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".

Hsieh PJM OpEd: "The Eyes of Big Medicine: Electronic Medical Records"

PJ Media has published Part 3 of my 4-part series on the changing face of American medicine under ObamaCare, "The Eyes of Big Medicine: Electronic Medical Records".

I discuss the ObamaCare mandate for physicians to implement electronic medical records (EMRs), how this can harm patient care, and the government's agenda in using EMRs to control doctors.

Earlier articles in the series:

Part 1: "Your Future Under Obamacare: Big Medicine Getting Bigger".
Part 2: "How Big Medicine Will Affect Patient Care".

Catron on Obamacare's Latest Useful Idiots

David Catron adds labor unions to the list of "Obamacare's Useful Idiots".

They join the "not-very-exclusive society of organizations and individuals duped by the White House into supporting Obamacare" but now learning the error of their ways, including the American Medical Association, Big Pharma, the American Hospital Association, and Catholic Health Association.

Hey, at least misery loves company!

(For more details, read the full text of "Obamacare's Useful Idiots".)

Senator Milton Wolf?

Dr. Milton Wolf is reportedly considering running for the US Senate, challenging incumbent Pat Roberts in the 2014 GOP primary.

On his blog, he unveiled this catchy new logo:

If you want to learn more about his views, you can read his many columns at the Washington Times or watch his Daily Caller videos.

If Dr. Wolf decides to run, this could be a very exciting political development.  He is a practicing radiologist who's been "in the trenches" in the battle against ObamaCare. He has strong Tea Party roots, and is not beholden to the current GOP establishment.

I've featured many of his columns on the FIRM blog and they're worth reading. Although, I don't necessarily agree with all of his views on every issue, Dr. Wolf's candidacy could potentially move the country in the right direction.

It's time to stop Barack Obama

White House to Unions: No Waiver For You!

Washington Post: "Obama administration denies labor’s request for health care waiver".

Related story from Politico: "W.H. rejects labor’s bid for Obamacare exemption".

"Giving" Commercial

This is a really well-done commercial from Thailand, entitled "Giving".

As Gawker says, "This three minute commercial puts full-length Hollywood films to shame".

Baehr: Is America Ready for Obamacare?

PJ Media has published part 2 of Rich Baehr's series on insurance under ObamaCare: "Is America Ready for Obamacare?"

He discusses specific answers to common questions about what Obamacare means to consumers.

Hsieh PJM OpEd: "How Big Medicine Will Affect Patient Care"

PJMedia has just published part 2 of my 4-part series on changes in American health care: "How Big Medicine Will Affect Patient Care"

Here is the opening:

The first article of this series described how the ObamaCare law is fueling the rise of government-controlled Big Medicine. This second article will take a closer look at how Big Medicine will control how what medical care patients can receive.

I discuss how government controls over health spending will lead to controls on the health care you may be able to receive. These controls interpose the government between the doctor and the patient, endangering the doctor-patient relationship.

Direct Primary Care National Summit

This conference also looks interesting: "Direct Primary Care National Summit".

I won't be able to make it, but others might find it worthwhile.

New John Lewis Essay

At The Objective Standard blog, Jared Rhoads reviews a newly-published essay by the late John Lewis, "There is No 'Right' to Healthcare".

From Rhoads' review:

Lewis describes two basic and conflicting views of rights in America today. One is the idea of rights as entitlements to goods and services. The other is the idea of rights as moral prerogatives to freedom of action.

The first view holds that if a person has an unmet human need—a need that could be satisfied by some good or service—then it is incumbent upon others who are able to satisfy that need to do so. In other words, needs impose duties.
Lewis explains that this view fails in two important ways. First, because human needs are boundless, the consistent application of the notion that needs impose duties would lead to

an endless creation of duties, and to ever-increasing government control over the lives of citizens, precisely because there is no end to the needs that one person may demand that others satisfy.

The other main problem, Lewis explains, is that imposing duties upon one person in the name of satisfying the unmet needs of another inescapably violates the rights of the first person. Applying this to health care, Lewis writes, “There is no right to medical care because there is no right to coerce medical professionals to provide it.”

I've just purchased the Kindle edition of the book, Medical Ethics, 2nd Edition (edited by Michael Boylan of Marymount University), and I look forward to reading the Lewis essay (as well as the other chapters)!

Baehr On Consolidation

Rich Baehr will also have a multipart series of articles on ObamaCare at PJMedia for the month of September.  His focus will be on changes in the insurance industry, whereas mine will be on changes in medicine and practice.

Here is his first piece, "Obamacare and the Consolidation Wave".

Key point: It is inevitable that many people who currently have insurance will wind up in new plans with new doctors.

Hsieh PJM OpEd: "Big Medicine Getting Bigger"

PJ Media has published my latest OpEd, "Your Future Under Obamacare: Big Medicine Getting Bigger".

This will be part 1 of a 4-part series on the changing face of American medicine, and what patients can do about it.  In part 1, I discuss how new laws are spurring the growth of government-controlled "Big Medicine".

Here is the opening:

Recently, there’s been an enormous shakeup in three traditionally stable professions — law, education, and medicine. But where law and education are moving towards decentralization and greater consumer control, medicine is moving in the opposite direction — towards greater centralization and less consumer (patient) control.

Why? Because the upheavals in law and education are being driven by market forces. In contrast, the upheaval in medicine is being driven by new government controls. Hence, Big Law and Big Education are struggling, while Big Medicine is growing.

This series of articles will discuss how the ObamaCare health law is fueling the rise of Big Medicine, what this will mean for patients, and how patients can respond to best protect their medical care...

(Read the full text of "Your Future Under Obamacare: Big Medicine Getting Bigger".)


Future installments will appear each Wednesday during the month of September at PJ Media.

Unions Increasingly Unhappy with ObamaCare

David Catron: "Unions to Get Yet Another Obamacare Break?"

Avik Roy: "White House Considers Awarding Obamacare Subsidies, Intended For The Uninsured, To Labor Unions"

The Hill: "Labor union frustration boils over with president on ObamaCare"

The unions are increasingly unhappy with ObamaCare.  Ideally, they should recognize that the law is fundamentally flawed, rather than merely asking for an additional special subsidy to sweeten the deal for themselves.  Which is why I'm not crying too many tears for their latest complaints.

After all, those subsidies will be coming from our pockets.

Snarky Commercial

Today's snarky anti-ObamaCare commercial.

Destroying Jobs

The Economist asks, "Will Obamacare destroy jobs?"