Hsieh Forbes Column: The New Congress Should Propose Free-Market Health Care Reforms

My latest Forbes piece is now up, "The New Congress Should Propose Free-Market Health Care Reforms".

Here is the opening:

As we prepare to ring in 2015, we will see a new Congress as well as a New Year. When the Republicans take over both houses of Congress, they’ll have an unprecedented opportunity to reshape the health care debate in a positive direction.

Ever since capturing the House in 2011, Republicans have voted more than 50 times to “repeal, dismantle, or defund” ObamaCare — to no avail. Opposing ObamaCare is not enough. Instead, The GOP should couple those efforts with their own positive free-market alternative to ObamaCare.

The good news is that there is no shortage of good alternatives to ObamaCare that Congress could rally behind...

In particular, I'm encouraged by the new media attention being given to alternative health care financing and delivery models such as "direct pay" primary care and "health care sharing ministries".

For more on positive free-market alternatives to ObamaCare and how Congress can promote them, see the full text of "The New Congress Should Propose Free-Market Health Care Reforms".

Consider Donating to the Benjamin Rush Institute

As 2014 draws to a close, many people are finalizing their year-end charitable deductions.

If you like to support good health policy work, consider donating to the Benjamin Rush Institute.

I've been impressed with their series of debates and panel discussions hosted at medical schools around the country, helping to expose tomorrow's doctors to a broad range of perspectives on important policy issues.

From their website:

BRI is an organization that unites medical students, residents, fellows, and doctors from across the political spectrum — as well as members of the general public — who believe that the medical profession calls its practitioners to serve their patients, rather than the government. We believe that the doctor-patient relationship is a voluntary and mutually beneficial one. Both parties have a right to enter it freely. The proper role of government is to protect this freedom, not to diminish it.

You can also see videos of talks and debates they've sponsored, including topics such as:

"Does healthcare require government intervention?"
"Sale of human organs?"
"Can the ACA be mended?"

Also, BRI is a a 501(c)3 non-profit organization, so your donations are tax deductible.

And for the month of December, all donations will be matched by an anonymous donor -- so you get twice the bang for your buck!

Here's how to donate.  I've already done so and I hope you consider doing so as well!

Podcast Interview Posted: Radiology In Practice

Philosopher Dr. Diana Hsieh recently interviewed me about "Radiology in Practice" on her live internet radio show, Philosophy in Action. You can listen to or download the podcast any time. You'll find the podcast on the episode's archive page, as well as below. About the Interview:

Most people have seen cool medical imaging devices such as CT and MRI scanners on TV shows. But what do those machines really do? Advanced medical imaging has revolutionized patient care in the past 25 years, allowing doctors to make diagnoses more accurately, quickly, and safely than ever before. Radiologist Dr. Paul Hsieh discussed the basics of modern radiology (x-rays, MRI, ultrasound, and nuclear medicine), how these different tests work, what they show about the human body, and how they help doctors take better care of patients.

Listen or Download:

• Duration: 1:17:28
• Download: Standard MP3 File (44.3 MB)

Topics: Topics:

• About radiology
• The different imaging modalities
• X-rays
• CAT Scans
• MRI Scans
• Ultrasound
• Nuclear Medicine
• PET Scans
• Interventional Radiology
• Radiation dangers
• Medical education
• Access to the radiologist
• Specialization in radiology
• Paul's work
• Paul's choice of radiology

Links:

• PowerPoint Slides
• New England Journal of Medicine: A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
• New York Times: For First Time, Treatment Helps Patients With Worst Kind of Stroke
• Wall Street Journal: Stents Boost Stroke Recovery, Study Finds

For more about Philosophy in Action Radio, visit the Episodes on Tap and Podcast Archives.

Interview With Diana on "Radiology In Practice"

Announcement: On Thursday evening, philosopher Dr. Diana Hsieh will interview me about "Radiology in Practice" on her live internet radio show, Philosophy in Action. This episode of internet radio airs at 6 pm PT / 7 MT / 8 CT / 9 ET on Thursday, 18 December 2014, in the live studio.

If you miss that live broadcast, you can listen to the podcast later. Here's a bit more about the show:

Most people have seen cool medical imaging devices such as CT and MR scanners on TV shows. But what do those machines really do? Advanced medical imaging has revolutionized patient care in the past 25 years, allowing doctors to make diagnoses more accurately, quickly, and safely than ever before.

Radiologist Paul Hsieh will discuss the basics of modern radiology (x-rays, MRI, ultrasound, and nuclear medicine), how these different tests work, what they show about the human body, and how they help doctors take better care of patients.

To join the live broadcast and its chat, just point your browser to Philosophy in Action's Live Studio a few minutes before the show is scheduled to start. By listening live, you can share your thoughts with other listeners and ask follow-up questions in the text chat. The podcast of this episode will be available shortly after the live broadcast here: Radio Archive: 18 December 2014.

For more about Philosophy in Action Radio, visit the Episodes on Tap and Podcast Archives.

Michigan Can Assist In Real Health Care Reform

From the Detroit News: "Michigan can assist in the creative destruction of Obamacare".

An excerpt from the article:

Just like the smartphone pretty much eliminated the market for cell phones and calculators, enterprising doctors and other medical providers are starting to eliminate the demand for insurance companies and government bureaucrats to spend our health dollars for us. In Michigan, Lansing is poised to help this “destructive” process.

State Sen. Patrick Colbeck has introduced legislation to clear the way for direct primary care. For a fee, doctors deal directly with patients and bypass costly insurance or government regimes. Considering the traditional health insurance system adds about 40 percent to typical medical bills, charges to treat many common diagnoses are steeply discounted. For instance, treating an ingrown toenail costs $50 under a direct primary care doctor in Kansas. Under the traditional system, he’d have to charge $200.

This health care model is nothing new but is seeing a resurgence thanks, ironically, to a clause in the Affordable Care Act itself which Colbeck calls a “free market loophole” that he wants to drive a Mack Truck through.

The direct primary care model already has a reported half million people on board and is rapidly picking up steam with doctors, patients and even investors. It is really an offshoot of the higher priced “concierge care,” which is also gaining popularity.

From Colbeck's website:

[L]legislation sponsored by Senator Patrick Colbeck (R-Canton) to assert that Direct Primary Care Services should not treated as an insurance product was reported  out of the Senate Insurance Committee.  The purpose of the bill (SB 1033) is to assure physicians who convert their practice to a Direct Primary Care Service model that the administrative burden associated with insurance regulations will not interfere with their treatment of patients. 

Colbeck's position is absolutely right -- a "direct pay" practice should not be subjected to onerous insurance regulations.  

This approach will allow consumers and physicians to more easily contract to their mutual benefit -- saving money and lives in the process.

(Link via Dr. Megan Edison.  And if you haven't done so already, please feel free to check out her group blog on health care policy, RebelMD!)

Why Doctors' Waiting Rooms Have Such Crappy Magazines

A little change of pace from heavy health care policy: "Researchers Finally Figured out Why Doctors’ Waiting Rooms Have Such Crappy Magazines" (Slate, 12/13/2014).

From the Slate article:

Bruce Arroll, a doctor and professor at the University of Auckland in New Zealand (apparently this is a global problem) gathered up 87 new and old magazines (a number determined by "how many magazines the investigators could rustle up from family and friends") covering a variety of topics and placed them in the waiting room of his practice.

It turns out that if there are current magazines around, people steal them.

Jerks.

Here's the original British Medical Journal article: "An exploration of the basis for patient complaints about the oldness of magazines in practice waiting rooms: cohort study" (12/11/2014).

From the BMJ article:

"Figure 1. Survival probability for gossipy and non-gossipy magazines in waiting room"

Personal case example: When I went to take my father to a doctor's appointment in Los Angeles earlier this year, they had this 1987 (!) magazine in the waiting room.

I'm pretty sure this falls in the BMJ "non-gossipy" category.

Barnett on How to Finally Kill Obamacare

Georgetown University law professor Randy Barnett has a nice piece in the 12/5/2014 USA Today: "How to finally kill Obamacare".

He highlights the importance of having a positive alternative to offer to Americans.  Some of his suggestions include:

Restore the private insurance market using actuarially based insurance priced according to risk. For example, young people would pay much less than older people.

Restore consumer choice to buy true private insurance limited to the terms they want to pay for, including policies insuring only against the catastrophic health care costs, and medical savings accounts.

Increase competition by allowing state-regulated insurance to be sold across state lines so consumers can keep their policies when moving from one state to another.

Increase equity by extending the tax benefits now available only to employer-based insurance to all health insurance. Like car insurance, you shouldn't have to change health insurance policies when changing jobs.

These reforms would all be excellent steps moving us in the direction of a true free market in health care.  I hope Congress gives his ideas the consideration they deserve.

(Read the full text of "How to finally kill Obamacare".)

Alaska Doctors Overwhelmed By New Federal Rules

More consequences of various government mandates on physicians: "Alaska Doctors Overwhelmed By New Federal Rules".

From the article:

Dr. Oliver Korshin, a 71-year-old ophthalmologist in Anchorage, is not happy about the federal government’s plan to have all physicians use electronic medical records or face a Medicare penalty...

EHR,  ICD-10 and PQRS may sound like alphabet soup. But most doctors around the country know exactly what those acronyms stand for. They are programs championed by the federal government to improve quality and bring medicine into the electronic age. But in Alaska, where small medical practices and an aging physician workforce are common, the new requirements can be a heavy burden...

He says for his tiny practice, an electronic medical records system would cost too much to set up and to maintain.  “No possible business model would endorse that kind of implementation in a practice situated like mine, it’s crazy,” he says.

Korshin will lose another 1.5 percent of his Medicare payments next year for failing to enroll in PQRS, a federal program that requires doctors to report quality data.  And then there is ICD-10, a new coding system for medical bills — also set to take effect in the fall of 2015.

“This flurry of things one has to comply with,” Korshin says, “means that unless you work for a large organization like a hospital that can devote staff and time to dealing with these issues, there’s no economy of scale, I can’t share these expenses with anybody.”

The government is driving smaller independent physicians out of business, essentially forcing those who wish to practice to join large provider groups or to become hospital employees.

Why is this happening?  From an earlier piece I wrote for PJ Media on the rise of "Big Medicine":

Nor is this centralization of health care some “unintended consequence” of ObamaCare. Rather, it is an explicitly desired goal. In 2010, Obama health advisor Nancy-Ann DeParle wrote in the Annals of Internal Medicine that the health law will “accelerate physician employment by hospitals and aggregation into larger physician groups” and that “physicians will need to embrace rather than resist change.”

This consolidation of American medicine is merely a continuation of a much older strategy. In his book Liberal Fascism, Jonah Goldberg described how the Roosevelt administration sought similar consolidations of American agriculture and business during the New Deal:

[I]f you… want to use business to implement your social agenda, then you should want businesses themselves to be as big as possible. What’s easier, strapping five thousand cats to a wagon or a couple of giant oxen?

Similarly, it will be much easier for the federal government to regulate 1,000 large hospital groups and ACOs than 10,000 small private practices and independent hospitals. The New York Times notes that after physicians become hospital employees, they become much more accepting of government controls than their counterparts in private practice.

Unfortunately, physicians like Dr. Korshin and his patients will pay the price.

Hsieh PJM Column: Should You Have to Speak with Others in a Way the Government Can Understand?

My latest column at PJ Media is a change of pace from the usual health care writing. It is entitled, "Should You Have to Speak with Others in a Way the Government Can Understand?"

I discuss the demands by the federal government for "backdoor" access into your encrypted smartphone data and communications. Fortunately, Apple and Google are standing up to the government's demands.  I explain why they are right to do so.