Vecchio Slideshow on ObamaCare

Dr. Jill Vecchio is the head of the Colorado chapter of Docs 4 Patient Care, and she's put together a nice slideshow on ObamaCare and what it means for doctors and patients.

Click on the image below to watch it:



You can sign up for the D4PC e-mail list here.

Quick Links: Catron, McQuain, Zemack

David Catron explains why you won't be able to keep your health plan under ObamaCare.

Bruce McQuain explains why government health care's inevitable fate is either bankruptcy or denial of care.

Mike Zemack describes "The Coming Collision Between the Doctors and the State".

Hsieh PJM OpEd: "Free Speech: Use It or Lose It"

PajamasMedia has just published my latest OpEd, "Free Speech: Use It or Lose It".

My theme is that Americans need to be aware of some dangerous new threats to our freedom of speech, and we must fight back based on a proper intellectual defense of free speech.

Here is the introduction:

"We're from the government and we'll have to revoke your blogging license if you keep spreading too much 'misinformation.'"

A few years ago, such a warning would have seemed far-fetched. But recent developments threaten to turn this from bad science fiction into grim reality. If bloggers and independent journalists wish to avoid this nightmare, we must speak out now to defend freedom of speech -- and we must defend it for the right reasons...

(Read the full text of "Free Speech: Use It or Lose It".)

Bloggers and independent journalists in particular need to be aware of this issue. During the peak of the ObamaCare debate, it was only through the blogosphere that I was able to keep up with a fully representative set of viewpoints and arguments.

If I had to rely only on the New York Times (publishing all the news they consider "fit to print"), I wouldn't have learned about the projected cost overruns that they are only now reporting or the praise for ObamaCare as a means of redistributing wealth until after the bill had passed.

Update: Thank you, Instapundit!

McArdle: No Refills

Megan McArdle discusses some of the factors hindering new drug development in her latest article in The Atlantic, "No Refills".

But although she (appropriately) places some of the blame on the government, she also place blame on the drug companies. However, some of the economic concerns of the drug companies are indirectly attributable to downstream effects of other government regulations!

For more details, see "How the FDA Violates Rights and Hinders Health" by Stella Daily in the Fall 2008 issue of The Objective Standard.

Our Canadian Future

Dick Morris and Eileen McGann tell us what we can expect in, "A Health Care Horror Story From Canada".

Here's an excerpt:

With the full implementation of Obamacare and its likely cuts in physician reimbursement, more and more doctors will choose to opt out of Medicare and charge their patients for their care. The elderly who need specialized care will have no choice but to take out insurance, not to fill gaps in Medicare coverage, but to overlay the system with private coverage so they can get the care Medicare now provides to all seniors. If you want to see a family doctor, it will be rough unless you are paying for the care privately. And to see a specialist, at the low reimbursement rates afforded by the program in the future, will be well nigh impossible.

Medical care for the elderly will become like public housing or public education in the inner city. Those who can afford to go elsewhere will. Those who can’t will be left to fend for themselves in overcrowded public facilities that will be, at least, free.

And then, as in Canada, liberal critics will rail, not against the system that dried up the resources in the first place or against the socialist rules that drove doctors out of medicine, but against the private clinics for resources from the public sector.

By plunging our excellent medical care system into this new world of regulation, fee cuts, and care rationing, the U.S. is going down the disastrous road Canada has taken.

(Read the full text of "A Health Care Horror Story From Canada".)

We can't say we weren't warned...

PJTV: Watkins and Ramirez on ObamaCare

The June 5, 2010 edition of PajamasTV's "Front Page" features Don Watkins of the Ayn Rand Center for Individual Rights and Michael Ramirez of Investor's Business Daily discussing the latest problems with ObamaCare.

Click on the image below to watch, "Freedom and ObamaCare: Incompatible":



(Via Dr. Evan Madianos.)

Four Physicians Discuss Medical Regulations

In the latest segment of PajamasTV's "Medically Incorrect", four practicing physicians discuss how government regulations interfere with their ability to practice according to their best judgment for their patients' best interests.

Click on the image below to watch "Corporate Medicine v. ObamaCare: Which One Is the Tougher Pill to Swallow?"



The doctors discuss problems with mandatory practice standards, electronic medical records, and "one-size-fits-all" treatment algorithms.

The full video lasts 10 minutes.

(Via Ed Cline.)

AFCM: What Health Care Reform Could Be and Ought to Be

Americans for Free Choice in Medicine has now posted video of its May 10, 2010 symposium, "Redeeming Reform: What Health Care Reform Could Be and Ought to Be".

The speakers for their joint briefing include:

Part 1

Introduction
Richard E. Ralston, Executive Director
Americans for Free Choice in Medicine

"The Constitutional Context for Health Care Reform"
Robert McNamara, Staff Attorney
Institute for Justice

"Federalism and Health Reform: Unhealthy States"
John R. Graham, Director, Health Care Studies
Pacific Research Institute

"A New Congress Will Have Opportunity to Reform, Not Deform, the Malfunctioning U.S. Health Care System"
Sue Blevins, M.P.H., M.S., Founder and President
Institute for Health Freedom

Part 2

"Morality — Not Costs — As the Proper Basis for Health Care Reform"
John David Lewis, Ph.D.
Philosophy, Politics and Economics Program, Duke University

Question Period

Part 3

"Loss of Freedom and Privacy in the Age of Corporate-State Medicine
Michael Ostrolenk, M.A., MFT, Public Policy Counsel
Association of American Physicians and Surgeons

"Selfishness at the Microscope: Your Diagnosis or Your Life"
Mark Hurt, M.D., Director
Americans for Free Choice in Medicine

"Better Access to Promising Developmental Drugs and Vaccines"
Frank Burroughs, President and Founder
Abigail Alliance for Better Access to Developmental Drugs

Part 4

"You Are Not Your Neighbor's Health Care Provider"
Yaron Brook, Ph.D., President
Ayn Rand Center for Individual Rights

Question Period

Click here to watch their talks.

Berwick Roundup

More commentary on Dr. Donald Berwick, President Obama's nominee to take over Medicare:

Dr Milton Wolf (MD):
"Meet 'Obama's Rationing Man'"

Dr. Brian Schwartz (PhD):
"Donald Berwick: Blame 'private' enterprise, embrace politically-controlled medicine"

David Catron:
"Whitewashing Donald Berwick's Record"
"An Incurable Romantic"

Dr. Hal Scherz (MD):
"Why Donald Berwick is Dangerous to Your Health"

Justice Dept Imposes Price Controls on Doctors

The May 31, 2010 Christian Science Monitor has published an editorial by S.M. Oliva on the federal government's latest intrusion into American medical practice -- namely price controls on physicians in Idaho.

Here's an excerpt from "Justice Department Declares War on Doctors":

Today the Antitrust Division, joined by Idaho Attorney General Lawrence Wasden, forced a a group of Boise orthopedists to accept price controls for worker's compensation and HMO contracts as part of a settlement accusing the doctors of "price fixing".

...[T]he Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal "price fixing."

The FTC has hinted at this when it said physicians must accept Medicare-based reimbursement schedules from insurance companies. But the DOJ has gone the final step and said, "Government prices are market prices," in the form of the Idaho Industrial Commission's fee schedule. The IIC administers the state’s worker compensation system and is composed of three commissioners appointed by the governor. This isn't a quasi-private or semi-private entity. It's a purely government operation.

(Read the full text of "Justice Department Declares War on Doctors".)

The DOJ's declaration that "government prices are market prices" is positively Orwellian.

When the government sets prices and refuses to allow competition, there is no market -- merely a fiat economy. (The current system of medical licensure which artificially limits supply of physicians is another violation of free market principles.)

As in any other sector of the economy, such price controls will merely lead to shortages, which in turn will result in rationing. The Idaho case is another warning to Americans.

(Via @AriArmstrong.)

Hsieh PJM Oped: Beware Dr. Galbraith's Snake Oil

The May 31, 2010 PajamasMedia has just published my latest OpEd, "Beware Dr. Galbraith's Snake Oil".

My theme is that even in the face of the Greek situation, some economists continue to argue that deficits don't matter. Here is the introduction:

As the Greek welfare state collapses, citizens there have been rioting over cutbacks in social spending necessitated by mounting government debt. The rioters apparently fail to recognize that whenever a government routinely promises to spend more money than it has, then eventually it will be unable to fulfill those promises. Many Americans worry that we will soon be facing similar troubles at either the state (e.g., California) or national levels.

Yet some renowned economists, such as Professor James Galbraith of the University of Texas, are trying to convince us that the U.S. government should ignore our massive federal budget deficit and instead spend even more. Galbraith argues that calls for fiscal responsibility are "misguided" and that greater deficit spending will create greater prosperity.

Galbraith's proposals are dangerous because they are based on the notion that you can get something for nothing. Unless we want to see a Greek-style collapse here in America, we must reject those ideas as economic "snake oil" and instead demand an end to our government’s fiscally irresponsible deficit spending.

James Galbraith is no street corner crank. Instead, he has a BA from Harvard and a Ph.D. from Yale, both in economics. He is a professor of economics at the University of Texas, Austin, and son of famous Keynesian economist John Kenneth Galbraith. Because of his impressive academic and intellectual pedigree, many Washington politicians and pundits take his ideas seriously. Hence, so must we...

(Read the full text of "Beware Dr. Galbraith's Snake Oil".)

As always, please feel free to leave supportive comments, blog about it, e-mail to friends, promote via Twitter/Facebook, etc.!

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.

Pipes: MA Health Meltdown Is Your Future

In the May 25, 2010 New York Post, Sally Pipes is the latest analyst to warn Americans that the "Massachusetts health meltdown is your future".

Here's an excerpt:

The Massachusetts "health reform" disease means more than just bureaucrats setting prices. It also includes rising government spending and taxes; politicians demonizing doctors, hospitals and insurers -- and patients getting lectured that the restrictions of managed care are good medicine...

Government finally caring about the little guy? Hold your cheers -- because the inevitable next step is rationing at the point of consumption. Massachusetts state Senate President Therese Murray has proposed putting an end to "fee for service" medicine in the next five years and moving to a system of capitated managed care, where doctors receive a flat fee for each assigned patient.

This "HMOs for all" approach is designed to lead to soft rationing -- which, in medical terms, means people will have a hard time finding doctors or seeing the ones they have. It's already started. In Massachusetts, one doctor in two is not accepting new patients. Waits for treatment in Boston are the highest in the nation.

(Read the full text of "Massachusetts health meltdown is your future".)

Fortunately, Americans aren't being fooled by the pro-ObamaCare rhetoric. Nearly 2/3rds of likely voters still want ObamaCare repealed.

Let's hope our politicians decide to listen.

Ralston: ObamaCare Contorts the Constitution

The May 25, 2010 Orange County Register has published Richard Ralston's latest OpEd, "Obamacare Contorts the Constitution".

Ralston nicely summarizes several of the arguments that judges will have to consider in the various anti-ObamaCare legal challenges.

Peikoff: Death Of A Profession?

The Ayn Rand Center for Individual Rights recently posted the full text and video of Leonard Peikoff's 1985 lecture, "Medicine: The Death of A Profession".

Even though it is 25 years old, his projections and predictions are quite prescient.

Some of the terms may have changed (e.g., "DRGs" for "HMOs" will now be "bundled payments" for "accountable care organizations"), but the underlying principles remain the same.

Read and/or watch the whole thing.

Gratzer On Berwick and the UK

The May 24, 2010 Boston Herald published Dr. David Gratzer's latest piece, "Central planning’s bad medicine".

Gratzer critiques the ideas held by President Obama's new nominee to head Medicare, Dr. Donald Berwick. Berwick wishes to emulate the British "universal system", despite its serious flaws. Here's an excerpt:

Berwick has decades of experience in health policy and, on paper, would seem a perfect candidate for the job. But he has fallen into the trap of many intellectual elites, which we might call the Harvard Disease: assuming that a government committee can guide one-sixth of the national economy into efficiency.

In many ways, the Harvard professor represents all that is wrong with the Obama White House’s approach to health-care reform. As an unabashed admirer of Britain’s National Health Service, he sees only one solution: a 10-point plan, with more micromanagement by clever elites...

(Read the full text.)

For more on Berwick's views, here's a chilling speech he gave in the UK two years ago praising their system as morally superior to the American system because it does a better job of "redistributing wealth":



The one thing I'll give him credit for -- he doesn't hide his socialist views under a facade of "moderation". At least Americans will have a clear idea of the ideology behind those who wish to assume control over our health care.

Legal Challenges to ObamaCare Rapidly Multiply

Clarice Feldman has the following update at PajamasMedia, "Legal Challenges to ObamaCare Rapidly Multiply".

Quick Links: Catron, Polls, Medicare, Taxes

David Catron points out that the AMA gave its support to ObamaCare and got nothing in return.

Hogberg and Higgins note that politicians who voted for ObamaCare didn't benefit in the polls this past week.

Dr. Brad Hennenfent pointed me towards this article, "Texas doctors opting out of Medicare at alarming rate".

The big question: how long before the government forces doctors to accept Medicare as a condition of practicing medicine?

And the "small business tax cuts" may be vaporware. Instead, small businesses may have a perverse economic incentive to fire workers. (Via Kelly V.)

Skepticism Over Electronic Medical Records

The May 4, 2010 Boston Globe reports on physician skepticism over electronic medical records, which is one of the supposed sources of cost-savings in ObamaCare.

Here's an excerpt from, "Doctors not in stampede to go digital":

Many doctors worry that promised savings to their practices will not materialize. And there are plenty of examples of frustration with computers on the front lines.

"If this is a cost saver, I don't get it," says Dr. Michael Cohen, 49, a nephrologist in Wakefield who uses electronic records.

Cohen often can't send crucial patient information to other physicians because their systems are incompatible. He finds that the records contain so much data that important information can be buried. Mistakes in the records, he said, can be hard to detect and change.

"I agree that a good working system can be an incredibly powerful tool, but there's an incredibly steep learning curve," said Cohen.

(Read the full text of "Doctors not in stampede to go digital".)

In my own experience, electronic medical records can be tremendously helpful if their use evolves naturally in response to consumer needs, organically driven by market factors.

But when imposed by government fiat in a top-down fashion, they will almost certainly create more problems than they allegedly solve. Much of the increased operational "friction" in hospitals and physician offices won't be immediately obvious to patients, but hospital personnel and physician office staff will feel the crunch. Eventually, these increased costs in time and money will translate into higher medical costs or decreased medical services. Which means all patients will eventually pay the price.

Quick Links: Wolf, Gottleib, Forrest

Dr. Milton Wolf rebuts the fallacies of Michael Kinsley on government and Tea Parties.

Scott Gottleib explains why ObamaCare really means "No, You Can't Keep Your Health Plan".

Another nice profile of Dr. Brian Forrest and his cash-only medical practice -- which saves money for patients and increases quality.

Public Option is Alive and Well, But Hidden

The May 17, 2010 SF Examiner warns that the "Public option is alive and well, but hidden".

Here's an excerpt:

The truth is the public option is alive and well, residing in Section 1334, pages 97-100, of the new health care law. That section gives the U.S. Office of Personnel Management -- which presently manages the federal civil service -- new responsibilities: establishing and running two entirely new government health insurance programs to compete directly with private insurance companies in every state with coverage for people outside of government.

Quoting the new law, former OPM director Donald Devine notes that it makes the OPM boss a health care czar, with power to set "'profit margin premiums and other such terms and conditions of coverage as are in the interest of enrollees in such plans.' That's open-ended. You can do anything." Dan Blair, another former OPM director, calls the new program "nothing but a placeholder for the public option." Indeed, the OPM head is also given the authority to "appoint as many employees" as needed to run the program, and to spend "such sums as may be necessary" to establish and administer it.

(Read the full text of "Public option is alive and well, but hidden".)

If we wish to undo this legislation, we will have our work cut out for us -- both in November and afterwards.

Can You Trust Your ObamaCare Navigator?

In the Galen Institute's May 14, 2010 health policy briefing, Grace-Marie Turner discusses the new "navigator" who will help you decide what kind of insurance to purchase:

Agents and brokers are on the front lines of navigating between health insurers, business owners, patients and health professionals, and the value they bring to the health sector is highly under-appreciated. Most of their clients are small and medium-sized businesses, and the agents basically serve as external human resources departments for them. They work hard to find policies to meet companies' needs (and budgets), hold seminars to brief employees on the benefit plans, and serve as intermediaries to make sure claims are paid and even help employees find physicians and the best hospitals.

The new health law indirectly acknowledges the value of agents by creating a new profession called "Navigators" for the new state health exchanges. But they won't be paid through the commissions that agents earn today. Instead, the Navigators will get government "grants" to help people select policies. The Navigators will, of course, more likely be beholden to politicians for their jobs than their clients. And once someone has a problem with a claim, good luck in getting them to help.

So when your employer stops offering health insurance because ObamaCare rules make it too expensive, and you're forced to fend for yourself in system of government-run "exchanges", will you be able to trust that your Obamacare "navigator" is really working for your best interests, rather than in the interests of his government paymasters?

Hsieh OpEd at AT: "The Health Insurers' Faustian Bargain"

The May 15, 2010 American Thinker has just published my latest OpEd, "The Health Insurers' Faustian Bargain".

My theme is that the compromises that the insurance industry have made with the Obama Administration will merely lead to their own destruction and to a nationalized "single-payer" health system.

Here is the opening:

In early 2009, health insurance companies struck a Faustian bargain with the Obama administration. In exchange for a law requiring Americans to purchase health insurance, they agreed to regulations requiring them to offer coverage to all comers regardless of preexisting illnesses. Now that ObamaCare is law, insurers are learning that they may have sold their souls to the Devil -- along with the lives of the American people.

At first glance, ObamaCare might seem a good deal for insurance companies by guaranteeing them a market for their services. But this guaranteed market comes at a steep price, with the government dictating whom insurers must cover, what benefits they must offer, and what prices they may charge...

(Read the full text of "The Health Insurers' Faustian Bargain".)

Update: Thank you, USA Today, for linking to my piece on your state news blog!

Howard: ObamaCare's Hidden Costs

Paul Howard of the Manhattan Institute has a nice breakdown of "ObamaCare's Hidden Costs".

Besides higher costs imposed on corporations and employers, there's the additional $115 billion implementation costs that the CBO admits it didn't include in its original projections because they "didn't have enough time to accurately estimate health bill's cost", plus costs for "high risk pools", for early retirees, and for the Medicare "doc fix".

(Read the full text of "ObamaCare's Hidden Costs".)

With respect to the $115 billion extra cost reported by the CBO, there are many liberals claiming that these are all "discretionary".

But as Megan McArdle notes in "The Health Care Reform Already Costs More Than We Thought It Would":

Some of the stuff we do have to fund, because the agencies are going to have to have staff to deal with the new requirements; and the stuff we don't have to fund is the demonstration projects that I was assured were going to bend the cost curve. So if we save this money in the first ten years, we lose the possibility of lower cost growth after the first decade.

What's really worrisome, however, is that I'm unaware of any happy surprises where it turns out this thing is going to cost less than expected.

I suspect we'll be in for more unhappy surprises in the near future.

Group Appointments in Colorado

One of the early indicators of tightening medical access in Massachusetts under RomneyCare was the growth of "group appointments", where a single doctor would see multiple patients simultaneously.

Basically patients give up privacy and one-on-one time with their physician in exchange for getting a timely appointment.

Now such group appointments are spreading to Colorado, as part of the trial for a new health model promoted by ObamaCare known as the "medical home". (Link via @Lucidicus and mtrunner2.)

Of course, voluntary "group appointments" can be perfectly fine if there are several patients with similar health problems willing to ask questions in front of other patients about issues of common concern. They can be a valuable adjunct to personalized appointments. But they cannot substitute for personal one-on-one time with a physician.

The Boston Globe story includes a video of such a group appointment.

As one commenter in that story stated:

In the group setting, the patients are not allowed to remove clothing for proper physical examination due to the lack of privacy. In the video, Dr. Lindsey is shown auscultating and percussing through the patients' clothing.

As a medical student, I would flunk, that's right, flunk my standardized patient examinations if I even thought of auscultating or percussing through clothing. It is obvious that the lack of privacy even in the cardiology setting restricts the doctor from doing a proper physical examination.

Moreover, while the concept of a "medical home" sounds nice in theory, it can also be easily corrupted to become just another vehicle for rationing.

As Shawn Tully of Fortune magazine wrote last year:

[Under ObamaCare,] Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America's health-care cost explosion.

Under the new "medical home" concept, the task of denying care is shifted from the government to the primary care physician (who may be operating under hidden government financial incentives to reduce referrals and control costs). As we've seen in countries like Great Britain, this pits the physician's interests directly again his patients' interests.

I fully support the concept of integrated personalized health care, where multiple specialists are coordinated by a primary physician working in the patient's best interest -- if patients and their physicians voluntary choose that approach with full disclosure and understanding on both sides.

But if such "medical homes" are made compulsory, then I am deeply concerned that Americans will be subjected to a nasty bait-and-switch, where their care is actually being rationed under the guise of "coordination" from their "medical home".

Schwartz: Questioning Your "Compassionate" Politics

The May 12, 2010 Huffington Post published Brian Schwartz's latest OpEd, "Questioning Your 'Compassionate' Politics".

Here is the opening:

"You oppose Medicaid and government-run schools? You're heartless and lack compassion." If you have ever made this accusation, even tacitly, I invite you to reconsider the government policies you support.

Why does being compassionate mean supporting government-run schools and health plans? This makes little sense if you view these programs as government-run charities. Would you agree to perpetually donate a portion of your monthly income to the same charity - regardless of its effectiveness? If the charity is doing a lousy job, wouldn't you want the freedom to find a better one?...

(Read the full text of "Questioning Your 'Compassionate' Politics".)

Brian Schwartz is asking some good questions.

And at a deeper level, we need to examine the concept of whether there is any such thing as a "right" to health care or not. If one believes that there is, then the only question is how best can the government guarantee it. If one believes that there is no such right, then any attempt to manufacture one is fundamentally flawed from the outset.

These are precisely the sorts of ideas that need to be openly discussed and debated in America. And I'm glad that Brian Schwartz is raising some of these issues.

Sagall: A Health Care Parable

In this short editorial, Jason Sagall of Americans for Free Choice in Medicine cuts to the heart of the health care debate.

Here's the opening of "A Health Care Parable":

Your wife is stricken with a terrible medical condition. Her insurance benefits just ran out. You need money for her treatment.

You go to your next-door neighbor and tell him about your wife's misfortune. You demand $5,000.

Your neighbor is stupefied. Still, he expresses sympathy for your situation. He refers you to a registered charity and offers to connect you with someone who could help start a campaign to raise donations for your wife. He gives you a check for $100.

Your frustration mounts. Your emotional state is the equivalent of that which one feels from the recognition of a moral injustice, as if nature has the ability to inflict illness upon your wife by a conscious, concerted intent to rob her of her life.

Although your reason tells you no one is to blame, you let your mind obsess on the fact that your neighbor earns a lot more money than you or your wife. You rationalize that he really ought to give you more than $100, in the name of fairness, equality, social justice.

Indeed, you have gleaned through cultural sensibilities that, by right, you have some claim on the time, money, goods or services of others. Moreover, you hold that those who have should give to those who have not, as a matter of moral duty. You feel justified -- even righteous -- in compelling others to act in accordance with moral truth as you see it.

So you point a gun at your neighbor and demand more money. While you are uneasy about this, you repeat to yourself that you have the moral high ground; that, in the grand scheme of things, you are doing the right thing -- and so, too, will your neighbor, if he acquiesces.

Your neighbor begs you to understand that you have no right to initiate force against him. You grant this, for now, and put the gun away. But you have another plan.

You organize a local town hall meeting and invite your Congressman...

(Read the full text of "A Health Care Parable".)

Why the AMA Wants to Muzzle Your Doctor

The May 7, 2010 Wall Street Journal carried a provocative OpEd by pediatric surgeon Dr. Hal Scherz entitled, "Why the AMA Wants to Muzzle Your Doctor".

Dr. Scherz, who is also president of the medical organization Docs4PatientCare opposed to ObamaCare, states the following about the AMA:

The AMA was not only a major supporter of ObamaCare but also an accomplice in its passage. Without the support of the AMA it is quite possible that the health-care reform initiative would have failed. So why the effort to silence other doctors? The AMA is not only worried about protecting this misguided legislation, it is worried about protecting itself.

...The irony is that in supporting ObamaCare and trying to silence doctors the AMA has forgotten its own mission statement and ethical code: "[T]o help doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues." It is always medically ethical to tell patients the truth, which is what doctors are now doing by educating them about ObamaCare.

Specificially, Schertz argues:

1) The AMA is attempting to inappropriately silence doctors speaking out to patients and the public against ObamaCare.

2) The AMA only represents 17% of physicians.

3) The AMA's political positions are not necessarily driven by any high-minded concern for patient welfare, but may be inappropriately influenced by a desire to retain special government-granted monopoly privileges over medical coding and billing standards, which can be quite lucrative for the organization.

(Read the full text of "Why the AMA Wants to Muzzle Your Doctor".)

Dr. Scherz raises many good questions. There may be some individual AMA members who are honestly mistaken in their support of ObamaCare, thinking it will benefit patients and doctors in the long run.

But many physicians I know are disgusted with the AMA's willingness to betray patients and doctors in exchange for questionable benefits, whether it be government-granted financial windfall (as Scherz argues) or the illusion of political clout from having "a seat at the table".

(Link via David Catron, who has his own good writeup on the Scherz piece.)

Live Internet Videocast: You Are Not Your Brother's Health Care Provider

If you aren't able to attend tomorrow's lecture "You Are Not Your Brother's Health Care Provider" by Yaron Brook at University of Pennsylvania, you can still hear the talk via a live internet videocast.

Thank you, Dr. Evan Madianos, for arranging this option!

Destroying Employer Based Health Insurance

Fortune magazine editor Shawn Tully describes how many employers may stop offering health insurance to workers under ObamaCare, judging that it would be cheaper to pay the penalties.

These employees would then have to find coverage on the state-run "exchange". Of course, if ObamaCare also drives private insurers out of business through a combination of mandatory benefits and price controls, then that would provide the government with the perfect opportunity to "rescue" the failing system with a single-payer government health plan.

The jaws of the government trap are being set. But Americans don't have to fall for it -- not if they are willing to fight to repeal ObamaCare.

Armstrong On Third Party Insurance

Ari Armstrong reviewed the film The Business of Being Born recently on his blog. Here's an interesting observation he made about our current mixed system:

...Another thing that struck me about the movie is how much it reinforced my existing political views about modern American medicine and health insurance. One person interviewed for the film claimed that often a C-section surgery is a legal strategy. The idea is that, if a doctor performs a C-section, he or she has made every possible medical intervention, and so cannot be sued. So the problems with American torts certainly show in this area.

I have long argued that third-party insurance payments -- entrenched by decades of federal tax policy and controls -- subvert individual responsibility. One women in the film said, "People in our culture spend more time and effort researching to buy a stereo system, a car, probably a camera, than they do checking out what their choices are for birth." In our third-party system of prepaid health care, most people have no incentive to seek out good value for their health dollars. Moreover, most people get the health care their employer's insurance company tells them to get, rather than the health care that would best serve their needs.

My wife and I, on the other hand, buy low-cost, high-deductible health insurance and pay for routine and expected care through our Health Savings Account. We're going to pay for our delivery by writing a check or running the debit card. We know what care we're getting and how much it costs. It is only if something goes terribly wrong, resulting in higher bills, that our insurance would kick in. ...

(Read the full text of his blog post.)

Unfortunately, those earlier government controls have led to yet further controls, which will further worsen the quality and availability of good medical care. How long will the downward spiral continue? The choice is ours.

WHO Praises North Korean Health Care

No, really.

"Lack of obesity" was one of the metrics they did well on.

Two Upcoming Lectures

If you live on the East Coast, you may be interested in these two upcoming talks on free market health care reform.

Public Policy Briefing in Washington DC: "Redeeming Reform: What Health Care Reform Could Be and Ought to Be"
Monday May 10, 2010
National Press Club
Official information on the AFCM website

Lecture: "You Are Not Your Brother's Health Care Provider"
Dr.Yaron Brook, Executive Director, Ayn Rand Institute
Tuesday May 11, 2010
Philadelphia PA
UNIVERSITY OF PENNSYLVANIA HOSPITAL AND MEDICAL CENTER
Medical Alumni Hall
1st Floor Maloney Building (HUP 1)
RSVP information
(Note to attendees: Photo ID required for hospital security)

Thanks to Dr. Evan Madianos for publicizing the first, and helping to organize the second!

How The AMA Sold Out Doctors

Scott Becker explains how the AMA sold out physicians in its desire to "have a seat at the table" in the health care legislative process.

In short, the Obama administration needed their moral sanction and political cover for its agenda, and they desperately needed to be able to claim the support of doctors. The AMA sold its support for essentially nothing. Rather than having a "seat at the table", they instead put doctors on the menu.

Most physicians are not members of the AMA anyways (contrary to popular misconception). The recent ObamaCare debacle may drive more of them out, and into the arms of alternative groups such as the Docs4PatientCare.

Knope: Internal Medicine Is Dead, Will Concierge Physicians Thrive?

At KevinMD.com, Dr. Steve Knope offers his take on the future of internal medicine and concierge medicine in the ObamaCare era.

Here's an excerpt from "Internal medicine is dead, will concierge physicians thrive?":

As fewer and fewer young doctors go into internal medicine and family practice, and thousands of primary care doctors retire early due to financial pressures, the primary care shortage will only worsen. Not only will there be no primary internists to take care of their own patients in the hospital, there will be fewer internists available to see patients in the office setting. This inevitable vacuum of internists and family practitioners (traditional diagnosticians) will be filled by nurse practitioners and medical assistants; people with far less training and expertise than an M.D..

If you are fortunate enough to have a good nurse practitioner, you will eventually be referred to an appropriate specialist, who will treat one of your medical problems. If you are not so lucky, a nurse or medical assistant may miss an uncommon or rare diagnosis; he or she may misdiagnose the "headache" that is actually an aneurysm, the "flu symptoms" that turn out to be meningitis, or the "gallbladder problem" that turns out to be a heart attack. Bad things will inevitably happen when doctors are replaced by medical assistants. It is simply a matter of statistics. All doctors make mistakes, but those with less training make more.

As a concierge physician, people often ask me how this move toward a government-run healthcare system will affect me professionally. Speaking honestly, I tell them that it will help my practice, but I do not think this is good news for the country. As an independent concierge doctor, I am not subject to the rules or fees set by Medicare or Medicaid, nor do I deal with third-party insurance carriers or HMOs. I work for my patients, not a third-party with a conflicting financial agenda. As someone who practices full-service internal medicine, the demand for my services will continue to increase.

However, this outlook about my own practice does not make me happy. I have small children. I am concerned about their future. I am concerned about what the changes in primary care will do the future of American medicine; what will happen if the art of internal medicine is completely lost. I am worried about what it will mean to the efficiency of medicine as a whole, to have no diagnosticians and clinicians to treat the majority of problems that do not need a specialist.

I do believe that patients and providers should be able to contract freely for medical services, and this includes so-called "mid-level providers" such as nurse practitioners. But Dr. Knope makes an important point -- namely,that you may not get the same level of care with a mid-level provider than with a MD.

To the extent that concierge physicians are allowed to operate, they potentially offer an excellent value for patients -- personalized service, individual attention, and high quality of care.

And as Dr. Knope points out on his own blog, these medical services can be surprisingly affordable. But he's also right about the wider issue of the corrosion of general internal medicine. The more Americans learn the truth, the better informed they'll be when the next round of health policy debates begin in earnest.

Siegel: "ObamaCare, Now What?"

In the March 26, 2010 Forbes, Dr. Marc Siegel points out that all the new promised ObamaCare "coverage" won't translate into actual patient care.

Here's an excerpt from "ObamaCare: Now What?":

When many of the real ObamaCare changes finally do take hold beginning in 2013, my patients will find that the world of their medical care will get even worse, not better. Hospital ERs will be even more crowded with the newly insured. Doctors' offices will be swamped.

Beginning in 2013 16 million more people will be eligible for Medicaid, but where will they go for care? I don't accept Medicaid now, because it doesn't pay my office expenses, and I won't accept it then, even if the reimbursements increase slightly for two years. Without a network of specialists to refer Medicaid patients to (specialists fees will not be increased), I won't be able to work with it any more in 2013 than I am now.

In 2014 patients with pre-existing conditions will be able to obtain insurance no matter whether they are working, healthy, or sick. Many will qualify for federal subsidies. But where will this group go for care? My office practice is already full. And I must admit that once the health reform bill takes hold in a few years, if I do have an opening in my overburdened schedule I will be more inclined to see a patient with a single problem rather than a complex patient. Insurance may cover those with multiple pre-existing conditions but this doesn't mean I will be able to take care of them.

(Read the full text of "ObamaCare: Now What?")

Most doctors already understand that "coverage" does not equal "care". The rest of America will learn this lesson soon.

(Via Medical Progress Today.)

Watkins: Massachusetts Law Would Turn Doctors Into Serfs

Don Watkins of the Ayn Rand Center for Individual Rights writes about a proposed new law in Massachusetts that would compel doctors to accept patients covered by the state's "Affordable Health Plans" or else lose their medical licenses.

In other words, doctors would have to treat these patients and accept what the state determines is an "acceptable" payment or else lose their ability to practice in Massachusetts.

This is specifically designed to prevent doctors from "opting out" of the state-run insurance system. As Watkins notes, the "Massachusetts law would turn doctors into serfs".

Given that ObamaCare is closely modelled after the Massachusetts plan, expect to see Congress propose something similar at the national level once ObamaCare's failure becomes more apparent to doctors and patients. Massachusetts is again the canary in the coal mine for the rest of America.

Cancer Research and Collectivism

Scientific American notes the developing tension between modern cancer research, which is making strides in "personalized medicine" based on your specific genomic data, and the current government push towards "cost effectiness" guidelines, which encourage physicians to treat patients according to aggregate population statistics.

The article notes that "the changing policies... present 'a conundrum' for cancer work":

The first challenge is that comparative effectiveness research, by necessity, focuses on broad populations of patients. But as [Duke University researcher Amy] Abernethy pointed out, "in oncology, we take care of individuals." Newly prioritized research might turn out new results about treatments that are best for most breast cancer patients with a defective HER2 protein, for example, but many other individuals with different genetic factors might still need trial-and-error treatment until research finds what works best for them.

Government "guaranteed" health care will accelerate this push where collectivist treatment guidelines and goals are favored over benefitting the individual.

For more on this, see the piece by Dr. Jane Orient, "Forget the Trees; Look at the Forest on Healthcare":

Traditionally, medicine is practiced by physicians, one patient at a time. The outcome is assessed by that patient. The right decision is the one chosen by the patient, in consultation with the physician, based on what is optimum for that patient, considering all aspects of his circumstances. The standard of care is the Oath of Hippocrates: providing treatment for the good of each patient according to the best of the doctor's ability and judgment.

In the "reformed" delivery system, healthcare is practiced from on high by committees of "experts" pulling the strings of marionette physicians (rankings, payment rates, other incentives and disincentives) who are judged on how well they achieve population-based outcomes. Patients are like sheep in the flock, categorized by race, income level, quality-adjusted remaining years (QARYs), compliance, functional ability, diversity score, or whatever metrics the rulers adopt. Any individual can be sacrificed for the good of the whole.

One indicator that ObamaCare will be running into fiscal trouble will be calls by government officials and pundits for further "sacrifices" by patients for the sake of the collective. And for some reason, the sacrificial victim will always be you! Funny how that works...

Cash Only Physician Practice

North Carolina physician Brian Forrest runs a very successful cash-only practice. During this short video presentation, he explains how his method saves his patients money, reduces Medicare costs, preserves high quality care, and improves access:



This is truly a win-win for patients and physicians.

Of course, if a significant fraction of American physicians move to this model, we would also need to more urgently eliminate licensing laws that artificially restrict the supply of physicians.

(Via George Berger.)

Hsieh Oped at PJM: "ObamaCare: Insurers Need Permission to Survive; Citizens, to Live"

The April 25, 2010 edition of PajamasMedia has published my latest OpEd, "ObamaCare: Insurers Need Permission to Survive; Citizens, to Live".

My primary theme is that ObamaCare and other recent developments in Massachusetts bring us perilously close to what Ayn Rand calls the "ultimate inversion" where tyrannical government can do anything it please, whereas ordinary citizens can do nothing without government permission.

My secondary theme is that the Tea Party movement must move to the next level of promoting proper limited government, based on the principle of individual rights.

Here is the introduction:

Suppose our government declared that everyone had the “right” to a nice steak dinner. The government would require restaurants to sell $50 steak dinners to all comers. But to keep prices affordable, restaurants could only charge $25. No restaurant could survive long under such a scheme, and most Americans would be outraged at such a blatant violation of restaurant owners’ rights.

But that is exactly what is happening with health insurance in Massachusetts. Events unfolding now in the Bay State should serve as a warning to the rest of America of the danger ObamaCare poses to our health insurance, our health care — and ultimately our lives.

(Read the full text of "ObamaCare: Insurers Need Permission to Survive; Citizens, to Live".)

A Tiny Bit of Freedom

The April 20, 2010 Denver Post reports that a proposed Colorado law would allow health insurers to give discounts to customers who choose healthier lifestyles.

The program is still subject to numerous state regulations. So it doesn't create a free market by any means.

In a fully free market, insurers would be able to offer any prices they wished to customers, who would in turn be free to accept or reject those terms.

Many would likely choose to offer steep discounts to healthy customers (who would presumably incur smaller medical bills in the long run) as a win-win. And this would create a virtuous cycle, as insurers competed with each other to lower prices to gain healthier customers, and customers responded to these incentives by improving their health (for both financial and the usual non-financial benefits).

Still, I'm glad to see a proposal to partially reduce the levels of regulation. Insurers and patients should insist on more such proposals.

(Via PatientPower.)

Wolf Speak to "An Army Of Davids"

Dr. Milton Wolf spoke at the Kansas City tax day Tea Party, rallying citizens to become an "army of Davids":



In particular, he notes that Americans should demand that politicians (1) follow the Constitution, (2) control runaway spending, and (3) defend the free market.

Unless Americans stand up and defend the principle of properly limited government, then we will be in deep trouble. But as long as Americans like Dr. Wolf continue to speak out, we still have a chance.

(Via WolfFiles.)

Gaming The System

Under ObamaCare, both patients and insurers will game the system -- albeit in different ways.

Patients will sign up for their "mandatory coverage" when they need it, then drop it (and pay the penalties) when they don't need it.

Insurers will try to shift as many administrative expenses as possible into "medical spending" in order to meet legal requirements that a certain percentage of their revenue be spent as "medical costs".

Nor can lawmakers call these "unintended consequences". Instead, these are entirely predictable responses to government controls.

Quick Links: Bowden, Black Ribbon Project

Thomas Bowden of the ARC appears on The Mike Slater Show to discuss the destructive nature of government health care.

FIRM is glad to support Dr. Beth Haynes' Black Ribbon Project.

Colorado Updates

Brian Schwartz has some good updates on the health policy battles here in Colorado.

In particular, see:

"Tuesday, April 27: Debate on ObamaCare lawsuit, CU-Boulder"

"The 'choice' to prohibit other people's choices"

"Health information technology: benefits and problems"

The New York Insurance Laboratory

The April 17, 2010 New York Times notes that New York state government regulations over health insurance has raised its cost.

Here's an excerpt from "New York Offers Costly Lessons on Insurance":

New York's insurance system has been a working laboratory for the core provision of the new federal health care law -- insurance even for those who are already sick and facing huge medical bills -- and an expensive lesson in unplanned consequences. Premiums for individual and small group policies have risen so high that state officials and patients' advocates say that New York's extensive insurance safety net for people like Ms. Welles is falling apart.

The spiral of controls causing problems leading to calls for more controls is clear:

In 1993, motivated by stories of suffering AIDS patients, the state became one of the first to require insurers to extend individual or small group coverage to anyone with pre-existing illnesses.

New York also became one of the few states that require insurers within each region of the state to charge the same rates for the same benefits, regardless of whether people are old or young, male or female, smokers or nonsmokers, high risk or low risk.

Healthy people, in effect, began to subsidize people who needed more health care. The healthier customers soon discovered that the high premiums were not worth it and dropped out of the plans.

ObamaCare seeks to avoid this problem by the individual mandate, requiring people to purchase insurance (as in Massachusetts). The result:

But analysts say that provision could prove meaningless if the government does not vigorously enforce the penalties, as insurance companies fear, or if too many people decide it is cheaper to pay the penalty and opt out.

Unfortunately, the insurance industry lobby has argued for stricter penalites rather than free market reforms -- i.e., further infringements on individual freedoms. Unless they take a principled stand for freedom, they'll just be aiding in their own eventual destruction through this increasing spiral of regulations -- and taking the rest of us down with them.

Reiland On Cassell

Ralph Reiland, a professor at Robert Morris University in Pittsburgh PA, has written an article in praise of Dr. Jack Cassell.

It appears in the April 12, 2010 Pittsburgh Tribune Review and is also on CapMag.

Here's an excerpt from, "A Prescription Against Tyranny":

Jack Cassell is too much for some people.

He's the Florida doctor who told his patients to go elsewhere for treatment if they voted for President Obama. The message posted on his office door: "If you voted for Obama ... seek urological care elsewhere. Changes to your health begin right now, not in four years."

...Cassell told Fox News that the real purpose of his door posting was educational, not racist, and that he wasn't literally turning down patients.

"I came across the timeline for implementation of ObamaCare and I got a little discouraged when I got to next year and found that most of the ancillary services and nursing homes and diagnostic imaging, all these things start to fade away, and I felt that my patients really need to know about this, and the more I thought about it, the angrier I got until I finally felt like I'm going to put a little splash page on my front door and just get people thinking a little bit," Cassell explained.

"I think there's a real, real problem that's going on here in this country and unfortunately ObamaCare fatally compromises my ability, or any doctor's ability, to uphold the Hippocratic Oath," he continued. "I mean, I can't believe that more people aren't standing up. I think all the doctors in the United States need to take a stand on this, because pretty soon it's going to be too late."

(Read the full text of "A Prescription Against Tyranny".)

Dr. Cassell is completely right with respect to ObamaCare compromising physicians' ability to uphold the Hippocratic Oath. And I hope his actions help wake up the rest of the medical profession.

Happy Tax Day!

Homer Simpson quote of the day: "Would you look at those idiots? I paid my taxes over a year ago!"

Quick Links: Medicare, Licensing, Off-Label Uses

The 4/14/2010 Denver Post reports that more Colorado doctors are dumping their Medicare patients because of poor reimbursements.

As always, those patients have "coverage" but that's not the same as actual care.

And this problem will get worse if the 4/12/2010 Wall Street Journal article is correct on the anticipated shortage of 150,000 doctors over the next 15 years.

(This shortage is made worse by medical licensing regulations which violate the rights of willing patients and providers to contract freely for medical services without government interference.)

Conko and Arnett of CEI have a new paper, "Truth Or Consequences" on the benefits of "off-label" promotion by drug and medical device manufacturers to patients and doctors. Here's the associated press release.

Quotes From The Founders

As Americans prepare to speak out at Tea Party rallies across the country, here are a few inspiring quotes from the American founders on limited government, rule of law, and the rights of man.

(Thanks to Bill Whittle for putting these together.)

Finding Out What's In The Bill

Prior to the passage of ObamaCare, House Speaker Pelosi famously declared, "We have to pass the bill so that you can find out what is in it".

According to the April 12, 2010 New York Times, Congress is also finding out what's in the bill. Here's an excerpt from "Baffled by Health Plan? So Are Some Lawmakers":

In a new report, the Congressional Research Service says the law may have significant unintended consequences for the "personal health insurance coverage" of senators, representatives and their staff members.

For example, it says, the law may "remove members of Congress and Congressional staff" from their current coverage, in the Federal Employees Health Benefits Program, before any alternatives are available.

The confusion raises the inevitable question: If they did not know exactly what they were doing to themselves, did lawmakers who wrote and passed the bill fully grasp the details of how it would influence the lives of other Americans?

(Read the full text of "Baffled by Health Plan? So Are Some Lawmakers".)

It's almost as if Congress hastily rammed this bill through for bad political reasons, without really thinking about the consequences of their actions!

Nah...

Wolf Exposes His Congressman's Dereliction of Duty

Dr. Milton Wolf has a new OpEd in the April 13, 2010 Washington Times detailing his congressman's dereliction of duty in voting for ObamaCare.

Here's an excerpt from, "Dennis Moore must be recalled":

Instead of our elected Representatives in Congress giving us answers, they regurgitated talking points (if they could be bothered to address us at all). Instead of thoughtful, needed health care reform, they arrogantly forced upon us the largest expansion of government power and largest intrusion into our lives that our nation has ever seen.

...Mr. Moore, you refused to read the bill before foisting it upon us. You swore to us that health care rationing was not in it. When you were asked to discuss specific provisions in the bill, you said no. Your actions are worse than dishonest. They represent a dereliction of duty. You refused to perform the most basic function of your office: to read a bill before voting for it.

As a result of your dereliction, patients will suffer and lives will be lost. Because of your reckless abandonment of your duty to Kansans, families will be shattered. Your profound arrogance and cavalier disregard for the needs of your constituents make you dangerous. It's sad but true: You have not faithfully discharged your sworn duties as a United States congressional representative.

(Read the full text of "Dennis Moore must be recalled")

I'll bet the Congressman Moore was not the only one who didn't read the bill.

As we know, some Congressmen even swore an oath to uphold the Constitution, then betrayed that oath by brazenly declaring that they'll pass whatever laws they want without "worrying about the Constitution."

As voters, we must exercise our constitutional power to fire those politicians who would exert arbitrary power over us -- and replace them with men and women who respect the proper role and limits of government.

Tea Party: Then And Now

The Heartland Institute has a nice video about the Tea Parties -- then and now:

Bowden on ObamaCare and the FDA

Tom Bowden of the Ayn Rand Center for Individual Rights has two good recent pieces touching on different aspects of the health care debate.

In his blog post, "Doctors ask: 'Is this what I have to look forward to?'", Bowden discusses some poignant responses he has received from physicians in the wake of ObamaCare being signed into law.

At least some doctors are realizing that this will lead to involuntary servitude, where the fruits of their labors are regarded as someone else's automatic "right".

In his OpEd, "What About Private Health Emergencies?", Bowden dissects the inconsistencies behind the government allowing FDA rules to be bypassed in "public emergencies" but not for individual patients' illnesses.

Bowden notes:

Every life-threatening disease presents a health emergency to the individual patient. Morally, you have the right to seek the best treatment you can find. Yet our legal system denies you that right when it comes to private health emergencies.

I'm glad to see more discussion of health care issues from the ARC, and I hope their works receive the attention they deserve.

Armstrong: Keep Pushing for HSAs

Ari Armstrong explains why Americans who value quality medical care should, "Keep Pushing For Health Savings Accounts".

Here is the opening:

Despite enactment of the Democratic health law, one reform Republicans and market advocates should fight to keep alive is the Health Savings Account (HSA), which allows people to put pre-tax money into an account dedicated to health-related expenses.

Experiences my wife and I have had this week illustrate the power of paying for one's own health care, which an HSA encourages. Rather than pay a hundred plus dollars each to a doctor and an out-of-state testing facility, we each paid King Soopers $20 to test our blood cholesterol. I'm not saying this is a good substitute for seeing a doctor, but we wanted to get a test between regular doctor visits. Our actions illustrate the fallacy of claims that self-payers don't get preventive treatment. We are highly committed to doing what we can to prevent long-term health problems by taking care of ourselves and paying for preventive care.

(Read the rest of "Keep Pushing For Health Savings Accounts".)

Hsieh OpEd at PJM: The Deadly Tax on Medical Innovation

As Tax Day approaches, PajamasMedia has just published my latest OpEd on health care, death, and taxes:

"The Deadly Tax on Medical Innovation"

My theme is that one of the greatly under-appreciated effects of ObamaCare will be how it will stifle medical innovation, thus leading to millions of preventable deaths. I make the analogy with Moore's Law and the growth of personal computing power as a model for how medical progress can and should happen in a free society -- and as a warning as to future progress jeopardized by ObamaCare.

Here is the opening:

The Deadly Tax on Medical Innovation

Most technology aficionados are familiar with Moore's Law, which states that computing power tends to double roughly every two years. The average American experiences this most clearly when purchasing personal computers. In 1998, Apple introduced its iMac computer with a 233 MHz processor, 32 MB RAM, and 4 GB hard drive, for a price of $1300. In 2010, Apple's low-end iMac includes a 3.06 GHz processor, 4 GB RAM, and a 500 GB hard drive for $1200. This represents a greater than 10-fold increase in processor speed and over 100-fold increases in RAM and hard drive sizes for roughly the same nominal dollar amount (30% fewer real dollars after adjusting for inflation).

Similar but more quiet progress has also occurred with medical technology. During my medical career, MRI scanners have advanced from creating crude but workable images of brain tumors to generating high-resolution scans displaying not just their anatomic extent, but also their internal chemical composition and the extent of functional disruption caused to the rest of the brain architecture. These advances allow doctors to plan surgery and radiation treatments in an extremely precise fashion to remove the tumor while preserving as much normal brain function as possible. As Clayton Cramer has observed, modern American medicine is much closer to the Star Trek "Sickbay" than doctors could have imagined a mere 20 years ago.

Raymond Kurzweil has generalized Moore's Law as "The Law of Accelerating Returns," arguing that technological progress overall follows a roughly exponential curve. This exponential curve is a natural reflection of the fact that today's progress forms the base of tomorrow's innovation. This create a virtuous cycle in which innovators continually build on each other's work, adding to an ever-increasing fund of knowledge, which in turn allows for future innovations. When people are left free to innovate, the exponential gains they create are therefore akin to the exponential growth we see in our bank balances when we allow compound interest to operate over time.

However, such exponential gains are not automatic. Moore's Law (and Kurzweil's generalization) are not laws of nature. Instead, they presuppose a system of government that leaves innovators free to create. Conversely, a government that penalizes innovation could dramatically slow the pace of medical progress, leading to millions of preventable deaths. And this may be one of the worst long-range consequences of the recently passed ObamaCare health legislation...

(Read the full text of "The Deadly Tax on Medical Innovation".)

Voters Fight Back Against Congress

FireThe219.com is fighting back against the Congressmen who voted for ObamaCare.

Here's their video urging a recall of Kansas Congressman Dennis Moore:



(Via WolfFiles.)

The Value of a Trained Intuition

Update: Welcome WolfFiles readers!

[As ObamaCare rules increase the pressure on physicians to make sure everyone receives their "guaranteed" care, we'll see doctors rushing through cases and not taking the time to do a thorough job for their patients. Do you want to be the patient whose abnormal x-ray finding is missed? -- PSH]

It was a busy Friday night in the ER. A 34-year old woman came in with chest pain, and I saw her chest x-ray. I was just about to call it "normal" and move onto the next case, when a nagging little voice in the back of my head told me to look one more time. Can you see the abnormality? (Click on image to see it full sized):



I decided that I didn't like a very subtle shadow in her right upper lung. It was just a little too asymmetrically dense compared to the opposite left side:



Hence, I told the ER doctor that there was a possible but not definite abnormality in that area (such as an early pneumonia). I recommended that he order a CT scan to see if it was real or not. He ordered the CT scan, and we saw this:



Based on the irregular contour (and other features), this is almost certainly a 2-cm lung cancer rather than pneumonia. The patient is now "in the system", and we expect biopsy proof soon.

If I had decided to ignore that nagging doubt and instead called her x-ray normal, then 6 months later when the cancer had grown and become obvious, some sharp lawyer could easily have gone back through the records, reviewed the film, and argued that I should detected it back then.

Hence, I probably avoided a lawsuit by taking a second careful look at her x-ray, even though it was a crazy busy night in the ER with x-rays, CT scans, ultrasounds, and MRI images piling up.

Lesson: If a little nagging voice in your head tells you to look at or think about something one more time, then listen to it!

This is, of course, the thesis of Malcolm Gladwell's book Blink. And I believe Gladwell is fundamentally correct.

If one has trained one's subconscious to make good "lightning" evaluations over the years through a process of reason (in adherence to the facts of reality), then one's resultant "intuitions" can be quite valuable. At the very least, one should take those intuitions seriously -- in the sense of using them as a red flag indicating that one should reconsider the issue at hand and apply some more careful conscious reasoning.

Of course, if one's "intuitions" are just a hodgepodge of emotional reactions shaped by chance and whim, then they will almost certainly lead one astray. And Gladwell also emphasizes this point in his book.

Dr. Leonard Peikoff also covers this topic nicely in his Podcast #103 (timestamp 6:55), answering the question on intuition.

(Crossposted from NoodleFood.)

Balko on Shifting Rhetoric

Radley Balko explains the shifting rhetoric:

Obamacare supporters then: Talk of rationing talk is just paranoia from "death panel" types.

Obamacare supporters now: "Saying no" to medical care will be most important task of those who implement the new health care system.

The oPad vs. the iPad

What would the iPad version of ObamaCare look like?
(YouTube version.)



As BulletPeople says, "Just think how the price will drop when the law says you have to buy one!"

(Via Newsbusters, via S.D.)

Shapiro: Five Hidden Costs of ObamaCare

Gary Shapiro, President & CEO of the Consumer Electronics Association, recently wrote a piece for Huffington Post on the "Five Hidden Costs of Health Care: What the Government Doesn't Want You to Know".

The first four are important points and he discusses each in detail:

1. The new law will increase the federal budget deficit.
2. The new law will reduce jobs in private industry.
3. The new law will increase government jobs.
4. The new law will hurt health care for those with critical needs.

But I wanted to highlight his 5th point with an extended excerpt:

5. The new law will reduce American innovation.

The new law will reduce innovation in several ways. First, specific taxes on innovative medical devices and new costs for drug companies mean a special tax on innovation. New taxes will be added to the overall cost of treatment and innovation thus will be discouraged.

Second, innovative medical treatments will be discouraged in America. Articles by American doctors dominate almost every medical journal in the world. Today's system encourages breakthroughs and creativity. Yet the new health law encourages cookie-cutter treatments and punishes deviation from treatment norms thereby discouraging innovation.

Third, the bill imposes several new taxes on investment. This means less money will go to new businesses and taking risks. The result will be less money for research, development and innovation.

(Read the full text of "Five Hidden Costs of Health Care: What the Government Doesn't Want You to Know".)

In my opinion, this could be one of the most under-appreciated consequences of ObamaCare. The mind is man's basic means of survival. Our ability to produce and create new value is how we live. Stifling innovation will result in technological stagnation and death.

(Link via J.G.)

Schwartz in Daily Camera: Insurance Slumlords

The April 6, 2010 Boulder Daily Camera has just published Brian Schwartz' latest OpEd, "Get ready for health insurance slumlords". Here is the opening:

If you dislike your health insurer now, get ready for insurers' response to insurance price controls. The recently passed HR 3590 will impose them nationally, and some politicians in Colorado want more. Insurance price controls will make your insurer act like a slumlord. Expect worse customer service, skimpier plans, and more claim denials.

Price controls on rental properties encourage landlords to become slumlords. Forbidden from making a profit by renting at market rates, to make a living landlords must skimp on quality and service, rather than please customers. The same will result from insurance price controls: lousy policies for people with pre-existing conditions or anyone who might get sick. That is, everyone...

(Read the full text of "Get ready for health insurance slumlords".)

Controls breed more controls. Hence we need free-market reforms along the lines Brian Schwartz advocates to undo the existing bad controls. Otherwise, we may face the bleak future.

Gaming The System In Massachusetts

According to the April 4, 2010 Boston Globe, patients are gaming the mandatory insurance system in Massachusetts:

Thousands of consumers are gaming Massachusetts’ 2006 health insurance law by buying insurance when they need to cover pricey medical care, such as fertility treatments and knee surgery, and then swiftly dropping coverage, a practice that insurance executives say is driving up costs for other people and small businesses.

(Read the full text of "Short-term customers boosting health costs".)

Of course, there will be statists who will claim that this proves that the market has failed, even though the failure will be caused by the government restrictions of the free market. And they will claim that this "proves" that we need a complete government takeover of health care.

The problems in Massachusetts will be a preview for the rest of the country unless we repeal ObamaCare.

(Link via Brian Schwartz and Jared Rhoads).

Constitutionality Roundup

Glenn Reynolds interviews Georgetown law professor Randy Barnett on the constitutionality of ObamaCare:



Although Barnett believes ObamaCare is unconstitutional, he also warns that we shouldn't count the Supreme Court to strike it down. (Via PatientPower.)

David Kopel challenges the notion that there's a "consensus" by the legal academic community that ObamaCare is constitutional.

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.

Nightmare

In honor of April Fool's Day, I'm posting this image from the WolfFiles blog:



As Dr. Wolf says, "I'm pretty sure the "Universal Nightmare" is referring to ObamaCare and not me..."