The blog of Freedom and Individual Rights in Medicine (FIRM)
My latest Forbes column is now out: "Perks And Incentives For Covid-19 Vaccination May Backfire".
I discuss the proliferation of prizes and incentives being offered to get people vaccinated, and how this can sometimes create the opposite effect of making people more suspicious of the vaccine.
Diego Morris said he’s alive today because he used experimental drugs to treat his cancer even though they weren’t approved by the FDA.Click through to see related video.
In 2012, Morris was diagnosed with osteosarcoma. But because the medicine needed to treat it was not approved in the US, he traveled to Europe with his mother to get it.
Now he’s cancer-free and he flew to Oregon to join Rep. Knute Buehler to support the Right To Try bill...
(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.
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.And:
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.
David Catron: "Obamacare Pimps Smear Lipstick on Another Pig"
Megan McArdle: "How the Oregon Study Should Change Our Thinking"
In 2008, the state of Oregon initiated an ambitious health care policy that allowed researchers to shed light on the effects of guaranteeing Medicaid coverage for low-income adults. The results have been closely followed in large part because insurance for the poor is a major component of the Affordable Care Act—aka Obamacare—that will soon be rolled out across the country.Here's the direct link to the NEJM article: "The Oregon Experiment — Effects of Medicaid on Clinical Outcomes".
A study published on Wednesday in the New England Journal of Medicine reports that—at least as far as health outcomes are concerned—the Oregon Medicaid experiment hasn’t lived up to the hopes of many universal care advocates. Two years after getting randomly assigned to Medicaid coverage, recipients fared no better than a control group of uninsured, low-income Oregonians in tests for hypertension, cholesterol, and diabetes treatment—all medical conditions that can be managed with proper care. The Medicaid recipients did report much lower rates of depression and—perhaps relatedly—were much less likely to be on shaky financial footing than those in the control group. But the Oregon study’s findings indicate that the claim that universal health care on its own will make Americans healthier, at least in these particular dimensions, may be wishful thinking.
...[L]awmakers earlier this year approved ambitious reforms that would turn over the state's Medicaid-funded Oregon Health Plan to beefed-up managed care groups called coordinated care organizations.
Now, members of the new groups are crying foul after a directive Thursday that they'll receive no new funds for the additional responsibilities they've agreed to take on -- mental health care, prevention efforts, quality measurements and new patient-care staff, among others.
They say the success of the reforms is at risk because revamping the care of 600,000 people takes money.(Read the full text of, "New health care groups say Oregon's reforms could sputter without more cash".)
Since 2006, the state of Oregon has had the strictest pseudoephedrine laws in the country. The popular decongestant, a common additive to over-the-counter cold and allergy medications, is also used to make black market methamphetamine. As meth use soared and volatile homemade meth laboratories proliferated in the early 2000s, many states began to put restrictions on the sale of the drug.However, the law has done little to restrict the production of illegal drugs, while imposing unnecessary burdens on legitmate users of pseudoephedrine:
The most common such restriction was to move the medications behind the counter, and require customers to show identification before purchasing them. But Oregon was the first state to require a doctor's prescription to purchase cold and allergy medication....
A trip to the doctor requires a fee for an office visit, transportation costs and missed time from work, all of which can be especially burdensome on parents. The Cascade report points out that the hassles associated with visiting a doctor likely cause many patients to seek less effective treatment or no treatment at all, resulting in a longer recovery and lost productivity.The article also describes other "unintended consequences" of the anti-pseudoephedrine campaign.
One 1992 study published in the Journal of Law and Economics found that the increasing availability of over-the-counter cold and allergy remedies prevented 1.6 million annual doctor visits. That number would likely be much higher today if all states had Oregon's law, resulting in higher health care costs, lost productivity, and lost time for doctors who would be spending time with sneezy patients that they could be spending with those suffering more serious illnesses.
The Oregon Health Services Commission Web site explains that the 2009 list emphasizes preventive care and chronic disease management because these services are less expensive and often more effective than treatment later in the course of a disease. However, there is no evidence that preventive care will reduce expenditures for the general population. Good evidence for the cost-effectiveness of disease management programs beyond those currently offered by physicians, individuals, insurers and patient groups also remains elusive.Given that many of the supporters of "universal health care" at the national level are also plugging preventative care as an alleged source of savings, we may be on the verge of seeing this dynamic play out at the national level.
What is driving the move away from procedures to save lives in immediate danger? Oregon's prioritized list is drifting toward increasing expenditures for politically popular care. This means preventive care for the healthy and treatment of diseases with active political constituencies. This drift in rationing appears to be unavoidable when political processes are given control over medical decision making.