AZ Approves "Right to Try"

I just learned of this bit of good election news, in the Washington Post (11/5/2014):"Voters in Arizona just overwhelmingly backed a 'Dallas Buyers Club' law":

Arizona voters on Tuesday became the latest state to approve a law providing terminally ill patients with greater access to unproven medical treatments, following in the footsteps of four states enacting similar measures this year.

Arizona's new law marks the first time a so-called "Right to Try" measure was approved by ballot initiative — and did so convincingly — after Colorado, Louisiana, Missouri and Michigan all passed laws in the past six months.

USA Today supported similar laws in its 8/17/2014 piece, "FDA vs. right to try: Our view".

For those who want to read an opposing view, see "USA TODAY flubs it big time over right-to-try laws".

Catron: GOP Governors Squander SCOTUS Victory

An unfortunate update from David Catron: "Eight GOP Governors Squander SCOTUS Victory".

He reminds us that the 2012 Supreme Court decision

...dealt the Obama administration an important defeat on one of the two primary issues decided, namely whether the federal government has the right to withhold all matching funds from a state that fails to expand Medicaid according to the dictates of the unpopular health care law.

Medicaid is a joint state-federal program, yet a provision of Obamacare required the withholding of all federal funds from noncompliant states. The plaintiffs argued that this was so coercive that it amounted to an unconstitutional “commandeering” of the states. Seven of the nine justices agreed. This victory, despite the Court’s ruling that the individual mandate is somehow a tax, was viewed by many as an opportunity for GOP governors to thwart implementation of an integral component of the law.

To the disgust of Obamacare’s opponents, however, eight GOP governors have nonetheless decided to comply with the law’s Medicaid provision. Arizona’s Jan Brewer, Florida’s Rick Scott, Michigan’s Rick Snyder, Nevada’s Brian Sandoval, New Jersey’s Chris Christie, New Mexico’s Susana Martinez, North Dakota’s Jack Dalrymple, and Ohio’s John Kasich have all caved. Even worse, several of these people have been vocal opponents of Obamacare and govern states that participated in the lawsuit that produced the Court’s favorable ruling.

 He discusses the fiscal implications, then adds:

What makes this so infuriating is that these Republican governors are waving the white flag after winning a hard fought legal battle in order to escape this very dilemma.

 (For more details, read the full text of "Eight GOP Governors Squander SCOTUS Victory".)

Amendment 63 Wrapup

Unfortunately, Amendment 63 lost last night here in Colorado.

However, similar health freedom measures did pass in Arizona and Oklahoma.

I'd like to take moment to thank my friend Brian Schwartz for his tireless writing and blogging on health care.

And I'd like to thank his colleagues at the Independence Institute for fighting the good fight on this issue.

Preventing You From Spending Your Own Money

Dr. Eric Novack discusses how the "no cost sharing" provision in ObamaCare will drastically curtain your ability to spend your own money for some legal health services.

Read his 9/23/2010 piece, "ObamaCare: The Used Car Contract of Lawmaking".

(Dr. Novack is the author of the Arizona Health Care Freedom Act, which is a 2010 ballot initiative similar to Colorado's Amendment 63.)

Update: Some readers commenting on Dr. Novack's piece have asked about the "no cost sharing" rule and whether that amounts to banning spending your own money (as opposed to merely obliging insurers to provide certain services "for free".

Here's something I wrote earlier on this topic, from "ObamaCare: Tightening the Noose Around Private Health Care":

Similar restrictions against "cost-sharing" or out-of-pocket spending are already established policy for Medicare -- the federal government’s "universal heath care" program for the elderly.

Under current federal law, if a doctor accepts Medicare patients (i.e., he is a "participating physician"), he must accept the payment set by Medicare. If the doctor can't make ends meet on the low Medicare fees, then that's his problem. Medicare rates are currently so low that many physician practices would go under if they had to rely solely on Medicare -- which is why many doctors currently limit the number of Medicare patients they are willing to accept.

But suppose a patient tells his doctor, "I know that Medicare doesn't pay you enough to cover your costs of performing the surgery which you and I both agree is necessary. I'll pay you extra in addition to Medicare to get it done."

By law, the physician cannot accept this offer. If he did, he could face stiff fines (or possibly jail) for illegal "cost-sharing." As long as he is a "participating physician" in Medicare, he may not accept any out-of-pocket money from his patients for covered Medicare services.

So a combination of "no cost sharing", pending government price controls, and physician exclusion from "qualified plans" if they accept money from patients creates the problem of patients being effectively prevented from spending their own money.

It's already the case for Medicare patients. As ObamaCare is implemented, this will likely affect millions of non-Medicare patients as well.

Lawsuits Update

The September 29, 2010 Christian Science Monitor discusses the status of the various anti-ObamaCare lawsuits in "Lawsuits to undo key parts of health-care law move forward, so far".

Some excerpts:

State of Florida v. United States Department of Health and Human Services, was filed in federal district court in Pensacola and joined by 12 other states via their attorneys general. In May, four states via their governors and three states via their attorneys general joined Florida's suit. Also joining the suit were the National Federation of Independent Business and two individuals from Florida and Washington State.

Mr. Cuccinelli's suit was filed on behalf of Virginia alone in US district court in Richmond. Cuccinelli, a Republican, has championed conservative causes since taking office in January...

Further, the states claim that Congress is commandeering traditional state powers under the 10th Amendment, such as regulating intrastate insurance programs.

To bolster their 10th Amendment claims, Virginia and five states in the Florida suit -- Georgia, Idaho, Louisiana, Utah, and Arizona -- created conflict between federal and state laws by passing laws prohibiting government from compelling their citizens to purchase health insurance.

More information in the full article.

The October 3, 2010 Washington Times has more information on the separate voter initiatives in CO, AZ, and OK to exempt residents from the ObamaCare mandatory insurance requirements. Read more at "Voters in 3 states to consider opting out of 'Obamacare'".

Update: USA Today has its own summary, "Lawsuits over health care law heat up".

Amerling on Arizona

The December 1, 2008 Wall Street Journal printed the following LTE by Dr. Richard Amerling, commenting on the defeat of Arizona's ballot initiative which would have guaranteed that patients could pay for private health care (2nd letter on the page):

The apparent defeat of Proposition 101 in Arizona strongly suggests the ultimate goal of the single-payer wonks is to delegitimize, or frankly outlaw, private medical contracting. Based on experiences in Canada and the U.K., the only way a government-run health-care system can survive (finances notwithstanding) is with a private pay option to handle the excess demand such systems always create.

If private medicine is outlawed in the U.S., doctors will no longer work for patients, and a basic freedom will be lost. I hope my colleagues, many of whom naively endorse the single-payer concept, are paying attention.

Richard Amerling, M.D.
Director
Outpatient Dialysis
Beth Israel Medical Center
New York

I also hope that more doctors listen to Dr. Amerling.

The Obama Health Plan Emerges

The November 20, 2008 Wall Street Journal has more analysis of the Obama health plan, including why it will lead to a government takeover of medicine. Here are a few excerpts:

The Obama Health Plan Emerges

...First, Democrats want the government to create a national insurance exchange, or marketplace, in which all comers could buy into a range of heavily regulated private policies at group rates. These private plans would then "compete" with a new public insurance option, i.e., a program managed by the government and modeled after Medicare. Lower-income earners would get subsidies to make coverage "affordable." Businesses that didn't cover their employees would pay a tax on some portion of their payroll.

... Even if Congress doubled all individual and corporate tax rates, it still wouldn't raise enough revenue to pay for Medicare and Medicaid.

The Obama-Baucus solution to this slow-motion catastrophe is to add tens of millions more people to the federal balance sheet. Because the public option will enjoy taxpayer sponsorship, it will offer generous packages to consumers that no private company could ever afford or justify. And because federal officials will run not only the new plan but also the "market" in which it "competes" with private programs -- like playing both umpire and one of the teams on the field -- they will crowd out private alternatives and gradually assume a health-care monopoly.

Many proponents of plans similar to Mr. Baucus's openly cite this as one of their goals. Eventually, the public option will import Medicare's price controls into the private sector as it tries to manage the inevitable cost overruns. When that doesn't work, Congress will deal with the problem by capping overall spending and rationing care through politics (instead of prices) -- like Canada does today.

Whether the advocates of the Democratic plan(s) open admit it or not, this is the natural logic of their ideas.

Concierge physician Dr. Steve Knope predicts the following:

...I also believe that there are enough people, limousine liberals included, who would never tolerate a Canadian system in which they would have to wait to see an overworked, governmental employee who calls himself a doctor. Even they will pay for real doctors. So I think we are destined to have an English system, in which people with means pay for good care and the rest get a diluted form of Medicare medicine. The only way that excellence will be preserved will be inside the private arena, which is why I believe our movement will grow.

(From private correspondence, quoted with his permission.)

I hope he's right. If Arizona's "Freedom of Choice in Health Care Act" (which would have guaranteed that, "No law shall interfere with a person's right to pay directly for lawful medical services") had passed, then concierge medicine would remain a viable option.

But if the federal government decides to outlaw this practice (on some supposed grounds of "equal access" or "fairness"), then we'll all suffer. Whether this happens is up to us.

A Few Updates

It looks like Arizona's Proposition 101 (Freedom of Choice in Health Care) just barely failed, 49.9% to 50.1%. (Via Patient Power.)

The UK may start allowing patients to use their own money to purchase small amounts of extra private medical care, without automatically forfeiting their government NHS medical care. (Via RS.)

Canadian patients are facing waits of up to 5 years for government-run sleep apnea testing. Canadian medical guidelines call for a maximum of two to six months for this disorder. (Via DS.)

WSJ on AZ "Freedom of Choice in Health Care"

The November 1, 2008 issue of the Wall Street Journal makes some interesting observations about the proposed Arizona ballot initiative:

Who could be against an initiative that protects the right of patients to choose and pay for a doctor or a health plan? The answer is proponents of a health-care system run by the government. For them, enshrining into law protections for private health plans is anathema. Believe it or not, the Phoenix Chamber of Commerce also opposes the initiative. Its big health-insurance members want to protect their interests as contractors to the state's Medicaid plan.

Democratic Governor Janet Napolitano argues that Proposition 101 would limit future health-care reform options. Eric Novack, a physician and the chairman of Proposition 101, responds, "The only option that our initiative rules out is a mandatory single-payer system." Single-payer health-care systems, as in Canada, make it illegal in most cases for people to go outside the government's system and contract for their own medical services. Arizona's proposition forbids those kinds of restrictions.

...Proposition 101 goes to the heart of the national health-care debate. Universal coverage plans, regulated by government, nearly always try to restrain costs by restricting the choices individual can make. This assumes a uniformity in the real-world of patients or the practice of medicine that simply doesn't exist, especially amid rapid developments in medical science. Who should decide -- the patient or a government treatment schedule -- whether a cancer sufferer should be able to try an experimental therapy or under what circumstances a senior citizen gets a hip replacement?

Allowing patients to choose their own medical treatment, get third or fourth opinions, or seek out experimental medicines saves lives. Randy Kendrick, an early supporter of the initiative, says her ability to look around for treatments among doctors after a serious leg injury saved her from what her original physicians said would be a life confined in a wheelchair. Courageous patients and innovative medical clinicians find each other constantly this way. The patient-clinician interface is one reason the U.S. remains a locus of medical progress. Ensuring this progress continues depends on maximizing patient choices. A publicly bureaucratized system will slow it.

That is indeed the fundamental issue: Is your life your own, or are you allowed to seek your own self-interest only by permission of the state? Arizonans will get to decide.

Will on AZ "Freedom of Choice in Health Care"

In the October 26, 2008 Washington Post, George Will discusses the Arizona ballot initiative entitled the "Freedom of Choice in Health Care Act":

On Election Day, Arizonans can give the nation the gift of a good example. They can enact a measure that could shape the health-care debate that will arrest or accelerate the nation's slide into statism. Proposition 101, the Freedom of Choice in Health Care Act, would put the following language into Arizona's Constitution:

"Because all people should have the right to make decisions about their health care, no law shall be passed that restricts a person's freedom of choice of private health care systems or private plans of any type. No law shall interfere with a person's or entity's right to pay directly for lawful medical services, nor shall any law impose a penalty or fine, of any type, for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan."

Will discusses his reasons for supporting the ballot measure. I only wish there were a similar measure to support here in Colorado.

Arizona Updates

Sandy Szwarc notes two positive stories from Arizona.

First, she has a nice writeup of Dr. Steven Knope's efforts to practice quality medicine free from onerous insurance company restrictions in a concierge practice. For more on this, see his blog.

Second, she reports on the proposed "Freedom of Choice in Health Care Act", which would prevent the state from imposing a Massachusetts-style individual insurance mandate on its residents.

As Sue Blevins, RN (and president of the Institute for Health Freedom) notes:

Supporters of the ballot initiative want to ensure that no health-reform scheme will strip them of their freedom to pay privately for health care. Opponents are concerned that if the initiative passes, it could preclude mandatory socialized health insurance.

Sounds good to me! I just wish Colorado voters had the chance to support a similar measure, which would go a long ways towards protecting our individual rights in health care.

Arizona Surgeon Speak Out Against Socialized Medicine

Ari Armstrong recently forwarded the following e-mail to me from an Arizona surgeon. I don't know anything about his organization besides what's on their website, but I thought I would pass this on as a FYI:

Medical Choice for Arizona
Freedom of Choice in Health Care Act -- A State Constitutional Initiative
March 2008

A MESSAGE TO ANYONE WHO IS, OR MAY SOMEDAY BE A MEDICAL PATIENT

Dear Friend:

My name is Jeff Singer, MD. I am a general surgeon in the greater Phoenix area, and am the Treasurer of a campaign committee called "Medical Choice for Arizona." We are circulating petitions to place on this November's ballot, "The Freedom of Choice in Health Care Act."

As I am sure you are well aware, momentum is building across the nation, by well-intentioned and not-so-well-intentioned people, for comprehensive --even radical-- reform of our health care system. Frustrated with the gridlock in Washington, many states are taking matters in to their own hands, and passing reforms aimed at achieving "universal coverage," but that ultimately will result in rationing of health care and limitations on our freedom of choice of health care options, treatments, and providers.

"The Freedom of Choice in Health Care Act" would amend the Arizona Constitution to insure that, whatever type of health care legislation ultimately emerges from our legislature, it will not be able to restrict our freedom of choice of private health care systems, plans, or options; it will not be able to prevent us from directly paying for lawful medical services; and it will not, in any way, be able to force us to participate in a plan or program if we don't want to.

What's more, our legal counsel, Clint Bolick (co-founder of the Institute for Justice, and currently Director of the Goldwater Institute's Center for Constitutional Litigation, among other things), who designed the language for our initiative, believes this might actually prevent a further FEDERAL intrusion into the healthcare system. He says that there is legal precedent for state constitutional law actually trumping federal law when the federal law trespasses into an area of police power that has been traditionally reserved to the states under the US Constitution. So passage of this amendment in AZ and other states would at least give us a fighting chance against those in DC who want to force us into a one-size-fits-all national health care plan.

Medical Choice for Arizona consists of people from across the political spectrum, all of whom want serious reform to our health care system -- all of whom want to reduce the ranks of the uninsured -- all of whom want to make sure our kids get adequate health care -- but who have differing views regarding what constitutes the best kind of reform. But there is one thing on which we all agree: WE MUST RETAIN THE RIGHT OF PEOPLE TO HAVE CONTROL OVER THEIR OWN HEALTH CARE CHOICES.

Medical Choice for Arizona is not about enacting -- or blocking -- any specific health care legislation. It is about preserving and protecting patients' choice.

WE NEED YOUR HELP TO SUCCEED!

Please visit our website at www.medicalchoiceforaz.com to learn more about "The Freedom of Choice in Health Care Act." The actual ballot language, as well as "Frequently Asked Questions," and a way to donate online can be found at the site. If you have further questions, feel free to phone us at: 623-271-9576.

But most important, please consider making a contribution to our campaign. Arizona law places NO LIMITS on the amount of money that can be contributed to non-partisan citizens initiative campaigns like ours. The donations are not tax deductible. However, Arizona law DOES ALLOW corporate contributions to be made to initiative campaigns.

Please make your check out to: "Medical Choice for Arizona," and mail it to our address at:

3655 W. Anthem Way
Suite A-109--PMB 212
Anthem, AZ 85086

Health care reform is on the front burner in all the political debates this year. No time is more important than NOW to act to protect our right to choice in health care.

Thank you for your consideration.

Sincerely,

Jeff Singer, MD
Treasurer
Our Website: www.medicalchoiceforaz.com