Minton: The Coming War on Vitamins

Michelle Minton of CEI (Competitive Enterprise Institute) has a new OpEd in the 7/28/2011 Washington Times, "The coming war on vitamins".

Minton describes the latest proposal by Senator Durbin (D-IL) which, in conjunction with other FDA regulations, would seriously hinder the ability of ordinary Americans to freely purchase many over-the-counter vitamins and dietary supplements. Many of these dietary supplements would have to go an onerous FDA approval process which would either drastically raise their prices or drive them off the store shelves completely.

I'm personally seeing more medically-savvy Baby Boomer patients taking ownership of their health and using these inexpensive supplements to protect against arthritis, digestive problems, etc. Hence, the Durbin proposal would significantly impair ordinary Americans' ability to act on their own best judgment for their best medical interests.

(Read the full text of "The coming war on vitamins".)

NewsMax has a related article drawing on Minton's analysis at, "Now Government Trying to Ban Sale of Your Supplements".

Americans need more health freedom, not more nanny-state regulations!

Government Response to Medical Student Debt?

Glenn Reynolds (aka "Instapundit") has linked to this 7/28/2011 New York Times piece, "The Hidden Costs of Medical Student Debt".

NYT writer Dr. Pauline Chen correctly notes that this may drive medical students away from lower-paying primary care careers and into higher-paying specialties. One likely response from the government already hearing too many complaints from their constituents about a shortage of primary care doctors may be to step up programs such as the "Public Service Loan Forgiveness" for new medical graduates willing to work as primary care doctors in "underserved areas".

Now I have no problem with small rural communities making private deals with aspiring doctors to help pay for their education in exchange for a promise to work there for a certain number of years (i.e., a fully voluntary version of "Northern Exposure").

But if government policies artificially raise student indebtedness, then the government later lets them off the debt hook in exchange for the government telling them where to practice (according to the latest government guidelines of course), that's different.

Then it seems a little too much like a Mafia boss telling the storekeeper that his debt to the local loanshark will be forgiven if he'll let the Mafia decide what products he can (and cannot) sell in his neighborhood store and at what prices.

UK Waiting Lists

The 7/29/2011 Telegraph reports, "Patients struggle even to get on NHS waiting lists".

Here's the opening:

One woman waiting four months for a knee operation was told by a hospital that her name would drop off the list unless she replied to a letter, while a man had to pay £11,000 for a replacement hip after his doctors repeatedly refused to refer him for treatment. A multiple sclerosis sufferer claimed he had had to wait 18 months just to be added to a waiting list.

The examples emerged after The Daily Telegraph disclosed how health service funding bodies are artificially increasing waiting times as they wait for patients to die or go private.

(Read the full text of "Patients struggle even to get on NHS waiting lists".)

Because of the problems of socialized medicine, the UK health providers are increasingly trying to "game" the system to make their statistics look better -- but at their patients' expense. Let's hope this doesn't start happening here in the US.

(Via Dr. Evan M.)

Our Friend the FDA

The FDA says walnuts are drugs.

Also, "The Food and Drug Administration has banned the only over-the-counter asthma inhaler, Primatene Mist, on the grounds that it releases chlorofluorocarbons (CFCs) and is thus bad for the ozone layer."

Fortunately, some people are speaking out against the nanny state mindset. For instance, Scientific American recently urged the FDA and our politicians to "End the War on Salt".

UK Rationing Update

The UK's National Health Service has announced explicit rationing of "hip replacements, cataract surgery and tonsil removal" procedures.

Lucidicus Parodies Romney

The Lucidicus Project has posted a nice video reply to Mitt Romney's campaign commericial.

Here's the Lucidicus version:



I like it much better than Romney's original.



(Learn more about the Lucidicus Project. Here's how to donate.)

Quick Links: Wolf, Simberg

Two recent OpEds not directly related to health care, but worth reading:

Dr. Milton Wolf, 7/26/2011 Washington Times, "GOP's unfounded Obama fears".

Rand Simberg, 7/27/2011 PajamasMedia, "Lies, Damned Lies, and Revenue Enhancements".

Why Should Doctors Trust the Government?

In the 7/26/2011 TownHall column, Dr. Mike Koriwchak asks, "Why Should Doctors Trust the Government?"

An excerpt:

it is despicable for a government representative to contact a physician’s office to gather information under false pretenses. This is a sting operation designed to entrap decent, hard working medical office staff into saying things that could be recorded, taken out of context, refined into sound bites, and used to slander physicians. President Obama has already accused physicians of performing tonsillectomies just for the money. He has also stated that surgeons earn $50,000 for an amputation, which is grossly inaccurate. It is not far-fetched to suggest that the true purpose of this "study" was to gather doctor-bashing material to support Obamacare in the 2012 campaign. Their promise not to identify the responses of individual physician practices is of little comfort- in fact this would make it easier for them to "exaggerate" what was said to suit their purpose. It is incredible that Obama thinks nothing of spying on American citizens.

This "study" would have negative effects on health care. Office staff would no longer be able to trust the person on the other end of the phone. Doctors would have to pay an army of consultants to train office staff how to verify a caller’s identity before having any further conversation. Can you imagine the consequences to customer service and quality of care?

Just making the suggestion of this study serves the government’s true purpose- to intimidate physicians into behaving the way the government wants. This is not the first time. The WH has tried to intimidate us into reporting critics of Obamacare (remember "fishy" comments?). The government has bullied doctors for years with threatened pay cuts, an ever-increasing regulatory burden, and audits using outside contractors who are paid by the amount of fines they extract from their victims ("bounty hunters"), with no accountability regarding the accuracy of their audits.

(Read the full text of "Why Should Doctors Trust the Government?")

The government wants doctors docile and obedient to its edicts. Yet it also wants them to exercise their independent unwavering judgment in the practice of medicine. This contradiction is unbridgable.

(Via D4PC.)

Quick Links: Government Growth, Morality, AARP

At the AEI blog, Christopher Conover writes, "Health Is the Health of the State".

His take-home point, "Between 1966 and 2007, the entire increase in the size of government relative to the economy resulted from growth in tax-financed health spending."

At the NCPA blog, John Goodman discusses, "Is There a Moral Case for ObamaCare?"

Short answer, "No".

Is the AARP lobbying to protect its insurance business bottom line in the debt ceiling debate?

(Links via Dr. Kathleen Brown and Dr. Beth Haynes.)

Manhattan Institute: The Limits of Comparative Effectiveness Research

President Obama has touted "comparative effectivness research" (CER) as a way to save money under his health care plan. In his words:

If there's broad agreement [that] the blue pill works better than the red pill, ...and it turns out the blue pills are half as expensive as the red pill, then we want to make sure that doctors and patients have that information available to them.

Although this sounds good at first glance, there are serious problems using this approach in a one-size-fits-all government health system.

Philipson and Sun of the Manhattan Institute discuss this topic in depth in their latest article, "Blue Pill or Red Pill: The Limits of Comparative Effectiveness Research".

In particular, they note that this approach can cause tremendous problems when policy-makers then treat patients as some sort of global "average" while neglecting their individual differences:

..[I]t is the drug or treatment with the larger average effect on an entire population that "wins." In the president's hypothetical, the blue pills are "just as effective" as the red ones because, on average, they do as much good for patients. But the average patient is not the same as any particular individual patient. Declaring a treatment most effective based on an average is a medical and an economic error, for two reasons.

First, individuals differ from one another and from population averages. Therefore, what may be on average a "winning" therapy may simply not work for a large number of patients. Conversely, a drug that is less effective on average may still be the best, or only, choice for a sizable proportion of patients.

The second reason is the variance in dependence in patient responses across therapies. Dependence, for any individual patient, is the degree to which response to one treatment predicts response to another. Dependence varies from illness to illness and from drug to drug but is often an important aspect of finding treatments that work. One cannot know in advance, as a general rule, that Drug A's failure guarantees the failure of Drug B. Yet a reimbursement policy based on CER could well make this error: by refusing to reimburse Drug B on the grounds that Drug A is "more effective," such a policy assumes that failure with Drug A will predict failure with Drug B.

The bulk of their paper discusses how this CER methodology would fail if applied to real-world antipsychotic drugs, where there are seeming equivalents of Obama's "red pill" and "blue pill".

Because of the factors mentioned above, a policy based on CER that restricted doctors' ability to prescribe (and patients' ability to receive) drugs deemed by the government as insufficiently "cost effective" would actually cost more money in the long run, as well as inflict tremendous and unnecessary hardship on patients.

Of course, CER data can be valuable to practicing physicians who treat patients as individuals. But it can be a dangerous tool when fallaciously misused by policy-makers who treat patients as a collective or an "average".

(Read the full text of "Blue Pill or Red Pill: The Limits of Comparative Effectiveness Research" or download the PDF version.)

Did ObamaCare Torpedo the Economy?

According to the Heritage Foundation, it did.

Here's a graph from their analysis, "Recovery Stalled After Obamacare Passed":

(Via David Catron.)

ACO Humor

Jaan Sidorov of Disease Management Care Blog passes on some ACO jokes. Here are a few samples:

Q: What's the difference between an ACO and a HMO?
A: An ACO is just like a HMO but with more government oversight. It will have the discipline of the Securities and Exchange Commission mixed with IRS-style responsiveness, all brought to you courtesy of CMS.

Q: What's the nicest thing a VP for Medical Affairs could spin about ACOs to a room full of skeptical doctors?
A: "It's not entirely without merit, but close."

Q: What is the difference between an ACO and quicksand?
A: People don't go into quicksand on purpose.

Q: Why is it called an "ACO?"
A: To honor the folks who thought of it: academics, consultants and Obama.

Quick Links: CO-OPS, ACO Lepers, VT

Jared Rhoads of the Lucidicus Project notes, "Government-backed CO-OPs stunt innovation".

(As he noted on Twitter, "If HHS sets the rules, then shouldn't these be called 'HHS-Controlled Health Plans?'")

Dr. Stewart Segal describes how ACO rules will encourage providers to dump expensive patients at "ACOs and the modern day leper".

In the 7/17/2011 Washington Examiner, Sally Pipes observes "It's déja vu all over again in Vermont".

Claeys on ObamaCare, Constitutionality, and Politics

George Mason University law professor Eric R. Claeys has a nice detailed article on the constitutional issues related to ObamaCare and their political implications.

His article appears in the Summer 2011 issue of National Affairs and is entitled, "Obamacare and the Limits of Judicial Conservatism".

I'm still digesting Claeys' piece, but one of the many interesting points he makes pertains to the conventional wisdom that when the "individual mandate" is eventually decided by the US Supreme Court (SCOTUS), there will be 4 conservative votes against and 4 liberal votes for, with the "swing vote" being Justice Kennedy.

Claeys warns:

[T]his conventional wisdom is wrong -- and adhering to it could prove highly counterproductive for Obamacare's opponents. It is wrong largely because it assumes that the Roberts Court's 'judicial conservatives' are members of a monolithic bloc.

In the final section of the paper, he also discusses 4 principles that ObamaCare opponents should keep in mind as the SCOTUS decision draws here:

1. There should be no irrational exuberance about the Virginia and Florida decisions.

2. Obamacare opponents should not despair if the Supreme Court votes not to declare the individual mandate unconstitutional.

3. Opponents of Obamacare must anticipate what to say if the Supreme Court votes not to declare the individual mandate unconstitutional.

4. If legislators and candidates will need to argue against Obamacare's constitutionality later, they might as well start now. And they should consult the opinions of Justice Thomas.

(He discusses each of these points in greater depth in the paper.)

As I mentioned above, I'm still digesting this piece. But it's a thought-provoking read. The full text is available at "Obamacare and the Limits of Judicial Conservatism".

Disclaimer: Professor Claeys was on my wife's PhD dissertation committee.

(Link via GMU law professor Adam Mossoff.)

BHI: The High Price of the Massachusetts Plan

Beacon Hill Institute analysts David Tuerck, Paul Bachman and Michael Head have published a new paper, "The High Price of Massachusetts Health Care Reform".

According to this summary at NCPA:

In this study, researchers calculated the effect of health care reform on state and federal governments and the private health insurance markets, including employee contributions to their private insurance plans:

State health care expenditures have risen by $414 million over the period.
Private health insurance costs have risen by $4.311 billion over the period.
The federal government has spent an additional $2.418 billion on Medicaid for Massachusetts.
Over this period, Medicare expenditures increased by $1.426 billion.
This amounts to a total cumulative cost of $8.569 billion over the period.

The state has been able to shift the majority of the costs to the federal government.

This is clearly an unsustainable approach. The end-stage will have to be European-style rationing of health care. Let's hope the rest of America learns from the example of Massachusetts -- before it's too late...

Update: Investor's Business Daily also summarizes the BHI findings in their OpEd, "Massachusetts Mess".

Wolf: Barack Obama’s Pants On Fire

Dr. Milton Wolf's latest OpEd for the 7/19/2011 Washington Times details the President's disturbing habit of stretching, bending, and tearing up the truth when politically convenient.

From "Barack Obama's pants on fire":

"I will never forget watching my own mother... worrying about whether her insurer would claim her illness was a pre-existing condition," claimed Democratic presidential candidate Barack Obama, explaining the foundation of Obamacare. This too was a lie.

Recent revelations by author Janny Scott in "A Singular Woman: The Untold Story of Barack Obama's Mother" (Riverhead Hardcover, 2011), show that Stanley Ann Dunham, the president's mother, was in fact well-insured and, what's more, her health insurance company -- those evil corporatists -- never attempted to deny payment for her health care...

Dishonoring the dead with deception, as pathetic as that is, barely scratches the surface of the Obamacare falsehoods. You can keep your current doctor: Lie. You can keep your current insurance: Lie. Hearings will be made public: Lie. The deficit will be reduced: Lie. Four hundred thousand jobs will be created immediately: Lie. There are no death panels: Lie. Taxes won't be increased on families earning less than $250,000 a year: Lie. And all of this comes before the first Obamacare waivers exempted the White House's best friends from the rules that you must follow.

This degree of dishonesty is not merely taking a mulligan on the back nine or fudging a couple of pounds on your driver's license. There's something far more sinister at work here. America is being "fundamentally transformed" by deception...

Even worse, the problems go far beyond health care policy. For more information, read the full text of "Barack Obama's pants on fire".

Then decide if the country can survive 4 more years of the current political leadership.

Scherz: Has the American Medical Association Lost Its Way?

Dr. Hal Scherz has a new OpEd in the 7/18/2011 Fox News, "After Supporting ObamaCare, Has the American Medical Association Lost Its Way?"

The short answer is, unfortunately, "yes".

In his piece, Dr. Scherz covers some facts not well-known to many in the general public, including:

(1) The AMA does not speak for anything close to a majority of physicians. Rather, less than 17% of practicing physicians are AMA members.

(2) The AMA's source of revenues (including their government-granted monopoly on medical coding) creates a deep conflict-of-interest when the support government policies such as ObamaCare.

(3) The current CEO of the AMA has close links to the Obama administration.

These are some reasons that many doctors like myself refuse to join the AMA.

Instead, I hope doctors and patients take a closer look at other medical organizations like Docs4PatientCare.org that can speak out for genuine health care reforms.

Catron: Pre-Existing Prevarication

In his 7/18/2011 AmSpec piece, David Catron lays out Obama's "Pre-Existing Prevarication".

He shows how candidate Obama (and later President Obama) twisted the truth of his mother's battle with cancer to create a politically useful -- but false -- narrative to justify his health care legislation.

I'm glad this story is getting the attention it deserves.

Quick Links: NHS, Waivers, Competition

The 7/15/2011 Telegraph reports on more problems with the British National Health Service: "NHS 'creaking at the seams' as waiting lists rise". (Via @DrAmerling.)

ObamaCare waivers are now up to 1,471.

John Goodman discusses how "Price Competition Can Lead to Quality Competition".

Helpful Health Care Negotiating Tips

Although there are a lot of problems with American health care, we still have a mixed (and thus still-partially free system).

If you want to take advantage of the freedoms we still have, here are some tips on "How You Can Negotiate Better Prices for Medical Care".

Some of their suggestions include:

Price comparison shop
Don't overplay your hand
Don't assume insurance is cheaper
Watch the clock

(Read the full text "How You Can Negotiate Better Prices for Medical Care" for more details on each of these points, plus some other tips.)

Will Colorado Follow Massachusetts?

John Graham and the Pacific Research Institute have issued a report that "shows how ObamaCare threatens the solvency of private health plans, which will significantly reduce consumer choice and increase costs. The ultimate result will likely be either a massive taxpayer bailout of private health plans or continued momentum toward a single-payer government-monopoly system."

Graham's report studies Massachusetts and Colorado. He concludes that continued government controls of health insurance will create a "cascade of insolvency", eventually destroy the private insurance market, and leave consumers with little choice but a government insurance option.

He also notes that one tactic used by statists will be to blame the insolvencies on failures of the free market, whereas they will actually be the fault of the government controls.

Of course, his analysis extends to the other 48 states -- not just MA and CO.

The report Bust or Bailout? The Future of Private Health Plans Under Obamacare is available at the PRI website. It can be downloaded here.

(Via Dr. Matthew Bowdish.)

Quick Links: IPAB, Consolidation, UK Starvation

At the 7/9/2011 Daily Caller, Chris Jacobs asks "Who am I to decide how my own health care should be handled?" (Via D4PC.)

Dr. John Mandrola notes how the government push to consolidate physicians will inevitably restrict patient choice. (Via @MatthewBowdish.)

The 7/11/2011 Daily Mail reports that the UK's National Health Service would rather let this 22-year old woman starve than perform the necessary stomach surgery.

Quick Links: Snoopers, Mandates, Medical Ghetto

The 7/11/2011 American Medical News discusses, "Why HHS abandoned 'mystery shopper' study". Short answer -- because of the public comments they received.

Most doctors are very upfront about the fact that they cannot afford to accept unlimited numbers of government patients. As the article notes:

...71% of family physicians are accepting new Medicare patients, according to a September 2010 study. Physicians also were asked how Medicare payment cuts would impact their practices. Nearly 75% said they would limit Medicare appointments, and 62% said they would stop accepting new Medicare patients.

We don't need mystery snoopers to learn this.

In the 7/10/2011 PajamasMedia, Rick Richman discusses "ObamaCare, ObamaCars, and Government-Mandated Broccoli".

Brian Schwartz at PatientPower notes that Medicaid is becoming the medical equivalent of a "ghetto" for poor Americans.

Black Ribbon Project Poster

FIRM is honored to be one of the groups, projects, and organizations fighting for free-market health care reform listed in the new Black Ribbon Project poster! (Click on the image to see it full size.)

They include:

Docs 4 Patient Care
AAPS
The Galen Institute 
The Benjamin Rush Society
Freedom and Individual Rights in Medicine
The Lucidicus Project
PatientPowerNow.org
Citizens' Council for Health Freedom
MediBid

Not pictured:
National Center for Policy Analysis

Hsieh PJM OpEd: The Coming Collectivization of American Health Care

The 7/11/2011 edition of PajamasMedia has just published my latest OpEd, "The Coming Collectivization of American Health Care".

Here is the opening:

In the 1930s, the USSR forced independent farmers into large state-run collective farms. Despite possessing some of the richest farmland in the world, these collective farms could not feed the country. By the end of the Cold War, the USSR survived only by importing Western grain. Unfortunately, the United States is about to make the same mistake in health care by collectivizing doctors and hospitals into government-supervised accountable care organizations (ACOs)...

(Read the full text of "The Coming Collectivization of American Health Care")

Note that this government-drive consolidation of doctors and hospitals into a few large provider groups is not some "bug", but rather a desired "feature", because it allows the government to more easily control what kind of medicine will (and will not) be practiced in the US.

Scherz On Spying

Dr. Hal Scherz of Docs4PatientCare has a new OpEd in the 7/6/2011 Health Reform Report on the just-cancelled government "secret shopper" program.

Here's an excerpt from, "Domestic Spying on Doctors -- Who Will Be Next?":

Although this plan is ostensibly tabled for now, we must not simply let it slide by. This type of behavior is sinister and malevolent. What were HHS and the White House hoping to discover that they already didn't know?  Physicians, of course, are limiting their practices to patients whose health insurance helps them meet their basic overhead of running a practice. If they don't stay in business, patients can't be treated.

For an Administration that has recognized that there is already a doctor shortage and that patients today have to wait longer to see a doctor, it certainly is disingenuous to make a "phony" appointment for a patient and takes a slot from someone who might desperately need it.

The greater problem is not with doctors, but with a government-run healthcare system (Medicaid, Medicare, state children's health plans) that has set reimbursements so arbitrarily low, that doctors cannot rely on it to pay the bills. The solution is not to conduct survey to gather information we already know. It is to allow patients to have financial control of their healthcare. In short, the government needs to get out of the healthcare business.

The information garnered from any potential survey would have undoubtedly been used by President Obama to blame doctors for the healthcare access problem. We could then expect a heavy handed response from the government to get doctors to behave, perhaps telling them that in order to practice medicine they must accept Medicaid patients or others on government programs. This is a formula that  Massachusetts has been trying to enact since Gov. Mitt Romney implemented his health reform plan. After that, government could instruct doctors on just about anything including edicts on how many patients they see daily.

Some may think this is farfetched or paranoid. But then again, who expected Obamacare to get this far?

Doctors are right to be mistrustful, given the Administration's lack of transparency through the health care process, including how the legislation was passed with back-room deals and how ObamaCare waivers were mysteriously granted to those with political connections.

Prediction: Look for a revival of this "secret shopper" idea after the 2012 elections are over...

Amerling: The End of Fee-For-Service Medicine

In the 7/5/2011 Health Reform Report, Dr. Richard Amerling discusses the latest attempted "reform" and what's wrong with it. Here's an excerpt from, "The End of Fee-for-Service Medicine":

The payment transition from the current fee for service to salaried status also also creates a loss of autonomy for physicians. Doctors will have no choice but to follow hospital dictates regarding length of stay, choice of medicine, and adherence to clinical practice guidelines, many of which are either obsolete or inappropriate. The practice of medicine will become textbook instead of individualized to the patient...

The payment transition from the current fee for service to salaried status also also creates a loss of autonomy for physicians. Doctors will have no choice but to follow hospital dictates regarding length of stay, choice of medicine, and adherence to clinical practice guidelines, many of which are either obsolete or inappropriate. The practice of medicine will become textbook instead of individualized to the patient...

FFS has been wrongly blamed for runaway health spending, when the real culprit is the third party system, unrestrained by meaningful co-pays or deductibles...

(Read the full text of "The End of Fee-for-Service Medicine".)

Dr. Amerling has it absolutely right. Eliminating fee-for-service will create perverse incentives for doctors and will ultimately harm patients.

Medical organizations should be left free to work out the best incentive structures that suit their particular needs and circumstances. It may include straight salary, salary-plus-productivity-bonus, or pure fee-for-service. For government to declare any one model as wrong and compelling doctors to work under its preferred system violates the rights of doctors and patients to contract to their mutual interest according to their best judgment.

Catron on Kagan

In today's AmSpec, David Catron gives a nice rundown on the debate over whether Judge Kagan should recuse herself from any Supreme Court proceedings on ObamaCare.

Read, "ObamaCare and Kagan's Conflict of Interest".

Here's a related story.

Quick Links: Wolf, Schwartz, Sidorov

Dr. Milton Wolf has a new piece in the 7/7/2011 Washington Times on signs of panic in the Obama administration over their failing policies, including the multiple ObamaCare "waivers". Read more at: "'No Drama' Obama Losing His Cool".

Brian Schwartz has a piece in the 7/6/2011 Huffington Post on problems with the Colorado SCHIP program, "Gov. Hickenlooper's Veto of SB 213 Insults Low-Income Parents".

Jaan Sidorov notes, "Parallels Between The Lessons of 'Reckless Endangerment' and the Ideological Promotion of the Electronic Health Record".

Crowdsourcing Benefits of Personal Genetic Testing

At FuturePundit, Randall Parker described how "Crowd Sourcing Identifies 2 Parkinsons Disease Genes".

Here's an extended excerpt from his post:

The folks at personal genetic testing company 23andme.com recruited Parkinson's Disease (PD) patients from mailing lists and other means and compared their genetic variants with a group of 23andMe customers who also got their genetic variants tested by 23andMe.

They used the resulting data to discover 2 more genetic variants associated with Parkinson's Disease. The results demonstrate the speed, low cost, and power of web-based recruiting to do genetic research outside the traditional academic framework.

We conducted a large genome-wide association study (GWAS) of Parkinson's disease (PD) with over 3,400 cases and 29,000 controls (the largest single PD GWAS cohort to date). We report two novel genetic associations and replicate a total of twenty previously described associations, showing that there are now many solid genetic factors underlying PD. We also estimate that genetic factors explain at least one-fourth of the variation in PD liability, of which currently discovered factors only explain a small fraction (6%–7%). Together, these results expand the set of genetic factors discovered to date and imply that many more associations remain to be found.

Unlike traditional studies, participation in this study took place completely online, using a collection of cases recruited primarily via PD mailing lists and controls derived from the customer base of the personal genetics company 23andMe.

Our study thus illustrates the ability of web-based methods for enrollment and data collection to yield new scientific insights into the etiology of disease, and it demonstrates the power and reliability of self-reported data for studying the genetics of Parkinson's disease.

You can read the whole open access Plos Genetics research report at that link.

What's cool about this: Using a web site and cheap genetic testing services people can volunteer themselves as research subjects on a scale that historically has taken far more effort to organize. This approach can scale into the hundreds of thousands, and even hundreds of millions of people. There's a big network effect where the more people who get tested the more useful genetic testing becomes.

Direct-To-Consumer (DTC) genetic testing is what made the study above possible. Whether we will be able to continue to get our DNA tested without paying for a doctor's visit and additional testing mark-ups remains to be seen. In the United States the Food and Drug Administration (FDA) is taking a dim view of DTC genetic testing.

(Read the rest of Parker's post: "Crowd Sourcing Identifies 2 Parkinsons Disease Genes".)

Here's the full PLOS Genetics paper: "Web-Based Genome-Wide Association Study Identifies Two Novel Loci and a Substantial Genetic Component for Parkinson's Disease".

I completely agree with Parker. Proposed FDA controls over the growing consumer genetic testing market not only deprive individuals of the right to learn the content of their DNA, but could also stifle the growth of new discoveries (and downstream therapies) made possible only by this sort of innovative free-market "crowdsourcing".

The FDA has no business stopping people from voluntarily sharing their genetic information with others in hopes that they might reap life-saving benefits.

(See also my July 2010 PajamasMedia piece, "Should You Be Allowed To Know What's In Your DNA?")

Lipana on the Sissel Challenge to ObamaCare

At the American Thinker blog ("ObamaCare: The Antithesis of the Founders' Vision"), Joshua Lipana posts about a recent article in The Objective Standard covering the lawsuit filed by Iraq war veteran Matt Sissel challenging the individual insurance mandate.

The TOS article, "ObamaCare v. the Constitution", was written by attorney Paul Beard of the Pacific Legal Foundation, representing Sissel. Beard covers the basic legal arguments in a fashion accessible to the layman.

Beard's piece does a nice job of covering the essential legal issues -- as well as putting a human face on what an individual mandate would mean.

Do-it-Yourself Health Reformers

David Chase has a fascinating interview with Dr. Brian Forrest, one of the best-known proponents of the "direct pay" model of primary care. Here an excerpt from, "How direct primary care reduces primary care costs":

In an age of family physicians literally not being able to give away their practices, Brian Forrest has built a successful model that is similar to the age of Marcus Welby where there was a direct relationship between a patient and their doctor. Practices such as Forrest's Access Healthcare in North Carolina run unencumbered by insurance hassles.

As word of Dr. Forrest's direct pay practice has spread, he has had a constant stream of physicians visiting his practice so others could learn how he has a successful financial model, happy patients and a sane lifestyle -- something increasingly less common in the hamster-wheel model of primary care that is prevalent in current fee-for-service based primary care practices. Dr. Forrest runs a cash-only practice sees 16 patients a day at a maximum, works a 40 hour week and takes home more than the average family physician a year with a highly satisfied patient base that pays less than those in fee-for-service, insurance models.

Dr. Forrest embodies a rapidly expanding cohort of what could be called Do-it-Yourself Health Reformers. That is, they aren't waiting around for politicians to fix what is widely understood to be the broken facets of healthcare. Rather, through their own trial and error, they are refining care and payment models that are demonstrating impressive results...

(Read the full text of "How direct primary care reduces primary care costs" for more information.)

Genuine health care reform doesn't require more government control, but rather unleashing the creativity and energy of individuals in a free market.

Update: Chase has a related article at TechCrunch aimed at businessmen and entrepreneurs covering some of these same issues: "How DIY Health Reform Can Help You Win The Talent Wars".

Update #2: Welcome Instapundit readers! Please feel free to take a look around. Our full list of published articles and OpEds (including several PajamasMedia pieces) is available here!

George Will Asks An Inconvenient Question

On ABC's This Week, George Will asks the inconvenient question, "Can Congress Require Obese People to Sign Up for Weight Watchers?"



Note how the other panelists duck, clearly uncomfortable with wanting to say "no" (because it would undercut the legal basis of ObamaCare, but also realizing what a "yes" answer would mean.

(Via Instapundit.)

Update: David Catron links to a transcript (plus commentary) of the relevant sections.

Happy July 4!

I'd like to offer my gratitude to all who have fought to protect and restore freedom and individual rights here in America. Enjoy this well-deserved holiday!

Zwelling on Medical Tourism

In the 6/22/2011 Investor's Business Daily Dr. Marcy Zwelling of AAPS discusses the rise of medical tourism.

Here's an excerpt:

For years, Canadians have crossed our northern border to access procedures not available in their government-only system, where the average wait in 2010 from seeing a primary care doctor to getting treatment by a specialist was 18.2 weeks. I don't imagine it will take long for those same patients and Americans to find their way to Istanbul or Bangkok.

While medical tourism is not appropriate for every situation or procedure, it is the wave of the future as patients look for affordable and timely care. Self-insured employers will surely look for better ways to cover their employees that don't jeopardize their businesses. It happened with the car industry back in the 1970s and is going to happen to U.S. health care.

Americans will find their way to the "best value" in health care. Sadly for American doctors and hospitals, that may soon be overseas.

(Read the full text of "Medical Tourism: A New Rx For Timely, Affordable Care".)

Quick Links: Medicare Myth, 6th Circuit, Death Star

In his 6/30/2011 Forbes post, Avik Roy debunks "The Myth of Medicare's 'Low Administrative Costs'".

In particular, Roy notes:

1) Medicare is partially administered by outside agencies
2) Administrative costs are calculated using faulty arithmetic
3) Medicare has higher administrative costs per beneficiary

(Click through to see more details on each point.)

Randy Barnett covers "Eight Things To Know About Yesterday's Sixth Circuit ObamaCare Decision".

In this 6/29/2011 Washington Examiner OpEd, US Senator Jim DeMint warns "Obamacare Death Star will strike soon". One excerpt:

In fact, Credit Suisse has told clients that forcing employers to drop coverage is "exactly what was intended" by the law. This was the main goal of many advocates of ObamaCare --to completely replace private insurance with a single-payer government healthcare system.

(Via Dr. Matthew Bowdish.)

How the FDA Impedes Innovation

GMU economics professor Alex Tabarrok discusses a disturbing example of "How the FDA Impedes Innovation".

In particular, he cites the case of the FDA using unrealistically strict criteria to reject a melanoma (skin cancer) detection device. In particular, he notes:

But even if MelaFind is not perfect today nor appropriate in all circumstances it’s exactly the type of innovation that we should encourage. Devices such as MelaFind could not only improve medical care they can reduce costs and make good quality medical care more widely available in developing countries, for example, where experienced dermatologists are in short supply.

Most importantly, innovations get better over time. But if you impede the first generation the second generation may never come into existence and, as Mandel notes, no first-generation device could satisfy the FDA's conditions. It's like refusing to give the Wright Brothers a license to fly because their first airplane only flew for 59 seconds...

By stifling promising fledgling technologies in their infancy, the FDA thus deprives us of countless future improved versions as well. But because we don't know what will never be invented, we don't know what life-sustaining benefits we're missing out on.

The FDA's policies thus represent just another (deadlier) version of Bastiat's principle of "the seen vs. the unseen".

Accountable Grocers

Hey -- if Americans aren't getting enough value for their food dollars spent, maybe we need a system of government-managed "Accountable Grocers"!

Great post by Dr. Beth Haynes.

Wolf on Obamanomics

Dr. Milton Wolf's latest OpEd at the Washington Times makes the crucial point that, "Obamanomics is shovel-ready".

My favorite passage is when Wolf debunks President Obama's shamefully ignorant fallacy of blaming ATMs for unemployment:

Mr. Obama, meet Ned Ludd. In the early 1800s, the Luddites -- named for Ned Ludd, an alias used to conceal their leaders’ true identities -- sabotaged factories for fear of new technology. Their mistake was a belief that jobs themselves are prosperity when, in fact, it’s the products and services of those jobs that create prosperity. The government could hire people to dig holes and other people to fill them back in, but America would be poorer for the wasted effort. In reality, new technologies, from the advent of the wheel to today’s nanotechnology -- including the ATM and the iPad -- increase efficiency, which frees people for more important endeavors. This is the precise mechanism that improves mankind's standard of living.

(Read the full text of "Obamanomics is shovel-ready".)

Whether it be in health care or the broader economic realm, the current administration's policy of stifling innovation and replacing it with government make-work projects merely shunts precious capital and resources from productive to unproductive venues. In essence, it squanders the lifeblood of any healthy economy.

Hsieh PJM OpEd: "Why the 'Unexpected' Keeps Happening"

The 6/29/2011 edition of PajamasMedia has just published my latest OpEd, "Why the 'Unexpected' Keeps Happening".

Here is the opening:

If an irresponsible teenager repeatedly crashed his car into a tree whenever he had a few beers, we would never say his accidents were "unexpected." Rather, they would be foreseeable consequences of driving while drinking. Similarly, we shouldn’t let journalists get away with describing as "unexpected" the foreseeable negative consequences of bad government policies.

Blogger Glenn Reynolds recently highlighted numerous examples of the media’s increasingly frequent use of "unexpected" to describe bad economic news. Unemployment "unexpectedly" rose despite federal "stimulus." Home sales "unexpectedly" fell despite taxpayer bailouts. ER visits unexpectedly rose in Massachusetts despite RomneyCare. Similarly, the Pundit Press blog has rounded-up dozens of examples of such "unexpected" developments since January 2011...

Read the full text of "Why the 'Unexpected' Keeps Happening" for the answer!

Obama Administration Cancels "Secret Shopper" Program

Breaking news: The Obama Administration has just canceled the controversial "secret shopper" program intended to learn if doctors treat privately insured patients differently from those with government insurance:

"White House dumps 'secret shopper' survey of doctors"
By SARAH KLIFF 6/28/11 5:57 PM EDT, Politico.com

From their official statement:

After reviewing feedback received during the public comment period, we have determined that now is not the time to move forward with this research project. Instead, we will pursue other initiatives that build on our efforts to increase access to health care providers nationwide...

Good riddance to a bad idea!

Snooping Shoppers and the End Game of ObamaCare

In his 6/27/2011 Forbes blog post, Avik Roy discusses the latest NYT story about government "secret shoppers". Roy's take-home point:

...[D]octors won't take federally-sponsored snooping lying down. Instead, more and more of them will drop out of Medicaid, and increasingly Medicare, rather than subject themselves to the onerous hassles and financial burdens of staying involved—only to face a federal audit for doing so. Doctors will avoid setting up shop in inner cities, where a higher proportion of patients are in these programs. In turn, access to care for those patients will get worse, not better, in a system that is already a humanitarian catastrophe.

The endgame for Obamacare’s proponents will necessarily involve compulsion: forcing doctors to see Medicaid and Medicare patients, despite penurious reimbursement rates, or revoking their licenses to practice medicine.

(Read the full text of Roy's post as well as the original NYT article.)

Roy is very likely correct. Last year, the Massachusetts legislature state legislature considered forcing doctors to accept government-controlled insurance rates as a condition of retaining their state medical licenses (regardless of whether or not the doctors lost money on each patient) -- in effect, creating a "physician mandate". (That law did not pass.)

Supporters of government health care will view a national equivalent as a logical next step to "fix" the problems of ObamaCare.

Calls for such a "solution" may increase as more patients with private insurance start experiencing similar problems as reported in this 6/27/2011 San Francisco Chronicle article, "Doctors Reject Insured Patients on Low Payments, Study Says".

If the government imposes a "physician mandate", expect a mass exodus of physicians out of the American medical system.

Quick Links: MA, AMA, Sweden

The 6/22/2011 Boston Business Journal reports that MA Attorney General Martha Coakley is demanding more price controls on health insurance. This is in addition to the proposed "global payments" (which are the 21st-century version of HMOs). For her, the solution to problems created by prior government controls is more controls. (Via Scott K.)

Dr. Mark Neerhof of Docs4PatientCare discusses why, "Obamacare Makes AMA Irrelevant to Doctors". His article gives many reasons why I'm not a member of the AMA.

Carl Svanberg debunks many of the American leftist myths about health care in his home country of Sweden at, "The Right To Wait".

Schwartz OpEd on SCHIP

The 6/26/2011 Boulder Daily Camera has published Brian Schwartz's latest OpEd on the Colorado SCHIP program (State Children's Health Insurance Program), "The poor keep their money for luxuries".

In response to CO governor Hickenlooper's decision to veto bill asking the SCHIP parents to pay more, he notes "Maintaining current fees would not only be an injustice to taxpayers, but also an insult to eligible parents. The fees imply that parents value enjoying life's amenities more than their own children's health."

Eventually, these programs (can and should) be privatized. But as an interim step, having parents assume more responsibility for their children's medical expenses (even if it means they must forgo various other discretionary expenses) would lessen the burden on taxpayers and would be a step in the right direction.

(Read the full text of "The poor keep their money for luxuries".)

From the Massachusetts Trenches

On 6/21/2011, the Boston NPR station (WBUR) had an interesting report on how "payment reform" is affecting Massachusetts doctors "in the trenches".

Here's an excerpt from their story, "Payment Reform: Panacea Or Debacle? A View From Middle Massachusetts":

...[T]he dominant message I take from Dr. Glazier is one of concern. It’s not kneejerk resistance to change. It's a view from the medical trenches that says: "I honestly don't see how what you're proposing is going to contain costs. But I do see some very real dangers." Here are seven of his top concerns, lightly distilled:

Some of the dangers he cites include:

1) Global payments don’t get the patient involved in containing costs.
2) No one even knows how much things cost.
3) The problem with risk-sharing is the risk.
4) Without full information, how can we take full risk?
5) How do you operationalize it?
6) Benchmarking is everything.
7) More consolidation to come.

Each of these seven points is covered in more detail in the full article, "Payment Reform: Panacea Or Debacle? A View From Middle Massachusetts".

Again, the problems in Massachusetts serve as a canary-in-the-coal-mine for the rest of the United States.

(Via @Lucidicus.)

Quick Links: HSAs, IPAB, Propaganda

Americans for Tax Reform note, "HSAs Increasingly Popular Despite Attacks from Obamacare".

In the 6/20/2011 Washington Times, Dr. Daniel Palmisano notes that the IPAB rationing board is becoming increasingly unpopular with both Democrats and Republicans in Congress. Read his OpEd, "Nailing Obamacare's rationing board".

The 6/20/2011 LA Times reports that our tax dollars will be used to fund another round of pro-ObamaCare commericials. (Via David Catron.)

Wolf OpEd: The FDA's One-Man Death Panel

Dr. Milton Wolf has a great new OpEd in the 6/22/2011 Washington Times, "The FDA's one-man death panel".

In his piece, he nicely summarizes the controversy over the FDA's decision to slow down the approval of the anti-cancer drug Avastin. Then he makes this crucial broader point:

The FDA, despite its intentions, drives up the costs of medicines and often dries up the supply chain altogether. America is currently facing a shortage of about 246 drugs - a record high. This doesn't happen by accident. Consider the alarming conclusions reached, not by the supposedly evil pharmaceutical companies, but by physicians and pharmacists at last year's Drug Shortages Summit.

A joint report by the American Society of Anesthesiologists, the American Society of Oncology, the American Society of Health-System Pharmacists and the Institute for Safe Medication Practices sounded the alarm: "Several drug shortages have been precipitated by actual or anticipated action by the FDA." They note that the "cost and complexity" of the FDA's "regulatory barriers" to providing new and even existing medicines is a "disincentive" to suppliers. Additionally, the "lengthy and unpredictable" approval process limits manufacturer's ability to develop reliable production schedules.

The Obama doctrine to keep the government’s "boot on the neck" of private-sector companies is not just limited to Big Oil. A nanny state that won't trust you to choose your own light bulbs certainly won't approve of even a life-saving medication until every bureaucrat has had his say in triplicate. Americans have landed on the moon and mapped the human genome and yet we suffer from the self-imposed scientific stagnation created by the FDA.

(Read the full text of "The FDA's one-man death panel".)

For more information on how ordinary Americans can submit input to government officials on the Avastin issue, visit Dr. Wolf's website.

Quick Links: Colvin, Conko, WSJ

Geoff Colvin of Fortune asks, "Why can't we fix Medicare once and for all?" (H/T: Dr. Beth Haynes.)

In particular, Colvin notes that we have the choice between the Brute Force approach and the People Aren't Dummies approach. The first has failed, and it's time to try the second. (Note: I don't necessarily agree with his endorsement of the Ryan plan).

In the 6/20/2011 Wall Street Journal, Greg Conko of CEI writes, "There's No 'Average' Cancer Patient". The FDA's reliance statistics and collectivized health measures jeopardizes individual patients. (H/T: Tom Bowden.)

As Conko notes:

The weakness of the FDA's reasoning here is that averages ignore that individual patients respond differently to treatments. Particularly with life-threatening illnesses, where the downside of any treatment is relatively small, average or median survivability too often masks the fact that some patients respond very well.

The 6/19/2011 WSJ editorial also describes, "The Accountable Care Fiasco". The basic premise behind ACOs is that government micro-management can guarantee good health care.

(As I noted in my recent TownHall piece, this is just the latest incarnation of the "central planner fallacy" applied to modern health care.)

Hsieh TownHall OpEd: Obama's Health Care Fallacy

The 6/20/2011 TownHall.com has published my latest OpEd, "A Doctor Exposes Obama's Health Care Fallacy".

My theme is that Accountable Care Organizations (ACOs) represent the latest incarnation of the failed "central planner fallacy" as applied to American health care. Here is the opening:

Suppose President Obama proposed reviving the faltering American economy by creating a federal "Department of Technology" to encourage Silicon Valley technology companies to merge into large consortiums. Bureaucrats would then tell these companies what products they should produce and sell.

Most Americans would consider that approach ridiculous. They know that innovations such as iPads and smartphones were created by entrepreneurs competing in a free market, not by government central planners. Yet the Obama administration is committing the same error by pushing doctors and hospitals into government-supervised "Accountable Care Organizations"...

(Read the full text of "A Doctor Exposes Obama's Health Care Fallacy".)

Thanks to Dr. Hal Scherz and to Dan Rene of Docs4PatientCare for helping to arrange this!

The FDA and Drug Shortages

At Marginal Revolution, Alex Tabarrok discusses the FDA and drug shortages.

Although the problem is multifactorial, FDA policies are making the shortages worse.

(John Goodman also discusses some of these issues in his 6/19/2011 TownHall OpEd, "Deadly Regulations".)

The Noose of Government Clinical Guidelines

Dr. Doug Perednia discusses, "How physicians not adhering to clinical guidelines may be punished".

As he notes:

If the Justice Department investigation is, in fact, going to target clinicians based upon their adherence to guidelines, the American healthcare system is headed down a very slippery slope. Government regulators and prosecutors will, of course, contend that they're simply looking for "waste, fraud and abuse", and that looking for non-adherence to guidelines is a reasonable screening tool when looking for criminals. But let's not kid around. Any such policy is going to have a chilling effect on treating patients as individuals rather than statistically average widgets. You may need a test or procedure as a part of good medical care, but your doctor is going to be too scared to order it if her record of "guideline compliance" is at stake.

Think about it. For the first time your doctor may have a real choice to make if your medical condition doesn't happen to fit neatly into some academic cookbook. Adhere to the guideline and commit malpractice, or violate the guidelines and risk jail time.

Using guidelines in this way is unscientific, unethical and just plain wrong.

In other words, the federal government is going to claim that it knows better than your doctor whether you should have a certain test or treatment. And it will base that determination on statistical data which may or may not apply to your particular case.

We have been warned.

Quick Links: Cronyism, Courts, Concierge Care

In the 6/13/2011 Forbes, Daniel Mitchell notes how "Obamacare Waiver Process Is Like Scene From Atlas Shrugged". Corruption and cronyism!

In the 6/14/2011 Wall Street Journal, David Rivkin and Lee Casey explain "Why ObamaCare Is Losing in the Courts".

This 5/13/2011 Fox News piece asks, "Concierge Health Care: Worth the Hefty Price Tag?" (Via @aapsonline.)

Quick Links: Medicaid, Markets, MA, Doctors Leaving

The 6/15/2011 New York Times used "secret shopper" techniques and found that Medicaid patients are having a more difficult time seeing doctors. Again, "coverage" does not equal actual care. (Via Tyler Cowen.)

John Goodman demonstrates numerous ways that the free market encourages private entities to offer affordable (or even free!) health services.

The 6/14/2011 Boston Globe reports "Massachusetts health care costs outpace nation".

UPI reports, "More physicians leaving private practices".

Mayo Clinic Opposes ACOs

The 6/10/2011 Minneapolis Star Tribune reports that, "Mayo opposes key health reform provision". In summary, the Mayo Clinic "says it already is accountable to patients without the government's proposed oversight system."

Here's an excerpt:

The Mayo Clinic says it will not be part of a critical piece of national health care reform under the government's proposed rules.

The prestigious Rochester clinic is raising questions about accountable care organizations, or ACOs, which are supposed to be updated -- and better -- versions of health maintenance organizations. Approved as part of the 2010 health care law, they are designed to improve care and cuts costs by over half a billion dollars a year.

But Mayo says the proposed regulations from the federal Centers for Medicare and Medicaid Services (CMS) conflict with the way it runs its Medicare operations, which treat about 400,000 patients a year...

Among the clinic's biggest concerns is the government's demand that patients be included on oversight boards that judge performance. Mayo doesn't do that now and is not eager to change.

"You don't have to have a [patient] on the board to make [treatment] patient-centered," Wood said.

(Read the full text of "Mayo opposes key health reform provision".)

Government ACO rules presume that bureaucrats know better how to run their operations better than doctors and hospital administrators whose own reputations are profitability are at stake. This is just another example of the central planner fallacy applied to health care. (Link via D4PC.)

Michael Cannon argues a similar point in his 6/3/2011 piece in Kaiser Health News, "ACO Debacle Exposes Obamacare's Fatal Conceit". (Via PatientPower.)

McArdle on High Risk Pools

In her 6/2/2011 blog post for The Atlantic, Megan McArdle asks a interesting question: "Why Hasn't Anyone Signed Up For the High-Risk Health Insurance Pools?"

She notes that ObamaCare supporters repeatedly argued that the law was necessary because millions of Americans were supposedly uninsurable because of "pre-existing conditions". Part of ObamaCare legislation included setting up government-sponsored "high risk" pools to enable these people to obtain insurance coverage that they could not otherwise find in the current mixed (semi-regulated/semi-free) economy.

Yet very few have chosen to do so, despite the relatively affordable subsidized prices.

It's almost as if the Obama administration had exaggerated the extent of the problem for political purposes!

There is a genuine problem of some Americans having a difficult time obtaining insurance, due to our current perverse system of tying insurance to employment (an artifact of government regulations going back to World War 2). But this problem cannot be solved by further regulations. Rather we need free-market insurance reforms.

For a discussion on how a free market would help those with pre-existing conditions, see my article in the Fall 2009 issue of The Objective Standard, "How the Freedom to Contract Protects Insurability".

ObamaCare Problems: Counting The Ways...

The 6/8/2011 Investor's Business Daily describes how "ObamaCare's Many Flaws Could Doom It".

The many problems they cite include:

* Millions of private employers will drop their worker coverage.
* Cost estimates keep rising
* The ACO concept to save money is meeting serious opposition
* The IPAB payment board is facing serious opposition
* The "high risk pools" are a flop
* The waivers

(Read the full text of "ObamaCare's Many Flaws Could Doom It".)

More and more Americans are catching on that this is a bad idea.

Hsieh PJM OpEd: Dude, Where's My Freedom?

The 6/11/2011 PajamasMedia has published my latest OpEd, "Dude, Where's My Freedom?"

My theme is that ongoing forms of "gun control", "health control", and "travel control" are just examples of a broader "freedom control".

Here is the opening:

Benjamin Franklin once warned Americans that “they who would give up an essential liberty for temporary security, deserve neither liberty or security.” Yet in the seemingly unrelated areas of health care and physical security, our political leaders are embracing this folly with predictably bad results...

(Read the full text of "Dude, Where's My Freedom?")

I'd like to thank JaredR and VickyG for pointing me to some of the links I used.

And thank you, Glenn Reynolds, for the Instapundit link!

Lucidicus Interviews Sally Pipes

Jared Rhoads of the Lucidicus Project has posted their recent interview with Sally Pipes, "Sally Pipes on doctors, students, and activism".

One excerpt:

With many negative aspects of the PPACA now coming to light, doctors are now beginning to see the impact on their practices and are getting engaged.

I think it is important to note that America does not have a free market in its health care system today. Fifty percent of health care is in the hands of government through Medicare, Medicaid, SCHIP, and the VA system. It does concern me greatly that a growing number of doctors in the academy and hospitals favor a single-payer system. The medical schools where our young students are training for a future in medicine either as primary care doctors or specialists are being indoctrinated by their professors who constantly tell them that a government-run system would bring about affordable, accessible, quality care for all.

It was this realization in 2008 that medical school students were not hearing any alternative to this type of system that emboldened me to found the Benjamin Rush Society. It is patterned after the Federalist Society but for medical students and doctors instead of law students and lawyers. It is a chapter based organization with affiliates at over 20 medical schools around the country—from Duke to Harvard; from Stanford to George Washington University. The chapters hold debates and seminars on issues of importance on issues that should be important to them. Topics range from "How do you achieve affordable, accessible, quality health care?" to "Are pharmaceuticals too expensive?" to "Is universal coverage the responsibility of the federal government?" Our goal is to have a chapter at every medical school in the nation.

These debates are very informative for students. We find that about 65 percent of students in the pre-vote tend to support a greater role for government. Following the debate, some gains have been made, with about 60 percent supporting our position. There is still much to be done if we are going to save a health care system that empowers doctors and patients. It is worrying that 49 percent of newly graduating specialists are now working for hospitals rather than going into private practice. In recent polls, 45 percent of doctors have said that unless ObamaCare is repealed, they will seriously consider getting out of the practice of medicine. This has serious implications for all of us who will at some point need medical care.

(Read the full text of "Sally Pipes on doctors, students, and activism".)

Pipes is absolutely correct. The key to the health care debate will be education -- of doctors, medical students, and patients. Activists like Sally Pipes deserve tremendous credit for their work in this arena.

Catron: Obamacare Has Another Rough Day in Court

In the 6/10/2011 American Spectator, David Catron has a nice wrapup of the latest legal proceedings in Atlanta over ObamaCare, "Obamacare Has Another Rough Day in Court".

Here's an excerpt:

Chief Judge Joel Dubina pointed out that there is no precedent for the claim that Congress is permitted to impose such a mandate by virtue of the Constitution's commerce clause: "I can't find any case like this.… If we uphold the individual mandate in this case, are there any limits on Congress's power left?"

Judge Stanley Marcus was also unequal to the task of finding a precedent for this arrogation of power by the federal government: "I can't find any case… telling a private person they are compelled to purchase a product in the open market.... Is there anything that suggests Congress can do this?"

Judge Frank Hull asked whether Congress could pass a similar law requiring Americans to buy certain types of cars or energy-saving devices to comply with federal energy policy.

(Read the full text of "Obamacare Has Another Rough Day in Court".)

These judges are asking exactly the right questions and addressing the fundamental issue of freedom vs. government compulsion.

The battle is a long ways from being won. But the latest courtroom proceedings are potentially encouraging for those who value freedom and individual rights.

Haynes: The Changing Character of Medicine

The 6/9/2011 edition of PajamasMedia has published another fine OpEd from Dr. Beth Haynes, "The Changing Character of Medicine: Are We Headed in the Right Direction?"

One crucial excerpt:

When you are ill, do you go to your physician to receive a government (or industry) derived practice guideline? Or do you want your physician to be able to apply his independent judgment to your individual situation? Which kind of doctor is more likely to be willing to rely on his own judgment in service of your individual best interests? One steeped in the ethics of social justice, beholden to a third-party for payment? Or a physician whose livelihood is directly related to and primarily dependent upon the quality of care he provides to you, the patient?

What if you have an unusual illness, or even a common illness for which a new but not yet thoroughly tested and approved treatment is available? Which physician would be more likely to suggest and/or support an innovative treatment? A doctor whose job depends on keeping the politicians or administrators happy, or the physician whose primary loyalty is to you?

(Read the full text of "The Changing Character of Medicine: Are We Headed in the Right Direction?".)

Dr. Haynes is asking the questions that all Americans should be asking.

Wolf: Why Obama Is Wrecking Medicare

Dr. Milton Wolf has a new OpEd in the 6/8/2011 Washington Times, "Obamacare wrecks Medicare by design, but why?"

He observes that (1) Medicare is increasingly unsustainable and that (2) current Obama administration policies seem designed to drive the American health care into a government-run single-payer system:

In the few remaining years Medicare has left, dispirited doctors are already fleeing the program in droves - and medicine altogether - leaving behind helpless patients. Democrats’ only plan is to maintain the crumbling status quo: Plunder Medicare, chase more doctors away with an additional 30 percent cut in reimbursement next year, and then watch from the bleachers as Americans are turned into medical refugees desperate for any salvation.

The president's intentions are chillingly clear: "I happen to be a proponent of a single payer universal health care program. ...That's what I'd like to see." Obamacare is a major step in that direction. "I don't think we're going to be able to eliminate employer coverage immediately," he says, but he can envision it "a decade out, or 15 years out, or 20 years out."

The current system of employment-based health insurance has many problems. But destroying the remnants of the semi-private insurance system and replacing it with a government monopoly insurer isn't going to make things better.

As one wag noted, "If you don't like health insurance companies now, think of how much better our customer service will be when you have to buy it from us."

(Read the full text of "Obamacare wrecks Medicare by design, but why?".)

ObamaCare Put Through The Wringer

Jay Bookman of the Atlanta Journal Constitution described the recent proceedings of the ObamaCare legal challenge at the 11th Circuit Court of Appeals today.

One excerpt:

Provisions of the federal Affordable Care Act, also known as ObamaCare, "may violate the constitution of Ayn Rand, but they do not violate the Constitution of the United States," acting solicitor general Neal Kumar Katyal told a three-judge panel of the 11th Circuit Court of Appeals Wednesday.

Conversely, attorney Paul Clement, representing Georgia and 25 other states, framed the issue of mandated purchase of health insurance as an issue of liberty.

"Can the federal government compel an individual to take part in commercial activity in order to better regulate that individual?" he asked the judges.

(Read the full text of "ObamaCare gets put through judicial wringer".)

I'm encouraged that the fundamental issue of liberty vs. government compulsion is being discussed in such frank terms. I'm also encouraged that the statists are identifying Ayn Rand as their explicit philosophical opposite.

The more that Americans understand Rand as providing a philosophical defense of liberty and individual rights, the better off we'll be in the long run.

(H/T: Beth Haynes and Sasha Volokh.)

Update: Ilya Shapiro has a nice report from the courtroom as well.

(And fixed a typo in the original title!)

Quick Links: Schwartz, Harsanyi, Pipes, Turner

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

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

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

(Read the full text.)

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

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

Goodman Dissects Evidence-Based Medicine

John Goodman does a nice job dissecting the many problems with the current concept of "evidence based medicine".

Often, the purported "evidence" is shaky. Or subject to commercial bias. Or applicable only to a subset of patients. Or simply lacking.

Yet doctors will be increasingly pressured to follow "evidence based" government practice guidelines (or risk not getting paid), even if that's not the appropriate care for the individual patient.

And note how the term "evidence based medicine" is carefully crafted to cast aspersions on any doctors who stray from those guidelines -- not-so-subtly implying that they are disregarding evidence or failing to practice according to sound scientific principles.

So beware the double-speak of "evidence based medicine".

(Read the full text of Goodman's post, "Cookbook Medicine". Link via Donna R.)

Quick Links: Lucidicus, ACOs, Government Power

Neil Weikel has a nice interview with Jared Rhoads of the Lucidicus Project.

I also highly recommend Jared's recent blog post, "Moral arguments on the rise in healthcare".

The 5/27/2011 Washington Post reports that a 5-year trial of ACOs really did not save much money. But it did increase the bureaucracy.

The 6/2/2011 Washington Times discusses "ObamaCare's Unlimited Power":

As Judge James L. Graham asked acting Solicitor General Neal Katyal, "Where ultimately is the limit on congressional power?" The question sounds rhetorical but is not.

Haynes on Paying for the Cake You Want to Eat

Dr. Beth Haynes of the Black Ribbon Project and Docs4PatientCare has a new OpEd in the 6/2/2011 PajamasMedia, "Medicare Reform: Paying for the Cake You Want to Eat".

Here is the opening:

Since Medicare and Medicaid became law in 1965, people have been told: "You can have your cake and eat it too." You can have the medical care you need and not have to pay for it. (You may think you are paying for Medicare with your payroll taxes, but in fact those taxes cover less than 1/3 of your projected health care costs.)

For decades, Medicare and Medicaid have been paying for health care with no one facing the difficult question: "Is what we are purchasing worth the cost?" Not the doctors, nor the "beneficiaries" -- and especially not the politicians. Doctors get income; patients get health care; politicians get votes -- all with the carefree ease of paying for it with other people's money while simultaneously ignoring the debt looming larger and larger behind the proverbial curtain.

(Read the full text of "Medicare Reform: Paying for the Cake You Want to Eat".)

As Dr. Haynes notes, the crucial issue will be "Who decides?"

As long as we attempt to "guarantee" universal health care for any group of Americans (such as senior citizens), the government will attempt to control what medical care it will pay for (and what care patients can receive). The end result will be Canadian and UK-style rationing.

Hence, if we want to restore control over these decisions back to senior patients and their physicians, we need to phase out and eventually privatize Medicare. That will be the only way out of our current Medicare mess.

Hsieh CSM OpEd: "Obamacare's Big Brother: Accountable Care Organizations"

The June 2, 2011 edition of the Christian Science Monitor has published my latest OpEd, "Here comes Obamacare's Big Brother: Accountable Care Organizations".

My theme is that the federal government's proposed new model of Accountable Care Organizations (ACOs) is dangerous because it will corrupt the doctor-patient relationship and stifle genuine health delivery innovations. Here is the opening:

Suppose President Obama declared he would tackle rising food prices by forcing everyone to eat at government-supervised restaurant chains. Small restaurants would be nudged to merge with national ones. Bureaucrats would monitor menu items and prices. Restaurants would record orders in a central database to ensure meals adhered to federal nutrition guidelines.

Most Americans would be outraged at such infringements of their basic freedoms. Yet this is precisely the approach the Obama administration is taking by pushing doctors and hospitals into government-supervised Accountable Care Organizations (ACOs).

(Read the full text of "Here comes Obamacare's Big Brother: Accountable Care Organizations". This piece will appear in both the online edition as well as the weekly print edition.)

For more on how Dr. Brian Forrest uses "direct pay" and price transparency to achieve such remarkable results in his small clinic in Apex, NC, see this eye-opening video:



Here's a related shorter news video covering much of the same material:



I'm honored to once again appear in the pages of the Christian Science Monitor. My earlier two CSM pieces were:

"Health Care in Massachusetts: A Warning for America" (9/30/2009)
"Universal Healthcare and the Waistline Police" (1/7/2009)

Economic Sense and Nonsense

Sally Pipes makes some good legal and economic arguments against ObamaCare in her 5/30/2011 Forbes piece, "The Administration's Argument For Obamacare Makes No Sense".

In particular, she notes:

...[U]pon careful inspection, the Obama team's argument for the constitutionality of the individual mandate amounts to little more than "because we said so."

She also discusses how the claim that ObamaCare will lessen the cost-shifting are faulty. Rather than fixing that particular problem, ObamaCare will simply make things worse.

These are not necessarily the most fundamental problems with ObamaCare, but they are important ones. And I'm glad they're being addressed by analysts like Sally Pipes.

Hospitals Skeptical About ACOs

The 5/30/2011 New York Times notes, "Medicare Plan for Payments Irks Hospitals". In particular, hospitals are expressing increasing skepticism about new rules for so-called Accountable Care Organizations (ACOs) intended to encourage them to save money by "integrated care".

A couple of excerpts:

This plan has drawn fire from hospitals, which say they have little control over services provided after a patient’s discharge — and, in many cases, do not even know about them. More generally, they are apprehensive about Medicare’s plans to reward and penalize hospitals based on untested measures of efficiency that include spending per beneficiary...

Charles N. Kahn III, president of the Federation of American Hospitals, which represents investor-owned companies, said he supported efforts to pay hospitals according to their performance. But he said the administration was "off track" in trying to hold hospitals accountable for what Medicare spends on patients two or three months after they leave the hospital.

"That's unrealistic, beyond the pale," Mr. Kahn said.

(Read the full text of "Medicare Plan for Payments Irks Hospitals".)

The push towards government-supervised ACOs represent a top-down "central planner" approach towards health care, with government carrots and sticks used to incentivize hospitals to follow government "quality" guidelines.

This approach ruined the Eastern Bloc economies during the Cold War. Why should we expect it to do any better for American health care?