Hsieh LTE in WaPo on ObamaCare Enrollees

The Washington Post published my letter-to-the-editor (LTE) on how the White House counts ObamaCare enrollees:

An Obamacare and income tax accounting

So the White House counts as Obamacare enrollees “those who simply picked a plan and put it in their online shopping cart” but have not yet paid for it. Do I then get to count as having paid my taxes if I’ve filled out my 1040 form but haven’t mailed in my check?

Paul Hsieh, Sedalia, Colo.

(My letter was in response to their 11/11/2013 article, "HealthCare.gov tally: 40,000 are signed up".)

Hsieh DP LTE on ACOs

The 1/15/2012 print edition of the Denver Post has published my LTE, "Accountable care organizations would backfire". This was in response to their 1/9/2012 story, "Medicare reform rewards doctors for better, cheaper care".

My LTE was as follows:

"Accountable care organizations" would backfire

In theory, "accountable care organizations" should encourage physicians to provide cost-effective, "integrated" care. In practice, they will reward physicians for limiting care.

Suppose you see your ACO doctor for a severe headache. He briefly examines you then says, "You don't need a MRI scan of your head; just take two Tylenol and call me in the morning." Can you be completely sure he is acting in your best medical interest? Or might he be unduly influenced by the bonus he receives for reducing the number of MRI scans performed by the ACO?

ACOs make doctors accountable -- but to Medicare bureaucrats, not their patients.

Paul Hsieh, Sedalia

Quick Links: Schwartz, Harsanyi, Pipes, Turner

The 6/2/2011 Denver Post has published Brian Schwartz's letter criticizing Governor Hickenlooper's veto of Colorado Senate Bill 11-213.

David Harsanyi reminds us, "Let's Not Forget About Obamacare":

Rationing boards. Political favors. Lies. Coercion. Broken promises. Precedents that can force us to buy about anything. It might not be socialism, technically speaking. But really, what's not to like?

(Read the full text.)

As Vermont proceeds with its "single payer" plan, Sally Pipes at Forbes (6/6/2011) describes, "Single-Payer Health Care Systems, Multiple Health Care Disasters".

In the 6/7/2011 Wall Street Journal, Grace-Marie Turner notes, "No, You Can't Keep Your Health Insurance". The end-game for many ObamaCare supporters is to drive private insurers out of business, leaving patients to the tender mercies of a government monopoly insurer.

Hsieh DP LTE on ObamaCare Savings

The March 3, 2011 Denver Post has published my latest LTE on ObamaCare.

I was responding to an earlier OpEd by Dr. Ned Calonge of the Colorado Trust claiming huge cost savings to Colorado under ObamaCare.

Here is my LTE reply as published by the Denver Post:

Questioning the savings under health reform

Re: "In Colorado, health care reform means lower costs," Feb. 23 guest commentary.

The cost savings that Dr. Ned Calonge and The Colorado Trust are counting on under Obamacare are unlikely to materialize. After Massachusetts adopted a similar "reform" plan in 2006, health insurance premiums went up at double the national average -- not down. Similarly, Medicare chief actuary Richard Foster recently told Congress that the new health law is unlikely hold down costs for the federal government. If it won't save money for the feds, it's unlikely to save money for Colorado. Finally, the national plan relies on an "individual insurance mandate" of dubious constitutionality -- and a gross infringement of individual freedoms.

We’re more likely to see John Elway come out of retirement and quarterback the Broncos to another Super Bowl than see any of Dr. Calonge's promised cost savings.

Paul Hsieh, M.D., Sedalia

Hsieh LTE in Gazette on Amendment 63

The August 30, 2010 Colorado Springs Gazette has published my LTE supporting their position on Amendment 63 (the second one down):

Doctor gives thanks for 63

Thank you for speaking out in favor of the Colorado Health Care Choice Initiative protecting us from mandatory health insurance. This idea forming the core of ObamaCare has already been tried -- and failed -- in Massachusetts, resulting only in skyrocketing health costs, a desperate shortage of doctors, and significantly longer waits for medical care than in the rest of the country. Some Massachusetts patients must now wait almost a year for a routine physical exam.

As a practicing physician, such Massachusetts-style problems are the last thing I want here in Colorado. Colorado voters can avoid the mistakes of Massachusetts by supporting Amendment 63.

Paul Hsieh, MD
Sedalia

The original Gazette OpEd can be found at: "Amendment 63 protects our freedom".

Hsieh LTE in NYT on Cass Sunstein

The New York Times has published my LTE on former University of Chicago law professor Cass Sunstein, a leading advocate of so-called "libertarian paternalism".

My LTE was in response to their May 16, 2010 article in the Sunday Magazine section, "Cass Sunstein Wants to Nudge Us" praising his work as President Obama's director of the Office of Information and Regulatory Affairs (OIRA) to use his philosophy to push people into behaviours the government deems desirable, including health and financial matters -- i.e., the modern "behavioural economics" form of the nanny state.

The LTE will also be appearing this weekend in the May 30, 2010 print edition of the NYT in the Sunday Magazine section (as opposed to the main letters section of the newspaper). It's the second one down:

Cass Sunstein explicitly compares Americans to Homer Simpsons requiring government guidance to live. In my view, the proper function of government is to protect individual rights and freedoms. Unless we violate others' rights by force or fraud, the government should leave us alone to live according to our best judgment.

Of course, individuals may voluntarily "nudge" themselves to achieve long-term goals, like having your bank automatically deposit a portion of each paycheck into a child's college fund. But each person must make these decisions for himself based on his goals and circumstances. These choices are his responsibility and his right -- not the government’s.

Libertarian paternalism in essence says, “Don’t worry -- we’ll do your thinking for you.” If Americans start surrendering their minds thus to the government, they will become easy prey for demagogues and dictators.

PAUL HSIEH
Sedalia, Colo.

Ralston LTE in Pittsburgh Tribune-Review

The Apri1 1, 2010 Pittsburgh Tribune Review published this LTE by Richard Ralston on ObamaCare:

Health Care 'Disaster'

You are right that the collapse of TennCare ("The TennCare lesson: A natural disaster," March 27 and TribLIVE.com) was an ominous indicator of what will now happen across the U.S. A more recent example is Massachusetts, where mandated health insurance has become the most expensive insurance in the U.S.

Federal mandates and new coverage requirements on top of state regulations will result in a new "race to the top" of rapidly escalating insurance premiums caused by this government action -- while Medicare and Medicaid costs continue to spin out of control. Then a nonexistent "free market" will get the blame and justify an even heavier government hand.

Richard E. Ralston

The writer is executive director of Americans for Free Choice in Medicine in Newport Beach, Calif.

The fight continues.

Watts LTE in GJ Sentinel

The March 31, 2010 Grand Junction Sentinel has published Richard Watts' latest LTE on ObamaCare:

Emergency-room costs don’t justify health bill

This is regarding the article, "Local supporters cheer health vote," The Daily Sentinel March 22:

"We already decided health care is a right by the way we treat ERs," Michael Pramenko told the Sentinel.

Who decided? Not "we," but Congress, when it passed a law forcing emergency rooms to treat everyone, regardless of ability to pay. By what right? None.

Each person has a right to liberty, as the Declaration of Independence asserts. Any law forcing anyone to provide a good or service violates our liberty.

It is wrong for anyone to take others' earnings, achieved through their own efforts to spend by their own judgment. It is wrong to force anyone to serve others. That is why America abolished slavery.

Forced emergency-room treatment does not justify national health care. Rather, we should restore liberty. For more on this, please visit WeStandFIRM.org.

RICHARD WATTS
Hayden, CO

Thank you, Richard, for again speaking out in support of liberty and individual rights.

Quick Links: Schwartz and Gramm

The March 27, 2010 Boulder Daily Camera has published Brian Schwartz's analysis of "The ObamaCare Scam".

The March 25, 2010 Wall Street Journal includes an OpEd by former Senator Phil Gramm on repealing ObamaCare, "Resistance Is Not Futile".

A key excerpt:

Republicans have a job to do. They must make it clear to the American people that this is only the beginning of the debate. There will be two congressional elections and a presidential election before the government takeover is implemented in 2014.

I believe that Republicans should take the unequivocal position that if they are given a majority in Congress in November, they will stop the implementation of the government takeover. And if a Republican is elected president in 2012, they will do with Mr. Obama's health-care bill what the American voters will have done to the Democrats: throw it out. If the voters demand change in November, even the Democrats who remain in Congress will help give it to them.

We'll see if the GOP is up to the task -- or if they disappoint Americans by once again capitulating to and compromising with the statists.

Watts LTE in Denver Post

The March 19, 2010 Denver Post printed the following LTE by Richard Watts responding to Dan Haley's column on the Congressional contortions to pass ObamaCare:

The transfer of taxpayers' wealth

Dan Haley notes the congressional health bill is "larded up with special deals and gross kickbacks." True, but the bill is not merely wrong because of added pork. National health care is inherently wrong because it forcibly transfers wealth. Sure, it's immoral for Congress to take some people's money and shovel it to others as pork. But why? Because the money belongs to those who earned it, not to Congress, nor to anyone who accepts the loot.

If done in the private sector, such activities are known as theft, robbery and receiving stolen goods. These are just as wrong if government perpetrates them, and worse -- because it is government's responsibility to defend people's rights.

Richard Watts, Hayden

Regardless of how the big vote in Congress turns out this weekend, I'd like to thank Richard for this fine LTE which cut right to the heart of the issue. Richard has been a stalwart supporter of FIRM from the very beginning, when Lin Zinser founded it in January 2007.

Zawistowski LTE, Rhoads OpEd

Stella Zawistowski of ReasonPharm had a nice LTE published in the New York Times on President Obama's recent trip to Ohio to promote his health care plan (3/18/2010 edition, 4th one down):

President Obama is resorting to Natoma Canfield's sad story and saying that "every argument has been made" because he has not answered so many arguments against his plan. How, for example, when an insurance mandate has failed spectacularly in Massachusetts, will it work times 50?

I, too, feel sorry for Ms. Canfield, an uninsured woman with leukemia. But that does not justify brushing aside the facts and increasing government intervention in health care.

In fact, it is government intervention that places individually purchased insurance out of Ms. Canfield's price range in the first place.

Feelings of pity, however strong, must not get in the way of a reasoned debate. The only way to help Ms. Canfield and other Americans get health care is a fully free market.

Stella Zawistowski

Jared Rhoads of the Lucidicus Project has a new OpEd, "21 musings before the vote". Here are a few choice items:

2. According to preliminary numbers from the Congressional Budget Office, health reform will cost an estimated $940 billion. I'm sure we will see people proffer calculations of what that comes to for every man, woman, and child in the nation. But remember to multiply that figure by at least two in order to get your share, because over 40 percent of Americans pay no income tax.

8. The same people who advocate taxpayer-funded incentives for "healthy lifestyle decisions" also support disassociating risk from insurance pricing through community rating. Wouldn't risk-based pricing be the best incentive of all, and save us the IRS middleman?

14. A good test of a person's values these days is to bring up the Tea Party movement. Anyone can disagree, but if he calls it "astroturf" or uses the "teabag" epithet, then run the other way. You have nothing to gain from dealing with such a person.

(Read the full text of "21 musings before the vote".)

Ralston LTE in NY Times

The February 17, 2010 New York Times has published an LTE by Richard Ralston on health care reform (5th one down):

Although you do not think small ideas will do much, you provide a good list of small ideas that would improve the cost and availability of health care. Some of them would be more helpful than you indicate. (Health savings accounts help middle-income Americans and do not primarily help the wealthy, for whom the few hundred dollars in tax savings are not worth the paperwork.)

Americans have rightly become suspicious of big, bad, expensive ideas that are adopted only because they pay off a laundry list of special political interests. They would not object to small ideas that actually work and that don't need bribes to get votes in Congress.

Richard E. Ralston
Executive Director
Americans for Free Choice in Medicine
Newport Beach, Calif., Feb. 15, 2010

(He was responding to their 2/14/2010 editorial, "Small Ideas Won't Fix It".)

Parker WSJ LTE on Health Care Entitlements

The December 23, 2009 Wall Street Journal published an excellent LTE by Dr. Richard Parker that cuts to the heart of the health care debate (second one down):

Scott Harrington rhetorically asks, "How can a new entitlement reduce deficits?" As he concludes, a massive new entitlement cannot and will not reduce government debt. As our experiences with Medicare and Medicaid have clearly demonstrated, whenever the government promises a "free" service, costs will necessarily rise as more and more people scramble to receive their share of "free" health care. Ultimately this can only lead to ballooning deficits and health-care rationing.

It is precisely this type of government intrusion in what should rightly be a free market that has caused health-care expenditures to skyrocket.

You cannot have your cake and eat it too. This focus on costs, however, misses a more fundamental issue with the proposed nationalization of health care -- the rights of physicians and patients.

Under ObamaCare, patients will lose their freedom to choose what health care they receive and which doctor treats them. Physicians will lose the last of their freedom to practice according to their best judgment.

The battle for medicine will be lost or won not on actuarial analysis of costs, but rather on the more fundamental principle of the rights of individuals.

Richard Parker, M.D.
McKinney, Texas

Schwartz: Why To Condemn Insurance Companies

In the December 5, 2009 Boulder Daily Camera, Brian Schwartz explains why we should or should not condemn insurance companies:

Why to condemn insurance companies

Is the for-profit insurance industry a "predator" that "prevent[s] us from having a decent health care system"? Letter writer Bruce Robinson says so (Daily Camera, December 1). He's partially right. The real predators are politicians who inhibit needed health policy reform. But insurers are guilty for concealing how they benefit from Congress's predatory practices, which shield them from competition and accountability to patients.

Predators gain value by using force or threats of force. Politicians prey upon patients who prefer to finance their own medical care in "politically incorrect" ways. As a result, insurers need not compete for your business. Politicians punch you with a tax penalty for buying insurance directly from an insurer instead of through your employer. They prohibit you from buying affordable policies available in other states. They tax you more for paying cash for routine medical expenses rather than buying an expensive health plan with tax-deductible premiums.

Like a true predator, politicians support legislation that backs you into a corner -- where as the patient, you are the consumer but not the customer. Hence, neither insurers nor doctors aim to please you. They cater to who pays them. Employers pay the insurers and insurers pay the doctors.

So don't condemn for-profit insurance. The profits are "anemic," reports the AP. Condemn insurers for supporting an un-free market, where profit is disconnected from pleasing consumers. Only in a free market insurers' profits would depend on satisfying you, the patient, rather than satisfying employers and politicians.

(The original is here, and a version with HTML hot links can be found on the PatientPowerNow.org website.)

Mundy: Comparing Screening of Breasts and Shoes

Lee Mundy asks the following very perceptive question in this LTE in the December 7, 2009 Wall Street Journal:

Compare Screening Of Breasts and Shoes

The U.S. Preventative Services Task Force feels that mammograms are a waste of time and money because of false-positive exams, and anyway, the risk is evaluated at a meager 0.05% (Letters, Dec. 2). If, indeed, mammograms for women under 50 are not cost effective, and only save a few lives, then why are we taking our shoes off at every airport in the country?

Lee Mundy
Ellensburg, Wash.

Schwartz LTE On Public Option

Brian Schwartz just alerted me to an LTE of his which had been published in the October 30, 2009 Denver Post.

The topic was the so-called "public option":

Health care reform and the public option

Say your neighborhood deli rigged its scales so that customers who paid for a pound of meat left the store with less. Does such fraud justify a government-run "public option" for delicatessens?

Surely not, but this is how Colorado AFL-CIO Director Mike Cerbo argues for a new government-run insurance plan. Cerbo says it should "impermissible" for insurers to "drop coverage due to pre-existing medical conditions" -- presumably when patients had been honest about medical histories.

This is called "post-claim underwriting," and it violates the insurer's contract with the policy-holder. But this is no justification of a "public option." Rather, if it happens frequently and without penalty, it shows that government has been lax in one of its legitimate duties: enforcing contracts.

Brian T. Schwartz, Boulder

Letters from Peck and Stoddard

Recent polls show that even more Americans are opposed to ObamaCare than ever before.

The November 23, 2009 Rasmussen poll reports, "Support for Health Care Plan Falls to New Low".

Rasmussen notes that only 38% of Americans now support the proposed changes vs. 56% against -- "the lowest level of support measured for the plan in nearly two dozen tracking polls conducted since June".

And more Americans are speaking out against the plan. I especially liked these two recent letters and want to highlight them.

The first was written by Tim Peck of Ashville, NC, and published in the November 28, 2009 Ashville Citizen-Times. The second was written by William Stoddard, and sent to his two California Senators. Both are reposted here with their permission.

First Tim Peck's letter:

Health pitch a violation of basic American rights

The health care legislation in Congress contains mandates to obtain individual health insurance coverage. With this provision, Congress would violate my rights, rather than protect them, which is Congress's constitutional mandate.

This provision is a clear violation of my right to voluntarily associate and contract with health care professionals and insurance providers to our mutual benefit without the interference of a predatory third party.

It violates my right to economic freedom by forcing me to purchase health insurance services against my will. It violates my right to property by forcing me to pay penalties for declining to participate in a coercive program. It violates my right to liberty by forcing me to submit to incarceration for nonpayment of penalties or additional taxes.

It violates my right to self-determination. It violates my right to use my mind to make judgments regarding my own interests and actions.

In short, this legislation violates my right to peaceably live my life as I see fit. I oppose these violations. I say "no" to the coercive mandates contained in this proposal.

And it is my hope and wish that Senator Hagan will stand with me and say "no" to this rights-violating health care bill.

Tim Peck, Asheville

And William Stoddard's letter:

One of the principal stated purposes of the Democratic Party's proposed health care legislation is to better meet the health needs of those who are currently uninsured. As a self-employed man of 59 who cannot afford health insurance, I am strongly concerned with that issue, and have followed it closely over the past year and a half. I regret to say that the passage of the proposed legislation will make my situation worse, rather than better. I urge you to protect the uninsured by voting against it.

The reason I'm uninsured is that health care, and therefore health insurance, costs too much. But the proposed legislation would require me to purchase health insurance from the same insurance industry that is now failing to restrain the growth of health care costs, either from the uncompetitive private firms that now dominate it, or from a government-run system that is likely to charge even more. It offers subsidies for this purchase so inadequate that they would be laughable, if not for the real hardship they will inflict on people who pay them. And when the many people who still can't afford insurance remain uninsured, it fines them nearly $1,000 yearly... which will only make it harder for them to get health care. The CMS estimates that of the uninsured people who won't be eligible for Medicaid, 12 million will become insured, but 18 million will remain uninsured and suffer punishment for it.

Advocates of this punitive approach attack the irresponsibility of people who remain uninsured, and who depend on emergency rooms for health care. But under this bill, the people added to Medicaid will largely continue to do exactly that, as most doctors don't want to take patients at Medicaid rates. And the many millions of people who can't afford insurance will often have to do the same... until they are diagnosed with some serious and costly illness, when they will be able to sign up for insurance, and insurance carriers will be compelled to accept them despite their "preexisting conditions," further driving up insurance costs and premiums. And in any case, the reason many self-employed people and employees of small businesses don't have insurance is not irresponsibility, but fear of financial ruin if they have to pay for it.

If buying health insurance remained voluntary, and you came up with a system under which it cost too much, the uninsured could remain uninsured, and at least not be any worse off... and send you a message that your efforts weren't good enough. By resorting to compulsion, you are making it a violation of law to send that message. And that very fact is the strongest reason to believe that your plan will not make health care affordable, but make its costs even more ruinous.

I urge you to reconsider, and reject this proposal.

William Stoddard

I liked both letters because they show the bad consequences that will result from basic violations of the right to contract in a free market.

Americans are speaking out to oppose ObamaCare. Will our elected officials listen?

Liggett DP LTE on Junk Food Tax

The November 17, 2009 Denver Post printed the following LTE by Gina Liggett opposing proposed new taxes on so-called junk food:

Governor's proposal to tax candy and soda

The Post reported on Gov. Bill Ritter's proposal to tax candy and soda pop. Ritter said, "We thought that people would be willing to pay 3 cents on a dollar candy bar." How utterly arrogant of him to decide what any citizen would be willing to pay for anything. What I do with my money and property should be my business in a free society.

America's local, state and federal governments are becoming ever-more authoritarian, serving themselves instead of protecting individual liberty. Wake up! Our individual rights are in serious jeopardy. The people must fight against this creeping and metastatic growth in governmental power or America will die.

Gina Liggett, Denver

Her letter was a response to the November 15 news story, "Ritter's plan to tax soda and candy gets cheers, jeers".

Schwartz: HB3962, Insurance, and Preexisting Conditions

The November 8, 2008 Boulder Daily Camera published Brian Schwartz's opposition to requiring insurers to cover pre-existing conditions.

His comments are the third on the page:

HB3962, Insurance, and Preexisting Conditions

Should government force you to pay more for medical insurance so others can pay less? Dr. Laura Rosenthal thinks so, calling it "compassion and kindness." It's more like charity at gunpoint.

In a recent Camera article, Rosenthal advocated making it "illegal for health insurance companies to discriminate on the basis of pre-existing conditions." That is, insurers must sell policies to everyone at the same price.

These mandates have dire consequences, including more people without insurance. "Individual insurance markets deteriorated," concludes a Milliman actuarial study. "Insurance companies chose to stop selling individual insurance," "premium rates tended to increase, sometimes dramatically."

This legislation encourages insurers to design products that sick people don't want, as insurers lose money by insuring the sick because it's illegal to charge higher premiums. Such policies lack features higher-risk customers want, like comprehensive coverage and minimal bureaucratic obstacles to doctor-recommended treatments.

These political controls cause a "death spiral:" premiums increase, so the healthiest stop buying insurance, the remaining risk pool is less healthy, and premiums rise again. Repeat. To prevent this, politicians want mandatory insurance, which Massachusetts imposed in 2006. Since then Massachusetts insurance premium costs have skyrocketed, affordable policies become illegal, and patients have poor access to care.

Preexisting conditions are a problem because the tax code favors non-portable employer-based insurance. This prevents people from buying guaranteed renewable policies before contracting a chronic condition. A free-market in insurance would also offer innovative products such as health status insurance, which would pay for premium increases should you get sick.

(A version with hyperlinks is available on Brian's website.)

Hsieh LTE in WSJ on Bad Incentives in Massachusetts

The November 2, 2009 Wall Street Journal published my LTE replying to their October 14, 2009 story on the proposed Massachusetts health care "global payment" system.

Here's my LTE:

The Incentives Aren't to Help You

The proposed Massachusetts "global payment" system creates a tremendous incentive for physicians and hospitals to render as little care as possible ("Your Massachusetts Future," Review & Outlook, Oct. 14). If your care costs less than the annual allotment, then they keep the unused amount. If your care costs more, then the difference comes out of the providers' pockets. Such a system thus pits your doctor's interests against your own.

Suppose the state has already used up 85% of your annual allotment. You then see your doctor for a severe headache. He examines you and says, "No, you don't need a $1,000 MRI scan of your brain. Why don't you take two Tylenol and call me in the morning."

Would you be 100% sure that he's giving you unbiased medical advice?

And even if your doctor continues to conscientiously practice in your best interest, he must constantly battle hospital administrators seeking to reduce spending on your care.

Advocates of government-run health care like to claim that it is morally superior because it "doesn't put a price on human life." But when the government sets an annual spending cap for each patient, then that's exactly what it is doing. A government big enough to "guarantee" you health care will also be big enough to limit it.

Paul Hsieh, M.D.
Sedalia, Colo.

(I eventually argued a similar point in the longer PajamasMedia piece which also came out yesterday.)