Why I'm Voting Straight-Ticket Democrat on Tuesday

Because I want to support President Obama's agenda and continue his string of domestic and foreign policy successes, including:

1) Getting the federal budget deficit under control

2) Getting our economy back on track

3) Guaranteeing universal health care, while making sure everyone who likes their current health plan gets to keep it

4) Reducing unemployment to near-record lows

5) Getting our troops out of Iraq and Afghanistan and getting our enemies abroad to stop hating us

6) Fighting for the rights of gays serving in the military

7) Changing the rancorous tone in Washington and moving us in a "post-partisan" direction

...Wait, what's that? ...Hang on a sec

[Quick internet search]

...Um, never mind

Two Doctors In The Washington Times

The October 27, 2010 Washington Times carried two good health care OpEds by physicians.

Dr. Daniel Johnson, Jr. wrote, "Patient beware of accountable care organization".

Johnson warns how ACO's being promoted with government help will set physician practice standards and payment incentives that will likely lead first to capitation -- then a single-payer system.

Dr. Mark Neerhof of Docs4PatientCare wrote, "Repeal president's ploy".

Neerhof shows how the insurance regulations will drive private insurers out of business and herd Americans into single-payer, government-run health care.

ObamaCare thus constitutes a two-pronged attack on the freedoms of American patients and physicians.

If Americans don't like this prospect, they should let their elected officials know next Tuesday!

A Humorous Look at ACOs and Medical Homes

The Disease Management Care Blog has posted two short videos on ACOs (Accountable Care Organizations) and "Medical Homes":





For a more serious look at ACO's, read Dr. Beth Haynes' recent post at the Black Ribbon Project.

Schwartz: Amendment 63's Foes Only Want You for Your Body

The October 26, 2010 Huffington Post has just published Brian Schwartz's latest piece, "Amendment 63's Foes Only Want You for Your Body".

Here is the opening:

Should Colorado mandate that each car owner buy a comprehensive lifetime vehicle warranty? By the logic of a common argument against Colorado Amendment 63 and for mandatory medical insurance, the answer is "Yes." Mandatory insurance treats your body as a means to political ends, rather than respecting your rights as an individual.

He goes on to show how the mandatory insurance in ObamaCare is both a form of exploitation as well as a restriction of basic freedoms.

(Read the full text of "Amendment 63's Foes Only Want You for Your Body".)

Quick Links: MLRs, Employers, Alternatives

David Hogberg at the 10/21/2010 Investors Business Daily looks at the proposed new "Medical Loss Ratio (MLR) rules and asks, "Will New ObamaCare Regulation Reduce Insurance Competition?"

This 10/24/2010 AP story reports, "Employers looking at health insurance options".

As those first two stories indicate, ObamaCare rules will slowly strangle the current insurance market, thus herding Americans into the state-run "exchanges". The inevitable result will be a "single-payer" government-run system.

John Goodman at NCPA offers some positive alternatives to this bleak future in his 10/25/2010 post, "A Radically Different Approach to Health Insurance"

My Latest in Denver Post and CapMag

Two of my health care pieces have just been published:

The October 23, 2010 Denver Post has published "The 'Right To Health Care Choice'is right for Colorado".

Here is the opening:

Suppose the government required everyone to purchase their meals from state-run restaurants. The government would also select the menu items. If you liked spinach but their vegetable choice was broccoli, then tough luck. Everyone would also have to purchase dessert, whether they wanted it or not. And if some customers couldn't afford the overpriced meals, you'd have to cover their tab.

Most Coloradans would be outraged at such a violation of their basic freedoms. But this is precisely what ObamaCare does with health insurance -- and which the "Right To Health Care Choice" Initiative (Amendment 63) would help prevent.

(Read the full text of "The 'Right To Health Care Choice'is right for Colorado".)

Also, Capitalism Magazine has just posted "A Medical Doctor Explains the Pros and Cons of ObamaCare: An Interview with Dr. Paul Hsieh".

(Thank you, Joshua Lipana, for that nice interview!)

Hsieh/Armstrong on Personhood and Health Choice

The October 22, 2010 Denver Daily News published the OpEd by Diana Hsieh and Ari Armstrong, "A62, A63 Reveal Ideological Rifts". In this piece, they discuss Amendment 62 (the "personhood" measure) and Amendment 63 (the Health Care Choice measure).

They discuss why a proper approach to individual rights leads them to oppose Amendment 62 and support Amendment 63. In particular, they note:

Both the left and the religious right, then, express contradictory views about liberty and individual choice. They support it in some cases, but not in principle. Why is that?

The left rejects America’s founding ideal of liberty as each person’s freedom to pursue his own life and happiness using his own property. They regard rights as entitlements to goods and services provided by others, not freedoms to think and act without coercive interference.

...The religious right claims to support individual rights, but its conception of rights is little more than sectarian dogmatism. Rights are whatever God declares them to be, on this view.

By contorting some Bible passages and ignoring others, advocates of Amendment 62 claim that newly fertilized zygotes -- even before implantation in the uterus -- must be declared persons with full legal rights. By similar methods, they ignore the Bible's overt hostility to individual rights and capitalist values.

The consistent, secular view of individual rights is opposed to both the entitlements of the left and the dogmatism of the religious right. Rights, on this third view, define the individual's proper sphere of freedom in a social context. They enable each person to act by his own judgment and for his own life and happiness.

Such rights are based on the facts of man's rational nature, not the whims of the majority or the arbitrary commands of God. They apply equally to every person, to individuals living in society, as opposed to an embryo or fetus entirely contained within a pregnant woman’s body.

(Read the full text of "A62, A63 Reveal Ideological Rifts".)

Wolf: Obamacare's Unkeepable Promises

Dr. Milton Wolf has a new OpEd in the 10/22/2010 Washington Times, "Obamacare's Unkeepable Promises".

In it, he debunks all of the promised benefits, including cost savings, "you can keep your own insurance", "no rationing", an open legislative process, etc.

Read the whole thing.

I doubt the President will take Dr. Wolf up on his invitation for a chat. But it never hurts to ask!

You can read more from Dr. Milton Wolf at his blog, The Wolf Files.

Killing Marcus Welby

Scott Gottleib discusses how Accountable Care Organizations (ACOs) will destroy independent small private practices and lead to indirect rationing.

Otis On WA Regulations

Maryallene Otis of Lynwood, WA responds to her state regulators forcing insurers to sell child-only policies.

This is her LTE in the October 19, 2010 Seattle Times:

State regulator orders Regence to reinstate child-only plans

Profit motive more dependable than government bureaucrats

State insurance commissioner Mike Kreidler has ordered Regence BlueShield to resume selling child-only insurance policies ["WA orders Regence to resurrect child-only plans," seattletimes.com, Oct. 15].

Regence (and insurance companies across the country) recently made the sound business decision to stop selling these policies because of the new federal law forbidding them to exclude children with pre-existing conditions.

To force a company to sell policies without considering pre-existing conditions, means that what Regence would be selling would not be insurance. Insurance takes risk into account. Kreidler is forcing Regence to make a bad business decision, on which they cannot possibly make any money.

Government is strangling the business of medicine and the business of medical insurance with more and more regulations. Then, when the regulations create a disaster, bureaucrats vilify medical professionals and insurance companies for wanting to make a profit.

Capitalism, the political system that protects individual rights to property and contract, is the moral and practical way to provide goods and services. I would far rather depend on the profit motive than the whim of a bureaucrat.

-- Maryallene Otis, Lynnwood

I especially liked how she linked the specific regulatory issue to the broader theme and proper definition of capitalism.

Thank you, Maryallene, for speaking out in Washington state!

Schwartz and Novack on Amendment 63

Brian Schwartz debunks the latest anti-A63 alarmists at the 10/18/2010 Huffington Post: "Amendment 63 vs. the Unlicensed Vampire Alarmists"

Dr. Eric Novack discusses in the 10/14/2010 Boulder Daily Camera why "Amendment 63 is good for Colorado".

Zawistowski: Lessons Learned From The ER

Stella Zawistowski tells her "Lessons learned from the ER".

Not Just Bad PR

The Obama administration has been spending millions of dollars on advertisements to promote the alleged benefits of ObamaCare. (Via David Catron.)

But as the 10/15/2010 Wall Street Journal notes, "Voters on ObamaCare: Informed and Opposed". Many Americans actually understand that ObamaCare will hurt them by raising their costs and limiting their freedoms -- and they don't like it.

The problem with ObamaCare is not just bad PR.

ObamaCare Unravelling

The October 8, 2010 Investors Business Daily discusses "The Unraveling Of ObamaCare".

As more companies and special interest groups get waivers from ObamaCare rules, it highlights two facts:

1) The rules are bad.
2) Those with political pull will get special treatment.

At best, this will create rule by men, rather than rule by law. At worst, this is a recipe for widespread political corruption.

Maybe the entire country should request a waiver from ObamaCare...

Legal Scholars On Latest ObamaCare Ruling

Hadley Heath has a nice round-up of various legal scholars' reactions to the latest court ruling allowing the multi-state lawsuit against ObamaCare to go forward.

(Via David Catron.)

Carrots and Sticks for Electronic Medical Records

The AMA has summarized the various financial carrots and sticks that the government will wield against doctors to get them to adopt electronic medical records (EMRs, also known as EHR for "electronic health records").

The laws require "meaningful use", to prevent doctors from buying the machinery but just letting it sit on the shelf. Initially, the inducements are in the form of carrots (rewards), but later they turn into sticks (penalties):



These EMRs will be used to track physician compliance with "practice guidelines".

When Big Brother watches your doctor and decides whether or not your doctor will get paid, it could lead to a chilling effect on physicians' ability to use their best independent judgment.

Pro Amendment 63 Commercial

Let's hope this doesn't become a reality:

Quick Links: Costs, Rebellion, Greeks, Wolf

Dr. Beth Haynes of the Black Ribbon Project discusses, "The Real Reason Medical Costs Are Rising".

Jeffrey Anderson describes rising discontent within the medical profession against ObamaCare at, "Battling ObamaCare: The Health Care Industry Starts to Awaken".

The Greek health care system announced the following gruesome policy:

...[T]he nation's largest government health insurance provider would no longer pay for special footwear for diabetes patients. Amputation is cheaper, says the Benefits Division of the state insurance provider.

And on a personal note, last week I had the pleasure of meeting in person Dr. Milton Wolf, who coincidentally happened to be attending the same medical conference as myself. We had a nice chat about his activities and goals. All I can say is that it's too bad we can't clone 50 more of him.

(But then, Mizzou alumni might not want that many more Jayhawk fans roaming the earth...)

Catron: The Criminal Intent of ObamaCare

David Catron warns about a provision of ObamaCare that undermines the legal rights of physicians and a core principle of our justice system.

Read his piece, "The Criminal Intent of ObamaCare".

Preventing You From Spending Your Own Money

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

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

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

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

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

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

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

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

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

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

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

Lawsuits Update

As many know, a federal judge in Michigan has just upheld the Obamacare insurance mandate.

At the Volokh Conspiracy law blog, Ilya Somin offers his initial critique. So does Randy Barnett.

As many observe, this issue will likely end up being decided in the US Supreme Court.

If you're interested in more information, the Health Care Lawsuits blog and their main website look like promising sources.

Schwartz Rebuts Semro on Amendment 63

The 10/6/2010 Huffington Post carried Brian Schwartz's latest piece on Amendment 63, "Colorado Amendment 63: Freedom Is Too 'Haphazard' for Bell Policy Center".

In it, he rebuts the various objections raised by Robert Semro of the Bell Policy Center in Semro's earlier Denver Post OpEd, "No on Amendment 63: It won't hold down health care costs".

One excerpt from Schwartz's piece:

Semro also does not like Amendment 63 because it would "tie the hands of policymakers who want to reduce costs by expanding health care coverage in Colorado." Yes, and this is a good thing. "Reducing costs by expanding coverage" is code for turning health insurance into a tax, or compulsory charity. Mandatory insurance doesn't mean just any kind of insurance, but policies loaded up with mandated benefits and minimum copayments and deductibles. All of these drive up premium prices and force many people to buy more insurance than they'd otherwise want. This "cost-shift" or hidden tax is larger than that from the popular scapegoats, the uninsured.

Semro continues with Orwellian Newspeak. Amendment 63 would prohibit government from forcing you to buy an insurance plan designed by politicians. It also protects your right to pay cash for medical care. But Semro claims Amendment 63 "will obstruct the ability of Coloradans to make decisions about their health care." Nonsense. Amendment 63 does just the opposite. It obstructs the ability of the Colorado politicians and bureaucrats to make decisions about your health care.

(Read the full text of "Colorado Amendment 63: Freedom Is Too 'Haphazard' for Bell Policy Center".)

Thank you, Brian!

Lawsuits Update

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

Some excerpts:

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

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

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

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

More information in the full article.

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

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

Milton Wolf on Election Day Tea Party

Dr. Milton Wolf promotes the Election Day Tea Party:



As the good doctor says, "The quickest way to stop the Obama big-government agenda is to pry the gavel out of Nancy Pelosi's hand."

More information at the official website.

More Commentary On Amendment 63

As the election draws closer, we've seen more commentary on the proposed Amendment 63 to protect health care choice in Colorado.

The September 30, 2010 Salida Mountain Mail published Linda Gorman's piece, "Amendment 63 protects right to spend money on your own medical care".

The October 3, 2010 Denver Post has a point-counterpoint segment on Amendment 63 including:

"Yes on Amendment 63: Stand up to D.C. on health care choice" by Jon Caldara and Linda Gorman.

"No on Amendment 63: It won't hold down health care costs", by Bob Semro.

The October 3, 2010 Boulder Daily Camera published Brian Schwartz's piece, "Amendment 63: Refuting the opposition".

Interview with Free Enterprise

Joshua Lipana interviewed me for the Phillipines-based Free Enterprise periodical. Thanks to Joshua for the opportunity to spread free-market health care ideas to his readers in the Phillipines!

Read the interview here. Here's the PDF version.

Hsieh PJM OpEd: "2010: Dawn of the Terran Empire?"

PajamasMedia has just published my short, tongue-in-cheek piece, "2010: Dawn of the Terran Empire?"

My theme is that we must have entered a bizarre political parallel universe if Democrats are now running on how they voted against universal health care, and France is now telling us that we're being too soft on our enemies.

Enjoy!

Why the MLR Rules Matter

The MLR (medical loss ratio) rules of ObamaCare are showing up more frequently in the news.

In the 9/29/2010 Forbes, Avik Roy explains "How ObamaCare May Disrupt Your Health Plan".

The 9/30/2010 Wall Street Journal shows how McDonalds insurance for employees may be the first casualty at, "McDonald's May Drop Health Plan".

Although many commenters call these "unintended consequences", there are undoubtedly many single-payer advocates who are cheering the demise of private health insurance -- so as to eventually force Americans into a monopoly government plan.

The Lobbying Heats Up

The 9/27/2010 Denver Post reports that, "Christian Scientists push for health insurance that covers spiritual care".

This is a completely predictable development. When the government specifies what benefits shall (or shall not) be covered by insurance, special interest groups will lobby ferociously to have their particular pet benefit be part of the mandatory package.

The result is that ordinary people are forced to pay extra for "benefits" they may neither need nor want in order to satisfy those with the greatest political pull.

As I discussed a few months ago in the 3/24/2010 Denver Post, this turns medicine into a permanent political football.

Quick Links: IT Consequences, MLR

The 9/27/2010 Wall Street Journal health blog discusses how, "Computerized Order Entry System Has Unintended Consequences". Expect to see more of this as physicians are forced to adopt government-approved health IT systems.

Why should you care about MLR's ("medical loss ratios")? John R. Graham of PRI discusses why in, "ObamaCare Will Dramatically Reduce Choice in Private Insurance".

More Mammography Brouhaha

The question of the value of screening mammography is in the news again.

Here is one typical article from the 9/22/2010 New York Times, "Mammograms' Value in Cancer Fight at Issue".

The abstract of the original paper at the New England Journal of Medicine is here at, "Effect of Screening Mammography on Breast-Cancer Mortality in Norway".

Of the various commentary I've seen, one of the best has been from the 9/23/2010 Wall Street Journal Health Blog, "Study: Mammograms Save Lives — Just Not As Many As Expected".

As NEJM co-author Marvin Zelen notes in the WSJ piece:

Zelen says women need to weigh the benefits of screening (a lower chance of dying from breast cancer, at least in this age group) against possible risks. As an accompanying editorial notes, those include false alarms and unnecessary biopsies, as well as the "less frequent but more worrisome" problem of needlessly treating cancer found via mammogram that never would have amounted to anything if it went undetected. If you take the approach of "minimizing the maximum risk," as Zelen says, that suggests being screened.

But "we have to make decisions about our health on the basis of what's important to us," he says.

That last point deserves highlighting.

Patients must have the freedom to decide for themselves (in consultation with their doctors) whether they wish to undergo certain tests and procedures -- or if the risk aren't worth it (in their opinion). Those decisions are intensely personal and no government agency can or should make those decisions for us.

Hence, people should be left free to spend their own health care dollars according to their own best judgment for their benefit based on their priorities and values.

This precious freedom will evaporate as ObamaCare is implemented. Instead of patients and doctors making these decisions according to the patient's values, they will be made by central committees enforcing "practice guidelines" dictated from above to doctors working in government-sanctioned "Accountable Care Organizations" and "Medical Homes". These decisions will be based on the government's values, not the patients'.

Do Americans really want the government making these decisions for them?

Haynes on the Doctor-Patient Relationship

Dr. Beth Haynes of the Black Ribbon Project has a great post on how ObamaCare will destroy the doctor-patient relationship.

Nor is this some "unintended consequence". Instead, it is the explicitly desired goal of men like Donald Berwick.

Read the full text of, "ACA intentionally undermines the Doctor-Patient relationship".

Faith-Based Propaganda

The Obama Administration further entangled religion and politics in this latest attempt to salvage his deeply unpopular health care plan.

Sarah Kliff at Politico reports, "Obama seeks divine intervention on health care":

With nothing else working, President Barack Obama is asking religious leaders to help him sell the public on health care reform.

POLITICO listened in to an Oval Office conference call Tuesday, where Obama and top administration officials, beseeched thousands of faith-based and community organizations to preach the gospel on new insurance reforms, chiefly the Patients' Bill of Rights.

"Get out there and spread the word," Obama told leaders from across the religious spectrum on the conference call, organized by the Health and Human Services Center for Faith-Based and Community Partnerships.

(Read the full text of "Obama seeks divine intervention on health care". Link via David Catron.)

His appeal to faith is not surprising, especially given that fact-based analysis of the law increasingly shows that "Obamacare is even worse than critics thought" (Washington Examiner, 9/22/2010).

Two quick comments:

1) I support the principle of separation of church and state. Hence, I think it's inappropriate for politicians of either major political party to attempt to enlist any kind of official religious backing (or opposition) to government policies.

2) I am also a supporter of abortion rights.

Hence, with respect to the Examiner OpEd, it is true that one serious problem with ObamaCare is that it compels people to pay for others' elective abortions against their will. But this is just an instance of the more fundamental problem -- namely that ObamaCare compels people to pay for all sorts of medical procedures (such as heart surgeries and colonoscopies) for others against their will.

Hennenfent on Death Panels

Dr. Brad Hennenfent has updated his blog post, "The 'Death Panels' are Real and They Exist Now".

He notes that the stealth rationing occurs due to government policy and "crony capitalism" (i.e., insurance companies acting as proxies for the government).

The quote by Dr. Kevin Pezzi on the problems of the government-run VA hospital system is especially worth reading. Here's an excerpt:

Anyone who values their life, or the lives of loved ones, should fear any healthcare system controlled by the government because the government excels at creating massive bureaucracies, such as those in VA hospitals, in which employees who are not doctors can overrule physician orders. No President or Congressman would have the guts to personally tell a doctor what he can and cannot do, but the need of politicians to control us is so strong that they create cold and uncaring bureaucracies to do the dirty work for them.

Who is on the short end of the stick when politicians ration care? Patients, who pay for that rationing with more suffering and an increased risk of death. President Obama tried to dismiss the notion of government "death panels" by claiming that he would create no such bureaucracy. He doesn't need to do that to achieve his objectives because every government bureaucracy in which doctors can be overruled by people who don't know what they are doing is functionally a death panel even though it is never labeled as such.

Quick Links: Avastin, Taxes, Thuggery

The FDA has delayed its decision on whether or not to ration the cancer drug Avastin until after the November elections.

ObamaCare levies a new 3.8% tax on the sale of your home.

Brian Schwartz covers the upcoming state-level thuggery here in Colorado over some insurers' plans to stop offering certain types of plans due to costly government regulations.

FIRM's Facebook Page

I recently created a fan page on Facebook for FIRM. If you're a fan, please spread the word about free market medicine by hitting the "like" button!



Also, you can find FIRM on Twitter here: @WeStandFIRM.

Zawistowski On Free Market Health Reforms

The Fall 2010 issue of The Objective Standard features an article on free market health care reforms by Stella Daily Zawistowski, "A Prescription for America's Health Care Ills".

Her article:

Compares and contrasts the cost, quality, and accessibility of government-regulated, rights-violating medicine with that of free-market, rights-respecting medicine and finds, once again, that the moral is the practical.

The introduction is available to all.

Subscribers have access for the full text. Interested non-subscribers can purchase the PDF for $3.95.

Armstrong Interviews Cassell

Ari Armstrong attended the 9/12 Tea Party rally in Washington, DC, and interviewed several participants, including Dr. Jack Cassell.

Casell is the Florida urologist who made national headlines by posting a sign on his office door after ObamaCare had passed saying, "If you voted for Obama, seek urologic care elsewhere".

The short segment with Dr. Cassell starts at 0:29:



In particular, Cassell notes that ObamaCare makes it impossible for doctors to uphold their Hippocratic Oath to their patients. And it will lower the life expectancy of the American people. He also expects that it will be "defunded", then eventually repealed.

Let's hope he's right.

Catron on Accountability

David Catron writes on "Accountability and Its Discontents".

He examines some of the leading theories by leftist pundits as to why America has turned so sharply against the current administration's policies:

...[A] variety of lesser liberal outlets have used their columns and posts to vent frustration with the electorate's inability to see that the current regime has been a success. Why, they ask, is the public not grateful for the "historic" health reform bill, the stimulus package and Wall Street reform? What, they demand to know, are the voters not getting?

Catron notes that they are blaming the voters -- for instance, blaming it on voters' seeming madness ("cognitive dissonance"), stupidity, or racism.

Of course, they seem to not even consider the possibility that the voters' concerns are justified -- that Americans don't want their freedoms infringed, that they don't want their hard-earned money spent on boondoggle make-work "stimulus" projects, and they don't want to support a system that punishes people who live responsibly, create values, and sustain the economy while rewarding those who live irresponsibly at others' expense.

And most critically, they don't want to be held accountable for the failures their policies have caused -- so they instead blame the voters for not "getting with the program".

Come November, we'll see another round of accountability as voters make their preferences known loud and clear.

Whether the "progressives" learn from that reality-check will be up to them. But given their bizarre "blame-the-voters" mindset, I won't hold my breath waiting.

OECD on Canada

Canada's socialized health care system is in trouble. Yes, I know you're all surprised.

Here are more details from the 9/14/2010 National Post, "OECD Prescription".

(Via Monica Hughes.)

Sissel Fights Back

Matt Sissel explains, "Health-care reform: Why I'm suing to get back my freedom" in the 9/13/2010 Christian Science Monitor.

Here's an excerpt:

I'm a healthy young man fresh out of art school. I'm starting a small business, based in Iowa City, as a fine artist specializing in realistic drawing and painting. I have limited means and struggle to achieve my modest dreams. Every penny counts in the service of my career goals, but the federal government is intent on slowing down my progress and the progress of every other productive man and woman in this country in its drive to socialize the American health care system.

As a business person, I intend to cover my own medical expenses, and I want the freedom and flexibility to do my own budgeting, including setting aside money for medical needs.

I don't want the federal government dictating my personal financial decisions.

It can't even run its own budget!

The closing is especially nice:

I proudly served our country in the Iowa Army National Guard as a combat medic, spending two years in Iraq and eventually being awarded the Bronze Star. I mention that experience in order to drive home this point: While I am proud to have served my state and my country as a volunteer, I object to being conscripted into a federal health-care program that is at odds with basic constitutional principles of individual rights and limited government.

I see my lawsuit as a battle for my liberty -- my freedom to live out my life to the fullest without costly, one-size-fits-all dictates from the government. I am fighting the command-and-control health-care plan in order to safeguard the health of our Constitution and the freedoms it protects for me and for all Americans.

Thank you, Mr. Sissel, for standing up for your rights!

Hsieh PJM OpEd: Get Ready For Your Health Care 'Re-Education'

The September 14, 2010 PajamasMedia has just published my latest OpEd, "Get Ready For Your Health Care 'Re-Education'".

My theme is that the government has started an Orwellian "re-education" program to get the public to embrace ObamaCare -- and Americans must respond by teaching our politicians a lesson this November.

One excerpt:

In effect, the government is saying: "Let's pretend we never said ObamaCare would lower costs -- even though that's how we sold it to the public." "Let's push patients into restrictive health plans -- and call it a 'medical home.'" "Let's label it 'misinformation' when insurers tell the truth about how our laws raise their costs -- and then punish them if they complain about it."

And as the problems of ObamaCare deepen, we can expect such "re-education" efforts to intensify.

(Read the full text of "Get Ready For Your Health Care 'Re-Education'".)

And thanks to Glenn Reynolds for the Instapundit link!

Thuggery Updates

Betsy McCaughey warns us, "Get set for big premium hikes". (NY Post, 9/13/2010).

Michael Barone notes, "Gangster Government Stifles Criticism of Obamacare". (RealClearPolitics, 9/13/2010).

The 9/13/2010 Wall Street Journal explains that "Sebelius Has a List". As they note:

What Ms. Sebelius really means is that the government will prohibit insurers from doing business if reality is not politically convenient for Democrats.

Sebelius' approach is the federal government's latest version of the old saying, "The beatings will continue until morale improves".

Wolf is Back!

Dr. Milton Wolf is back and he's blogging up a storm!

Here's his latest, "Presidenting is Hard"

Sarrionandia Reports From The UK

UK resident Roberto Sarrionandia reports on his experience with the British National Health Service (NHS) when he suffered bad burns.

Basically, his experience was a roller-coaster of excellent and terrible care. In many ways, it's like the government (public) schools -- maybe you'll get a good teacher for your children, and maybe you won't. But you don't really have a say in the matter and your future is essentially up to luck.

Read the full text of his post, "A Healthcare Anecdote".

Quick Links: Cost Curve, Primary Care

Hot Air notes that "ObamaCare bends the cost curve... upward". (Related article, "Health Outlays Still Seen Rising".)

The WSJ notes, "Access to Primary Care No Guarantee of Better Care". Hence, any central-planning approach to somehow increase the numbers of primary care doctors won't necessarily actually improve medical outcomes.

Plus based on the Masschusetts experience, we can expect that primary care shortage will get worse and wait times will get longer once ObamaCare is implemented nationwide.

It's All About The Control

Today's nanny-state story on nutrition and health comes from Iowa, "Big Brother in Iowa? School District Monitors Kids' Lunch Choices":

An Iowa school district's lunch program asks children as young as 5 years old to memorize a four-digit PIN code so it can monitor what they eat in the school cafeteria -- prompting some parents to claim it's an unhealthy case of "Big Brother."

The Ankeny Community School District is maintaining a database that records what the kids buy to eat and then checks their food choices against national nutrition guidelines.

The program is intended to provide the children with more food options while ensuring compliance with new and stricter state-mandated nutrition requirements. But some parents are worried that the program infringes on people's freedoms...

Just as the government wants to monitor doctors to see if they follow proper "guidelines", some people want to ensure all children eat according to government guidelines.

It's not about keeping people healthy, it's about controlling people.

Doctors Hiring Scribes for EMRs

Under ObamaCare, physicians' offices will be required to use government-approved electronic records. (The Department of Health and Human Services even specified what counts as "meaningful use" to prevent physician offices from just purchasing the equipment but not using it.)

But because the EMRs (electronic medical records) make physicians so inefficient, many doctors are responding as one would expect: "Doctors hiring scribes because of electronic medical records".

Here's an excerpt:

...[I]t's rather difficult to tend to the computer when you’re supposed to be tending to the patient. It's relatively easy to write with pen and paper while listening and explaining. It's far harder to keep two hands on a keyboard, a third hand on the mouse, one eye on the screen and another eye on the patient and his family.

And the fact that most EMRs and user interfaces are designed by computer geeks with no knowledge of clinical care or workflow certainly doesn't help matters. As soon as EMRs are deployed, physician productivity typically goes down by about 50%. It rarely gets back to where it was prior to installation.

(Read the full text of "Doctors hiring scribes because of electronic medical records".)

So rather than saving money, mandatory EHRs will increase costs, decrease physician productivity, and increase patient waits. This is another lose-lose for both patients and doctors under ObamaCare.

Ari Armstrong and Diana Hsieh on Personhood

[Ari Armstrong and Diana Hsieh have just released the following major policy paper on the Colorado "Personhood Amendment". This is a major contribution to the abortion and "personhood" debate and I hope FIRM readers will circulate this information to all interested friends and colleagues. -- PSH]

==========

The Coalition for Secular Government is pleased to announce the release of its policy paper on the "personhood" movement by Ari Armstrong and Diana Hsieh (Ph.D): The 'Personhood' Movement Is Anti-Life: Why It Matters that Rights Begin at Birth, Not Conception (PDF or HTML).

The 'Personhood' Movement Is Anti-Life

Why It Matters that Rights Begin at Birth, Not Conception

by Ari Armstrong and Diana Hsieh, Ph.D.

A policy paper written for the Coalition for Secular Government (www.SecularGovernment.us)

Published on August 31, 2010

Formats: HTML or PDF

Contents

• Introduction
• The 'Personhood' Movement
  • "Personhood" and the Abortion Debate
  • Colorado Campaigns
  • Campaigns in Other States
• The Destructive Effects of 'Personhood'
  • A Legal Quagmire
  • Harsh Legal Penalties
  • Bans of Elective Abortions
  • Abortions to Protect a Woman's Health
  • Abortions for Rape, Incest, and Fetal Deformity
  • Bans of Common Birth Control Methods
  • Bans of Common Fertility Treatments
  • Bans of Embryonic Stem-Cell Research
  • Amendment 62 Is Anti-Life
• Individual Rights and Abortion
  • The Compromise of Roe v. Wade
  • Today's "Pro-Choice" Rhetoric
  • The Core Arguments for "Personhood" Laws
  • Rights in Pregnancy
• The Morality of Abortion
• 'Personhood' and the Separation of Church and State
• Amendment 62 Is Not a 'Message'
• Notes

From the Introduction

Amendment 62, set to appear on Colorado's 2010 ballot, seeks to legally establish personhood from the moment of conception, granting a fertilized egg (or zygote) full legal rights in the state's constitution. Following in the footsteps of 2008's Amendment 48, Amendment 62 is the spearhead of a national campaign to outlaw abortion and other practices that could harm a zygote, embryo, or fetus.

If fully implemented, Amendment 62 would profoundly and adversely impact the lives of sexually-active couples, couples seeking children, pregnant women and their partners, doctors, and medical researchers. It would subject them to severe legal restrictions, police controls, and in many cases protracted court battles and criminal punishments.

Amendment 62 would outlaw abortion, even in cases of rape, incest, terminally deformed fetuses, and danger to the woman's health. It would prohibit doctors from performing abortions except perhaps in some cases to save the life of the woman, thereby endangering the lives and health of many women. In conjunction with existing statutes, Amendment 62 would subject women and their doctors to first-degree murder charges for willfully terminating a pregnancy, with the required punishment of life in prison or the death penalty.

The impact of Amendment 62 would extend far beyond abortion into the personal corners of every couple's reproductive life. It would outlaw many forms of birth control, including the pill, IUD, and "morning after" drugs. It would require criminal investigation of any miscarriages deemed suspicious. It would ban potentially life-saving embryonic stem-cell research and common fertility treatments.

Amendment 62 rests on the absurd premise that a newly fertilized zygote is a full human person with an absolute right to biological life-support from a woman--regardless of her wishes and whatever the cost to her. The biological facts of pregnancy, in conjunction with an objective theory of rights, support a different view, namely that personhood and rights begin at birth. Colorado law should reflect those facts, not the Bible verses so often quoted (and creatively interpreted) by advocates of Amendment 62 and other "personhood" measures.

About the Authors

Ari Armstrong publishes Free Colorado and co-authors a column for Western Colorado's Grand Junction Free Press. He is the author of Values of Harry Potter: Lessons for Muggles, a book exploring the heroic fight for life-promoting values in the Potter novels.

Diana Hsieh founded the Coalition for Secular Government in 2008. She earned her doctorate in philosophy from the University of Colorado, Boulder. She is currently working on a book on Ayn Rand's novel Atlas Shrugged, based on her series of podcasts at ExploreAtlasShrugged.com. More of her work can be found at DianaHsieh.com.

Read The 'Personhood' Movement Is Anti-Life: Why It Matters that Rights Begin at Birth, Not Conception (PDF or HTML).

Schwartz on Amendment 63

Brian Schwartz has an OpEd in the September 4, 2010 Colorado Springs Gazette, "Opposition to Amendment 63 both flawed and deceptive".

In particular, he debunks the following fallacy:

Edie Sonn of the Colorado Medical Society says Amendment 63 “will lead to higher health care costs for insured individuals and businesses as they are forced to absorb the costs of the uninsured.” This cost-shifting argument is both wrong and deceptive. Mandatory insurance will increase costs and impose much larger cost shifts.

(Read the full text of "Opposition to Amendment 63 both flawed and deceptive" for his detailed analysis.)

I also left the following comment on the editorial webpage:

Although I am a member of the Colorado Medical Society, I have to disagree with them when they declare that Amendment 63 will raise costs. Instead, it will lower costs and protect individual freedoms. It's the right thing for Colorado, and I hope the voters take advantage of this opportunity to defend both their pocketbooks and their freedoms.

Desperate Measures

Because of costs imposed by burdensome regulations, drug companies often do not pursue research into treatments that could benefit patients.

Dr. Stephane Huberty learned this the hard way when he was diagnosed with myasthenia gravis.

The September 2, 2010 Wall Street Journal describes the measures Dr. Huberty had to take (including injecting himself with an unapproved treatment he helped develop) in its article, "Desperate for a Treatment, One Physician Heals Himself".

(Via Dr. AA.)

Quick Links: Scherz and Amerling

Dr. Hal Scherz of Docs4PatientCare has piece in the September 1, 2010 Wall Street Journal entitled "Dear Patients: Vote to Repeal ObamaCare".

One critical passage:

In making doctors answerable in the federal bureaucracy this bill effectively makes them government employees and means that you and your doctor are no longer in charge of your health care decisions. This new law politicizes medicine and in my opinion destroys the sanctity of the doctor-patient relationship that makes the American health care system the best in the world...

(Read the full text of "Dear Patients: Vote to Repeal ObamaCare".)

Dr. Richard Amerling of AAPS warns of "Enslavement by Health Insurance".

He likens our current system of tax-preferred employer-based health insurance to working in an oppressive "company store":

During World War II, the government imposed wage and price controls. In an effort to attract and retain workers, companies offered health insurance in lieu of wages. These benefits were not taxable for either the employer or employee. When the war ended and controls lifted (everywhere except in New York City, where rent controls persist to this day), the tax subsidy for employer-sponsored health insurance was retained. This explains why the majority of working Americans buy health insurance at work, at the "company store." This accident of history underlies much of what has gone wrong with health care in America...

(Read the full text of "Enslavement by Health Insurance".)

University of Colorado Clinics Turn Away Medicare/Medicaid

The August 27, 2010 Denver Post reports that "Two University Hospital clinics balk at government insurance".

Specifically, they are turning away patients covered by Medicare and Medicaid -- because they lose money on each one. These patients all have theoretical "coverage", but that's not the same as getting actual medical care.

Medicare and Medicaid are the government-run "universal coverage" programs for the elderly and the indigent, respectively. We can expect to hear about more such problems as the entire country moves towards a system of government "coverage".

(Via @MatthewBowdish.)

Hsieh LTE in Gazette on Amendment 63

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

Doctor gives thanks for 63

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

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

Paul Hsieh, MD
Sedalia

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

Catron: The Laugher Curve

David Catron illustrates the unintentional comedy stylings of the advocates of ObamaCare in his latest piece, "The Laugher Curve".

Here's an excerpt:

Among the most hilarious ObamaCare justifications is the claim that it will reduce the federal budget deficit. No less a jokester than Paul Krugman produced this gag in a recent blog post, "the Medicare actuaries believe that the cost-saving provisions in the Obama health reform will make a huge difference to the long-run budget outlook... All the facts we have suggest that health reform was the biggest move toward fiscal responsibility in a long, long time."

The comedy writers from whom Krugman got this quip are the CMS bureaucrats who produced the latest Medicare Trustees Report, which claims "reform" will control Medicare spending enough to keep the program solvent while easing upward pressure on the deficit.

Alas, not everyone appreciates this brand of humor. One such stick-in-the-mud is Richard Foster, Medicare's Chief Actuary...

(Read the full text of "The Laugher Curve".)

Fortunately, we have a chance in November to send a message to our elected officials that we want ObamaCare repealed.

Let's make sure the last laugh is on the ObamaCare supporters, rather than on us.

Laugesen Defends Amendment 63

In the August 27, 2010 Colorado Springs Gazette, editor Wayne Laugesen defends the Right to Health Care Choice Initiative in their editorial "Amendment 63 protects our freedom".

In particular, Laugesen notes:

This is not a country in which might makes right. It's a country designed to protect minority interests against big government and mob sentiment. Therefore, the massive size of the federal bureaucracy alone does not equal legal authority to impose upon individuals and state governments. Congress has no authority to require individuals to buy private insurance, which is the basis of the lawsuit filed by states. It has no such authority because the Constitution does not grant it, not by any twisting of any phrase. That might not bother a majority in Congress, but it will most certainly matter to federal judges when they determine which rights belong to whom -- based entirely on their interpretation of the Constitution.

(Read the full text of "Amendment 63 protects our freedom".)

I'm glad to see newspapers like the Colorado Springs Gazette and editors like Laugesen speaking out for limited government and individual rights!

CO Amendment 63 and Risk Pools

Brian Schwartz discusses "Colorado Amendment 63, risk pools, & health care costs" at PatientPower.

Go check it out!

CastroCare In Crisis

So how's that universal Cuban health care working out?

Laurie Garrett discusses the current state of health care in Cuba in "Castrocare in Crisis". Here's an excerpt:

For years, Cuban hospital patients have needed to provide their own syringes, bed sheets, and towels. Some say they fear getting infections while visiting clinics because of shortages of soap, disinfectants, and sterile equipment.

A preventable form of cancer, cervical carcinoma, now ranks as the fourth leading cause of death for Cuban women. In most of the world, cervical cancer is on the decline thanks to annual gynecological screenings (with the Pap test) and the use of the human papillomavirus vaccine. In Cuba, however, the number of routine Pap tests performed has fallen by more than 30 percent and the number of diagnosed cervical cancer cases has doubled since 1985...

Cuba's doctors are increasingly strained. Physicians return from years abroad because they must, both contractually and to avoid repercussions for their relatives in Cuba. They then must accept whatever assignments the government gives them, including sometimes years of service in a remote village, a Havana slum, or a sparsely populated tobacco-growing area.

Many doctors and nurses leave the health-care system altogether, taking jobs as taxi drivers or in hotels, where they can earn CUCs. In February 2010, seven Cuban doctors sued the Cuban and Venezuelan governments, charging that the mandatory service they had performed in Venezuela in exchange for oil shipments to the Cuban government constituted "modern slavery" and "conditions of servilism for debt."

(Read the full text of "Castrocare in Crisis".)

Michael Moore must not have gotten the memo...

Via NCPA.

CO Health Care Choice Qualifies For Ballot

Today's Denver Post reports that the "Right to Health Care Choice" amendment has qualified for the November 2010 ballot, as Amendment 63.

There's also an official website for Amendment 63, where you can read the text of the Amendment.

I'm glad to see CO joining the list of states where voters are able to express their desire for genuine health care choice!

(Via @AriArmstrong.)

Quick Links: Innovation, Medicaid, Braking ObamaCare

Cleveland Clinic CEO Toby Cosgrove warns that "health-care reform could stifle medical innovation". (Cleveland Plain Dealer, 8/19/2010)

John Goodman points out how government-run Medicaid arbitrarily withdraws benefits from patients ("recissions") in far more arbitrary and abusive fashion that private insurance. (Kaiser Health News, 8/12/2010)

Grace-Marie Turner discusses 6 ways to slow down ObamaCare until its eventual repeal. (WSJ, 8/25/2010)

Hsieh PJM OpEd: "Avastin and Your Life"

PajamasMedia has just published my latest OpEd, "Avastin and Your Life".

Here is the introduction:

The Food and Drug Administration (FDA) is on the verge of taking the highly unusual step of "decertifying" the cancer drug Avastin that it had previously approved.

In addition to sparking concerns that this is another step towards medical rationing, the FDA's proposal will worsen another important but less-frequently recognized danger of government-run health care -- namely, the politicization of health benefits. Both problems will accelerate under ObamaCare unless our politicians repudiate the principle of government-run health care...

(Read the full text of "Avastin and Your Life".)

Fast Track To Government Health Care

Grace-Marie Turner explain how regulators' interpretation of the seemingly arcane "medical loss ratio" could determine whether private insurance survives as an industry, or whether it becomes a back-door path to a government-run "single payer" system.

Her piece in the August 20, 2010 Investors Business Daily is entitled, "Fast Track To Government Health Care".

Here's more political wrangling over the same issue: "Debate Heats Up Over Medical Loss Ratios".

Economist on Consumer DNA Testing

The Economist has a short series of articles on consumer DNA testing:

"What lies within" (The personal genetic-testing industry is under fire, but happier days lie ahead)

"Reading genes" (Alas, a DNA test probably won’t reveal your future. But a crackdown on consumer genetics is unwise)

"The part where I find out that I may get fat" (What our science correspondent found out about herself when she tried commercial gene testing)

"The part where I find out the government doesn't like what I'm doing"

(My own piece on this topic is available at PajamasMedia: "Should You Be Allowed to Know What’s in Your DNA?")

Stuff Found In Patients

As a change of pace from heavy policy stuff:
"Medical Tales Of Strangest Objects Found In Patients".

(Via Cosmic Log.)

Pipes: Why ObamaCare Must Be Repealed

In the August 17, 2010 RealClearPolitics, Sally Pipes discusses "Why ObamaCare Must Be Repealed".

She draws on the experience in Canada and Massachusetts to show how ObamaCare's proposed incremental "reforms" will inevitably lead to a full government takeover of American health care. Here's an excerpt:

Obamacare promises to expand coverage in the same way that Massachusetts did -- by expanding government-funded insurance. Canada did the same thing. Worse, Rep. Lynn Woolsey (D-CA) - introduced on July 21 an amendment to the Affordable Care Act, backed by 128 lawmakers, to bring back the "public option" that failed to make it into the final health reform package.

To pay for all this new coverage, Obamacare introduces a number of new taxes on individuals and businesses. Once the Treasury has its hands on all that new revenue, it's unlikely that it will ever be able to let go. Those taxes will be here to stay.

And when costs spiral out of control -- as they have in Canada and in Massachusetts -- American officials will likely double-down on their bets and seize ever-greater control of the healthcare system. Canada banned the private delivery of medicine in response to runaway costs, while Massachusetts sees a system of global per-patient budgets as the solution to its cost problems. Federal officials will no doubt implement some combination of the two...

(Read the full text of "Why ObamaCare Must Be Repealed".)

It's still not too late to repeal it!

Colorado Updates

In the August 14, 2010 Wall Street Journal, Stephen Moore describes some of the obstacles that had to be overcome in order for the Colorado Health Care Freedom Act to qualify for the November ballot. The details can be found in his piece, "Health Care Freedom Comes to Colorado".

In the August 9, 2010 Colorado Springs Gazette, Seth Richardson discusses the benefits of that initiative in his piece, "Opposing Obamacare with the 'Right to Health Care Choice' initiative".

Brian Schwartz explains why the CO initiative is not just a PR stunt. Instead, it's carefully crafted to avoid the standard objection of "a state law (or state constitutional amendment) can't trump federal law".

(First two links via StateHouseCall.)

Update: One sharp-eyed reader noted a minor inaccuracy in the Moore WSJ piece. The CO initiative does not block any federal law. Instead it blocks any state-level measures to require residents to purchase health insurance. Also, it's not yet officially on the ballot.

Off Topic: Hsieh OpEd on NYC Mosque

Off topic: For those who are interested, the August 17, 2010 American Thinker has published my OpEd, "The Real Problem Is Not the Mosque But the Nukes".

My theme is the NYC Mosque would become a non-issue if the US would adopt a proper foreign policy, explicit identify our enemy, and take the necessary action against Islamic Totalitarianism and its primary state sponsor Iran.

I also cite and quote John Lewis' article from The Objective Standard, "No Substitute for Victory" as an example of the approach our current political leaders should adopt.

Hsieh PJM OpEd: "Transparency For Me, But Not For Thee"

PajamasMedia has just published my latest OpEd, "Transparency For Me, But Not For Thee".

My theme is that our government's ever-increasing demands for access to our personal data while simultaneously preventing us from gathering information about it threatens to turn America into a chilling "interrogation room society" where transparency only goes one way. Hence, Americans must demand government transparency as a corollary to the broader principle of properly limited government.

Here is the opening:

When President Barack Obama took office, he pledged to make his administration "the most open and transparent in history." However, government officials are now demanding ever-increasing amounts of information about ordinary Americans, while preventing citizens from gathering similar information about government operations. If this ominous trend continues, this "transparency" will be in one direction only -- which bodes ill for the future of our republic.

(Read the full text of "Transparency for Me, but not for Thee".)

The Specialist Wall

Physician-blogger "911doc" describes the latest response of specialists to federal EMTALA requirements that they treat emergency room patients for free, regardless of need.

Here is an excerpt from his post, "The Specialist Wall":

If you are unfamiliar with EMTALA or our take on it you can read about it here, but to be brief, EMTALA is an unfunded federal mandate passed in 1986, which, de facto, has made it a crime to tell anyone 'no' in the ER. Because of this, the specialists on call have learned to hate the ER. The ER is no longer a place from which one can build a practice, it is, rather, a place that compels you lose sleep, and money. It compels consultants to expose themselves to full malpractice liability EVERY SINGLE TIME they accept a patient from us whether they ever get paid or not.

No doubt there is a strong tradition in western medicine to treat first and seek payment later. This dates to Hippocrates and is part of the original oath. My question is this. How far should this obligation extend, AND, should it be extended by force of law rather than by individual choice?

...[T]he specialists are fed up, and they have figured out how to fight city hall. For years their battle has been against the system or even the ER doc downstairs. But now (oh the genius!) they have turned the bureaucrats game against them. EMTALA and the bylaws, policies, and rules that it has generated are being followed to the letter.

For instance, almost all hospitals have an on-call policy for specialists that require them, if the ER doc requests it, to come in to the ER and evaluate the patient. Well, they can be forced to do this, but in many cases they CAN NOT be forced to treat the patient. Unheard of twenty years ago and before EMTALA, but specialists are now routinely coming in, evaluating the patient, and finding reasons why this particular case is out of their area of expertise, or not appropriate for their care, or not in need of surgery immediately, and the specialists are going home.

Recently, a child came in to the ER after sustaining a facial laceration. Two different surgeons were called to fix the cosmetically sensitive but clearly non-emergent laceration. Both came in, and both told the ER doc, "No issue, you can do this." And that's exactly what happened -- the ER doc sewed it up (I hope he did it well). And that's exactly what EMTALA means, and exactly what Obamacare means, and it ends up hurting people who do not deserve it, and it ends up rewarding those that do not deserve it. And yes, I said "DESERVE", and yes, I mean it. Punishing the doers eventually causes them to slip the yoke.

(Read the full text of "The Specialist Wall".)

This is a tragic (and predictable) consequence of the notion of an automatic "right" to health care. Attempting to create such a right necessarily enslaves those who must be compelled to provide such care. Many doctors will refuse to work under such terms, recognizing the gross injustice of such attempted automatic claim upon their time and expertise -- especially when it only brings them medico-legal risk with no compensation.

I thank for "911doc" for analyzing this important issue at a deeper moral level (rather than at simply the economic level), for showing how bad ideas will have real-life consequences for patients and doctors, and for speaking his conscience.

Medicare Miscounting

The August 10, 2010 Chicago Tribune summarizes the various bad accounting tricks and assumptions used to falsely bolster the fiscal health of Medicare.

Here's an excerpt from "Medicare's Rosy Health*":

For example: The report assumes that Congress will deeply slash doctors' Medicare pay. Congress has threatened to do so, but has always backed off. That's the infamous "doc fix." The doctors are due for a 23 percent pay cut in December. Congress will back down, as it always does.

Scratch about $250 billion to $300 billion in "savings" over a decade.

...Another example of the absurdity of these projections: Under an inflation formula imposed by the new law, Medicare payments would tumble below the abysmally low Medicaid payments by the end of the decade. They'd fall from nearly 80 percent of private insurance prices now to about 50 percent by 2050. That would squeeze many doctors, hospitals, surgical centers and other providers into oblivion.

Long before that happens, hospitals and other facilities will stop treating Medicare patients and raise costs for private patients...

(Read the full text of "Medicare's Rosy Health*".)

Sooner or later, reality will always catch up with bad accounting. The only question is when.

Haynes on Social Justice and Medical Ethics

Dr. Beth Haynes of the Black Ribbon Project makes some insightful observations about the recent push to teach "social justice" to medical students.

Here's an excerpt from her essay, "Social Justice and Medical Ethics":

Since 2005, the "Initiative to Transform Medical Education" has been working to correct what it views as deficiencies in the current training of phsicians. These include an over-emphasis on the ability to acquire knowledge and problem solve-- to the detriment of "caring." Traditionally, physicians have expected to be autonomous decision-makers -- but that clashes with "increasing requirements...to be more accountable to various constituencies, including...the public, payers and government." Although physicians are recognized as "prepared to do what they believe is best for individual patients... [t]hey are not...prepared to participate in ethical and political discussions about the allocation of health care resources, which are not limitless."

"Social justice" is a euphemism for economic egalitarianism--and since people do not naturally come by equal wealth, "social justice" requires taking from some to give to others. "Social justice" is in direct conflict with the principles of equality before the law and the right to private property. "Social justice" also requires that a physician NOT advise his patients solely based on what is in the patients own best interest. He must instead somehow "balance" the patient's interests with those of the rest of society.

This collectivist view of "social justice" places doctors at odds with their Hippocratic Oath to do their best for the individual patient. Yet this is what our government attempting to force doctors to do.

Dr. Haynes goes on to explain the proper way to approach medicine -- as a business in which physicians and patients exchange value for value as traders in a free market. In other words, capitalism:

Capitalism is nothing more than individual rights applied to trade. Profits, in medicine as in any economic transaction, are not gained by exploiting patients or customers. Profits are simply the proper reward for successfully offering a value to others which is worth more to them than it costs to produce. In a system of free trade, self-interests are not in conflict -- not even between a physician and a patient. In a direct-pay, fee-for-service relationship, it is in the best long term interest of the physician to offer advice and treatment based on the patient's best interest. And, it is in the best long term interest of the patient to only deal with a physician who does!

We can not defend patients' freedom without also defending the freedom of physicians. We can not protect the doctor-patient relationship without protecting the autonomy of both. Freedom of association and freedom to contract are interrelated principles fundamental to a free republic, to capitalism and to the ethical practice of medicine. "Social justice" requires that the individual be sacrificed to the collective. Such an act is as immoral in medicine as it is anywhere else.

Read the whole thing.

And if you like her work, feel free to contribute to the Black Ribbon Project!

What To Expect Under Berwick

Dr. Richard Amerling of AAPS explains "What to Expect Under the Reign of Berwick".

Here's an excerpt:

How will standardized care be implemented? One route will be the electronic health record (EHR). They cite the example of HealthPartners in Minnesota who, in order to cut down on the use of high-tech imaging procedures "incorporated appropriateness criteria for radiological tests into the EMR as a reminder to primary care doctors."

There will also be a "primary focus on changing professional practice culture through the engagement of physicians in developing and implementing practice standards. The framework derives partly from known principles and methods of guideline or protocol development." They suggest starting small with "selective, smaller scale efforts to reduce overuse," as this will "prepare the local culture for broader changes in the future."

There can no longer be any doubt that this is what the future holds should ObamaCare survive the dozens of legal challenges. The underhanded recess appointment of this devoted central planner confirms our grim predictions. There is also no question this approach will fail, and fail on a grand scale. There will be shortages, dislocations, more massive bureaucracies, huge cost overruns, and what may be an irreversible loss of quality. Along the way, thousands, if not millions of patients will be harmed.

(Read the full text of "What to Expect Under the Reign of Berwick".)

The government will seek to control ever-increasing aspects of health care in the name of "efficiency" and "standardization". But once you give the government control over the people's health, you've given it control over their lives. Our freedoms and our individual rights will be the inevitable casualties.

Ten Inconvenient Truths

Dr. Richard Reece lists 10 "Inconvenient truths about our health care system".

Here are a couple of examples:

4. The next political crisis will be limited access to doctors; this is already occurring in Boston, where waiting times to see doctors are 2 to 3 times the national average for comparable cities.

7. Passing federal laws permitting patients to enroll in plans and "portability" of plans across state lines would make a public option unnecessary and would render private plans "competitive."

8. Ending "community ratings," which force the young to pay the same premiums as older individuals, and reducing "standard benefit plans," which often include unnecessary benefits, would reduce premiums for the young and decrease the number of uninsured.

Read the whole thing.

(My only comment is that I don't think we should try to salvage Medicare by patching the low rates paid to primary care physicians; instead we should gradually phase the program out entirely and privatize it.)

Get Ready For the Bureaucracy

How much bureaucracy will we be in for under ObamaCare? Nobody knows -- not even Congress.

According to this recent article in Politico, "Health reform's bureaucratic spawn":

Don't bother trying to count up the number of agencies, boards and commissions created under the new health care law. Estimating the number is "impossible," a recent Congressional Research Service report says, and a true count "unknowable."

The reasons for the uncertainty are many, according to CRS's Curtis W. Copeland, the author of the report "New Entities Created Pursuant to the Patient Protection and Affordable Care Act"...

(Read the full text of "Health reform's bureaucratic spawn".)

What we do know is that costs will continue to go up and freedoms go down.

Green Light for Paul Hsieh's Top-Tier Op-ed

[From Diana.]

I'm pleased to announce that, thanks to your generous pledges, Paul Hsieh will be diligently working on publishing an op-ed on a top-tier paper over the next few months. Hooray!

Many thanks to those of you who pledged -- 48 people in total! You've made this step-up in Paul's activism worth his extra time and effort. But please don't send any money now... Paul has to publish the op-ed for any of us to owe him so much as a cent. (Yes, I pledged!)

The pledge form will remain active until Paul publishes the op-ed -- or until the deadline expires at the end of 2010. (Let's hope for the former!) So if you missed the original pledge drive but wish to offer Paul some additional motivation, you're welcome to pledge below.

Our many, many thanks to everyone who pledged. It's so gratifying to see people support Paul's work, as we've seen here. It's major spiritual fuel for us -- and I hope for you too!

Here's the pledge form:

How's That Swedish Universal Care Going?

John Stossel discusses the latest medical outrage in Sweden in his blog post, "Great Moments In Government-Run Health Care":

...What really astounds me is not that a Swedish man sewed up his own leg after waiting for a long time in a hospital. Heck, I wouldn't be surprised if things like that happened in all nations.

The really disturbing part of the story is that the hospital then reported the man to the police. A classic case of "blaming the victim." The bureaucrats in Sweden's government-run healthcare system obviously were not pleased that he called attention to their failure.

Here's the original news story.

Lucidicus Interview With Peter Schiff

The Lucidicus Project has a nice interview with US Senate candidate Peter Schiff.

Schiff gives several good suggestions for free market health care reforms. Read the whole thing!

Brook: How To Free Health Care

From ARC-TV:

Yaron Brook presents a series of concrete suggestions on how to bring us closer to a free market in health care. This is an excerpt from the Q-&-A session of a talk that Dr. Brook delivered at the University of Pennsylvania on May 11, 2010.

Virginia Update

David Catron explains the importance of the latest positive court decision on Virginia's challenge to ObamaCare.

Ilya Somin offers some additional legal analysis.

Market Shift

Are Americans really cutting back on health spending, as the Wall Street Journal suggests?

Professor Mark Perry argues that they're just spending their money more efficiently:

Consumers aren't necessarily consuming less health care like the WSJ suggests; rather, they are shifting their demand for health care away from expensive, conventional physician offices with limited hours to affordable and convenient retail clinics. Especially when consumers are spending their own out-of-pocket money for health care and they have a choice, they prefer market-driven, consumer-driven options like affordable, convenient retail clinics over conventional physician offices.

People can be rational actors when it comes to their health spending. We need the government to respect that fact, and protect our freedom to act in our medical self-interest.

(Via K.V.)