Tuesday, February 24, 2015

Catron: Still Not Working

David Catron discusses the latest snafus with ObamaCare in his latest AmSpec piece, "No, Mr. President, Obamacare Isn’t Working".

A couple of excerpts:
Last week, the White House took to Twitter for purposes of publicizing its latest Obamacare enrollment blarney. Far more informative than the tweet’s fictitious sign-up numbers was the schmaltzy video to which it was linked. Staged in the Oval Office, this one-act farce features a simpering HHS Secretary briefing our Thespian in Chief, who then delivers the following soliloquy: “The Affordable Care Act is working. It’s working better than we anticipated. It’s certainly working a lot better than many of the critics talked about early on.” In Obama’s 27-word script, “working” appears three times. The President doth protest too much, methinks.
Ask the folks who learned last Friday that Obama’s bureaucrats sent them erroneous tax information relating to PPACA. AP reports, “Officials said the government sent the wrong tax information to about 800,000 HealthCare.gov customers, and they’re asking those affected to delay filing their 2014 returns.” And, as with most government blunders, the price will be paid by those who can least afford it. Robert Pear points out in the New York Times, “[T]housands of lower-income Americans who qualified for subsidized insurance had hoped for tax refunds and now must wait for weeks to file their taxes.”
For more, read the full text of  "No, Mr. President, Obamacare Isn’t Working".

Monday, February 23, 2015

FDA Hindering Promising Therapies Derived From Patient's Own Cells

Interesting update from the Winter 2015 issue of City Journal: "Patient, Heal Thyself".

Their teaser line: "Treatments from our own cells could cure many diseases -- if Washington will only allow it to happen."

They discuss how the current FDA regulatory paradigm stifles this promising research:
Unlike conventional drugs, these cell therapies are created from scratch, one patient at a time, and many of the tools used to create them are simple, compact, and cheap enough to land in laboratories that serve hospitals, small clinics, and doctors in private practice. They have been landing there in growing numbers in the last decade, and Washington has been trying to keep pace.

The Food and Drug Administration (FDA) has taken the position—upheld in February 2014 by a federal appellate court—that a patient’s cells become a “drug” when extracted and manipulated in a laboratory, and may not be used to treat the patient without FDA approval. But it is far from clear how the agency should set about approving a custom-made drug that will be prescribed to only one patient, in whom its safety and efficacy will be largely determined by how the patient’s molecular biology interacts with itself....

[R]igidly scripted trials remain the norm at the FDA. Responding to the advent of drugs precisely designed to modulate specific molecular targets, the FDA has gradually come to accept that the drug-approval process must take into account the relevant patient-side molecular factors as well.

The FDA has, however, been slow to accept trial protocols that systematically investigate those factors and incorporate them into prescription protocols that increase the likelihood that the drug will be effective. With rare exceptions, the agency requires that the molecular factors that might affect a drug’s efficacy be identified by studying the disease before a clinical trial begins, or by analyzing the drug’s performance in short, early-phase trials that involve few patients—far too few to provide a full understanding of how variations in patient chemistry may affect a drug’s performance. This has already been recognized as a serious problem in the testing of certain categories of conventional drugs...
The scientific aspects are fascinating. And the regulatory aspects are infuriating.

For more details on both, see the full text of "Patient, Heal Thyself".

(Link via Instapundit.)

(Image from the article, captioned: "Emily Whitehead, a child given cell therapy for acute leukemia; her family says that she shows no sign of the cancer today. Ed Cunicelli, The Children's Hospital Of Philadelphia/AP photo.")

Saturday, February 21, 2015

BRI Debate at Georgetown

The Benjamin Rush Institute will be sponsoring a debate on 3/27/2015 at Georgetown University School of Medicine:

"Be It Resolved: Affordable, quality healthcare develops from maximizing freedom of choice – not government programs or mandates".

If you're in the Washington DC area, it looks like a great event!

From their announcement page:
When: March 27, 2015 @ 6:00 pm – 8:00 pm
Georgetown U. School of Medicine - New Research Building Auditorium
Georgetown University
3900 Reservoir Road Northwest, Washington, DC 20007
Free, but RSVPs requested.
John Grimsley
Please RSVP through the green “Tickets” link on the announcement page.

The event is free but we want to plan the right amount of food! There is a parking garage located under the Leavey Center accessible from Reservoir Road, or there is the Southwest Parking garage accessible from Canal Road.

Debate Venue Details:

Date: Friday, March 27, 2015

Time: [Eastern]
6:00 PM Reception with soft drinks and hors d’oeuvres; Registration and initial voting
6:30 Debate Begins
7:45 Debate Ends. Final voting, tally.
8:00 Announcement of results.

Place: Georgetown University School of Medicine
Room — New Research Building Auditorium
3900 Reservoir Road Northwest,Washington, DC 20007

Moderator: Michael Ramlet (Morning Consult)

Arguing the Affirmative:
Dr. Josh Umbehr MD (AtlasMD)
Dr. Lee Gross, MD (Epiphany Health, Inc.)

Arguing in Opposition:
Dr. Dennis McIntyre, MD
Dr. Adriane Fugh-Berman, MD

Friday, February 20, 2015

WSJ On Records and Regulators

Two quick links to recent Wall Street Journal pieces worth reading.

Singer: "ObamaCare's Electronic-Records Debacle".

He highlights both the obvious and hidden costs of mandated electronic medical records, and how they harm patients in the real world.

Huber and Howard: ''What Failed, the new Cancer Treatment or Regulators?"

They discuss how rigid FDA testing guidelines hinder the approval of drugs that might work well for one subpopulation of patients, even if they have minimal effect on the general population.  In essence, this means stifling the development of "personalized medicine" and "precision oncology" based on an individual's unique genetic traits.

(As always, if these direct links only show the preview page, you can often read the full text for free by typing the article title into a Google search box, and getting the "Free Day Pass" version of the article.)

Wednesday, February 18, 2015

ICD-10 Costs

From the Daily Signal: "How This New Regulation Will Drive Up Your Health Care Costs".

Our own medical practice is already undergoing ICD-10 training as well as upgrading our business office software.  I don't know how much money it is costing, but it sure is taking a lot of man-hours!

(Via Benjamin Rush Institute.)

Monday, February 16, 2015

Hsieh Forbes Column: Why You Should Record Your Doctor Visits

My latest Forbes piece is now out: "Why You Should Record Your Doctor Visits".

Here is the opening:
NBC's Brian Williams has gone from being a respected news anchor to the butt of Internet jokes after he recanted a false story about being shot down in a helicopter over Iraq. As a result of the subsequent controversy, NBC has suspended Williams without pay for 6 months -- essentially costing him $5 million.

But whether or not Williams' story was an innocent "false memory" or a deliberate lie, it is the case that false or unreliable memories are a surprisingly common phenomenon. In a health care setting, patients' false memories of medical conversations might cost them more than money -- it might even endanger their lives. Hence, patients may wish to record their doctors' visits to protect themselves...
During my research for this piece, I learned that "40-80% of medical information provided by healthcare practitioners is forgotten immediately" and "almost half of the information that is remembered is incorrect" (!)

Fortunately, modern technology now makes it easier for patients to record these important discussions with physicians, for instance with a smartphone.

For more information on the benefits of this practice, read the full text of "Why You Should Record Your Doctor Visits".

Wednesday, February 11, 2015

Coverage But No Care in NJ, CA

Two recent news stories from New Jersey and California again highlight the fact that "coverage" does not equal medical care.

From the New Jersey Star-Ledger (2/5/2015): "Who will treat the flood of Obamacare Medicaid patients?"

From the San Jose Mercury News (2/7/2015): "Obamacare: Medi-Cal a waiting game for many low-income Californians".

In New Jersey, patient Justin Holstein said:
"You have a card saying you have health insurance, but if no doctors take it, it's almost like having one of those fake IDs," he said. "Your medication is all paid for, but if you can't get the pills, it's worthless."

Richard Holstein, his father, is a Long Branch psychologist who has watched his son struggle to get care. Yet he no longer accepts Medicaid in his own practice because the managed care payment of about $40 is half of what regular insurance pays, and a quarter of his full fee, he said.
Similarly, in California:
"We had a shortage of primary care doctors before this flood (of Medi-Cal enrollees) came about," said Dr. Steven Harrison, a veteran primary care doctor who directs a residency program for such physicians at Natividad Medical Center in Salinas. "Now we have a dire shortage."
A common theme in both stories: Patients were promised "coverage" under ObamaCare.  But they have a very difficult time finding a physician willing to see them, especially at the low rates that Medicaid pays.  Doctors essentially lose money on these patients, which means there is no way they can "make it up in volume".

The government even forbids Medicaid patients and doctors from reaching their own mutually-acceptable contractual arrangement to supplement Medicaid fees.  From the Star-Ledger piece:
Joanna DeProspero was desperate to find a pain management doctor for her adult daughter, who works part-time at Home Depot despite back pain. When she proposed paying cash, she learned it's illegal for a doctor to accept such a payment. Doctors who participate in Medicaid cannot bill a patient anything extra, said Downs, of the medical society -- even if that payment is freely offered by the patient.

 "I've literally cried at the end of the day after six or eight phone calls," said DeProspero...
One unfortunate side effect is that the patients end up going to the local emergency rooms instead (for care that isn't strictly an emergency), thus worsening the overcrowding situation in the ERs.

Supporters of the Affordable Care Act trumpet the increased "coverage" numbers provided by the law. But much of that increase is due to an expansion of Medicaid rolls, where the benefits are increasingly illusory for patients.

As we've seen throughout history, central planning and government fiats cannot create supplies of goods and services from thin air.  Instead, they merely create (or worsen) shortages.  Sadly, patients in New Jersey and California are paying the price for their lawmakers' ignorance of this lesson.

(New Jersey link via M.L.)

Tuesday, February 3, 2015

Hsieh PJM Column: Herd Immunity Applies To Guns As Well As Vaccinations

My latest piece for PJ Media, "Herd Immunity Applies to Guns as Well as Vaccinations":
The medical theory of “herd immunity” posits that enough vaccinated individuals in a population can reduce the risk of contracting a disease — even for those who aren’t vaccinated. From the experience in Illinois and around the country, a relatively small number of armed people can similarly reduce the risk of crime — even for those who aren’t armed.
The "payoff" may be even better for gun ownership than vaccination.  In the case of Illinois, even a relatively small 1% of people with new concealed carry licenses has resulted in a dramatic decrease in violent crime rates.

For more details, read the full text of "Herd Immunity Applies to Guns as Well as Vaccinations".

Catron: Uninsured Balk At Obamacare Bite

David Catron has a new piece in the American Spectator: "Uninsured Balk At Obamacare Bite".

Catron discusses the discovery by Kaiser that half of the uninsured remain without coverage because the cost of insurance is too high under Obamacare.  From his piece:
Such is the genius of our Beltway masters. They pass a law that distorts the insurance market so badly that coverage becomes unaffordable, then fine people for failing to buy it. Next, of course, these brilliant statesmen will try to escape the consequences of their meddling by giving special dispensations to those whose lives they have disrupted. Robert Pear continues, “The White House has already granted some exemptions and is considering more to avoid a political firestorm.” The Obama administration is like a drunk driver offering money to someone he has sideswiped so she won’t telephone the police.

Meanwhile, beyond the walls of the Washington rehab ward, the Kaiser Foundation survey contains more bad news about the President’s “signature domestic achievement.” Contrary to the claims of Obama and his media mouthpieces, the fortunate few who can still afford coverage have continued to experience problems finding their way through the labyrinthine Obamacare sign-up process: “Nearly two-thirds of uninsured adults who sought ACA coverage said they had some difficulty with finding out how to apply, filling in the information, assembling the paperwork, or submitting the application.”

And mere eligibility combined with the perseverance to navigate the application process is by no means a guarantee that an uninsured individual can sign up for an “affordable” health insurance policy. The Kaiser survey continues, “Among those who did try to get ACA coverage, the most common reason people gave for not having ACA coverage was that they were told they were ineligible.… This pattern holds among those who appear eligible for financial help under the ACA.” In other words, the HHS bureaucrats who “help” enrollees remain as clueless as they were the day Healthcare.gov was launched.
His piece peels back more of the pro-ACA narrative we've been seeing in the news. For more details, read the full text of "Uninsured Balk At Obamacare Bite".

Monday, February 2, 2015

Oregon Insurance Reform Proposal

One of my physician colleagues pointed me towards draft legislation proposed in Oregon to reform the insurance market: "LC 2991 2015 Regular Session".

I definitely like the three provisions on the second page, specifically:
(1) Protecting a patient's right to pay with their own money for medical services.
(2) Protecting a physician's right to decline to accept insurance (i.e., forbidding the state from requiring physicians to accept insurance.
(3) Forbidding the state from requiring physicians to provide medical care just because state orders it.
In other words, those provisions help protect the doctor-patient relationship and the individual rights of patients and physicians.

I'm more concerned about the major provision on the first page which, "Prohibits insurer from imposing cost sharing or similar requirements for services provided by out-of-network providers that are greater than requirements for services provided by in-network providers".

In a free market for insurance (which we don't currently have), it would be totally legitimate for insurers to charge lower rates for services provided "in-network" compared to "out-of-network".

But the current context most definitely is not a free market.  Rather, people are required to purchase insurance by the government, and insurance companies are heavily regulated as to what services they must cover and what prices they can charge. In essence, government tilts the playing field in favor of certain medical providers -- namely, those willing to "play ball" with insurance companies, which in turn are willing to "play ball" with the state.

One might therefore argue that this provision would help smaller independent practices from the increasing power of government-favored "Big Medicine".  This might (in theory) be justified as a temporary measure to help buy time to keep private medicine alive, while free-market advocates continue their broader fight to overturn ObamaCare and replace it with genuine free-market reforms.

I'm sympathetic to this argument, although yet not fully decided in my own mind.  As usual, readers should decide for themselves.

There's also a related petition at Change.org, "End Insurance Company discrimination against patients who choose out of network care".

And a second petition on the purer free-market elements, "Pass the Oregon Patient Access to Benefits Act".

(Information via Dr. Kathleen Brown.)

Some follow-up commentary from Dr. Brown (quoted with her permission):
Part of what we want to do with this bill is to educate people, including legislators, about how poorly these plans protect people financially, in the event of medical catastrophe. That should be one of the main functions of health insurance. Many people might see their $2500.00 deductible on an exchange plan, and not realize that their annual cap is actually $19,050.00. Patients don't always get to choose in-network in an emergency.

Our hope, if this passes, is that it would allow a "space" in the out-of-network arena for real price competition to occur. We are going to be seeing narrow networks, and doctors becoming involuntarily out-of-network. We want being kicked off the network to be a survivable event for the doctor or medical group.

It isn't perfect, but I think it is a decent strategy in a David vs Goliath battle. The best thing would be removal of lots of regulations so that insurance companies would have to provide choices in order to compete. If that happens, this bill won't be needed.
Another important point, is that subscribers and doctors get top-down control of their medical care by the payer, along with their financial benefits, when in-network. You cannot buy a policy without this. Furthermore, when there are only one to three insurers in a state, this in-network/out-of-network differential creates a huge leverage tool for the companies to ratchet down the rates they pay to "providers". I guess that is what some people call "competition". Not me.
Both are excellent points worth considering.