sugar, have met public backlash, but it’s unlikely many will step up to defend trans-fats, considering the scientific evidence that seems to link its long-term consumption with a slightly increased risk of cardiovascular disease.

Since almost any food can become dangerous if consumed in excess over an extended period, this move would set a precedent for the FDA to go after other food ingredients. Unsurprisingly, self-styled “public health” advocates — always at the forefront of nanny state regulatory efforts -- are elated at this prospect...

It may indeed be that new scientific evidence show these fats are bad for people. 

But I posted the following comment below on Facebook and wanted to repost it here:

If the only thing the FDA did was say, "We think Food A is healthier for you than Food B", then it wouldn't be too big of a deal. Various private advocacy groups (biased and impartial) do that all the time -- and I can take or leave their advice. And in that case, the FDA would also be superfluous in a world where other people and organizations (some with much better credibility) would already be weighing in with their opinions.

But when the FDA also has the regulatory power to push some foods onto the market (and drive others off), then that's a different story entirely.

I'm fine with private people and organizations making arguments along the lines of, "Science now shows that some of our ideas from 20 years ago are wrong." One recent example has been the rise of "barefoot running" or the "minimalist shoes" as an alternative to the heavily padded traditional running shoes that gained popularity in the 1970s/1980s. There's interesting work showing those minimal shoes may have genuine long-term orthopedic benefits.

People can study the research for themselves and make their own decisions about what kind of running shoe to purchase (relying on any experts they deem reliable.)

But I would have objected to the FDA (or any similar government agency) promoting old-style running shoes in the 1980s and I would be similarly opposed to a government agency attempting to now tilt the playing field towards the popular new minimalist running shoes.

For agencies like the FDA, it's not just about the science. It's about someone's vision of what the science means for how you should live.

Armstrong On Finding A Concierge Doctor

Ari Armstrong describes how, "Prior to Concierge Medicine, My Access to Health Care Was Inferior to that of My Cat".

From his post:

Although I loved my previous doctor, I had a difficult time scheduling a timely appointment with her. When I last called, I was told I’d have to wait three months to schedule a routine physical. Such delays are not unusual; many Americans—including many of my friends—are having trouble getting in to see a doctor in a timely manner (although for serious emergencies Americans almost always receive fast and excellent care).

Contrast my physical exam with that of my cat. When I called my veterinarian’s office last month, I was able to schedule my cat’s routine exam within days, and she received top-notch care, complete with detailed blood analysis. Why is it, I thought, that my cat has better access to health care than I have?...

Thankfully, my story has a happy ending: I found a “concierge” family practice in my area, similar to that of Dr. Josh Umbehr (whom I interviewed for the Fall issue of TOS). The practice accepts no insurance, provides many tests at cost, and charges a relatively low monthly fee (which my wife and I pay from our Health Savings Account). I was able to schedule my physical within days, and my new doctor was able to spend a full, unhurried hour with me.

For more details, read the full text of "Prior to Concierge Medicine, My Access to Health Care Was Inferior to that of My Cat".

John Hunt: Assume The Physician

Reader book plug from pediatrician Dr. John Hunt: His novel, Assume The Physician.

Roy On American Life Expectancy

Avik Roy discusses, "The Myth of Americans' Poor Life Expectancy".

A couple of excerpts:

If you really want to measure health outcomes, the best way to do it is at the point of medical intervention. If you have a heart attack, how long do you live in the U.S. vs. another country? If you’re diagnosed with breast cancer? In 2008, a group of investigators conducted a worldwide study of cancer survival rates, called CONCORD. They looked at 5-year survival rates for breast cancer, colon and rectal cancer, and prostate cancer. I compiled their data for the U.S., Canada, Australia, Japan, and western Europe. Guess who came out number one?

And:

Another point worth making is that people die for other reasons than health. For example, people die because of car accidents and violent crime. A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables?

Click through to read the answers.

Dr. Craig Wax' Letter To The President

Family physician Dr. Craig Wax has posted his letter to the President.

There are a lot of doctors in America who share his concerns.

Catron Update on Contraception Mandate

David Catron has an update on the latest court ruling here in American Spectator: "Whither Obamacare's Contraception Mandate Now?"

Here's the opening:

Last Friday, capping off a week filled with disturbing revelations of bureaucratic incompetence and presidential mendacity concerning Obamacare, the D.C. Circuit Court of Appeals struck down the “reform” law’s notorious contraception mandate. On behalf of the majority, Judge Janice Rogers Brown wrote that the mandate would force the plaintiffs in Gilardi v. HHS to choose between bankruptcy and violating their religious beliefs: “They can either abide by the sacred tenets of their faith, pay a penalty of over $14 million and cripple the companies they have spent a lifetime building, or they become complicit in a grave moral wrong.”

This, the court ruled, violates the constitutional rights of plaintiffs Francis and Philip Gilardi. The Gilardi brothers own Freshway Foods as well as Freshway logistics and provide health insurance for their 400 employees through a third-party administrator. They also oppose contraception, sterilization, and abortion. Thus, Freshway’s employee health plan excludes coverage of products and services related to those practices. Believing that the contraception mandate violates their rights under the Religious Freedom Restoration Act (RFRA) and the Free Exercise clause of the First Amendment, the Gilardis filed a lawsuit against the government last January...

This looks like it will be headed to the US Supreme Court. Read the full text for more.

Morning Snark: Hsieh PJM OpEd "Obamacare and the Wages of Spin"

PJ Media has posted my snarky piece, "Obamacare and the Wages of Spin".

The basic theme: Don't piss on my back and tell me it's raining.

Here is the opening:

Many years ago, the writer Ayn Rand noticed a curious kind of backpedalling from the political Left. First, they’d claim that socialism would provide enough shoes for the whole world. But when economic reality caught up with them, and they failed to deliver on their promises, they’d turn around and claim that going barefoot was superior to wearing shoes. In modern parlance, those broken promises weren’t a bug, but a feature!

In the past few weeks, we’ve seen precisely this pattern coming from defenders of ObamaCare. For example...

Read the full text at: "Obamacare and the Wages of Spin".

(And thanks to Jawaid Bazyar for flagging the Ayn Rand quote I used in the opening.)

PJ Media on Math and Security

Two noteworthy pieces on PJ Media.

From Charlie Martin: "Obamacare vs. Arithmetic".

(I agree with most of his proposals, although I don't think we should have a mandate on purchasing even "catastrophic-only" insurance plans.)

From Rick Moran: "Worrisome Security Breach at Healthcare.gov".

(If a private health care organization had similar data security breaches, the government would be on them like a ton of bricks.)

Catron Reviews Sebelius Testimony

David Catron gives a big thumbs-down to HHS Secretary Sebelius' recent testimony before Congress: "Sebelius Enters the Eighth Circle of Obamacare".

Absurd Arithmetic

At PJMedia, Charlie Martin explains "The Arithmetic Absurdity of Obamacare".

I really like how he distills the basic issues of risk stratification, mandates, and cross-subsidies in terms anyone can understand. Instead of me quoting the whole thing, you should just go and read it at their website.

Reminder: Math always wins.

Three From McArdle

Megan McArdle has written three good analyses of ObamaCare at Bloomberg lately.

"Is Obamacare in a Death Spiral?" (10/21/2013)

The exchanges were also broadly understood to be needed to get young, healthy people into the system. Somewhat naturally, almost every story you’ve seen about a new enrollee -- including those told by the president this morning -- has focused on someone who couldn’t buy insurance before, or who had very expensive insurance. But it’s not surprising that those people are fighting through the system to get coverage; they would pull themselves to the top of Mount Rushmore using only their teeth if that’s what it took to get a cheap insurance policy. What we need to know is what is happening among the people who didn’t need Obamacare to help them buy insurance, because insurers would be perfectly happy to sell them a policy without it. Those are the folks whose premiums will cover treatment for the rest.

"Obamacare Fiasco Isn't a Single-Payer Conspiracy" (10/24/2013)

In response to the current ObamaCare launch difficulties, she notes:

The interesting thing is that people on both ends of the political spectrum seem to believe that the answer is the same: single payer. What Walter Russell Mead dubbed the “pivot" to single payer has begun as various folks point out that if we only had a total government takeover, these issues wouldn’t put the whole system in danger. I’ve seen more than a few progressive commenters suggest that maybe an epic fail will finally open the way to the single-payer system we should have had in the first place.

In private, and occasionally in public, conservatives are expressing the same fear. There’s a pretty popular conspiracy theory running around to the effect that this was the Barack Obama administration’s intent all along: Design this big Rube Goldberg apparatus that couldn’t possibly work, and when it fails, sweep in and “fix” things by enacting the single-payer scheme you wanted all along.

Perhaps they did want single payer all along, in their secret heart of hearts, but it’s ludicrous to think that they were capable of designing and pulling off a conspiracy of that magnitude...

(I do think that many on the political Left will use this as a "justification" to promote the single-payer system, regardless of the intentions of the initial legislators who passed the law.)

"Stopping Overtreatment Sounds Easy, Until It's Your Heart Attack" (10/25/2013)

I recommend reading the whole thing.  McArdle notes:

Is this to say that there is no way to save money in health care without hurting patients? Of course not. But we should be wary of asserting that it will be easy to save money without hurting patients as long as we simply follow the best evidence. Studies are, of course, the foundation of science. But they also have limits. The questions they can answer are often much narrower than the questions we would like to answer -- and often other studies give different answers. There’s a decent amount of evidence that hospitals which do more intensive interventions get better outcomes.

One point -- it's very easy for central planners to opine from their armchair about "best practices" for doctors and patients.  Yet such plans often run into trouble with real-life patients.

Allen Describes ObamaCare 2016

Dr. Bradley Allen, a pediatric heart surgeon, has an excellent OpEd in the Wall Street Journal on ObamaCare 2016 (from 10/22/2013).

He discusses the more fundamental structural problems with ObamaCare after the initial launch problems and how it will accelerate current ominous trends.  

The combination of the worsening doctor shortage, doctors opting out of Medicare, doctors opting out of Medicaid, and the migration of doctors out of private practice (due to regulatory overhead) will create tremendous problems for patients seeking medical care.

A few excerpts:

The loss of private practice is another big problem. Because of regulations and other government disincentives to self employment, doctors began working for hospitals in the early 2000s, leaving less than half in private practice by 2013. The ACA rapidly accelerated this trend, so that now very few private practices remain.

When doctors are employed like factory workers by hospitals, data from the Medical Group Management Association and others indicate, their productivity falls—sometimes by more than 25%. They see fewer patients and perform fewer timely procedures, exacerbating the troubles caused by physician shortages. Continuity of care also declines, since now a physician's responsibilities end when his shift is over.

Of those doctors still in private practice, many have taken refuge from the health-care law by going into concierge medicine, where the patient pays an annual fee (typically $500-$3,000 a year per individual) to a primary-care physician. This doctor provides enhanced care, grants quicker appointments and spends more time with each patient, working with a base of 300-600 patients instead of the 3,000-5,000 typical in the ACA era. Doctors and patients who can afford it love concierge medicine: It allows treatment to be administered as the doctor sees fit, instead of as if the patient is on an assembly line with care directed on orders from Washington.

Patients who can't afford concierge medicine but have seen their doctor take that route are out of luck: They have been added to the swelling rolls of patients taken care of by the shrinking pool of physicians. So even people with "private" insurance have found that the quality of their health care declined. Nowadays, many are forced instead to see a nurse or other health-care provider. The traditional doctor-patient relationship is now reserved primarily for those who can pay extra.

As a result, fewer bright young students will go into medicine:

With an average of $300,000 in student loans, eight years of college and medical school, and three to seven years as underpaid, overworked residents, a prospective physician in the ACA era would be starting a career at age 30 in a job that requires working 70-80 hours a week in an assembly-line fashion to earn perhaps $100,000 a year. No wonder so many qualified individuals these days are choosing careers on Wall Street or in Silicon Valley instead of medicine.

Dr. Allen paints a chilling scenario.  It's up to us to make sure this doesn't happen.

(Read the full text of "ObamaCare 2016: Happy Yet?")

KHN: I Don’t Have Children, So Why Do I Have To Buy Pediatric Dental Insurance?

Kaiser Health News fielded the following reader question, "I Don't Have Children, So Why Do I Have To Buy Pediatric Dental Insurance?"

Here's the question in full:

Q. My husband is self-employed and currently has an individual plan. I recently received a letter that said that he must purchase pediatric dental insurance, and if he doesn't provide proof that he has it they will automatically enroll him in a plan. We don't have children, so why would we have to have pediatric dental insurance?

Their answer begins:

A. Under the health care law, starting in January new individual and small-group health plans must cover 10 so-called essential health benefits. The list of required benefits was developed following a process that solicited input from consumer groups and members of the public, employers, states, insurers, and medical and policy experts. The final list reflects a core package of benefits that it was determined everyone should have access to, even though most people may not use every single benefit. It includes hospitalization and prescription drugs, maternity and newborn care, mental health and substance abuse services, emergency care and doctor visits, as well as pediatric services, including vision and dental services for children.  

KHN also notes that "people are not required to buy separate pediatric dental coverage if they buy a plan on the state health insurance marketplaces, or exchanges, unless their state specifically requires it."

So perhaps (paradoxically), someone can avoid this requirement by purchasing within the government exchange.

However, the broader problem of mandatory "essential health benefits" still applies.  Why should single men have to purchase maternity benefits?  Why should a teetotaller purchase substance abuse treatment benefits they don't need and will never use?

(Note: The problem of mandatory insurance benefits preceded ObamaCare, mostly enforced at the state level.  But ObamaCare partially federalizes this problem and expands this.)

Hsieh Forbes OpEd: "Northwestern University Did Right In Offering A Peanut-Free Football Game"

Forbes has published my latest OpEd, "Northwestern University Did Right In Offering A Peanut-Free Football Game".

Here is the opening:

2013, Northwestern University hosted the first known peanut-free college football game against Big Ten rival Minnesota. For that day, the school forbade peanut products from being sold or brought into the stadium. Groundskeepers even power-washed the 47,000 seats before the game to eliminate any peanut residue.

To my surprise, this aroused enormous controversy from some conservatives.  I discuss why their reasons are misguided and why I approve of Northwestern's decision.

I'd like to thank Diana Hsieh, Jenn Casey, and Dr. Matthew Bowdish for reading an earlier version of this piece. I'd also like to thank Alex Knapp for providing the quote at the end.

And as a followup, on 10/21/2013 the Daily Northwestern reported, "Students praise Northwestern's first allergy-conscious football game".

Electronic Medical Mess

Observers across the political spectrum are raising questions about the ObamaCare electronic medical records mandate. (Note: This is the physician side of electronic records, separate from the website problems reported by patients trying to sign up for insurance on the "exchanges".)

Dr. Dan Morhaim, who is both a physician and a Democrat representing Baltimore County in the Maryland House of Delegate, wrote the following in the Washington Post, in "An electronic medical records mess":

These systems tend to be fantastically complex. One doesn’t have to be intimately familiar with, say, Hertz or Enterprise to rent a car online. But many electronic health record systems have pull-down screens listing each of the 68,000 possible diagnosis codes in the World Health Organization’s International Classification of Diseases and 87,000 possible procedure codes.

Or consider what happens when I write a prescription: Every potential drug interaction or side effect listed generates a warning prompt. Inevitably, recognizing that the warnings are generally inapplicable and take time to sort out, clinicians start to bypass the alerts. Sooner or later, ignoring one will lead to serious complications...

Perhaps the most pernicious side effect is the erosion of the provider-patient relationship. When I first began working with electronic health records, I caught myself staring at the computer screen instead of engaging patients, who rightly felt ignored. Like many colleagues, I’ve reverted to the practice of talking with the patient and taking notes with pen and paper. After the evaluation is over and the patient has left, I type in the data. This takes much more time, but it is the only way to complete a proper history and exam....

Ideally, electronic health records would provide doctors with instant access to information and help patients track their medical histories. Such records should be a giant step forward in continuity and comprehensiveness of care. So far, the “cures” are worse than the disease.

Conservative columnist Michelle Malkin wrote the following in "Don't Forget Obamacare's Electronic Medical Records Wreck":

In June, the Annals of Emergency Medicine published a study warning that the "rush to capitalize on the huge federal investment of $30 billion for the adoption of electronic medical records led to some unfortunate and unintended consequences" tied to "communication failure, poor data display, wrong order/wrong patient errors and alert fatigue." Also this summer, Massachusetts reported that 60 percent of doctors could not meet the EMR mandate and face potential loss of their licenses in 2015. And a few weeks ago, the American College of Physicians pleaded with the feds to delay the mandate's data collection, certification and reporting requirements.

Dr. Hayward K. Zwerling, an internal medicine physician in Massachusetts who is also president of ComChart Medical Software, blasted the Obamacare EMR mandate in a recent open letter: "As the developer of an EMR, I sincerely believe that a well-designed EMR is a useful tool for many practices. However, the federal and state government's misguided obsession to stipulate which features must be in the EMRs, and how the physician should use the EMRs in the exam room places the politicians in the middle of the exam room between the patient and the physician, and seriously disrupts the physician-patient relationship." Zwerling's call to arms appealed to fellow doctors to pressure the feds to repeal the mandate. "It is past time that physicians reclaim control of their offices, if not the practice of medicine."

As I've mentioned previously, my own primary care physician in Colorado Springs quit her regular practice and converted to "concierge care" because of the EMR imposition. Dr. Henry Smith, a Pennsylvania pulmonary doctor, also walked away. "Faced with the implementation costs and skyrocketing overhead in general," he told me, "I finally threw in the towel and closed my practice"...

Dr. Michael Laidlaw of Rocklin, Calif., told EHR Practice Consultants that he abandoned the Obamacare EMR "incentive" program "when I realized that I spent the first two to five minutes of each visit endlessly clicking a bunch of garbage to make all the green lights show up on the (meaningful use) meter. I said to myself: 'I'm not wasting precious seconds of my life and my patients' time to ensure some database gets filled with data. I didn't go into medicine for this. It is not benefiting my patients or me. I hate it.' I actually refused to take the $10K-plus this year. I have even accepted that I would rather be penalized in the future. What is worth the most to me is AUTONOMY."  

Electronic medical records can be a tremendous benefit, if adopted organically by physicians and hospitals based on their needs and requirements.  But ramming them down the throats of doctors is merely hampering good patient care.

(Note: I also discussed electronic medical records in part 3 of my 4-part PJ Media series on the changing face of health care in , "The Eyes of Big Medicine: Electronic Medical Records".)

Update: Even kids know this is a problem.  Here's a drawing made by a 7-year old girl published in the 6/20/2012 issue of the Journal of the American Medical Association.

The article explains:

No one was more surprised than the physician himself. The drawing was unmistakable. It showed the artist—a 7-year-old girl—on the examining table. Her older sister was seated nearby in a chair, as was her mother, cradling her baby sister. The doctor sat staring at the computer, his back to the patient—and everyone else. All were smiling. The picture was carefully drawn with beautiful colors and details, and you couldn't miss the message.

(Click on image to see full size.)

Quick Links: Amerling, Catron

Dr. Richard Amerling explains why people should opt out of ObamaCare.

David Catron notes that Obamacare's "insurance marketplace" works just as well as everyother Soviet-style system.

Just remember: "Under ObamaCare, insurance cancels you!"

"

McArdle: Four Things We Think We Know About Obamacare

Megan McArdle writes the following in her post, "Four Things We Think We Know About Obamacare":

I’ve been seeing a few things floating around the blogosphere about Obamacare that aren’t true. They’re not really conservative or liberal talking points; they’re just misconceptions that people may have about how the health-care law works. So it seems worth pointing them out, especially because relying on some of these “facts” could get you into big trouble...

She then discusses 4 points of conventional wisdom that might not be fully correct:

You have until March 31 to buy health insurance.

The penalty for being uninsured next year is $95.

If the exchanges don’t work, as a last resort, we can always get people signed up through call centers.

The state exchanges are doing fine.

McArdle discusses each in more detail.  Read more at: "Four Things We Think We Know About Obamacare".

Armstrong Times Two

Ari Armstrong has a couple of noteworthy recent blog posts at The Objective Standard site:

ObamaCare: "What the Hell Kind of Reform Is This?" (10/18/2013)

"Government Shut Down and All I Got Was this Blog Post" (10/16/2013)

Hitler Learns About the Obamacare Exchanges

"Hitler Learns About the Obamacare Exchanges".  (Via Art Fougner.)

Update: Link was bad, now fixed!

Projections Vs. Reality

AP News reports, "Obama Administration Projected Strong Health Plan Signups".

Here's the opening:

The Obama administration's internal projections called for strong enrollment in the states in the first year of new health insurance markets, according to unpublished estimates obtained by The Associated Press. Whether those expectations will bear out is unclear...

Also:

"Why there is this reluctance to share internal estimates, I don't know," said health economist Gail Wilensky, who ran Medicare for President George H.W. Bush. "This kind of information has a way of worming its way out into the open, which makes it look like they have something to hide."

While consumer interest in the new health insurance markets has been undeniably strong, it's hard to get a sense of how many people have been able to navigate balky federal and state websites and successfully enroll. Numbers released by states running their own marketplaces suggest upward of 100,000 people have enrolled so far, out of millions of potential interested customers.

The administration refuses to release numbers for the 36 states in which it is taking the lead. Officials at first said the frozen computer screens and other issues were the result of a high volume of interest. They later acknowledged software and design issues were also to blame.

HHS belatedly rolled out a feature that allows consumers to get a look at health plans in their area without first establishing an account. The requirement that people set up an account before shopping was at odds with the normal way e-commerce websites are run, and was blamed for overloading the system.

Appearing earlier this week on MSNBC, former White House spokesman Robert Gibbs said the situation is "excruciatingly embarrassing" for the administration.

Reality has a funny way of confounding the best-laid plans of politicians.

Quick Links: Catron, Crovitz

David Catron: "Obamacare and the Edsel: A Tale of Two Lemons" (American Spectator, 10/14/2013).  Excerpt:

As the Edsel flop demonstrates, businesses in the free market are quite capable of making colossal mistakes. However, when they do so and the customer rejects their products, they make the necessary adjustments...

Whereas the potential buyers of the Edsel simply grimaced when they finally saw the thing and walked out of the showroom, the President and his congressional accomplices have arranged for you to be fined if you refuse to buy their ugly, overpriced, and dysfunctional product.

Gordon Crovitz: "ObamaCare's Serious Complications" (WSJ, 10/14/2013).  Excerpt:

Have you ever seen a price list in your doctor's office or at a hospital? Probably not, except for services like laser eye surgery and elective plastic surgery, which aren't covered by insurance. In these rare cases, there is price transparency and open competition.

As hospitals have merged to cope with the costs of increasingly complex regulation, competition has further diminished. This is a reminder of the truism that monopolies can only be sustained when government policy supports them.

Milton Wolf Running For US Senate

Dr. Milton Wolf has announced he'll be a candidate for the US Senate, challenging incumbent Pat Roberts in the GOP primary.

Here's his recent interview with Glenn Reynolds (aka "Instapundit"):



He has captured the attention of conservatives at the national level, as seen by this article, "Is Milton Wolf the next Ted Cruz?"

His campaign has a website at MiltonWolf.com and a Facebook page.  Here's his "Meet Milton Wolf" campaign ad.


You can also see a list of his columns for the Washington Times, many of which I've also linked to on this site.

I very much like his views on free-market health care reform.  (There are some issues on which we undoubtedly diverge, but that's not my focus at present.)  Overall, I'm glad he's a candidate and I encourage others who want to learn more to check him out!

Quick Links: Armstrong, Adalja, Goodman, Hillman

Because of other obligations, my blog posting may be lighter than usual this week. But here are a few links that readers might find interesting and/or thought-provoking:

Ari Armstrong: "ObamaCare Supporter: 'I Didn't Realize I Would Pay for It Personally'".

Dr. Amesh Adalja: "Obamacare's Onerous Rules Include A Blacklist Of America's Doctors".

John Goodman: "Community Rating".  (Via Dr. Richard Amerling.)

Mark Hillman: "What ObamaCare Means For Rural Colorado".

Benjamin Rush Institute Calendar

The Benjamin Rush Institute has revamped their website and their calendar.

If you're in the area for any of their conference, lectures, or debates, you should check them out!

Here's a sampling of some of their upcoming 2013 events:

Oct. 12 8:30 - 9:30 am Lee Gross, MD to speak on Epiphany Health at the AMSA fall conference in Stratford, NJ at Rowan School of Osteopathic Medicine.

Oct. 22 6:00 pm Rowan School of Osteopathic Medicine, Stratford NJ  (flier attached)

Debate/Discussion: US Health Care: Do we need to Reform the Reform?

Debaters:

• Dr. Alieta Eck, MD, past president AAPS
• Dr. Beth Haynes, MD, Executive Director, BRI
• Dr. William Thar, MD, Physicians for a National Health Plan
• 4th debater from Doctors for America, TBA

 

Oct. 23 5:30pm Icahn School of Medicine at Mt. Sinai, (NYC) Flier attached.

Debate: Medical Malpractice and Quality: Where to go from here?

Debaters:

• Michael Cannon, CATO
• Shirley Svorny, prof of Economics, CA State University
• Dr. Jeff Segal, JD/MD
• Dr. Ellen Carson, MD/JD.

Crashing The Health Care System

CNN reports, "Doctor shortage, increased demand could crash health care system".

One noteworthy quote:

"I think of (Obamacare) as giving everyone an ATM card in a town where there are no ATM machines," [ER physician Ryan] Stanton said. "The coming storm of patients means when they can't get in to see a primary care physician, even more people will end up with me in the emergency room."

What happened in Massachusetts in 2006 when the state's mandated health insurance rules went into effect illustrates the impending national problem.

When the Massachusetts law kicked in, wait times to get an appointment at primary care physicians' offices increased significantly, and they've remained high ever since, according to an annual survey from the Massachusetts Medical Society. And Massachusetts has the second highest physician-to-population ratio of any state...

 Also, "half the nation's physicians are over age 50 -- meaning many are at or near retirement age".

As always, "coverage" does not equal actual medical care.

McArdle On Faulty Obamacare Conventional Wisdom

Megan McArdle discusses, "11 Pieces of Obamacare Conventional Wisdom That Shouldn’t Be So Conventional".

Some of the interesting items on her list include:

1. Once Obamacare goes into effect, it will be impossible to substantially cut it back.
2. Accountable Care Organizations are certain to bring down overall health spending.
4. Emergency room use will decline.
5. People can game the system by going without insurance and then buying it when they get sick.
11. Obamacare will make bankruptcy a thing of the past, at least for the people who gain coverage. 

Click through to read more discussion of each of those (and other) items.

Physician Summit 2013: Speaker Profiles

The upcoming Physician Summit 2013 conference has posted their speaker profiles.

I won't be able to attend, but they have a good lineup, including Dr. Lee Gross and Dr. Kathleen Brown.

Click through to learn more about their program and how to register.




Speaker Spotlight The Physicians Summit 2013 is ramped up and underway for November 1-2 in Dallas.

We are pleased to present our Speaker Spotlight series — overviews of some of the excellent speakers you will hear at the Summit. In this, our first Speaker Spotlight installment, we’re honored to introduce Dr. Lee Gross, M. D., Co-Founder of Epiphany Health, National Executive Board member of Docs4PatientCare, and tireless champion for freedom and innovation in medical care and delivery.

It is also our honor to spotlight Kathleen M. Brown, M.D., Dermatologist, and owner of Oregon Coast Dermatology as our second speaker for the summit.

Hsieh Forbes OpEd: "Why The Federal Government Wants To Redefine The Word 'Cancer'"

October 2013 will be Breast Cancer Awareness Month.

Hence, it's apropos that Forbes has just published my latest OpEd on this topic, "Why The Federal Government Wants To Redefine The Word 'Cancer'".  Here is the opening:

The federal government wants to reduce the number of Americans diagnosed each year with cancer. But not by better preventive care or healthier living. Instead, the government wants to redefine the term "cancer" so that fewer conditions qualify as a true cancer. What does this mean for ordinary Americans — and should we be concerned?...

I discuss the reasons behind the proposed redefinition, why it could matter from a political (as well as medical) standpoint, and implications for both patients and doctors.

I'd like to thank Dr. Milton Wolf for providing the quote at the end!

(Read the full text of "Why The Federal Government Wants To Redefine The Word 'Cancer'".)

Who's Exempt From ObamaCare

Here's a surprisingly long list of people exempt from the ObamaCare individual mandate.

According to this article in The Atlantic, the list includes:

• You’re uninsured for less than 3 months of the year
• The lowest-priced coverage available to you would cost more than 8% of your household income
• You don’t have to file a tax return because your income is too low (Learn about the filing limit.)
• You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
• You’re a member of a recognized health care sharing ministry
• You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
• You’re incarcerated, and not awaiting the disposition of charges against you
• You’re not lawfully present in the U.S.

There are also the following "hardship exemptions":

1. You were homeless.
2. You were evicted in the past 6 months or were facing eviction or foreclosure.
3. You received a shut-off notice from a utility company.
4. You recently experienced domestic violence.
5. You recently experienced the death of a close family member.
6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
7. You filed for bankruptcy in the last 6 months.
8. You had medical expenses you couldn’t pay in the last 24 months.
9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
10. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
11. As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.
12. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.

And as Dr. Hal Scherz reminds us in his latest OpEd, "Healthcare Reform For Thee, But Not Me", those with political "pull" are also seeking their own waivers and exemptions.

Weekend Links: Catron, Scherz, Gottlieb

After a crazy work week I'm catching up on some reading, including:

David Catron: "The Truth About Hobby Lobby and the Supreme Court".

Dr. Hal Scherz: "Healthcare Reform For Thee, But Not Me".

Scott Gottlieb: "If you loathed HMOs, you're not going to like Obamacare". (Via Matt Bowdish.)

Hsieh PJM OpEd: How Patients Can Protect Themselves Against Big Medicine

PJ Media has published the final segment of my 4-part series on the changing face of American medicine under ObamaCare, "How Patients Can Protect Themselves Against Big Medicine".

Earlier segments include:

Part 1: "Your Future Under Obamacare: Big Medicine Getting Bigger"
Part 2: "How Big Medicine Will Affect Patient Care"
Part 3: "The Eyes of Big Medicine: Electronic Medical Records"

Khullar on Carrots and Sticks

New York Times writer (and medical student) Dhruv Khullar discusses how, "Medicine is More than Carrots and Sticks".

Here is the opening:

“Did you take it out yet?” my supervising physician asked me, referring to the urinary catheter I placed in a patient several days before. “You know they’re keeping tabs on that now?”

I did know. We had recently discussed performance metrics during morning rounds, and were taught that prolonged urinary catheterization caused many hospital-acquired infections. Hospitals were now being penalized for that sort of thing.

Several months before, I had attended a conference where there was a heated discussion about whether to tie reimbursements to how well physicians managed hemoglobin A1c levels – a marker of blood sugar control in diabetic patients. Some argued doctors would pay closer attention to diabetes control. Others thought they would simply select healthier, more compliant patients to make their jobs easier.

Suddenly, a stately gentleman stood up and the room fell silent. I recognized him as one of the most distinguished faculty members at my medical school, a legend that physicians across the state consulted on their most difficult cases.

“What on earth are we teaching these young doctors?” he asked, exasperated.

He stressed that a physician’s responsibilities — to avidly manage diabetes or blood pressure, to promptly remove a urinary catheter, to ensure patient compliance with medications — come not from incentives, but from a sacred duty we assume upon entering the profession. Overemphasizing the former while underemphasizing the latter, he argued, does a disservice to the medical profession and to our patients...

Yet all the "pay for performance" incentives are leading to precisely this kind of sterile, "cookbook" medical care.

This is one of the disturbing facets of American medicine under ObamaCare that I also discuss in my recent PJ Media piece, "How Big Medicine Will Affect Patient Care".