Hsieh Forbes OpEd on Fertility Panic and Freedom

Yesterday's Forbes (2/27/2013) published my latest OpEd, "Freedom, Not Fertility, Is The Key To A Thriving Economy".

I respond to some conservatives fretting about America's low birth rate, and discuss why it's not the government's job to promote any specific lifestyle (e.g., single vs married or childless vs. multiple-child marriage).

Watson and Medicine

Atlantic: "The Robot Will See You Now".

Barring regulatory barriers, we'll see increasing use of computers as helpful adjuncts to physicians.  At some point in time, computers can (and should) take over many functions currently performed by humans just as they have in other industries.

The High-Tech Future of Medicine

Henry Miller: "The High-Tech Future of Medicine".

An excerpt:

Personalized drug therapy uses biological indicators, or “biomarkers”—such as DNA sequences or the presence or absence of drug receptors—as a marker of how patients should be treated and to estimate the likelihood that the intervention will be effective. This concept is not new. It has been known for decades, for example, that persons genetically deficient in an enzyme called G6PD can experience severe and precipitous anemia if they are exposed to certain drugs.

Similarly, various ethnic groups and individuals have widely varying abilities to clear medications from the bloodstream because of differences in the activity of the enzymes that metabolize, or degrade, drugs. For that reason, drug safety and efficacy are affected by variants of genes coding for the enzymes that metabolize chemical compounds; one genetic locus, for example, is responsible for the enzymes that degrade as many as 20 percent of commonly prescribed drugs; in the population, there are a large number of variants of this gene, some of which only poorly metabolize the enzymes’ substrates.

This is important because low metabolizers clear certain drugs slowly and have more medication in their blood for longer periods of time than high metabolizers. Thus, the former might be prone to overdose, and the latter to insufficient levels of the same drug...

We have increasing ability to take advantage of new technology to create personalized therapies.  However, our current regulatory scheme (and the various ObamaCare provisions) will push doctors into more "one size fits all" treatment protocols.

Whether the pace of technological progress will stay ahead of the regulatory "drag" is still an open question.

TPM: Four Ways Obamacare Could Still Fail

TalkingPointsMemo discusses, "Four Ways Obamacare Could Still Fail".

These include:

1) Ongoing Disapproval Of The Law
2) States Declining To Expand Medicaid
3) States Refusing To Build Insurance Marketplaces
4) Nullification Of The Medicare Cost-Cutting Board

For more details on each points, read the full text of "Four Ways Obamacare Could Still Fail".

Also, if/when the current system fails, it's not clear what will replace it.  We could move in the direction of more freedom or towards a government-run "single payer" system.  That decision will still be up to us.

Lipana on Medical Device Tax

Joshua Lipana writes at the blog for The Objective Standard: "Cheers to Bipartisan Support for Repealing the Medical-Device Tax".

Even if some of the supporters are driven by political expediency rather than a principled commitment to free markets, this could be a step in the right direction.

And public pressure can help in this regard.  As Milton Friedman once observed, "The way you solve things is by making it politically profitable for the wrong people to do the right things."

Roerig on Medical Tourism

In a 2/18/2013 blog post for The Objective Standard, Howard Roerig discusses "Medical Tourism: A Free Market Alternative to ObamaCare".

Here is the opening:

In 2009, in my home state of Colorado, a friend faced an estimated expense of $30,000 for necessary dental surgery, an amount far in excess of what he could afford. After doing some research, he opted to have the work done in Costa Rica, where he ended up paying $6,000 for the same surgery. He was treated in a facility so modern that “it looked like something out of Star Trek”; the staff all spoke fluent English; and they were friendly, competent, and supportive throughout his stays. As a bonus, he was able to enjoy two relaxing vacations in a beautiful Caribbean country. This kind of option for medical care, which has come to be called “medical tourism,” is rapidly increasing in popularity...

For certain types of non-emergency medical procedures, this option will be an enormous boon for Americans who may have an increasingly difficult time getting them through the US system in a few years.

For more details, read the full text of "Medical Tourism: A Free Market Alternative to ObamaCare".

(I also expect some entrepreneur to start a chain of floating hospital cruise ships that provide medical services in international waters, while family members can enjoy the amenities.)

Minton Interview on Health Freedom

Diana Hsieh recently interviewed Michelle Minton of the Competitive Enterprise Institute (CEI) on "Your Freedom to Eat, Drink, and Be Merry".   I've long been a supporter of her work in this area for CEI.

Here's more information from Diana:

About the episode:
 

The government heavily regulates food and drinks commonly regarded as dangerous or unhealthy. What motivates such regulations? Why are they so widespread? How can they be fought? 
Michelle Minton is the Fellow in Consumer Policy Studies at the Competitive Enterprise Institute. The issues she manages include food policy, FDA regulation of non-pharmaceuticals, alcohol regulation, and the online gambling industry. Her work has been published and cited by nationally respected news outlets such as the Wall Street Journal and USA Today, prominent magazines, and scholarly journals.

Topics:

• The most common regulations and laws pertaining to food and drinks
• Colorado's laws about grocery versus liquor stores
• Federal versus state versus local regulations
• The true purpose of these laws and regulations
• The goal of Michelle's advocacy
• Why we have more regulations today
• Conservative "solutions"
• Bad studies and sloppy journalism: the phony case against the egg
• The accusations against Four Loko
• Future trends, including appeals to children
• The three-tier system of alcohol distribution
• Bootleggers and Baptists
• Not being in the pocket of "big business"
• Advocating for freedom in this area
• Economic versus moral arguments for freedom
• Effective arguments
• Maintaining integrity in public policy work
• Whether to support or oppose mixed proposals
• How to support Michelle's work

Links:

• Michelle Minton's work at CEI
• The Wages of Sin Taxes by Christopher Snowdon and Michelle Minton (PDF)

(Listen to the audio of "Your Freedom to Eat, Drink, and Be Merry".)

• Duration: 58:26
• Download: Standard MP3 File (20.1 MB)

Hsieh PJM OpEd on Gun Laws and Civil Disobedience

PJ Media has published my latest OpEd, "Would New Gun Laws Spark Widespread Civil Disobedience?"

I discuss why the gun issue could be so unusually volatile for America.

Here is the opening:

In his State of the Union address, President Obama doubled down on his gun-control proposals, again demanding that Congress ban so-called “assault weapons” and “high capacity magazines.” This is not a surprise. What has been a surprise are the increasingly open calls for defiance from gun owners, state legislatures, and local law enforcement. If the president’s proposals become law, he may move the country into turbulent waters we haven’t seen in many years.

Gun control has long been a controversial issue in American politics. However, there are three aspects to this issue that make this more volatile than other hot topics such as taxes, foreign policy, or abortion...

(For the rest, read the full piece: "Would New Gun Laws Spark Widespread Civil Disobedience?")

Forbes: Cancer, Innovation and a Boy Named Jack

Forbes has a nice interview at, "Cancer, Innovation and a Boy Named Jack":

Jack is a scientist and  innovator.  And his work on creating a simple test for the identification of pancreatic, lung and ovarian cancer is simply amazing.

Here are some of his facts:

• His test is 168 times faster than what is currently available.
• It’s 26,000 times less expensive.  That’s not a typo.
• And it’s potentially almost 100% accurate.

Here’s what makes it even more astonishing:

• Jack is 15 years old.

So, I just had to speak with Jack...

Catron On SOTU

I didn't watch the State of the Union address. But David Catron did, and he discusses "Obama's Most Audacious SOTU Lie".

Here is the opening of his latest American Spectator piece:

It is difficult to say with certainly which of the many whoppers President Obama told tonight took the most crust to utter, but my money is going on this assertion, made a few minutes into the speech: "Already, the Affordable Care Act is helping to slow the growth of health care costs"...

(Read the full text of "Obama's Most Audacious SOTU Lie".)

Massachusetts 2013 Projections

The 2/7/2013 Boston Globe reports, "Massachusetts health care costs are heading up in 2013".

Representatives from the state’s nonprofit health plans as well as national for-profit insurers doing business in Massachusetts estimated the “medical cost trend,” a key industry measure, will climb between 6 and 12 percent this year — higher than last year’s cost bump and more than double the 3.6 percent increase set as a target in a state law passed last year.

Two observations:

1) This will likely lead for calls for more government controls over medical services (and medical service providers).

2) This is likely the future for the other 49 states under ObamaCare.

KevinMD Post on Doctors and Guns

I'm honored and delighted that the widely-read KevinMD.com website has reposted my Forbes piece, "Why doctors should not ask patients about guns".

The piece includes a quote from Colorado physician Dr. Matthew Bowdish.  Read the whole thing here.

Here's the link to the original Forbes piece (1/22/2013).

(Note: I don't regard myself as "conservative". The use of that word was the editor's decision.)

Adalja On Non-MDs And Licensing

Dr. Amesh Adalja notes that "Sometimes The Best Medical Care Is Provided By Those Who Aren't M.D.s" (Forbes, 2/10/2013).

From his piece:

...[F]or many conditions the expertise of a physician is not strictly required and an individual may be ably served by a nurse practitioner or the like. Expanded scopes of practice, in which a non-physician renders care independent of a physician, not only expand access to health care and have the potential to decrease the cost of healthcare, but also reflect a respect for the free market system.

Like Dr. Adalja, I support the elimination of licensing laws the unfairly restrict the ability of health professionals and patients to voluntary contract to their mutual benefit.

In a free market, patients might choose rationally some forms of medical care from an MD (and pay a higher fee) and other forms of care from a non-MD "mid-level provider" for a lower fee.  Provided that there is no fraud or misrepresentation by the provider to the patient, this can be a win-win for both parties.

(See also my related piece: "How Medical Licensing Laws Harm Patients and Trap Doctors", PJ Media, 10/1/2012)

However, we may also see state governments loosening some scope-of-practice laws for other, less-benign reasons.  The Los Angeles Times recently reported, "State lacks doctors to meet demand of national healthcare law" (2/9/2013).

The LA Times article notes:

There aren't enough doctors to treat a crush of newly insured patients. Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

In this case, the motivation of the state of California is different.  The proposed changes in the laws are not driven by a respect for individual freedoms, but because of the growing problems of the government health program.

Patients won't be choosing between MDs and non-MDs for medical care in a free market, but instead obliged to accept care from whichever providers still willing to practice under ever-growing state control.

Considered in isolation, the specific concrete legal changes in California might be similar to genuine free-market reforms, but the larger context is very different.

A Look At The Future

Walter Russell Mead: "British Hospital Carnage a Window into US Future".

Related from NYT: "English Hospital Report Cites 'Appalling' Suffering":

The report, which examined conditions at Stafford Hospital in Staffordshire over a 50-month period between 2005 and 2009, cites example after example of horrific treatment: patients left unbathed and lying in their own urine and excrement; patients left so thirsty that they drank water from vases; patients denied medication, pain relief and food by callous and overworked staff members; patients who contracted infections due to filthy conditions; and patients sent home to die after being given the wrong diagnoses. 

“This is the story of the appalling and unnecessary suffering of hundreds of people,” Robert Francis, the lawyer appointed by the government to lead the inquiry, said at a news conference.

Right now, such conditions would be nearly unthinkable here in the US.  For now.

The Exodus Continues

Bruce Japsen: "1 In 10 Doctor Practices Flee Medicare To Concierge Medicine" (Forbes, 1/30/2013).

Unionized Doctors?

In the 1/29/2013 Wall Street Journal, David Leffel discussed "The Doctor's Office as Union Shop".

In particular he asked, "As new health-care laws turn physicians into service workers, why wouldn't they organize?"

I don't think this would be a good development. But we may be heading in this direction nonetheless.

Why More Non-MDs Will Be Treating Patients

The 2/3/2013 Wall Street Journal describes how, "Battles Erupt Over Filling Doctors' Shoes".

The problem of physician shortages has loomed for a while, but will get worse as more doctors retire (or cut back) and as new patients enter the system.  The problems did not originate with ObamaCare, but ObamaCare will make things worse.

This means many patients will have to wait longer for care or will be seen by various non-MD "midlevel providers" such as Physician Assistants (PAs) and/or Nurse Practitioners (NPs). 

From the WSJ article:

Many health-care experts say PAs will be in even greater demand when the Affordable Care Act expands insurance to 30 million more Americans next year. The Association of American Medical Colleges has warned that the supply of new doctors can't keep pace, due to limits on federal funding for medical residency programs, and estimates that the U.S. will face a shortage of more than 90,000 physicians by 2020, particularly in primary care and in rural areas.

The number of licensed PAs, meanwhile, has doubled in the past decade, to 86,500, and is likely to grow another 30% by 2020, according to the American Academy of Physician Assistants.

The AMA says it supports using PAs, nurse practitioners and other midlevel professionals in health-care teams as long as they are led by physicians and don't exceed their training. It says physicians must be available to consult with PAs at all times -- though not necessarily in person.

Many PAs and NPs are very good at what they do and can handle routine health issues.

As an advocate of free market reforms, I support allowing widened scope of practice for such providers, as long as it Is with the patient's knowledge and consent and as long as those providers recognize what they can handle and what needs to be "kicked upstairs" for more direct care by the MD physicians.

However, I think many patients will find that they will have to see the PA or NP out of necessity, simply because they will have no other alternative.

Given the worsening physician shortages, patients who wish to have continued access to an MD may wish to establish a firm relationship with a good primary care MD now.  And some of the new "concierge medicine" services (or the surprisingly affordable "hybrid concierge" services) may be worth investigating as well.  But the numbers of available openings will necessarily be limited.

If you wait too long, you might find that others will have beaten you in this game of medical musical chairs and your options may be more limited than you wish.  Prudent patients will wish to plan ahead sooner rather than later.

Catron: Crony Contraception

In his 2/1/2013 American Spectator, David Catron suggests that that the HHS contraception mandate is a political payoff to Big Pharma for its support of Obamacare.

From his OpEd:

...The Wall Street Journal reported last summer that PhRMA and other industry lobbying groups coordinated with the White House to produce a multi-million dollar advertising blitz to promote Obamacare. “In particular, the drug lobby would spend $70 million on two 501(c)(4) front groups called Healthy Economy Now and Americans for Stable Quality Care.”

Moreover, as Peter Schweizer has reported, “[A]mong President Obama’s biggest financial backers are precisely the Big Pharma companies who benefit from the mandate.” And they go well beyond William Schultz and Barr Laboratories. Schweizer elaborates as follows: “Sally Sussman, head of government affairs for Pfizer, is one of [Obama’s] biggest campaign bundlers... Pfizer sells numerous contraceptives that now must be covered by health-care plans. Obama’s financial ties to the pharmaceutical industry run deep.”

But even their political pull might have limits, in the face of enormous public pressure against the mandate.

Yesterday, multiple news sources such as CNN reported, "Obama proposal would let religious groups opt-out of contraception mandate".

Here are more details from Timothy Jost, "Contraceptive Coverage And Religious Accommodation"

Stay tuned.

Quick Links: Creative Destruction, ACOs

Dr. Eric Topol on The Creative Destruction of Medicine: "Hospitals, Office Visits of Little Use in the Future". (Via Dr. Richard Amerling.)

John Goodman: "ACOs and the Nationalization of Healthcare".