Beezley: Market Driven Health Care Saves Lives

The Independence Institute has published an OpEd by Donald Beezley, arguing that "Market Driven Health Care Saves Lives".

Here's an excerpt:

...President Barack Obama thinks government bureaucrats can determine what [Beezley's diabetic son] Connor needs, when he needs it, and then get it to him--and to hundreds of millions of others. This is a lie. The President's scheme to seize control of our bodies through our health is dangerous, and will leave us helpless victims with no control over our health care. Government control also means an inevitable decline of supplies, and rationing via simpleminded regulations.

Only a system of competing prices, profits and producers--capitalism--results in the right thing being in the right place at the right time. Without prices and profits you have scarcity, rationing and poverty: the Soviet Union was one of the most fertile regions on earth; an army of central planning bureaucrats couldn't keep bread on the shelves for a reason.

It doesn't matter if rationing is "in the bill." Shortages are unavoidable without a profit-driven market providing price and profit signals to consumers and producers. Under government control doctors, insulin, test strips and all health resources will be disconnected from the needs and priorities of real people and driven instead by political priorities and the stunted thinking of bureaucrats. Freedom and capitalism respect the choices of individuals and provide incentives that align the interests of disparate people. This is true of healthcare just as surely as bread or anything else.

Beezley then offers some common-sense free market health care reforms:

...There are four essential reforms [that] offer an immediate start to protecting the lives of Connor and every American. To start, the federal government must assert its authority under the Interstate Commerce Clause and knock down foolish, expensive barriers to health insurance purchases across state lines so Americans can buy the insurance they want.

As another important reform, state governments must end coverage mandates that radically increase the cost of insurance and enrich health insurance companies at patients' expense.

In addition, lawsuit abuse must be curbed with sensible malpractice guidelines and limits.

And finally, tax policy that disconnects patients from their doctors must be changed by moving tax benefits to the individual level while empowering individuals with vehicles like Health Savings Accounts.

...My son doesn't deserve to have his life diminished by a government run healthcare monstrosity.

He and all Americans deserve a free, vibrant, competitive market in health care.

These reforms would make life much better for Connor as well as millions of Americans.

(Read the full text of "Market Driven Health Care Saves Lives".)

Maine Still In Trouble

Maine's attempt at universal health care gets less media coverage than Massachusetts'. However, the November 10, 2009 New York Times reports that it's still in trouble.

Here's an excerpt from their article, "Maine Finds a Health Care Fix Elusive":

Maine is the Charlie Brown of health care. The state's legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded. Indeed, many overhauls to the system have done little more than squeeze a balloon -- solving one problem while worsening another.

...Maine's history is a cautionary tale for national health reform. The state could never figure out how to slow the spiraling increase in medical costs, hobbling its efforts to offer more people insurance coverage. Many on Capitol Hill have criticized national reform legislation for similarly doing little to tame costs.

(Read the full text of "Maine Finds a Health Care Fix Elusive".)

Although the details differ from Massachusetts, the problems are very similar. Despite massive government regulations, costs continue to rise, patients continue to have a hard time getting access to care, and doctors are getting squeezed by low reimbursement. In other words, their statist policies are making things worse, not better.

Will the rest of the country learn from Maine's experience, or will we adopt those same failed policies at the national level?

Medicare Fact Check

The latest AAPS briefing tackles the myth that, "Medicare is the model of efficiency and fairness".

The points covered include:

* It is structured as a Ponzi scheme
* Its low administrative costs are a mirage.
* It is sustained by the general fund and by cost-shifting
* It is unfair to both patients and physicians
* The system is rife with fraud
* Government care costs much more
* Medicare taxes impose uncounted costs

These are good reasons to run away from any proposal called "Medicare For All".

Lin Gilbert's Rationing Story

Canadian Lin Gilbert tells of the wait she endured for over two years for her MRI and spine surgery, and the toll it took on her life:



In Canada, health care is never truly a "right". She was repeatedly told that she hadn't suffered for long enough to receive the surgery she needed, and that older patients were ahead of her on the waiting list.

Do Americans really want this kind of medical system?

(Via Instapundit.)

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.)

Fat In Japan? You're Breaking The Law

In the November 10, 2009 Global Post, David Nakamura describes the Japanese anti-obesity laws in his article, "Fat In Japan? You're Breaking The Law".

Here's an excerpt:

...Under Japan's health care coverage, companies administer check-ups to employees once a year. Those who fail to meet the waistline requirement must undergo counseling. If companies do not reduce the number of overweight employees by 10 percent by 2012 and 25 percent by 2015, they could be required to pay more money into a health care program for the elderly. An estimated 56 million Japanese will have their waists measured this year.

...Health care costs here are projected to double by 2020 and represent 11.5 percent of gross domestic product. That’s why some health experts support the metabo law.

(Read the full text of "Fat In Japan? You're Breaking The Law".)

Such nanny-state regulations are already present to a lesser degree in the United States. If we adopt some form of "universal health care", we can expect to see them explode in scope and number.

As I described in my January 7, 2009 Christian Science Monitor piece, "Universal Healthcare and the Waistline Police":

...Government attempts to regulate individual lifestyles are based on the claim that they must limit medical costs that would otherwise be a burden on "society." But this issue can arise only in "universal healthcare" systems where taxpayers must pay for everyone's medical expenses.

[Specific US nanny-state health regulation examples omitted...]

Just as universal healthcare will further fuel the nanny state, the nanny state mind-set helps fuel the drive toward universal healthcare. Individuals aren't regarded as competent to decide how to manage their lives and their health. So the government provides "cradle to grave" coverage of their healthcare.

Nanny state regulations and universal healthcare thus feed a vicious cycle of increasing government control over individuals. Both undermine individual responsibility and habituate citizens to ever-worsening erosions of their individual rights. Both promote dependence on government. Both undermine the virtues of independence and rationality. Both jeopardize the very foundations of a free society.

The US will soon have to decide whether we will base our health care policy on the principle of individual rights or a collectivist model, as in Japan.

For our sakes, I hope we won't be "turning Japanese".

Guidelines For Survival Under Socialized Medicine

A friend who asked to be identified only as "Christian W" recently posted this excellent essay on Facebook. Christian used to live in a country with socialized medicine. Hence, he has some valuable advice in case America goes down that path.

I originally found Christian's essay here at ReasonPharm, Stella Zawistowski's blog. They were both kind enough to grant me permission to repost his piece in its entirely (along with one parenthetical note by Stella).

Guidelines for Survival Under Socialized Medicine
by Christian W.

Folks, socialist medicine is likely inevitable in the United States. I think that it will either be implemented by means of sweeping bills like the one now approved by the House, or by a continued gradual strangulation of freedom in healthcare. The trends towards fascism and socialism have grown increasingly stronger over generations, and little will change their essential trajectories in our lifetimes. (I hope to be proven wrong.)

I think that it is still very worthwhile to wage an intellectual battle against the collectivist juggernaut, but it is also time to consider some personal strategies for coping with the coming deterioration of healthcare in this country.

Here are a few general practical guidelines for personal survival:

1) Rationing and shortages are inevitable under socialism. Therefore you must plan your life as if no healthcare will be available for you at all except in cases of acute trauma requiring ambulance transport. (There are some other exceptions, but this is the essence of health care in countries like Sweden.)

Absence of modern medical services means that you have to take meaningful steps to minimize the risk of acquiring a chronic illness or disease of aging and/or lifestyle. You will have to become your own doctor, primarily focusing on disease prevention. Special emphasis should be put on proper diet and exercise. Know these fields as if your life depends on it.

Note: Don't become overly reliant on supplements as a way to mitigate less-than-optimal dietary and lifestyle choices, because supplements that are in any way effective will gradually be outlawed, as they already are in Europe. The pharmaceutical industry lobby, in collusion with power-lusting congressmen/bureaucrats, will ensure this.

2) Treat your body as a delicate vintage automobile that you must take exquisite care of, since spare parts and/or access to a professional mechanic are either nonexistent or excruciatingly expensive. Many organs and systems of the body have good self-repair mechanisms, while others, unfortunately, have not.

Thus, for example, participating in sports that may wear down joints or cause other permanent damage should be minimized. (Services like hip replacements will not be readily available.) Many health-conscious people are unaware that the modes of exercise that they are applying may have short term health benefits, but could be detrimental in the longer term. Be informed, and always apply the ancient medical maxim "First, do no harm."

3) Avoid contact with the public healthcare system as much as possible. It can be deadly to be sucked into the machinery even for a minor issue. Misdiagnosis and faulty, dangerous, treatments and medication regimens are commonplace under socialism (just as in Dark Ages "medicine").

In many areas of medicine, particularly those related to especially politicized areas like CVD and other "life-style" diseases, government-franchised practitioners are often dangerously ignorant of essential facts. Remember that the worst aspect of socialist medicine is that medicine as a rational science is epistemologically destroyed by eliminating the role of the doctor as a sovereign, independently thinking, professional.

[SDZ: I consider that last point an incredibly important observation that needs to be spread widely.]

4) Don't trust at face value any pronunciation or recommendation that comes out of organizations like the FDA, USDA, NIH, American Diabetes Association, American Heart Association, the medical industry lobby, or your medical insurance company.

I deliberately lump together government agencies and some influential private entities here, because these are all primarily (or, in the case of the private organizations, to a very significant degree) vehicles for dissemination of propaganda having scant to do with the furtherance of objective health information.

Obtain your health information from honest clinical practitioners with proven track records, and from primary scientific sources. The latter can be done either directly, for example, by reading research papers (if you have the time and appropriate background knowledge to do so) or by finding experts that apply sufficiently rigorous epistemological standards to interpret and explain the content of such scientific sources for the layman. (Aim to get a second opinion on all important issues.)

5) Consider becoming a "medical tourist". Medical services are already cheaper, safer, and provided with better care for the patient in many former third world countries. (Thailand comes to mind.) If you'll ever need to travel overseas to save your own life, swear to never forgive those of your countrymen who let America deteriorate to such a despicable state.

To this excellent advice, I'd also add this suggestion from Dr. Steve Knope:

My advice: Maintain your private medical care if at all possible. If you are relatively healthy, look into a high-deductible health insurance plan linked to a Health Savings Account (HSA). Start putting money away in that HSA for a rainy day. Find a "concierge physician" or doctor with whom you can establish a direct financial relationship; someone who will act as your medical advocate in a system that is broken and will only get worse. You get what you pay for and medicine today is no different.

Of course the best way to protect yourself from the dangers of government-run universal health care is to stop it in the first place. So let your friends, family members, co-workers, and elected officials know that you don't want it! After all, it's your life that's at stake...

Bribing The Special Interests

On TheHill.com, analysts Dick Morris and Eileen McGann explain the political bribes paid to various special interest groups such as the AMA and AARP to get them to endorse ObamaCare.

Here's an excerpt from "ObamaCare Endorsements: What The Bribe Was":

* The American Medical Association (AMA) was facing a 21 percent cut in physicians’ reimbursements under the current law. Obama promised to kill the cut if they backed his bill. The cuts are the fruit of a law requiring annual 5-6 percent reductions in doctor reimbursements for treating Medicare patients. Bravely, each year Congress has rolled the cuts over, suspending them but not repealing them. So each year, the accumulated cuts threaten doctors. By now, they have risen to 21 percent. With this blackmail leverage, Obama compelled the AMA to support his bill... or else!

* The AARP got a financial windfall in return for its support of the healthcare bill. Over the past decade, the AARP has morphed from an advocacy group to an insurance company (through its subsidiary company). It is one of the main suppliers of Medi-gap insurance, a high-cost, privately purchased coverage that picks up where Medicare leaves off. But President Bush-43 passed the Medicare Advantage program, which offered a subsidized, lower-cost alternative to Medi-gap. Under Medicare Advantage, the elderly get all the extra coverage they need plus coordinated, well-managed care, usually by the same physician. So more than 10 million seniors went with Medicare Advantage, cutting into AARP Medi-gap revenues.

Presto! Obama solved their problem. He eliminates subsidies for Medicare Advantage. The elderly will have to pay more for coverage under Medigap, but the AARP — which supposedly represents them -- will make more money.

Morris and McGann also describe the payoffs to the drug industry and insurance companies.

Guess who will be paying the price?

Update: The Wall Street Journal discusses the political favors promised to the Rep. Ahn Cao. Cao was the sole Republican to support the Pelosi Bill.

Krening OpEd: Dissent and Nationalized Health Care

The November 8, 2009 Denver Post has just published Hannah Krening's OpEd, "Dissent and Nationalization of Health Care".

Here's the opening:

I am a law-abiding citizen and breast cancer survivor, and I completely disagree with the current move to nationalize health care. Dissent is not new to me. As a teenager I worked to abolish the draft. Now, as then, my dissent is as a thinking American, not a member of an "un-American mob."

If government owns and pays for my health care, they own my body just as a farmer owns his cow. If government is paying, it will decide what kind of care I get and when I will get it. Under "free health care for all," access will diminish as lines lengthen, and my care may not be there when I really need it.

(Read the full text of "Dissent and Nationalization of Health Care".)

Although supporters of free-market health care reform lost a battle last night in the House vote, the war is not over -- it has merely shifted to the Senate.

Ed Morrissey of HotAir.com notes in "Is this the high-water mark for ObamaCare?":

The Democrats wheedled, cajoled, begged, and finally abandoned its defense of abortion -- truly a watershed moment -- in order to get their version of ObamaCare passed ...in the House of Representatives, where they enjoy a 75-seat majority. In the end, they could only muster a five-vote win on Nancy Pelosi's bill out of that strong majority. Until this week, most had assumed that any ObamaCare bill would pass the House easily, but that the fight would be in the Senate.

So what does this 220-215 vote tell us? Capitol Hill Democrats know that this bill is an albatross. It's true that Pelosi was able at the end to negotiate votes to allow a few at-risk Democrats that supported the bill to oppose it in the final vote, but even that tells a tale of fear and consciousness of unpopularity. The razor-thin vote, as well as a number of earlier, more sincere defections, show that this bill was a radical and expensive approach to fix a 13% problem -- and even most of the Democrats know it.

...We always thought the fight was in the Senate, so the only real surprise yesterday was how weak Pelosi actually was on ObamaCare.

Morrissey also discusses some of the other procedural hurdles before ObamaCare can become law.

The fight is far from over.

So thank you, Hannah, for speaking out and for mentioning FIRM in your OpEd byline!

Health Care By Coercive Government

The November 6, 2009 Washington Examiner editorial, "Health care by coercive government" summarizes the major problems with ObamaCare.

Here is an excerpt:

That American citizens should be fined or even put in federal prison for refusing to purchase government-approved health insurance is as un-American as any idea we can imagine.

But such a mandate is the very heart of the bill written behind closed doors by House Speaker Nancy Pelosi and her privileged pals. If their bill is approved by the House tomorrow, we will be a big step closer to the day when everybody gets their health care insurance through the government or from an approved insurer offering policies that meet meticulously detailed specifications contained in thousands of pages of federal regulations.

...Besides rationing care, the bill adds expensive new mandates on people (compulsory insurance for all), as well as costly new regulatory burdens on insurance companies (thus increasing premiums) and on your employer (which will reduce your wages). The Democrats' bill also creates multiple new layers of federal bureaucracy to look over your doctor's shoulder.

This plan is doomed to fail, but in failing it will likely inflict severe collateral damage on the quality of your health coverage and your health care.

(Read the full text of "Health care by coercive government".)

The battle is not just about health care, but about basic American freedoms.

The Best Option For The Public

In the November 4, 2009 Boston Globe, Jeff Jacoby outlines the best option for the public. (Hint -- it's not the "public option".)

From his article, "An option for public: less government, more choice":

A government-run health insurer would radically tilt the health-insurance playing field. It would amount to a new entitlement program, able to undercut the price of private insurance by squeezing hospitals and doctors, reimbursing them at below-market rates. "Just like Medicaid and Medicare," which also underpay medical providers, the public option would force hospitals and doctors to charge private insurers more. Insurers would be compelled to raise their premiums, eventually losing millions of customers to the government plan.

Obama insists that any public option would have to be self-supporting, properly balancing its premiums and risk and not expecting the government to cover its losses. Sound familiar? The same assurances were made about Fannie Mae and Freddie Mac.

Instead, he recommends the following free-market reforms:

* Tear down the barriers to buying insurance across state lines
* Repeal mandatory benefits that make health insurance needlessly expensive
* De-link health insurance from employment

(Read the full text of "An option for public: less government, more choice".)

These are all excellent ideas. Let's hope our politicians are listening!

Schwartz PJM OpEd: "Expect Less, Pay More"

PajamasMedia has published Brian Schwartz's latest OpEd, "Bizarro Health Care 'Reform': Expect Less, Pay More".

Here's the introduction:

Expect less, pay more. It's not the slogan for some "Bizarro World" Target store in a comic book; it's an accurate slogan for congressional Democrats' health care "reform" proposals. They include a new government-run insurance plan, mandatory insurance, new political controls on insurance, and new taxes.

(Read the full text.)

Brian also blogs on health care policy for the Independence Institute at PatientPowerNow.org.

His discussion of how a free market in health care could work can be found at: "Real reform: free markets".

High Noon For Health Care

A number of health care advocacy groups have banded together to create an ad hoc coalition, "High Noon For Health Care" to oppose the proposed government takeover of medicine.

Their site makes it easy for citizens to contact their legislators by e-mail, telephone, or Twitter. Please feel to take advantage of this resource!

(Note: I'm not familiar with all of the groups within the coalition, so this does not necessarily constitute an endorsement of all of their positions.)

Beware the Health Insurance Police

In the November 2, 2009 Washington Times, Donald Lambro asks, "Is it constitutional to force Americans to buy coverage?"

As he notes in his piece, "Beware the health insurance police":

Congress has never before required Americans to buy a product or service under penalty of law. Yet that's precisely what the health care bills pending in the House and Senate would do in the age of Obama, despite compelling arguments that the Constitution gives lawmakers no power to do so.

Although the objections to "universal health care" based on Constitutionality are secondary (rather than primary), it is an important issue.

If the government can force you to buy a certain product as a legal requirement of living in the United States, then there's essentially no limit on what it can force people to do.

PJTV: Healthcare Debate Goes Behind Closed Doors

PJTV's latest video "Extreme Takeover: Health Care Debate Goes Behind Closed Doors" features Terry Jones (Investor's Business Daily) and Yaron Brook (Ayn Rand Center for Individual Rights) discussing the Congress' health care bill.



As Brook points out, the Republicans have a golden opportunity to offer an alternative free market reform proposal that would be a political winner. But I won't hold my breath waiting for them...

Schroeder: Too Little Thought Given to Doctors

The October 30, 2009 Grand Junction Sentinel published the following OpEd by pediatric cardiologist, Dr. James Schroeder. His piece is entitled, "Too little thought given to doctors in proposals for health care reform".

Here's an excerpt:

...The persistence, dedication, hard work and personal sacrifice to get through four years of undergraduate study, four years of medical school, three to six years of residency training and perhaps two to five additional years of specialty or subspecialty training cannot and should not be underestimated. Add that up and you are talking almost two decades of training, long hours, tedious study, time away from family and plain hard work.

Financial compensation during these years is hardly lucrative. Truly caring physicians accept this role willingly and without complaint because there is an indescribable satisfaction in the actual delivery of care.

...Get the government out of my way and let me do what I do for my patients and I will do it well. Let the compensation equal the value of what I do. Get rid of the many layers of bureaucratic nonsense that lie between me and my patients. Get rid of government-mandated cost distortions.

Let me negotiate fees and payment schedules directly with my patients willingly, unapologetically and in good conscience. Let me be a physician, not a "health care provider." Trust me, there is a difference!

I love what I do, with a passion, but I will not do it indefinitely and will not do it without reasonable compensation.

It is absolutely immoral for the government to "mandate" that I provide my expertise to whomever bureaucrats choose because someone has determined the patients are "entitled" to it.

(Read the full text of "Too little thought given to doctors in proposals for health care reform".)

Dr. Schroeder is absolutely right. I'm heartened to see more physicians like him standing up for their moral right to practice on their own terms, rather than being slaves to the state.

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.)

Hsieh PJM OpEd -- "ObamaCare: A National Version of RomneyCare"

PajamasMedia has just published my latest OpEd, "ObamaCare: A National Version of RomneyCare".

Here is the opening:

The details of Congress' health care "reform" legislation are finally coming into focus, and it's not a pretty picture. Congress is essentially proposing a national version of the failing Massachusetts system.

In 2006, Massachusetts adopted a health care plan which included an individual mandate requiring residents to purchase state-approved health insurance, new regulations on insurance companies specifying who they must cover and what benefits they must provide, and a government-subsidized "public option" for low-income residents. Supporters promised a utopia of "universal coverage" which would save money while improving quality of care. However, the exact opposite has occurred -- health costs in Massachusetts have skyrocketed, while patient care has suffered.

Before we adopt a similar plan at the national level, Americans should know three things about the Massachusetts plan...

I then cover the following points:

1) Massachusetts' system of mandatory insurance drives up costs and violates individual rights.
2) "Coverage" is not the same as actual medical care.
3) The Massachusetts plan will end in rationing.

(Read the full text of "ObamaCare: A National Version of RomneyCare".)

Challenging the Ban on Compensating Bone Marrow Donors

The Institute of Justice has posted a video, "Challenging the Ban on Compensating Bone Marrow Donors".



As they note:

Every year, 1,000 Americans die because they cannot find a matching bone marrow donor. Minorities are hit especially hard. Common sense suggests that offering modest incentives to attract more bone marrow donors would be worth pursuing, but federal law makes that a felony punishable by up to five years in prison.

(More info here.)

Individuals should be able to engage in voluntary transactions that benefit both sides. Repealing the current ban will respect this right and will save many lives.

As a physician, I'm glad that IJ is taking on this issue!

Government Cable

What if the government provided cable like it plans to do for health care?

Watch CMPI's short video "Government Cable" for the answer:



(Of course, cable is already highly regulated by the FCC as are health insurance companies.)

Video link via State House Call.

The Economic Consequences of BaucusCare

John Goodman explains the economic havoc that the Baucus health care bill (or any variant) will wreak in his post, "The Baucus Bill Explained".

The consequences include:

1. Millions of jobs lost
2. A shift to independent contracting
3. Major industrial restructuring
4. Emergence of niche markets
5. Growth of the underground economy
6. Higher insurance premiums
7. Fewer insurance choices
8. Higher than anticipated taxpayer costs
9. New unfunded liabilities
10. Exacerbating the problems of cost, quality and access

His conclusion:

Not only will "reform" not solve any of the problems it is supposed to solve, it will almost certainly undermine the ability of entrepreneurs in the private sector to solve them.

(Read the full text of "The Baucus Bill Explained".)

This is an entirely predictable consequence of the government taking control over 1/6-th of the US economy.

Coming New Taxes

Americans for Tax Reform lists a variety of new taxes that would be imposed on Americans if the 1900-page HR 3962 House health care "reform" plan is passed into law.

Here are a few of them:

Employer Mandate Excise Tax
Individual Mandate Surtax
Medicine Cabinet Tax
Increased Additional Tax on Non-Qualified HSA Distributions
Surtax on Individuals and Small Businesses
Excise Tax on Medical Devices

(Read the full list and related discussion.)

Watkins: In Defense of Health Insurance Discrimination

Don Watkins of the Ayn Rand Center for Individual Rights has written a nice blog post explaining why insurance companies should be able to charge different rates for different customers (or decline to cover some people at all).

Here's an excerpt from his post, "In defense of health insurance discrimination":

Forcing insurance companies to take all comers, and to charge all customers similar fees can accomplish only one thing: to force some health insurance customers (primarily the young and healthy) to subsidize other health insurance customers (the elderly and the sick). That's not insurance -- that’s welfare.

The overall effect of eliminating health insurance discrimination is to drive up the costs of health insurance. As the Wall Street Journal points out, states that currently prevent insurance discrimination through community rating and guaranteed issue rules have the most expensive individual insurance markets in the country. "In 2007, the average annual premium in New Jersey was $5,326 for singles and in New York $12,254 for a family, versus the national average of $2,613 and $5,799, respectively."

...If we can painlessly ban health insurance discrimination, then why don't we end all discrimination for all forms of insurance? Why should we have to buy car insurance before we get in an accident? Why should Geico be able to drop Robert Downey, Jr. after his fifteenth DUI? Why should a three-pack-a-day smoker have to pay more for life insurance than Michael Phelps?

Insurance is inherently discriminatory. An insurance company cannot function without assessing risk, charging greater fees for greater risks, and refusing to provide "insurance" to those for whom the outcome in question is certain. It is by carefully assessing risk and discriminating accordingly that insurance companies enable us to protect ourselves against some of life's unknowns. That is a crucial benefit, and those who provide it should not be smeared, but thanked.

(Read the full text of "In defense of health insurance discrimination".)

For more on this topic, see my Objective Standard article, "How the Freedom to Contract Protects Insurability".

Costs Keep Rising in Massachusetts

The October 27, 2009 Wall Street Journal includes a piece by Grace-Marie Turner discussing the fact that health care costs have continued to rise in Massachusetts despite the promised savings of the state's health care reform.

As Turner notes:

Massachusetts is a problematic model on which to base federal health-care reform because the state relies heavily on Medicaid. Washington in 2008 agreed to provide the state with $10.6 billion over three years as part of its Medicaid waiver request, which allows the state to subsidize insurance for people with incomes higher than Medicaid rules normally allow.

Unlike Massachusetts, the federal government doesn't have a back-up source of funds to help it pay for national health care. Washington might want to see how Massachusetts does in solving these problems before proceeding with a similar model for the country.

(Read the full text of "Costs Keep Rising".)

Implementing the Massachusetts plan at a national level will be a recipe for disaster.

Peikoff Videos: Health Care Is Not A Right

On Dr. Leonard Peikoff's website, he notes: "In light of the current debate on socialized medicine, this week's podcast will be a talk on the subject given 16 years ago by Dr. Peikoff."

His original speech was delivered at a Town Hall Meeting on health care in Costa Mesa, California, on December 11, 1993.

You can watch his talk here.

The updated 2007 version of his speech can be found here in HTML format or as printable PDF version.

Samuelson: Public Plan Mirage

In the October 26, 2009 Washington Post, Robert Samuelson explains some of the smoke-and-mirrors behind the newly revived "public plan". Here's an excerpt from his piece, "Public Plan Mirage":

...The public plan's low costs would be artificial. Its main advantage would be the congressionally mandated requirement that hospitals and doctors be reimbursed at rates at or near Medicare's. These are as much as 30 percent lower than rates paid by private insurers, says the health-care consulting firm Lewin Group. With such savings, the public plan could charge much lower premiums and attract lots of customers. But health costs wouldn't subside; hospitals and doctors would offset the public plan's artificially low reimbursements by raising fees to private insurers, as already occurs with Medicare. Premiums would increase because private insurers must cover costs to survive.

As for administrative expenses, any advantage for the public plan is exaggerated, say critics. Part of the gap between private insurers and Medicare is statistical illusion: Because Medicare recipients have higher average health expenses ($10,003 in 2007) than the under-65 population ($3,946), its administrative costs are a smaller share of total spending. The public plan, with younger members, wouldn't enjoy this advantage.

Likewise, Medicare has low marketing costs because it's a monopoly. But a non-monopoly public plan would have to sell itself and would incur higher marketing costs. Private insurers' profits (included in administrative costs) also explain some of Medicare's cost advantage. But profits represent only 3 percent of the insurance industry's revenue. Moreover, accounting comparisons are misleading when they don't include the cost of Medicare's government-supplied investment capital. A public plan would also need investment capital. And suppose the public plan suffers losses. Congress would assuredly bail it out.

The promise of the public plan is a mirage. Its political brilliance is to use free-market rhetoric (more "choice" and "competition") to expand government power. But why would a plan tied to Medicare control health spending, when Medicare hasn't?

(Emphasis mine. Read the full text of "Public Plan Mirage".)

Samuelson correctly notes that our politicians still feel the need to cloak their proposals in a free market guise to gain public approval. They recognize that overt socialism still won't sell with the American public.

Instead of adopting faux-free market reforms, perhaps our politicians should try the real thing.

Boston Health Reform Tea Party

Jared Rhoads of the Lucidicus Project reports on the October 17, 2009 Boston Health Reform Tea Party.

As he describes:

I had a slot as one of the featured speakers. I spoke for about nine minutes, near the middle of the program, after a prominent local conservative activist. My primary message was that the Tea Party movement needs to advocate for capitalism, not just against socialism, and that the only way to do so is with a moral defense of individual rights.

Here's an excerpt from his speech:

Yes, we need change. But it has to be rational change. We're not out to "block health reform" as such, or "stand in the way of progress" as President Obama put it yesterday. We're out to block Washington's version of health reform, because every last facet and feature of these health reform bills serves to introduce more government into the system, not less.

...This does not have to happen in America. There is a moral defense. It's a defense that recognizes man as an end in himself, not the means to the ends of others. It's the defense that man has a right to his own life, and that we have no duty to sacrifice ourselves to the alleged benefit of others. It's the only foundation from which one can consistently defend free markets.

(Read his full post, "Boston Health Reform Tea Party", which includes a short video clip of Jared speaking to a reporter.)

Thank you, Jared, for speaking out!

Catron: The AMA's Quisling Strategy

David Catron of HealthCareBS.com has written a nice piece in the October 22, 2009 American Spectator showing how far the American Medical Association has fallen.

Here is an excerpt from his piece, "The AMA's Quisling Strategy":

...The once-feared organization has become far more pliant in recent years, however. Since the Sustainable Growth Rate formula was imposed in the 1990s, the AMA has repeatedly been forced to go hat-in-hand to its Beltway masters for stays of execution. Each time, Congress has issued a reluctant reprieve from payment cuts -- but not without a price. In exchange for its 2008 reprieve, the AMA was forced to cooperate with congressional Democrats in their disgraceful move to gut Medicare Advantage (MA), a program that has greatly benefited poor and minority seniors. In that tawdry episode, the Dems attached an SGR waiver to a bill that cut funding for Medicare Advantage, whereupon the AMA cravenly began parroting DNC talking points about insurance company profits. This collusion helped the Democrats push through the first of several cuts in MA funding.

This year, the price of the AMA's reprieve is support of whatever health care legislation emerges from Congress. And, so long as the final bill does away with SGR, the organization is obviously prepared to be a willing accomplice in whatever fraud the Democrats perpetrate.

...The tragic irony of this cynical strategy is that it will not work. As Vidkun Quisling discovered in October of 1945, the advantages of collaboration are always short-lived. A temporary reprieve from Medicare payment cuts is all Dr. Rohack will have gained by delivering his patients and colleagues into the hands of Washington's health care bureaucrats. Because socialized health care systems are explicitly designed to circumvent the market mechanisms that actually control costs, they must always revert to the only remaining alternatives: rationing services to patients and cutting payments to providers. All government-run systems do both, and Obamacare will be no different.

(Read the full text of "The AMA's Quisling Strategy".)

Catron is absolutely right. Instead of taking a principled stand against government-controlled health care, the AMA has chosen to try to cut a deal with its future masters -- a strategy doomed to fail, as it has all throughout history.

And unfortunately, they'll end up betraying their patients' health and doctors' long-term ability to practice good medicine.

To paraphrase Benjamin Franklin, "Those who would exchange essential liberty for a temporary reprieve in Medicare cuts deserve neither the reprieve nor liberty."

(Note: I'm not a member of the AMA. According to this story, less than 30% of licensed US physicians are members of the AMA. Certainly, the AMA cannot claim to speak for anything close to a majority of US doctors.)

To Cut Your Health Insurance Costs, Move

How much do state-level insurance regulations raise the costs? As Steve Malanga notes, a lot. Here are a few excerpts from, "To Cut Your Health Insurance Costs, Move":

...[T]he trade group for the nation's insurers, America's Health Insurance Plans, estimated that the average premium for family coverage in the individual market nationally was $5,800. But the study found wide disparities in costs, ranging from average premiums north of $12,000 in New York and Massachusetts to premiums costing on average only $3,000 to $5,000 in more than a dozen states. Some states have even allowed insurers to introduce low-cost, high-deductible policies that can cost under $1,000 a year.

It's fair to say that the costs imposed by some states based on how they regulate health insurance are now a bigger burden on individuals and small and mid-sized firms than state and local taxes.

...There's no evidence that states garner any benefit from such regulation and mandates. States with numerous mandates don't have healthier populations, for instance. Indeed, many state mandates are enacted for political reasons that have little to do with health care outcomes. Several years ago New York's then-Governor Pataki signed into law the state's hefty in vitro fertilization mandate as a payoff to conservative religious groups whose members favor big families and lobbied heavily for the law. It's a rather classic example of how, when you vest such power in lawmakers, some will eventually abuse it.

(Read the full text of "To Cut Your Health Insurance Costs, Move".)

These increased costs are a result of the government usurping the individual's right to spend his own money for his own benefit according to his best judgment.

Extending these onerous regulations to the national level (as the President and Congress propose) will only make the problem worse, not better.

Swiss Update

John Goodman discusses the Swiss health care system in his October 19, 2009 post, "Swiss Health Care: The Good, the Bad and the Ugly".

One point I'd like to make is that the good aspect (i.e., the fact that health insurance is "individually owned, personal, and portable" would naturally happen in a free market, and would not require an individual mandate. As Goodman points out in the sections on the bad and the ugly, new regulations are driving insurance costs and and reducing patients' ability to retain a desirable plan.

In other words, the good elements of the Swiss system are present despite the mandates and regulations, not because of it.

Hillman: Kiss Your Money And Freedom Goodbye

Former Colorado state senator Mark Hillman discusses the fundamental problem with mandated insurance in his latest analysis, "Kiss your money and your freedom goodbye".

Here's an excerpt:

From a practical standpoint, the requirement to purchase health insurance will start badly and grow even worse. That's because the choice of what kind of insurance to purchase will no longer belong to consumers but to politicians and bureaucrats, relentlessly pressured by lobbyists to add to every conceivable screening or procedure in the nanny-state's wish list to your mandatory policy.

Politicians who resist that pressure and defend your right to choose your own level of coverage will be smeared at election time by dishonest advertisements accusing them of opposing mammograms and maternity care.

Requiring health insurance to pay for preventive screenings is like mandating that auto insurance must pay for oil changes and new tires. Only in health care do we forget that insurance was designed to pay for unforeseen catastrophes, not for predictable events for which we should plan and budget.

...If Congress can order us to use our own money to buy goods or services that we might not otherwise purchase, what's to stop it from ordering us to drive hybrid vehicles, install solar panels on our homes, or eat our vegetables?

(Read the full text of "Kiss your money and your freedom goodbye".)

Hillman is correct to highlight the dual threat to our pocketbooks and our freedoms. Both are violations of our individual rights, and must be opposed as such.

A Small Positive

I haven't had much positive to say about the Obama administration's health care policies. But when they do something decent, I want to acknowledge that fact.

Hence, I'm glad to support their move to refrain from bringing federal prosecutions against patients and physicians using medical marijuana in accordance with state laws.

This is a small step in the right direction of allowing patients to freely seek medical services from willing providers without government interference.

Of course, there are even further steps the federal government could take to reduce and eventually eliminate bad drug laws. But for now, I'll gladly welcome this small step and I hope this will be the first, not the last, move in this direction.

Gratzer's Broadside

Dr. David Gratzer has written a new short pamphlet criticizing the current ObamaCare proposals entitled, "Why Obama's Government Takeover of Health-Care Will Be a Disaster".

It is part of the new Broadsides series of public policy pamphlets published by Encounter Books, covering a variety of domestic and foreign issues.

In this short 48-page essay, Gratzer discusses the current proposals, shows how similar ideas have been harmful to both patients and doctors in Canada and the UK, and offers constructive alternatives that would move us in the direction of genuine free market reforms.

Overall, I thought the essay was quite excellent. Many of the ideas were also discussed in his earlier book The Cure: How Capitalism Can Save American Health Care, but updated for the current 2009 political context.

The most valuable portions were the discussions of how relevantly similar policies have already played out in Canada and the UK. The end result of any kind of government-run health care is rationing. Those countries should serve as a clear warning to Americans not to adopt any further government-run health care.

Gratzer's discussion of the special tax-exempt status of employer-provided health benefits and the damaging effect on the health insurance market (specifically in driving up costs and encouraging inefficient utilization) was also very clear and cogent.

Several of his specific free market proposals were also quite good, such as allowing insurance companies to compete across state lines and allowing Americans to use Health Savings Accounts for routine expenses. I do disagree with a few of them -- for instance, I believe Medicare and Medicaid shouldn't be reformed but rather eliminated altogether and replaced by private charity (although it would have to be done in a staged fashion over a number of years).

Gratzer makes a strong practical case against socialized health care. In conjunction with the more fundamental moral arguments, such as those discussed by Dr. Leonard Peikoff in his "Health Care Is Not A Right" (PDF version), he provides good intellectual ammunition for supporters of free market health care reform.

In summary, Dr. Gratzer's essay "Why Obama's Government Takeover of Health-Care Will Be a Disaster" is a short, timely, and informative contribution to the current health care debate.

Obligatory Disclaimer: The publisher gave me a free electronic review copy of this pamphlet, and I am disclosing this fact in accordance with forthcoming new FTC rules for bloggers. The retail value of this pamphlet is $5.99. There was no expectation or promise that I would publish any specific commentary about this pamphlet, either positive or negative.

I also think these FTC rules are dangerous and wrong, for the reasons outlined by Diana in her 10/5/2009 blog post, "Regulating Speech to Death".

For more on this topic, I also recommend the following:

"Interview with the FTC's Richard Cleland" (Edward Champion, 10/5/2009).
"The FTC's Mad Power Grab" (Jack Shafer, 10/7/2009).
"Required FTC blogger disclosure" (Walter Olson, 10/8/2009)
"FTC vs. bloggers, cont'd" (Walter Olson, 10/9/2009)

Free Market Referrals

As the threat of a government takeover of health care becomes closer to reality, more Americans are interested in finding ways to preserve their health care outside of any government system.

I expect that more doctors will start offering their services outside of any sort of state-regulated insurance system. And brokers and clearinghouses will naturally emerge to help match patients and doctors in a relatively free market.

One example of this is this website by Erickson Financial Services for "Affordable Surgery in the USA":

If you are in need of surgery, let Erickson Financial Services help you arrange for affordable surgery right here in the United States of America. Erickson Financial Services offers access to high quality, affordable surgery at a fraction of the cost of traditional U.S. hospitals. How do we do it? Quite simply, Erickson Financial Services acts as a liason between our clients and reputable, licensed practitioners who offer direct-pay services at reasonable, non-negotiable rates. There is no charge for our services.

If you are a citizen of the United States of America, there is no need for you to look towards medical tourism as a solution for your unresolved healthcare needs. The USA offers some of the highest quality healthcare services in the world. Why leave the country when you can receive services right here in the USA at prices comparable to those in countries such as Thailand?

Disclaimer: I have no financial relationship with Erickson Financial Services or any other referral service, and this does not constitute any sort of endorsement. Similarly, I'm not endorsing this particular surgery center or any of the physicians who practice there. I'm merely offering EFS as an example of the sorts of businesses that will likely arise in response to ObamaCare.

Likewise, EFS notes:

Erickson Financial Services offers no guarantees with regards to surgical outcomes. Once we have put the client into contact with a doctor or facility, we are no longer involved with any interaction between doctor and patient. It is up to the client to do his/her own due diligence to determine whether he/she wishes to receive services from the physicans that we refer.

As long as private health care remains legal in the United States, many smart patients will continue to seek the best for themselves and their loved ones outside of any government-run medical system. Hence, such free market alternatives will likely thrive.

I discuss related advice from concierge physician Dr. Steve Knope at: "How To Protect Yourself Against ObamaCare".

The Medical State of the Union

Richard Ralston of Americans for Free Choice in Medicine has written another OpEd, "The Medical State of the Union".

Here's an excerpt:

...The red herring that everyone who currently has insurance will be allowed to keep it omits the detail that a government-managed "public option" would provide an overwhelming financial incentive to every employer in the country to drop insurance for their employees in favor of throwing them into the public plan.

The President and many in Congress have indeed made it clear that they prefer a completely government-controlled, single-payer insurance system. The public option, as supporters like Rep. Barney Frank (D-Mass) have stated, is the best and surest path to a single-payer system and would accomplish that end by demonstrating "the strength of its power," as he puts it -- an accurate, if ominous, turn of phrase. The public option would be enacted with that intent and would be administered with that objective.

Further to that end, a "trigger" to impose a public option if insurance companies fail to reduce costs -- after all of the government-imposed costs are in place -- would inevitably be implemented by those anxious to pull the trigger.

Most deceptive about the President's stubborn defense of the public option is the assertion that only government can provide competition to private insurance, when it is only the government that now prevents private insurers from competing with each other. Current federal legislation that prohibits the selling of insurance across state lines could be repealed along with the massive coverage mandates now required in most states.

(Read the full text of "The Medical State of the Union", also available on the AFCM website.)

Brook: Capturing the Moral High Ground

"Capturing the Moral High Ground" the concluding talk from a presentation given at the National Press Club in Washington D.C. on September 19, 2009 by Yaron Brook during a public briefing on the "Joint Defense of Freedom in American Medicine" sponsored by Americans for Free Choice in Medicine.

Part 1:



Part 2:



Part 3: This is the Q&A session. The link will be posted when available.

Hsieh in Heartland Health Care News

The October 2009 issue of the Heartland Institute's Health Care News will include my OpEd, "Health Overhaul Could Force Doctors to Quit".

This is a condensed version of my earlier PajamasMedia piece, "Is Your Doctor Getting Ready to Quit?"

I'd like to express my deepest gratitude to the Heartland Institute for allowing me to appear in the pages of their monthly newsletter!

Government Air

The latest short video on government-controlled health care from the Independence Institute:



(Via Ari Armstrong.)

Dental Denial

Licensure requirements for medical and dental practitioners are another form of restriction of the free market, and hinder the ability of patients to seek services from willing providers.

Maggie Koerth-Baker shows how dental licensure requirements are harming patients in rural portions of America in her post, "Armed To the Teeth".

And of course, similar arguments apply to medical licensure. For more information, see this discussion from economics professor Shirley Svorny of Cal State University Northridge.

The Benefits of Tort Reform

How much difference would tort reform make in curbing excess medical costs?

According to this October 9, 2009 story from the Associated Press, a lot. Here are excerpts from "Limiting malpractice lawsuits can save big":

Limits on medical malpractice lawsuits would lead doctors to order up fewer unneeded tests and save taxpayers billions more than previously thought, budget umpires for Congress said Friday in a reversal that puts the issue back in the middle of the health care debate.

The latest analysis from the nonpartisan Congressional Budget Office estimates that government health care programs could save $41 billion over ten years if nationwide limits on jury awards for pain and suffering and other similar curbs were enacted. Those savings are nearly ten times greater than CBO estimated just last year.

...[CBO Director] Elmendorf essentially acknowledged what doctors have been arguing for years: fear of being sued leads them to practice defensive medicine. Some doctors will order a $1,500 MRI for a patient with back pain instead of a simple, $250 X-ray, just to cover themselves against the unlikely chance they'll be accused later of having missed a cancerous tumor.

...The CBO report means the malpractice issue will stay alive as the health care debate in Congress builds to a climax this year. The budget scorekeepers estimated the total effect of malpractice curbs could reduce the federal deficit by $54 billion over 10 years, once $13 billion in new tax revenues from economic ripple effects are taken into account.

Even in the health care debate, that's real money.

(Read the full text of "Limiting malpractice lawsuits can save big".)

In my practice, I see this sort of defensive medicine all the time. The ordering physicians don't like it. The radiologists reading these unnecessary scans don't like. Insurance companies don't like it. Patients don't like it.

But as long as the current legal system punishes doctors who fail to practice this sort of defensive medicine, we'll continue to see doctors practicing that way.

(Via Bradley R. Hennenfent, M.D, who blogs at BradMD.com.)

The Truth About The Baucus Bill

Mark Tapscott of the Washington Examiner has written a helpful two-part economic critique of the Baucus health care proposal.

Find out why the numbers just don't add up:

"The truth about the Baucus bill - Part 1" (October 11, 2009)
"The truth about the Baucus bill - Part 2" (October 12, 2009)

The Price of A Life in Massachusetts

Massachusetts' "universal" health care system moved one step closer towards explicit rationing, as reported by the Boston Globe in this October 11, 2009 story, "State plan may place limits on patients' hospital options".

Here are some excerpts:

Controlling Massachusetts' soaring medical costs, many health care leaders believe, may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want.

..."You can't reap these savings without limiting patients' choices in some way," said Paul Levy, chief executive of Beth Israel Deaconess Medical Center.

...A state commission recommended in July that insurers largely scrap the current fee-for-service system -- in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit -- and instead pay providers a per-patient annual fee to cover all of the patient's medical care.

This new system of "global payments" would discourage overuse of expensive medical services, force providers to live within a budget, and improve coordination of care for patients, supporters argue.

(Read the full text of "State plan may place limits on patients' hospital options".)

What the supporters don't mention is that it also creates a tremendous incentive for physicians and hospitals to render as little care as possible. Under the Massachusetts proposal, if your care costs less than the annual allotment, then they keep the unused portion. 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.

For the sake of argument, suppose your annual allotment is $5000 and you've already spent $4500 for that year. Now you go to your doctor's office complaining of a severe headache. He examines you and says, "No, Bill, you don't need a $1000 MRI scan of your brain. Just take two Tylenol and call me in the morning".

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

And even if your doctor consistently and conscientiously acts for his patients' best interests, he will inevitably find himself at odds with hospital administrators questioning whether this or that expenditure is appropriate:

"Does Mr. Jones really need another ultrasound test? Is there a cheaper antibiotic you could use? Isn't his heart rhythm stable enough to allow moving him down to a regular hospital bed, rather than spending another night in an expensive ICU bed?"

Do you want your doctor constantly looking over his shoulder trying to balance your needs vs. the demands of a hospital administrator who might be deciding whether or not to renew his practice privileges?

It is precisely this potential conflict-of-interest that caused patients in the 1980s to reject the similar "capitated" payment systems of HMO's (Health Maintenance Organizations). The 2009 Massachusetts proposals may carry a new name, but the basic principle is the same.

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 they're doing. In that case, you had better hope that your life is still worth enough to your government...

(Boston Globe story link via Instapundit.)

Update: Thank you, HotAir vistors!

The Stressed German Model

The October 10, 2009 Wall Street Journal points out that Germany's system of universal care is on the verge of collapsing.

Here's an excerpt from, "The Stressed German Model":

Germany's health-care system was brought to life in 1883 by Otto von Bismarck and became the model for virtually every such state-directed national insurance plan since. Alas, the German system is starting to come apart at the financial seams. Germany's system relies on a handful of state-supported health insurers. This week they informed the government that the system was on the brink of a financial shortfall equal to nearly $11 billion.

There's no reason to think that state-controlled health insurance will work any better in the United States.

Will The Baucus Plan Really Save Money?

Um, no.

And Mark Tapscott explains why not.

Paying the Health Tax in Massachusetts

In the October 9, 2009 Wall Street Journal, Wendy Williams explains how the Massachusetts mandatory insurance has harmed her and her husband.

Here are some excerpts from her article, "Paying the Health Tax in Massachusetts":

My husband retired from IBM about a decade ago, and as we aren't old enough for Medicare we still buy our health insurance through the company. But IBM, with its typical courtesy, informed us recently that we will be fined by the state.

Why? Because Massachusetts requires every resident to have health insurance, and this year, without informing us directly, the state had changed the rules in a way that made our bare-bones policy no longer acceptable. Unless we ponied up for a pricier policy we neither need nor want -- or enrolled in a government-sponsored insurance plan -- we would have to pay $1,000 each year to the state.

...IBM seems like a rock of stability compared to the state of Massachusetts. It's apparent that state health-care policies can change at the whim of politicians in Boston, and we might not be able to adjust to the new rules. The way we figure it, if we sign up for a state-subsidized plan we will be at the mercy of the state.

So we are sticking with our plan and paying the tax. But what bothers me most is that a similar health-care mandate is being proposed in Washington, and some of the same promises that were made here are being made again -- such as that the mandate will never hit middle-class folks with a new tax.

We have been warned.

Onion: Health Care Plan Would Give Seniors Right To Choose How They Are Killed

As a change of pace, here's the latest Onion piece on health care, "Obama: Health Care Plan Would Give Seniors Right To Choose How They Are Killed".

Here's an excerpt:

WASHINGTON -- President Barack Obama held a nationally televised address Tuesday to "clarify any misunderstandings" about his health care proposal, assuring Americans that under the new bill senior citizens—and not the federal government—will have the right to choose how they are executed.

"Let me dispel these ridiculous rumors once and for all and set the record straight: Under my plan, seniors are going to be killed the way they want to be killed, end of story," said the president, who acknowledged that "wiping out" the nation's elderly population has always been his No. 1 priority. "If your grandmother would rather be euthanized in the privacy of her own home than be gutted and hanged on a high school soccer field, she is entitled to that right."

"Once again, let me be perfectly clear," Obama continued. "Seniors, rest easy knowing that I will never, under any circumstance, sign a bill that doesn't give you the option of being murdered by my administration in a manner of your choosing. I promise you that..."

(Read the full text.)

Mayo Clinic Unit Stops Accepting Medicare

The October 9, 2009 Arizona Republic reports that, "Mayo unit no longer to accept Medicare".

Here's an excerpt:

One of the Mayo Clinic's two family-medicine practices in Arizona soon will stop accepting Medicare, leaving thousands of patients to pay out of pocket for routine doctor's visits or find a new physician.

...Hospital officials called the new policy a "two-year pilot program" and said Thursday that the changes are necessary because of low Medicare reimbursement rates.

..."Medicare now only covers about half our costs," [vice chairman of the executive-operations team at Mayo Clinic of Arizona, Dr. R. Scott] Gorman said.

If a "Medicare-for-all" system were implemented at the national level, expect to see more doctors declining to accept such patients.

This again illustrates the principle that "coverage" does not equal care.

(Via @aemenefee.)

WSJ: How the U.S. Government Rations Health Care

The September 30, 2009 Wall Street Journal featured a piece by Scott Gottlieb explaining, "How the U.S. Government Rations Health Care".

Gottleib shows how the bureaucracy in programs such as Medicare leads to bad spending decisions and de facto rationing. Yet this is the program being touted as model for "universal" health care?

Read the whole thing.

Which Insurer Denies the Most Claims?

The answer may surprise you.

Teresi: Free Market Best For Health Insurance Reform

The October 7, 2009 Colorado Springs Gazette has published an excellent OpEd by Amanda Teresi entitled, "Return to free market best hope for health insurance reform".

Here's an excerpt:

...In a free market, insurers and consumers voluntarily make an agreement to mutual benefit. When politicians dictate what policies and services will be sold and to whom, those politicians undercut people's ability to reach insurance agreements that work best for them.

In a free market, companies that don't take care of their customers risk losing them to a competitor, creating an incentive to provide the best service at the best price. When there is no free market for health insurance, there is less competition, resulting in less need to out-bid competitors for our business.

A free market also depends on the reliability of contracts. Once a contract between an insurance company and an individual is made, breaking that contract should be punishable by law. This means that if an insured individual's coverage is dropped when they find a medical problem that was covered, they should be able to sue the company for breach of contract.

It is true that many people today with pre-existing conditions have trouble finding affordable coverage. But politicians, not a free market, created the problem.

Currently, employer-based insurance makes it difficult for those with pre-existing conditions to stay on the same insurance because it is not portable. Current tax law that favors employer-sponsored insurance over directly purchased plans makes it more likely individuals will be tied to their employer for insurance.

Insurance is meant to hedge against unforeseen, catastrophic events or illnesses, as opposed to covering every doctor visit. If it were, protection against major health problems or accidents would be possible for a majority of individuals and pre-existing conditions would be much less of a worry for those who need coverage...

(Read the full text of "Return to free market best hope for health insurance reform".)

Thank you, Amanda, for making these excellent points!

WSJ: The Lesson of State Health-Care Reforms

In the October 6, 2009 Wall Street Journal, Peter Suderman reviews "The Lesson of State Health-Care Reforms".

Let's go through the list of states that attempted Obama-like policies in the past:

New York - FAIL
Massachusetts - FAIL
Maine - FAIL
Tennessee - FAIL

Suderman concludes:

Despite these state-level failures, President Barack Obama and congressional Democrats are pushing forward a slate of similar reforms. Unlike most high-school science fair participants, they seem unaware that the point of doing experiments is to identify what actually works. Instead, they've identified what doesn't -- and decided to do it again.

(Read the full text of "The Lesson of State Health-Care Reforms".)

John Lewis At National Press Club

Professor John David Lewis, PhD, of Duke University gave the following talk at the National Press Club in Washington D.C. on September 19, 2009 during a public briefing on the "Joint Defense of Freedom in American Medicine" sponsored by Americans for Free Choice in Medicine.

Here is Professor Lewis' lecture on the theme of "Individual Rights & Health Care Reform" (in 3 parts).

Part 1:



Part 2:



Part 3:

Positive Report on Retail Health Clinics

The September 30, 2009 Denver Post has a positive story on retail health clinics. One excerpt from "Coloradans shop for health care in retail-store clinics":

National researchers have now officially blessed both the quality and the pricing of fast-growing retail clinics. They say the care is as good as, and sometimes better than, emergency rooms and regular doctors' offices, and the fees are dramatically lower.

While the limited-care retail centers may not solve the entire health care mess on their own, Dr. Ateev Mehrotra said they are "intriguing."

Burgeoning retail health outlets are "providing care at a lower cost, at a higher quality, where it's more convenient," Mehrotra said. He wrote a RAND Corp. study in August praising costs and outcomes at retail clinics treating ear infections, sore throats and urinary tract infections.

(Read the full text of "Coloradans shop for health care in retail-store clinics".)

These clinics represent a small step in the direction of free market health care. It's no surprise that the result is good quality care, shorter waits, and lower costs.

(Via Brian Schwartz.)

The Canadian "Private Option"

Ari Armstrong alerted me to two recent stories about the "private option" in Canadian health care:

"In Canada, a move toward a private healthcare option"
By Kim Murphy, Los Angeles Times, 9/27/2009

"Canada's lack of special care empowers brokers"
By Valerie Richardson, Washington Times, 9/28/2009

From the first article:

...More than 70 private health providers in British Columbia now schedule simple surgeries and tests such as MRIs with waits as short as a week or two, compared with the months it takes for a public surgical suite to become available for nonessential operations.

"What we have in Canada is access to a government, state-mandated wait list," said Brian Day, a former Canadian Medical Assn. director who runs a private surgical center in Vancouver. "You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list."

At a time that more Canadians are recognizing the merits of private health care over the public system, too many American politicians are trying to push our country towards a "public plan".

Do Americans really want to give their lives over to the government like that?

Swiss Hit -- Or Miss?

As more American realize that they don't want to duplicate either the Canadian or British health care systems, proponents of "universal health care" have been casting about for other less well-known countries to propose as models.

The latest model being pitched as a "hit" is Switzerland. For example, the September 30, 2009 New York Times featured a piece by Nelson Schwartz entitled "Swiss Health Care Thrives Without Public Option".

In particular Schwartz claims:

The Swiss government does not "ration care" -- that populist bogeyman in the American debate -- but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs -- at a higher level than in the United States -- so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.

But what does that really mean?

Fortunately, Linda Gorman of the Independence Institute has looked more closely into the Swiss system and noted the following:

...[W]hen the Swiss replaced mixed government and private financing of health care with mandatory health insurance in 1994, the resultant cost cutting efforts both damaged quality and introduced a lot of waste into the Swiss system.

In 2002, the government banned all new medical practices to control costs. The ban runs until 2010. Until then, a new physician cannot open a practice unless an old physician retires or dies. Efforts to save money by merging hospitals have created irrational allocations of specialty units. Alphonse Crespo, a Swiss orthopedic surgeon, reports that resources are now so poorly distributed that "because of the mergers, the distances between specialty units in some cantons are large." Patients needing a urologist may have to go to another hospital. Patients have actually been put in helicopters just for a consultation. Researchers at the University of Lausanne report difficulties in accessing psychiatric care, rehabilitation care, long-term care, and orthopedic care. Rationing is more likely to be imposed on the elderly and those with "a poor level of social integration."

...Between 1971 and 2005, the average inflation-adjusted general practitioner salary in Switzerland fell by 37 percent before taxes. More young doctors are choosing to become specialists because the pay is better and the work is more interesting. There is a developing shortage of primary care. In March, swissinfo.ch reported that general practitioners held the first doctors' strike "in living memory." The government had decided to further ration practitioner access to laboratory tests.

With mandatory health insurance premiums set to rise 15 percent this year, the Swiss government is proposing more cuts. The cuts include restrictions on the type of health insurance that can be offered, restrictions on outpatient services, and a "patient tax" that would require people to pay for their first six visits to a doctor’s office.

...Even with the cuts, in some cantons, the mandatory premium increase may be as much as 20 percent.

(To see her references and hyperlinks, go to the full text of her post "Taking Another Look at Swiss Health Care".)

Restricting new medical practices? Raising prices to limit access? Limiting the availability of lab tests?

Sounds an awful lot like rationing to me.

Rather than being a hit, their system is a giant Swiss Miss...

Armstrong: Pay your own doctors

The October 1, 2009 Colorado Daily has published Ari Armstrong's latest OpEd, "Pay Your Own Doctor". Here's an excerpt:

While Barack Obama pretends that insurance companies are at fault, the reality is that federal tax distortions drove insurance into the expensive, non-portable, employer-paid system. This tax distortion explains why Americans tend to use insurance as pre-paid health care, rather than to cover unexpected, high-cost treatments.

Even as Obama demonizes the insurance companies that federal policies have coddled and favored, his policies expand political favoritism. Obama wants to force you to buy politically controlled insurance, on penalty of huge fines.

If you want to control your health care, you should advocate free- market reforms that expand medical competition, not more political controls. The experiences my wife and I have had with a Health Savings Account (HSA) and high-deductible insurance illustrate the benefits...

(Read the full text of "Pay Your Own Doctor". His piece also appears in the October 2, 2009 Denver Daily News under the title, "Health and the empowerment of payment".)

Hsieh OpEd in Denver Post: "The Real Stakes"

The October 1, 2009 Denver Post has published my health care OpEd, "The Real Stakes".

Here's the opening:

During President Obama's recent speech to Congress, he stated that health care was "a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."

President Obama is right, but not in the way that he means. Thousands of Americans recently assembled at Tea Parties across the country precisely to oppose the fundamental principles behind the President's plan. These protests were not just about health care, but about the proper scope of the government -- and ultimately, the future of America...

(Read the full text of "The Real Stakes".)

Hsieh CSM OpEd - "Health Care in MA: Warning for America"

The September 30, 2009 Christian Science Monitor has published my latest OpEd, "Health Care in Massachusetts: A Warning for America".

Here is the introduction:

In his recent speech to Congress, President Obama could have promoted healthcare reforms that tapped the power of a truly free market to lower costs and improve access. Instead, he chose to offer a national version of the failing "Massachusetts plan" based on mandatory health insurance. This is a recipe for disaster.

Three years ago, Massachusetts adopted a plan requiring all residents to purchase health insurance, with state subsidies for lower-income residents. But rather than creating a utopia of high-quality affordable healthcare, the result has been the exact opposite -- skyrocketing costs, worsened access, and lower quality care...

(Read the full text of "Health Care in Massachusetts: A Warning for America".)

It's also mirrored here at Yahoo! Opinion.