Oregon Pseudoephedrine Legal Fail

This is not a surprise: "Oregon's Prescription Requirement for Cold Medicine Has Little Effect on Meth".

From the article:

Since 2006, the state of Oregon has had the strictest pseudoephedrine laws in the country. The popular decongestant, a common additive to over-the-counter cold and allergy medications, is also used to make black market methamphetamine. As meth use soared and volatile homemade meth laboratories proliferated in the early 2000s, many states began to put restrictions on the sale of the drug.

The most common such restriction was to move the medications behind the counter, and require customers to show identification before purchasing them. But Oregon was the first state to require a doctor's prescription to purchase cold and allergy medication....

However, the law has done little to restrict the production of illegal drugs, while imposing unnecessary burdens on legitmate users of pseudoephedrine:

A trip to the doctor requires a fee for an office visit, transportation costs and missed time from work, all of which can be especially burdensome on parents. The Cascade report points out that the hassles associated with visiting a doctor likely cause many patients to seek less effective treatment or no treatment at all, resulting in a longer recovery and lost productivity.

One 1992 study published in the Journal of Law and Economics found that the increasing availability of over-the-counter cold and allergy remedies prevented 1.6 million annual doctor visits. That number would likely be much higher today if all states had Oregon's law, resulting in higher health care costs, lost productivity, and lost time for doctors who would be spending time with sneezy patients that they could be spending with those suffering more serious illnesses.

The article also describes other "unintended consequences" of the anti-pseudoephedrine campaign.

(Read the full text of "Oregon's Prescription Requirement for Cold Medicine Has Little Effect on Meth".)

The Myth of Runaway Health Spending

In the 2/17/2012 Wall Street Journal, J D Kleinke addresses, "The Myth of Runaway Health Spending".

The rise in health spending is commonly trumpeted as a reason for more government controls.

However, the NCPA notes the following take-home points from Kleinke's piece:

* Health care spending increased continuously since the 1970s, consistently outstripping inflation and economic growth.

* This trend continued into the last decade, with the 7 percent rate of growth in 2000 rising to more than 9 percent by 2002.

*However, this trend has since turned negative with the rate dropping almost every year since 2002, reaching a low of less than 4 percent in 2009.

It is crucial, in reviewing this trend, to note that the downward pressure existed long before the recession began -- this lends credence to the belief that the ingredients that drove down spending are independent from the economic situation as a whole. Specifically, a number of developments in the early 2000s are largely responsible for the gradual reduction.

* A number of expensive medicines that were developed in the 1980s and 1990s, such as drugs for mental illness, HIV, cancer, heart disease and schizophrenia, have since become generic and are much cheaper.

* Greater information channels exist for communicating health care options and preventative measures.

* Market forces have slowly permeated the health care industry with higher deductibles, new copayments, and Health Savings Accounts allowing participants to have a hand in controlling their own health care spending.

The current system is mixed, with both free-market and statist elements. We should not blame the free-market elements for problems caused by government controls. And indeed, it has been the free-market elements that have kept costs at least partially under control, as happens in the rest of the economy.

TPPF on Medical Loss Ratios

The Texas Public Policy Foundation has a new paper on the problems with Medical Loss Ratios.

They do a nice job describing the various "unintended consequences" of the MLR mandates, including how they will destabilize the state’s small group and individual insurance marketplace. The paper is worth reading for a short summary of this issue.

ObamaCare Regulations Now Up To 1,147,271 Words

ObamaCare Watcher notes, "1,147,271 Words of Obamacare Regulations Published So Far—270% as Long as the Text of the Statute":

If you thought that Obamacare was long, it is only a fraction of the length of the regulations.

Obamacare contains over 700 directives for HHS and other agencies to implement Obamacare.

We went through and counted all of the Obamacare regulation documents published so far. We found that the number of pages in regulations are already 114% as long as the number of pages in the Obamacare statutes! The statutes contain 961 pages compared to 1,093 pages of regulations.

But regulations published in the Federal Register are published in small font, three columns wide.

What is more telling is the word count comparison. The Obamacare statutes together contain 425,116 words. Compare that to 1,147,271 words published so far in Obamacare regulation documents. The regulations are 270% as long as the statute itself.

The 1.1 million words in Obamacare regulations published so far are only a fraction of the regulations yet to come...

(Link via David Catron.)

This is just a manifestation of a much broader problem as outlined in the latest issue of The Economist, "Over-regulated America". The Economist is more sympathetic to ObamaCare than I would be, but it does note the following tidbit:

Every hour spent treating a patient in America creates at least 30 minutes of paperwork, and often a whole hour.

Quick Links: Med Students, Responsibility, UK

The 2/16/2012 LA Times reports, "Med school admission tests change to reflect new care realities".

In short, medical schools will place lower priority on the hard sciences and greater emphasis on sociology, psychology, and ethics. Of course, the big question is what kind of ethics will future physicians be expected to follow? (Hint: "The Wisconsin Protests and the New Medical Ethics".)

In the 2/14/2012 Orange County Register, Richard Ralston of AFCM urges, "Restore true personal responsibility to health care".

The 2/17/2012 Daily Caller notes, "As Obama pushes new regulations, UK eyes privatizing its health care".

Book: What Problem Does the Individual Mandate Solve?

In the 2/15/2012 Forbes blog, Robert Book asks, "What Problem Does the Individual Mandate Solve?"

He notes that individual mandate is supposed to solve the so-called "free rider" problem. However, it exempts (or subsidizes) many who arguably fit that description, and is instead imposed on those who aren't actually free riders.

Scherz: Unequal Protection Under the Health Care Law

Dr. Hal Scherz of Docs4PatientCare has a new OpEd in the 2/15/2012 American Thinker, "Unequal Protection Under the Health Care Law".

Government-run medicine is supposed to take money out of the equation and give people theoretically "equal" access to care without financial bias. Of course, as we've seen in other countries such as Canada, this merely results in preferential treatment based on political "pull".

One of my colleagues who practiced in Canada before he moved to the US tells me of occasions where they would turn on the normally-closed MRI scanner during the evening to squeeze in a politically-connected VIP, even though ordinary Canadians with similarly-urgent medical problems had to wait weeks for their MRI scans.

Similarly, the US Preventative Services Task Force is now trying to clamp down on medical procedures they consider "unnecessary", such as screening mammograms for women between age 40-50 and prostate screening (PSA tests) for men. As Dr. Scherz notes, President Obama just had his PSA test recently -- but ordinary Americans are being told they shouldn't get one.

Sure, we're all "equal" under ObamaCare. But some will be more equal than others.

(Read the full text of, "Unequal Protection Under the Health Care Law".)

Quick Links: MD Shortages, Insurance Costs, Drugs Development

Dr. Patrick Hisel discusses, "Why the physician shortage is a perfect storm".

A couple of excerpts:

The Government’s answer is always to grow itself. Now its plan is to start planting the seeds to force physicians to see Medicare patients in order to maintain their license (definition: serfdom). This will lead to an even further disillusioned physician workforce and more attrition...

The best and brightest will choose other careers that don’t involve government-fettered patient care. Or they will simply choose to do something with their lives other than practice medicine.

MIT economist Jonathan Gruber, consultant for both RomneyCare and ObamaCare, admits that "that the price of insurance premiums will dramatically increase" under ObamaCare. (Daily Caller, 2/11/2012. Via Dr. Art Fougner.)

Megan McArdle explains, "New Drugs Cost Even More Than You Think". If we keep making it harder for industry to develop new drugs, we won't have many of them soon. (Forbes, 2/10/2012. Via Dr. Matthew Bowdish.)

Armstrong: Obamacare Grants Doctors Liberty to Withhold Care

Dr. Richard Armstrong of Docs4PatientCare has a new OpEd in the 2/15/2012 Washington Times, "Obamacare grants doctors liberty to withhold care".

He dissects the new Orwellian language in which government controls over physicians are now a new form of "freedom". Here's an excerpt:

The law promotes a “new” model, the Accountable Care Organization (ACO), in which an entity that covers a specified number of Medicare patients is given a fixed pot of money. This is quite similar to the HMO capitation systems that caused tremendous backlash in the early 1990s. In both, if the doctors can provide care for less than what is in the pot over a defined period, they get to share the leftovers. If, however, the doctors overspend the pot, they are financially liable for the consequences. With sleight of hand and fanciful re-packaging, Dr. Emanuel attempts to convince physicians that this gallows for private practice somehow improves and enhances autonomy. Nice try, but doctors have been fooled once, which is quite enough.

In particular:

Either consciously or subliminally, the message is the same: The less you spend on patient care, the more you gain financially. This is the reality of the ACO model and the "new ethics" of government cost control in medicine, courtesy of the Affordable Care Act. Shouldn't economic and professional decisions be transparent in medicine, where doctors and patients make joint decisions based upon available resources, not some underlying, unspoken financial advantage for the physician to offer the patient less.

This system rewards doctors for denying care, while pretending to the patient (and themselves) that they're merely practicing "efficient" medicine and "parsimonious care".

I highly recommend reading the full text of "Obamacare grants doctors liberty to withhold care".

Rhoads: Concierge Physicians Now Being Targeted By Regulators

Jared Rhoads of the Center for Objective Health Policy notes, "Concierge physicians now being targeted by regulators".

Here is the opening of his OpEd:

According to a new rule that was passed in October and took effect on January 1st, concierge physicians in Oregon are now required to register their practices with the state's insurance department.1 To comply, concierge physicians and other doctors on retainer must share their business plan, financial history, and practice information with the state, submit marketing materials for review, and disclose any past bankruptcies going back 25 years.

The legislation was proposed by the state's insurance division. Insurers complained that, since concierge practices take a fee up front in exchange for care to be provided later, the practices are in the business of managing risk not unlike insurers. Their portfolio of clients, for example, cannot be allowed to exceed the capacity of the practice to provide the service promised. (That is, in the judgment of some unelected bureaucrat.)

(Read the full text of "Concierge physicians now being targeted by regulators".)

More and more physicians are seeking to escape the government-controlled insurance system by forming "direct pay" or "concierge" practices, so that they can practice medicine on their terms, for the mutual benefit of patient and doctor alike. Patients receive better care at reasonable prices, and doctors are able to practice according to their best medical conscience.

These independent practices thus pose a huge threat to government bureaucrats wishing to control how American medicine is practiced. The state of Oregon has taken the next step in attempting to herd doctors back under government control. The battle over concierge medicine could become the next big front in the fight for American health care freedom.

Related:

"Oregon requires concierge physicians to register with insurance department", American Medical News, 2/1/2012.

"Myths about concierge medicine", Dr. John Kihm, 1/9/2012.

Nursing Director Asks Staff To "Take Some Risks"

A reader who prefers to remain anonymous sent me an excerpt from a recent memo issued by a Clinical Nursing Director to his/her staff at a major American university medical center.

It reads:

...I need your help! I need the whole team to help own the '[Department] Checkbook.' The whole hospital is currently looking at ways to increase revenue and decrease expenses. We did not meet our targets for the 1st quarter of 2012 and have to make it up over the next 3 quarters. This is effecting [sic] every division of the hospital and not just nursing.

I am 100% confident that we can work together over the next couple of months to meet our goals. This means we are going to need to take some risks. What those risks are and when they are is dependent on the team. We are not always going to get everything right -- but we need to trust in every member of the team that we are trying to do the right thing.

It's not entirely clear what the Nursing Director means by "take some risks".

But the natural question is whether this means the hospital will jeopardize patient safety or well-being to meet their revenue targets. And whether "not always going to get everything right" refers to any aspect of patient care.

I don't have any more information other than what's in this excerpt, so there could be a totally reasonable explanation for this.

And even if there is a reasonable explanation for this particular memo, patients should remain wary of any purported health care "reform" which pits doctor' and hospitals' financial interests against their medical well-being.

Wolf: Time For A Romneycare Mea Culpa

Dr. Milton Wolf has a new piece in the 2/10/2012 Washington Times, "Time for a Romneycare mea culpa".

It's time for Romney to repudiate RomneyCare. Given how he's been so "malleable" on all his other views, it's puzzling that he refuses to change his mind about his failed Massachusetts health care plan. If he becomes the GOP nominee, he is thus unable to muster any effective rhetorical or philosophical opposition to ObamaCare, which is

The fact that Romney still can't "close the deal" with GOP voters should be a warning sign to him.

(Note: I have severe concerns about Gingrich and Santorum, but for different reasons than Romney.)

Roy: Conservatives and the Individual Mandate

In the 2/7/2012 Forbes blog, Avik Roy has an extremely informative post, "The Tortuous History of Conservatives and the Individual Mandate".

Basically, conservatives have been split on this issue. Many supported it on the grounds that it was enforcing "individual responsibility", although others correctly opposed it as an infringement of individual freedom. Over time, many former supporters did eventually change their minds. Others, like Ann Coulter, now seem to favor it -- at least if imposed by state governments rather than the federal government.

Roy's piece is long, but worth reading in its entirety.

I wrote about the problems with the pro-mandate conservatives in this piece for the Fall 2008 issue The Objective Standard, "Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America":

Nor does mandatory health insurance promote "personal responsibility," as [some] conservatives claim.

Personal responsibility presupposes that an individual has the freedom to make his own decisions and enjoy (or suffer) the consequences thereof. Personal responsibility presupposes that if a patient wants to pay a willing insurer more money now in exchange for the assurance of lower future costs if he becomes ill, then he is free to make that choice.

Similarly, personal responsibility presupposes that if he chooses not to purchase health insurance and later incurs a $10,000 medical bill, he will be held accountable for it even if he has to sell his car, borrow money from his family, or rely on charity. When the government forbids an individual from making such choices about his health insurance, it makes personal responsibility in this area impossible.

Armstrong On Birth Control Mandates

In The Objective Standard blog, Ari Armstrong discusses why "Not Only Catholics Should be Angered by Birth Control Mandates".

I especially liked this segment:

True, the government should not force Catholics to fund birth control against their religious beliefs. But the government should not force anyone to fund any type of insurance coverage against their wishes. The government should not force people to buy insurance that covers birth control, acupuncture, maternity leave, or any other good or service. Such mandates violate the rights of insurance companies and their clients to freely negotiate terms, and they drive up the costs of premiums.

Insurance mandates not only violate Catholics' freedom of religion; they violate everyone's freedom of conscience and everyone's freedom to use their own resources as they judge best. To be genuinely "pro-choice," one must respect people's choices across the board—including their choice of religion or philosophy, their choice of whether to buy insurance and if so what kind, and their choice of how to dispose of the fruits of their labor.

(Read the full text of "Not Only Catholics Should be Angered by Birth Control Mandates".)

Update: Ari Armstrong pointed me to how the Obama Administration may try to use waivers to make this political hot potato go away, "Obama May Waive Away Contraception Uproar".

Quick Links: Amicus Briefs, BC Mandate, Liberty, Virtual Clinics

Sally Pipes: "Amicus Briefs Give A Supreme Condemnation Of ObamaCare" (Forbes, 2/7/2012).

CBS News: "Catholic League Poised To Go To War With Obama Over Mandatory Birth Control Payments"

Dr. Jane Orient: "Shall We Take the Liberty of 'the 1%'?"

Mark Perry: "Virtual Retail Clinics". (Via Kelly V.)

Washington State ER Medicaid Trap

The 2/7/2012 Seattle Times reports, "State Medicaid to quit paying for ER visits deemed unnecessary".

From the article:

Medicaid officials say the program will no longer pay for any medically unnecessary emergency-room visits, even when patients or parents have reason to believe they're having an emergency...

They would apply to all adults and children on Medicaid, with no exceptions, such as someone being brought in by ambulance or from a nursing home, or when patients have neurological symptoms or unstable vital signs...

Under federal law, patients that show up at the ER cannot be turned away, at least not until the treating physician determines they are not having a medical emergency. But for many conditions (which includes neurological impairment or unstable vital signs), it can be unclear whether or not there is a true emergency until after a fair amount of skilled testing and evaluation.

As the article notes:

For Medicaid patients, Schlicher said, the plan suggests that even before heading to the ER, they should know what their ultimate diagnosis will be.

"If we don't know without an X-ray or CT scan, how can they know it?"

For doctors, the plan could place them in legal jeopardy, Schlicher said.

If they turn patients away, "it's not good care and it doesn't meet the legal standard," he said. "I can't tell any provider to commit medical malpractice, no matter how much the state wants us to do that."

So in essence, the state will compel ERs and doctors to render medical services to these patients, then penalize them economically if the government deems that the condition wasn't a real emergency.

Note the trap: The government tells doctors, "We don't want to tell you how to practice medicine. But we have to control what gets paid for, for the good of 'society'." Doctors no longer have genuine freedom to practice medicine as they see fit, and patients suffer as a result.

(Read the full text of "State Medicaid to quit paying for ER visits deemed unnecessary".)

Right now, this affects only Washington state. But don't be surprised if we start seeing similar proposals in the rest of the country.

(Seattle Times link via a reader.)

Herrick on the Medical Devices Tax

Devon Herrick of NCPA has a new short policy brief, "The Job-Killing Medical Device Tax".

He notes that the tax would (1) harm an industry working on slim profit margins, (2) destroy many jobs, and (3) raise health care costs.

This tax will also stifle many new innovations before they ever reach the market. As always, we'll never know about the lives that could have been saved by new devices that weren't developed (but could have been). For more on this, see my PJMedia piece from 2010, "The Deadly Tax on Medical Innovation".

Goodman: Worse Than Death Panels

In this 2/4/2012 TownHall piece, John Goodman explains why ObamaCare will be "Worse Than Death Panels".

In particular, he describes how rigid clinical practice protocols will be foisted on doctors and patients under the guise of "evidence based care". This will happen through the following steps:

1) The ObamaCare exchanges will only allow health insurance plans that cover "evidence based care". Over time, these will likely be the only plans that survive.

2) Because doctors will want to get paid, they'll have to adhere to care that follows government guidelines.

3) Doctors who follow these guidelines will have protection from malpractice suits, whereas doctors who stray will have to take their chances in court if anything goes wrong.

While "evidence based" sounds scientific, there are many problems with what is currently called "evidence based". Often these guidelines are based on inadequate, outdated, or biased data.

Another problem:

[E]ven where there are well established guidelines, they are inevitably written for the average patient. But suppose you are not average. Is your doctor free to step outside the protocols and give you care based on her training, knowledge and experience? Or will she be pressured to stick to the cookbook, regardless of how the patient fares? Health plans always say that doctors are free to step outside the guidelines if they have good reason for doing so. But if the doctor is forced to fill out multiple forms and jump through lots of hoops, many will conform to the guidelines even if that’s bad for you.

And finally, guidelines are too-often wrongly applied to patients for whom they were not intended:

For example, a large number of studies of patients with heart failure excluded elderly patients, even though most of the people who have this problem are elderly! If you are an elderly patient do you want your doctor to follow procedures that were based on studies of patients 30 or 40 years younger than you are? According to Don Taylor, a health policy analyst at Duke University, it is not at all unusual to exclude patients with characteristics and conditions from clinical trials who are then subjected to the guidelines after the trial is over.

In effect, these guidelines represent the "central planner fallacy" as applied to health care. Bureaucrats in Washington DC regard themselves are more qualified to decide what medical care you should receive than your doctor who actually knows your medical condition.

Is this the kind of health care you want?

(Read the full text of "Worse Than Death Panels".)

Catron On Coulter

David Catron offers his own takedown of Ann Coulter's attempted defense of RomneyCare in his 2/6/2012 American Spectator piece, "Who Castrated Ann Coulter?"

He makes many good points, but I especially liked this section:

...[Coulter] adds the irrelevant point that mandates are constitutional when enacted by states rather than by the federal government. This is true enough, but it misses what should be an obvious point. Health care consumers are less concerned with constitutional nuances relating to federal versus state powers than with the reality that they will be forced to buy insurance whether they wish to or not. That the mandate was passed by a state legislature rather than Congress will not render voters less inclined to resent such government interference in their private transactions.

(Read the full text of "Who Castrated Ann Coulter?")

The debate should be about protecting individual rights, not which level of government is best suited to violating them. Catron does a nice job exposing Coulter's many inconsistencies.

According to the FDA, Your Stem Cells Are Now Drugs

The latest news story on FDA overreach, "According to the FDA, Your Stem Cells Are Now Drugs".

Here's the relevant section:

The bizarre controversy revolves around the FDA's attempt to regulate the Centeno-Schultz Clinic in Colorado that performs a nonsurgical stem-cell therapy called Regenexx-C. It is designed to treat moderate to severe joint, tendon, ligament, and bone pain using only adult stem cells. Doctors draw your blood, spin it through a centrifuge, extract the stem cells and re-inject them into your damaged joints. It uses no other drugs. No drugs means no FDA oversight and that does not sit well with the administration.

The FDA has since argued that a) stem cells are drugs and b) they fall under FDA regulation because the clinic is engaging in interstate commerce. That's right, a process performed at the clinic using the patient's own bodily fluids constitutes interstate commerce because, according to the administration, out-of-state patients using Regenexx-C would "depress the market for out-of-state drugs that are approved by FDA."

This is stretching the claimed limits of government power into hyperspace. By that "reasoning", the government could regulate anything that might alter what sorts of medications you might purchase from out of state, such as an exercise machine. (Via Instapundit.)

Related: Michelle Minton of the Competitive Enterprise Institute describes the latest FDA overreach with respect to dietary supplements at her 1/31/2012 OpEd for The Hill, "The FDA has it dead wrong":

[T]he NDI draft guidelines released by the FDA this summer would create a de facto pre-approval process on virtually all supplements on the market, thus giving the agency carte blanche to pull any supplement off the shelf without the need to prove that it is unsafe.

As Minton notes, the FDA's efforts are a "rogue effort to unilaterally expand its authority". Fortunately, some in Congress want to rein them in, at least on this issue. Let's hope they are successful.

Wolf: Obamacare Is Worth Getting Angry About

Dr. Milton Wolf has a great new OpEd at the Washington Times, "Obamacare is worth getting angry about".

He makes many good points, but I wanted to highlight this passage:

For the first time in the history of our republic, our government has demanded that every American, upon the condition of breathing, be forced to enter a legal contract with government-approved corporations. Not even King George III dared impose such control. In truth, if a government can force you to patronize companies of its choosing, the fundamental relationship between the government and the individual is irrevocably changed. If it is allowed to stand, there will be no part of your life the government cannot control and no crony it cannot enrich -- with your money.

Isn’t that worth getting angry about?

(Read the full text of "Obamacare is worth getting angry about".)

I don't know whether or not Mitt Romney will be the eventual GOP nominee for the 2012 presidential race. But if he is, our best hope for moving the country in the right direction with respect to health care policy is for Americans to keep up the pressure, letting him know that we want ObamaCare repealed.

Thank you, Milton, for reminding us what's at stake -- it's not just our health care but our basic freedoms.

Armstrong: Our Dead American Medical Association

Dr. Richard Armstrong of Docs4PatientCare has a new OpEd in the 2/1/2012 Washington Times, "Our Dead American Medical Association".

In his piece, Dr. Armstrong highlights a couple of facts that aren't widely known by the general American public:

1) The AMA now represents only 15% of American physicians.

2) They make most of their money from a government-granted monopoly on medical coding, rather than from physician membership dues.

Hence, the AMA is far more beholden to the federal government than to physicians. Is it any surprise that the AMA decided to back ObamaCare despite deep opposition from regular practicing physicians?

And because the public perception is that the AMA "is the voice of American doctors", most people wrongly concluded that there was of a "consensus" of US physicians in favor of ObamaCare when that was not the case at all.

Fortunately, more US physicians are joining other groups that do genuinely represent their interests and their patients' interests, such as Docs4PatientCare.

(Read the full text of "Our Dead American Medical Association".)

Finally, one commenter made the following astute observation:

Most doctors don't dare practice medicine any more.

They must simply fit their patients into templates designed by actuaries and prescribe negotiated, unimaginative, and often dated protocols handed down from the ivory tower regardless of documented dismal success rates. Straitjacketed by the constant threat of malpractice the MD now merely represents a certificate of applied medicine and board certified means guaranteed not to stray from Conn's Current Therapy.

They don't have a license to practice medicine, they have a permit to follow a flow chart. It sickens me.

This is the future of American medicine unless ObamaCare is repealed and we adopt genuine free-market health care reforms.

Coulter And Her Critics

Conservative pundit Ann Coulter recently attempted to defend the Massachusetts "universal" health care plan in her 2/1/2012 column, "Three Cheers for RomneyCare!"

Almost immediately, critics posted rebuttals of her various bad arguments. Here are a few:

Philip Klein: "Coulter's shameful defense of Romneycare".

AllahPundit at HotAir.

Mark Levin: Video rebuttal. (Or download the MP3 version).

Ultimately, Coulter's arguments don't hold water. And plenty of people noticed it.

Quick Links: Ethics, Algorithms, Managed Care

John Goodman: "Money, Medicine and Ethics". (Via D4PC.)

Dr. Jeffrey Parks: "How algorithm driven medicine can affect patient care". (Rigid protocols are no substitute for the rational mind.)

Dr. Rich Fogoros: "Whatever Happened To Managed Care?"

Side By Side: ObamaCare vs. RomneyCare

OHPCenter.org spotted this nice side-by-side comparison of Romneycare and Obamacare from a left-of-center advocacy group.

Rhoads: Fact-Checking Romney on Individual Mandate

In the 1/28/2012 Daily Caller, Jared Rhoads of the Center for Objective Health Policy does some much-needed "Fact-checking Mitt Romney on the Massachusetts individual mandate".

Here is the opening:

During Thursday night's CNN debate -- the final such event before the Florida primary on Tuesday, January 31 -- Rick Santorum attacked Mitt Romney over the individual mandate contained in the health reform legislation passed by Romney as governor of Massachusetts.

Santorum said that Romney's mandate requires individuals to buy an insurance policy "as a condition of breathing." He called it a top-down model that is "no different than Barack Obama’s mandate."

Romney objected to it being called a "top-down model" and contested that the logic behind the individual mandate in Massachusetts is that "if you don't want to buy insurance, then you have to help pay for the cost of the state picking up your bill." He noted that under federal law, hospitals are required to treat certain patients regardless of whether the patients have insurance. Romney then followed with, "... [W]e said, no more, no more free-riders. We are insisting on personal responsibility. Either get the insurance or help pay for your care. And that was the conclusion that we reached."

Rhoads analyzes the real truth behind Romney's disingenuous claims.

In particular, Romney employs a faulty concept of "responsibility" to justify government infringements on individual freedoms.

For a proper analysis of genuine personal responsibility in this context, read the full text of "Fact-checking Mitt Romney on the Massachusetts individual mandate".

Blog for Surgery Center of OK

Readers of this blog might also enjoy the blog by Dr. G. Keith Smith for the "Surgery Center of OK".

Dr. Smith's tagline: "I blog about free markets in medical care and pricing."

Here's an extended excerpt from his latest post, "Another 'not making a profit' story":

A nurse with whom I am acquainted told me the following story this morning. A relative of hers was recently diagnosed with breast cancer and a course of chemotherapy was advised. She has a high deductible insurance policy (good for her!) but just after the holidays is a little short on cash. After having received the news of her diagnosis and just having received her first round of chemo, she was told by the cancer treatment facility (owned by a LARGE health system in Oklahoma employing oncologists) that she must show up with no less than $495 at her next appointment or the deal was off: no more chemotherapy for her.

Now those of you that know me or read this blog know that I'm a fan of the free market. TANSTAAFL (there ain't no such thing as a free lunch). Here at the Surgery Center of Oklahoma, we charge for what we do and we make a profit. We just happen to charge about a fifth as much as our hospital friends who claim to "not make a profit." I continue to be amazed and shocked at the strong-arm money grubbing that characterizes these "not for profit" health systems (big hospitals). Come on! Seriously, this woman receives a diagnosis during the holidays of breast cancer and she is shoved against the wall for money? You think my characterization of this is unfair? This shakedown mentality isn't limited to the poor, either. Just ask Garth Brooks.

There's more. The oncologists, previously independent physicians with their own chemotherapy center, were free to make allowances for hardship prior to their sell out to the hospital for which they now work. The fees for their services are now higher than before by virtue of their affiliation with the "hospital system" and their old cancer treatment center is now abandoned. This is important to understand for those of you who think that physician-owned facilities represent a conflict of interest for the owners and that price gouging will be the inevitable result.

The opposite is actually true. Physicians who own their own facilities must also own and claim responsibility for the billing practices of the facility in addition to that of their private office.

This "accountability of ownership," as I like to call it (economists would refer to this as a lack of moral hazard, I think) represents a powerful deflationary effect on prices charged patients. Then there is the compassion factor. The physician-owned facility and its staff (including the billing and business staff) can't aggressively shake patients down for money without tarnishing the image of the physician...

Read the rest of the post for how his facility deals with this issue, "Another 'not making a profit' story".

I thought the discussion of reputation effects and accountability for the physician-owned medical facilities were especially interesting and worth wider circulation.

In medicine as in the rest of the modern economy, the enlightened self-interest of an honest provider of goods and services is the customer's best guarantee of good quality.

(Note: I've only begun looking into the various posts, so this isn't a blanket endorsement of everything on the website. But I am looking forward to exploring it in more depth.)

WSJ Debate on ACOs

The 1/23/2012 Wall Street Journal features this extended debate on the pros and cons of Accountable Care Organizations (ACOS): "Can Accountable-Care Organizations Improve Health Care While Reducing Costs?"

(If the direct link doesn't work, just Google the title of the article).

There's lots of information here, which I am still digesting.

Orient on Quitting Medicare

The 1/25/2012 Washington Times has published Dr. Jane Orient's OpEd, "Uncle Sam exacts penalty for quitting Medicare".

Federal rules make it extremely difficult for physicians and patients to privately and voluntarily contract for medical services outside of the Medicare system, even when they both wish to.

A good step towards the eventual privatization of medicine would be loosening such onerous Medicare restrictions. Patients and physicians could reap some benefits now, while we work to phase in other free-market reforms.

Par8o: Why EMR is a Four Letter Word to Most Doctors

Hint: It's all about the control.

EMRs (electronic health records) can be excellent tools when developed in a free market in response to physician and hospital needs. EMRs can also act as impediments to good patient care when imposed in a top-down fashion by government fiat.

CO Considering Repealing Health Insurance Exchange

Last year, the state of Colorado agreed to establish a health insurance exchange, after much political debate. This year, state Senator Tim Neville has introduced a bill to repeal last year's bill creating that exchange.

Although I won't be able to testify in person at the hearing on this bill, I was invited to submit a written statement in support of Senator Neville's bill:

Statement to CO Senate Health and Human Services Committee Supporting SB12-053

Paul Hsieh, MD
Co-founder, Freedom and Individual Rights in Medicine (FIRM)

I'm writing to support Senator Tim Neville's bill, SB12-053, "Repeal SB 200 Healthcare Exchange".  Establishing the exchange last year was a mistake.  As a practicing physician concerned about the medical freedom of Colorado patients, I'm glad to hear the state legislature is considering repealing the earlier bill and rectifying last year's error.

The fundamental problem with the state exchanges is that they serve as a vehicle for implementing the federal ObamaCare legislation at the state level.  Rather than facilitating a free market in health insurance, the exchanges would effectively put health insurance under the control of the federal government.  This would allow them to dictate what policies would look like and how doctors would manage their patients covered by exchange-provided insurance.

As Twila Brase of the Citizen's Council for Health Freedom notes, "State-established Exchanges may not write rules that conflict with or prevent implementation of federal rules issued by HHS under the law."  In other words, by creating our own state exchange in Colorado, we did not give ourselves greater flexibility and freedom from federal law, but rather surrendered to it.

Some negative consequences include the following:

1) Federal law will encourage employers to "dump" employees onto the state exchanges.

As reported by Minnesota Public Radio News and Kaiser Health News: "A loophole in the federal health care overhaul could allow employers to game the system by getting their sicker employees to opt into buying coverage on the health insurance exchanges, according to two University of Minnesota law professors.  They say the loophole could have dire consequences for the financial health of the exchanges..."

Hence, the exchanges will become a "budget buster" for the taxpayer-subsidized exchanges.

2) Coverage decisions would be mandated by Washington

For example, the federal government has empowered the USPSTF (United States Preventive Services Task Force) to determine what sorts of preventive care are or are not considered "cost effective".  In 2009, the USPSTF recommended restricting screening mammography to women over 50 (and only at 2 year intervals), despite the proven medical benefits of the current practice of screening women starting at age 40 at yearly intervals.

Under ObamaCare legislation, the USPSTF will set the de facto standards for what preventive services will or will not be covered by government insurance such as Medicare.  These criteria will inevitably also be applied to determine which private plans may be offered on the state exchanges.  Coverage decisions would be made by bureaucrats in Washington, DC.

3) Mandated benefits would drive up costs for patients

In Massachusetts, insurance prices on their state exchanges have risen much faster than the national average because pressure from special interest groups has resulted in mandatory coverage of services, whether or not patients actually need or desire such coverage.  Since 2006, special interests in Massachusetts have successfully lobbied to include 16 new benefits in the mandatory package (including lay midwives, orthotics, and drug-abuse treatment), and their state legislature is considering 70 more.  The decisions over what services will or will not be covered by exchange insurance plans have become fierce "political footballs" to the detriment of patients.  This will likely occur in Colorado as well.

Fortunately, states have a method of fighting back against this unwarranted federal control of health care.  In a recent editorial, Sally C. Pipes (president of Pacific Research Institute) and Dr. Hal Scherz (President of Docs4PatientCare) note the following:

The feds have further stipulated that people can only access billions of dollars in tax credits and subsidies earmarked for the purchase of policies by shopping in the state-run marketplaces.  If a state refuses to set up its own exchange, Obamacare allows the federal government to come into the state and set one up.

But here's the rub. The text of the law stipulates that only state-based exchanges -- not federally run ones -- may distribute credits and subsidies.  Without the federal cash, consumers won't patronize the government-run exchanges -- particularly with all the cost-inflating mandates they impose on insurers who wish to participate.

In other words, the federal government needs the acquiescence and active co-operation of the states to make the government-run exchanges work.  Hence, state governments can block this key feature of ObamaCare simply by refusing to establish a state exchange.

In conclusion, state-run exchanges under ObamaCare will harm patients and taxpayers.  For these reasons, other states such as Florida and Louisiana have already declined to establish their own state exchanges.  Colorado can join them by passing SB12-053, thus correcting last year's mistake.  Passing SB12-053 would be an important step in protecting essential medical freedoms for Coloradans.

=====

References:

"Don't get mugged by a politically controlled insurance exchange"
Brian Schwartz, Denver Post, 5/6/2011
http://www.denverpost.com/recommended/ci_18002925

"State Health Insurance Exchanges Will Impose Federal Control"
Twila Brase, Citizens’ Council for Health Freedom
http://www.cchfreedom.org/pdf/Policy_Insights-Insurance_Exchange.pdf

"Study: Employers Could Dump Sickest Employees On Public Health Care"
http://www.kaiserhealthnews.org/stories/2011/november/30/employers-dump-sickest-employees-public-heath-care.aspx

"Mass. health care costs outpace nation"
Boston Globe, 6/14/2011
http://www.boston.com/Boston/whitecoatnotes/2011/06/mass-health-care-costs-outpace-nation/DFCgMwvVZtunS7TIAn44BN/index.html

"Rejecting health-care exchanges"
Pipes and Scherz, Charleston Post and Courier, 12/29/2011
http://www.postandcourier.com/news/2011/dec/29/29pipes/

The idea of repealing a prior bad law should be proposed more often. I'm glad our state legislators are seriously considering this idea. Perhaps this will be the beginning of a larger trend!

Medicaid Coercion

Christopher Conover discusses, "Medicaid Coercion":

[S]tates face a relatively simple (albeit stark) choice when it comes to Medicaid. They can either accept the new Medicaid spending required under the ACA or they can reject the "deal" offered by Congress, in which case they must forego all federal funding of Medicaid.

States are caught between a rock and a hard place as state spending (and budgets) explode out of control. Conover concludes:

The problem with salami tactics like those encouraged through federal matching programs such as Medicaid is that eventually we will run out of salami. It's very generous for the federal government to offer 90 percent matching in perpetuity for those newly eligible under the ACA. But it is not at all clear Uncle Sam is in a position to fund this promise, especially in light of the fiscal tsunami posed by Medicare in the decades ahead.

If you live by federal money, you die by federal money.

Snopes Disputes Neurosurgery Rationing Claim

On November 26, 2011, I posted about proposed "HHS Restrictions on Neurosurgery" based on a neurosurgeon claiming to receive a briefing from Obama administration officials.

The Snopes.com website states that the American Association of Neurological Surgeons has investigated this issue and determined that anonymous caller was likely not a neurosurgeon and that the call "contained several factual inaccuracies". More here.

CO High Risk Pools and D4PC Response

The 1/16/2012 Denver Post reported, "Colorado high-risk health insurance pool runs up claims twice the U.S. average".

Docs4PatientCare made the following observation:

One year into a 4 year plan, Colorado is just one of a dozen states who have already burned through the federal funds allocated to set up this program. It's deplorable that even before the poorly designed Obama healthcare law is implemented, the bureaucracy claiming it will cover the "uninsurable" is already over budget and asking for a federal bailout.

If this administration understood the healthcare marketplace and truly wanted to provide these high risk patients with affordable medical insurance options, they would unleash the power of the national marketplace by changing the rules that currently [prevent] these patients from "pooling" their risk and using the resulting "purchasing power" to shop across state lines.

Pipes and Scherz: Rejecting Health Insurance Exchange

In the 12/29/2011 Charleston Post and Courier, Sally Pipes (Pacific Research Institute) and Dr. Hal Scherz (Docs4PatientCare.org) discuss "Rejecting health-care exchanges".

They note:

Obamacare instructs states to set up health insurance exchanges where consumers and small businesses can look for coverage starting in 2014. The exchanges would effectively put health insurance -- and the delivery of care -- under the control of the feds, who would dictate what policies would look like and how doctors would treat patients with exchange-provided coverage.

The feds have further stipulated that people can only access billions of dollars in tax credits and subsidies earmarked for the purchase of policies by shopping in the state-run marketplaces.

Pipes and Scherz explain how states can fight back against ObamaCare by choosing not to create such exchanges:

If a state refuses to set up its own exchange, Obamacare allows the federal government to come into the state and set one up.

But here's the rub. The text of the law stipulates that only state-based exchanges -- not federally run ones -- may distribute credits and subsidies.

Without the federal cash, consumers won't patronize the government-run exchanges -- particularly with all the cost-inflating mandates they impose on insurers who wish to participate.

Some states have already rejected the role of abetting the federal government in imposing ObamaCare on unwilling residents. Let's hope more follow suit.

(Read the full text of "Rejecting health-care exchanges".)

Quick Links: Herd Medicine, CO Risk Pools, Government Growth

Dr. Richard Fogoros discusses, "Herd Medicine". Soon, it will be considered ethically obligatory to sacrifice a few patients for the "cost effectiveness" of the herd.

The Denver Post reports more problems with the Colorado high-risk pool.

At PJMedia, Bryan Preston explains "How ObamaCare Grows Government While Reducing Access".

Hsieh PJM OpEd: SOPA, Guns, and Freedom

The 1/19/2012 edition of PJMedia has just published my OpEd, "SOPA, Guns, and Freedom".

I open with the following question:

Q: What does the proposed SOPA (“Stop Online Piracy Act”) legislation have in common with gun control?

A: Both would punish the innocent for the bad acts of a guilty few.

Click through to read more on how this applies to SOPA, gun control, freedom, and limited government.

This piece isn't directly related to health care policy, but I do briefly discuss how ObamaCare is yet another example of this dangerous statist mindset.

For more detailed discussion on how SOPA could have "broken the Internet", technically-minded readers might enjoy Paul Vixie's article from 1/11/2012, "Refusing REFUSED". Because of the intense political pressure from anti-SOPA advocates, some legislators have proposed a modified version of SOPA that they claim will avoid some of these technical problems.

PJMedia also published the following technical analysis on 1/14/2012, "SOPA and PROTECT-IP: A Line-By-Line Analysis of the Bills We Must Kill".

Diana has more links and information about SOPA in her recent webcast on this topic, "SOPA and Online Piracy".

(Note: This OpEd was written the day before the 1/18/2012 "blackout" and subsequent political events.)

Update: Thank you, Instapundit, for the link!

Hsieh RCM OpEd: Why Is Creating Value Good, Profits Bad?

The 1/17/2012 edition of Real Clear Markets has just published my latest OpEd, "Why Is Creating Value Good, Profits Bad?"

It's not directly related to health care policy, but rather the broader theme of defending the virtue of the profit motive in a free, capitalistic society. (I do use insurance as an example of how value is created). Here is the opening:

"Profit" is a dirty word. Profit-seeking businessmen are stock villains in Hollywood movies. "Occupy Wall Street" protestors demand, "People not profits" (whatever that means). Companies reporting healthy profits are automatically assumed to be exploiting customers and can only atone for this by "giving back" to their communities. "Making a profit" has an unsavory, morally suspect taint.

Yet simultaneously, Americans have a far more positive view of the concept of "creating value." The mainstream press lauds visionary businessmen who "create value," such as the late Steve Jobs of Apple. The business literature routinely emphasizes the importance of "creating value." So many organizations wish to be seen as "creating value" that it has become a business cliche, like "best practices" and "thinking outside the box."

But in a free society, "creating value" and "making a profit" are just two sides of the same coin...

(Read the full text of "Why Is Creating Value Good, Profits Bad?")

Those who earn honest profits by creating value should be proud of this fact.

I'd like to thank attorney-blogger Doug Mataconis for providing the Tweet which I cited later in the OpEd, as well as pointing me towards the Wall Street Journal piece on Bain Capital that I cited.

Quick Links: Squeezing Doctors, Insurers, Patients

Dr. Craig Koniver explains why, "Doctors are forced to choose between really small or super big".

Government controls are squeezing out traditional small private practices. A few doctors will survive by running "concierge" practices. The rest will join large "Accountable Care Organizations", where they'll have to practice according to standardized "cost effectiveness" guidelines.

The 1/12/2012 New York Times reports, "U.S. Seeks Rollback of a Health Insurer's 'Excessive' Rate Increase".

The government will determine what benefits insurance companies must offer, who they must accept, and how much they can charge. Over time, insurance companies will become the equivalent of heavily regulated utilities -- "private" in name only. Or they'll be squeezed out of business altogether, leaving us with only a government "single payer" option.

The Atlantic reports, "5% of Americans Made Up 50% of U.S. Health Care Spending". Furthermore, "In 2009, the top 1% of patients accounted for 21.8% of expenditures."

As the government assumes greater control over health spending, it will place tremendous pressure on physicians to minimize spending for that top 5% (and especially for that top 1%). But don't call it rationing.

Hsieh DP LTE on ACOs

The 1/15/2012 print edition of the Denver Post has published my LTE, "Accountable care organizations would backfire". This was in response to their 1/9/2012 story, "Medicare reform rewards doctors for better, cheaper care".

My LTE was as follows:

"Accountable care organizations" would backfire

In theory, "accountable care organizations" should encourage physicians to provide cost-effective, "integrated" care. In practice, they will reward physicians for limiting care.

Suppose you see your ACO doctor for a severe headache. He briefly examines you then says, "You don't need a MRI scan of your head; just take two Tylenol and call me in the morning." Can you be completely sure he is acting in your best medical interest? Or might he be unduly influenced by the bonus he receives for reducing the number of MRI scans performed by the ACO?

ACOs make doctors accountable -- but to Medicare bureaucrats, not their patients.

Paul Hsieh, Sedalia

Catron: The Thelma And Louise Party

In his latest American Spectator piece, David Catron discusses the seeming suidicdal tendencies of the Republican party.

From "The Thelma & Louise Party":

Barack Obama should be facing, as he himself phrased it, "a one-term proposition." His incompetence has reached depths that render the feckless Jimmy Carter positively Washingtonian by comparison, the sheer lawlessness of his administration evokes nostalgia for the merely corrupt Clinton years, and the state of the nation is worse by any objective measure than it was in on the day he took office.

The GOP should be well positioned to send the President into retirement. Instead, the party's nomination process has become a bloody battle in which the candidates are viciously attacking one another rather than Obama, denouncing core conservative principles rather than the failures of big-government, and seems to be on the verge of producing a "winner" who has no prayer of defeating the incumbent.

Catron then runs down the many serious problems revealed by candidates such as Perry, Gingrich, and Romney. I especially liked this discussion:

[Romney] obviously can't go after the President on Obamacare. Even if Romney hadn't provided the prototype for Obamacare while governor of Massachusetts, his company's acquisition of a for-profit hospital chain whose largest revenue stream comes from the pocket of the American taxpayer makes it impossible for him to attack the President's big-government approach to health care.

Romney can't even point out that Obamacare's insurance mandate is unconstitutional without being reminded that it is based on a virtually identical requirement that he signed into law in the Bay State. That the Massachusetts mandate was enacted at the state level, and is therefore constitutional, will be lost on all but a few voters. Thus, Romney can't criticize ObamaCare's most offensive feature without looking like a cheap flip-flopper.

2012 should be a GOP landslide. But Obama may have a legitimate shot at relection due to the weakness of the GOP field.

(Read the full text of "The Thelma & Louise Party".)

Rock Vs. Hard Place

Surgeon-blogger "Skeptical Scalpel" notes "Not news: Shorter hospital lengths of stay = higher readmission rates".

This illustrates the two jaws of the trap being set for physicians attempting to practice under upcoming Medicare guidelines. If you allow your patients to stay too long in the hospital, you'll be penalized for wasting valuable societal resources.

But if you discharge patients too early, you'll be penalized for having an unacceptably high readmission rate.

The bureaucrats will claim, "We're not trying to tell doctors how they should practice. We merely want to give them incentives for practicing good medicine." But in reality, they're setting rules that will make practicing good medicine increasingly difficult. And ultimately, it will be patients who pay the price.

Goodman: Why The Doctor Won't See You

At the 1/7/2012 Townhall.com, John Goodman explains, "Why The Doctor Won't See You".

The health "reform" in Massachusetts has led to near-universal "coverage", but patients are waiting longer to get actual appointments to see physicians. In other words, coverage does not equal care.

Goodman notes:

Turns out that more people are currently seeking care in hospital emergency rooms and at publicly funded community health centers than there were before the reform! As one academic study concluded, in Massachusetts you have the same people seeking the same care at the same places you had before. Health reform has mainly meant shuffling money around from one bureaucracy to another.

(Read the full text of "Why The Doctor Won't See You".)

The problems in Massachusetts under RomneyCare are just a preview for what the rest of the US can expect unless we repeal ObamaCare.

The Most Famous Urology Lecture of All Time

Another piece that's not directly related to health policy, but what the heck -- I'm on vacation this week!

Laurence Klotz: "How (not) to communicate new scientific information: A memoir of the famous Brindley lecture" (BJU International Volume 96, Issue 7, pages 956–957, November 2005)

Here's the opening:

In 1983, at the Urodynamics Society meeting in Las Vegas, Professor G.S. Brindley first announced to the world his experiments on self-injection with papaverine to induce a penile erection. This was the first time that an effective medical therapy for erectile dysfunction (ED) was described, and was a historic development in the management of ED.

The way in which this information was first reported was completely unique and memorable, and provides an interesting context for the development of therapies for ED. I was present at this extraordinary lecture, and the details are worth sharing. Although this lecture was given more than 20 years ago, the details have remained fresh in my mind, for reasons which will become obvious...

(Read the full text of "How (not) to communicate new scientific information: A memoir of the famous Brindley lecture".)

My wife Diana was laughing throughout while reading the article.

One of my friends remarked on Twitter, "A colleague of mine, now a professor of urology at Stanford, was at this lecture as a young resident. His story was hilarious."

Quick Links: CER, Concierge Medicine, Covert Rationing

Benjamin Zycher, "Obamacare inhibits medical technology"

Dr. John Kihm: "Myths about concierge medicine"

Dr. Rich Fogoros: "The ACP Further Elaborates On 'Parsimonious Medical Care'".

Amazing Emergency Auto-Appendectomy

This isn't directly related to health care policy. But it's an incredible story in the British Medical Journal about a Russian surgeon who had to perform an emergency appendectomy on himself because he was the only physician at the Antarctic base:

"Auto-appendectomy in the Antarctic: Case Report" (BMJ 2009;339:b4965)

The incident occurred in 1961 but was only reported in the English medical literature in 2009. There are some graphic images which may be borderline NSFW, depending on your workplace.

All I can say is, "Wow". (Via Rory H.)

Update: The original link appears broken, but here's a cached version at The Internet Archive.

Turner: Big Brother Is Watching Your Doctor

In the 1/5/2012 Forbes, Grace-Marie Turner describes how "Big Brother Is Watching Your Doctor".

As she notes, one of the most ironic features of the new push for "comparative effectiveness research" (CER) is that it will pressure physicians into one-size-fits-all medicine at a time we are just beginning to develop the ability to tailor medical care for patients based on their individual characteristics:

These tailored medicines have little or no place in a one-size-fits-all world with mega government studies trying to determine which treatments work for the majority of people. The outliers who would respond exceptionally well to a particular drug will find that their doctor is afraid to recommend it for fear of going outside the government guidelines.

Newer drugs, particularly the biologics that can be tailored to an individual’s particular genetic code, are unlikely to be on the government's recommended lists.

This kind of rationing of care will be hard to detect and document as doctors simply don’t discuss, and may not even know about, a new drug or treatment that could save a patient's life. And when there is no market for these drugs, the companies that will produce them will find they simply cannot get the funding for future research and development of these new medicines.

(Read the full text of "Big Brother Is Watching Your Doctor".)

CER and other related government initiatives could strangle such promising innovations before they ever take hold, much to the detriment of millions of Americans.

Scott Atlas Book

Dr. Scott Atlas, who is both is a senior fellow at the Hoover Institution and a professor of radiology at Stanford University Medical Center has a new health policy book out, In Excellent Health.

Here's the description:

The real facts on America's health care dilemma

Medical care in the United States has been loudly and repeatedly derided as inferior in comparison to health care systems in much of the developed world and even in some relatively undeveloped nations. In Excellent Health offers an alternative view of the much maligned state of health care in America, challenging the statistics often cited as evidence that medical care in the United States is substandard and poor in value relative to that of other countries. Rather than relying on purely subjective judgments about equity and fairness, the book provides extensive, detailed evidence with which to answer the paramount question when considering quality of health care: "Where would you rather be when you are sick?"

Drawing from research in scientific and medical journals, the author defends both the quality of and access to medical care in the United States compared to numerous countries with nationalized systems often held up as models for health system reforms. He then suggests a logical and complete reform plan designed to maintain choice and access to excellence and facilitate competition. His proposal offers a series of key improvements in the three critical areas of the health care puzzle -- tax structure, private insurance markets, and government health insurance programs -- that will reduce health costs and maintain essential support for America's most vulnerable citizens, seniors and low-income families, without jeopardizing the exceptional health care quality and access in the United States.

I haven't read the book yet, but based on the free preview pages available here, it looks quite informative.

(Link via OHP. BTW, I used Dr. Atlas' excellent book on neuroradiology as one my texts during my radiology residency.)

Par8o Blog

The new physician referral service Par8o.com has a blog. I look forward to reading more of their commentary!

Hsieh PJM OpEd: The Truth About RomneyCare

The 1/7/2012 PJMedia has published my latest piece, "The Truth About RomneyCare".

Here is the opening:

Now that Mitt Romney has shown himself politically vulnerable after Iowa, more people are taking a closer look at his claims about the "RomneyCare" health care plan he helped create as Massachusetts governor. In this interview from April 2010 which recently recirculated last month, Romney attempts to draw some distinctions (as well as acknowledge similarities) between his RomneyCare plan and the national ObamaCare plan.

One of the alleged virtues of RomneyCare over ObamaCare is that Romney's plan does not contain "price controls," whereas ObamaCare does. But how does this stack up against reality?

I then discuss several forms of price controls that have already been (or will soon be) implemented in Massachusetts, and their consequences.

(Read the full text of "The Truth About RomneyCare".)

Quick Links: Ethics, 5 Dates, GOP

Dr. Rich on "social justice" and "The ACP's New Ethics Manual".

Washington Post: "Five health reform dates to watch in 2012"

Dr. Marc Siegel, "ObamaCare, the GOP and You".

Rhoads: Health Wonk Review

Jared Rhoads of The Center for Objective Health Policy is hosting the latest Health Wonk Review.

Check it out!

John Lewis On ObamaCare

Duke University classics professor John Lewis recently passed away after his struggle with cancer. He was a dynamic and inspiration speaker as well as a gentleman, a scholar, and a friend.

In his honor, here's a lecture he gave on health care in 2010, "Morality -- Not Costs -- As the Proper Basis for Health Care Reform":



RIP, John. You'll be missed.

(Please also see Ari Armstrong's remembrance, "John David Lewis Fought For The Future".)

Physician Exit Strategies

As more physicians find clinical practice unsatisfying (whether due to ObamaCare or other factors), many are considering switching fields.

At the KevinMD.com website, Dr. Franz Wiesbauer has posted this, "Advice for doctors who want to change careers".

No one knows (yet) how many physicians will choose to leave clinical medicine as ObamaCare is phased in. But we know it worsen the anticipated physician shortage. And it won't be good for American patients.

ObamaCare and Racheting History

Harvard physicist Mike Stopa makes some interesting observations in this 12/23/2011 American Thinker piece, "Obamacare and the Ratchet Theory of History".

In particular, he nicely rebuts the Lawrence Tribe argument that regulating "inactivity" is constitutionally legitimate because those who fail to purchase health insurance are choosing to become free riders on the rest of us:

In addition to being simply incorrect, this argument is ahistorical as well as insulting.

Until quite recently in American history, most people, when they became ill, went to a doctor, and, upon receiving a bill for the doctor's services, they paid it. Nowadays, most people who choose not to buy health insurance do so not because they are poor, but because they are young. They are betting (and usually the odds are in their favor) that they will stay relatively healthy. But still, in most cases, when such people get sick, they pay their doctor. To say that their intention upon not buying health insurance is to bilk the rest of us is to fail to realize that most people in America take their financial obligations seriously.

The most pertinent fault of Tribe's argument, however, is to establish a chain whereby the regulated activity, in some cases, is causally linked with an undesirable economic consequence. It is not failing to buy insurance that causes economic damage -- it is failing to pay the doctor's bill. Thus, an ultimately statistical argument is being used as a moral arbiter of behavior...

(Read the full text of "Obamacare and the Ratchet Theory of History".)

Quick Links: Barr, Puzder, CER

Andrew Barr: "Obamacare, Europe and the Sophistries of Socialized Medicine". (Via @sonodoc99.)

Andrew Puzder: "Job Creation Is Price for New U.S. Health Law". (Via J.G.)

AP News: "New fee soon to be added to health insurance". To pay for the "comparative effectiveness research" used to limit your future access to medical care(!)

Hsieh: Who Will Your Doctor Work For Under ObamaCare?

The 12/30/2011 TownHall.com has published my latest OpEd, "Who Will Your Doctor Work For Under ObamaCare?"

The theme is that ObamaCare will pressure doctors to sacrifice their individual patients' welfare for a collectivist concept of "social justice".

Here is the opening:

Suppose you move to Las Vegas, and you hire a real estate agent to help you buy a house. She returns with several inappropriate choices -- all too expensive and too far from your work. She explains, "I know these aren't what you wanted. But you'd really help the struggling Nevada housing market by purchasing one of these."

Most people would fire her on the spot. Your real estate agent has a professional obligation to look out for your individual interests, not some nebulous "Nevada housing market." Yet under ObamaCare, your doctor will be increasingly pressured into sacrificing your individual medical interests for a nebulous "social justice"...

(Read the full text of "Who Will Your Doctor Work For Under ObamaCare?")

I'd like to thank Diana for her assistance editing an early version of this piece.

I'd also like to thank Dr. Hal Scherz, Dan Rene, and Docs4PatientCare for helping to arrange its publication!

Wolf: In Obama He Trusts

Dr. Milton Wolf has a new Washington Times OpEd, "In Obama He Trusts".

An excerpt:

Where once the American flag was hailed universally as the ultimate symbol of freedom, we who live under it have slowly but surely surrendered our liberties to an insatiable government. Consider our decline in just the past two generations. Our grandfathers, who stood against evil and shed their blood to stop it, never would have tolerated their own government becoming so totalitarian that it would dictate to them what car they should drive, what (if any) health insurance they should choose or even what light bulb they should buy...

The sum total of Mr. Obama's political philosophy, the unifying theme of his presidency, amounts to this: You cannot be trusted to live as a free American.

Dr. Wolf spells our more details of our steady erosion of freedom in, "In Obama He Trusts".

And he has this crucial warning for the Republicans:

The GOP should resist the temptation simply to become a cleverer version of autocrats who pull the same powerful levers of government but in different directions. Instead, they should become the party that embraces liberty.

Let's hope they heed his advice.

Dr. Wes On The Future

Physician-blogger Dr. Wes has some good insights on the future of American medicine in "A Look Ahead".

In particular, he highlights trends to anticipate under the growing centralization of health care such as loss of privacy, less contact with primary care physicians, and increasing reliance on algorithms.

Although some of these trends may be good if they had evolved in a free market context, in the context of ObamaCare they often represent market responses to external government compulsion.

The Coming Squeeze On Private Insurance

One of my friends here in Colorado received this letter from his health insurance company a few weeks ago.

This will just be the beginning of the shakeout in the private market due to "uncertainty brought on by the regulatory environment" (i.e., the slow strangling of the private insurance industry under ObamaCare):

Dear [name omitted]

We are writing to inform you of an important decision World Insurance Company ("World") has made regarding individually underwritten comprehensive major medical insurance in Colorado, which impacts your coverage.

This letter contains important information about the cancellation of your policy/certificate.

Like all companies, we continually monitor our business strategy to ensure a competitive presence in the rapidly changing insurance market. With the changes in the major medical insurance marketplace and the resulting uncertainty brought on by the regulatory environment, World has decided it is no longer able to provide the kind of major medical protection our customers have come to expect. During a recent review of World's overall businesses, the difficult decision was made to exit the individually underwritten comprehensive major medical insurance business in all of our existing markets.

You can click on the image below to see it full size.

Brian Schwartz also discusses this topic at, "State regulations force insurers out of market, Obamacare will make it worse".

Merry Christmas!

Merry Christmas! (Note: Posting may be lighter than usual next week due to the holidays.)

Quick Links: Mandates, Kagan, Bad Year

Brian Schwartz: "Feds won't add any insurance coverage mandates in exchanges -- for now"

Michael Ostrolenk: "Elena Kagan: The Justice Who Knew Too Much"

Paul Conner: "Obamacare's terrible, horrible, no good, very bad year"

Zycher on Medical Innovation

In the 12/21/2011 PJMedia, Ben Zycher of PRI discusses "Coal In Our Stockings: The Destruction of Medical Innovation".

In particular, he warns how "comparative effectiveness research" mandates will slow medical innovation as well as cause politicization of results. Patients will be the ultimate victims, deprived of treatments they could have received if the government interference hadn't existed.

Hsieh PJM OpEd on Gingrich and Personhood

PJMedia has published my latest OpEd, "Would a President Gingrich Ban The Birth Control Pill?"

My theme is that if Newt Gingrich wins the 2012 GOP nomination, it would introduce the controversial "fetal personhood" issue into the presidential race and potentially tip the election to Obama.

Here is the opening:

If history is any guide, Newt Gingrich's views on birth control, abortion, and the controversial "personhood" movement will be likely targets for Democrats if he wins the 2012 GOP nomination for President.

Gingrich recently signed the "Personhood Republican Presidential Candidate Pledge" which affirms that "unborn children" should be regarded as persons with full legal rights "from the moment of conception… without exception and without compromise." Gingrich signed the pledge after taking heat for an earlier statement stating that human life began after embryo implantation in the womb (which occurs a few days after fertilization). His campaign has since clarified: "Newt believes that human life begins at conception, that is, at the moment of fertilization." If enacted into law, this seemingly small distinction could have serious implications for the legality of many forms of birth control.

The "personhood" movement represents the most ideologically consistent endpoint of the anti-abortion movement. In their view, once a human sperm fertilizes an egg, the zygote deserves full protection as a legal "person" comparable to a born child. Under this standard, abortion would become illegal even in cases of rape and incest -- one of the goals of "personhood" advocates. However, recognizing fertilized eggs as legal persons would also have serious implications for issues other than abortion. As Ari Armstrong and Diana Hsieh describe in their 2010 paper, this includes potentially limiting women's ability to receive in vitro fertilization and physicians' ability to treat women with life-threatening ectopic pregnancies. But one of the biggest political issues would be the legality of many forms of birth control...

I'd like to thank both Diana and Ari Armstrong for their earlier writings on this topic, as well as giving me feedback on earlier drafts of this OpEd.

Pipes On Socialized Medicine

In her 12/19/2011 Forbes column, Sally Pipes reminds us that "The Ugly Realities Of Socialized Medicine Are Not Going Away".

In her critique of the UK National Health Service she notes, "The British healthcare system may 'guarantee' access to care -- but that doesn’t mean patients actually receive it."

In addition to the poor quality care and rationing, there are indiginities such as:

A report released in October by Britain's health regulator found that a stunning 20 percent of hospitals were failing to provide the minimum standard of care legally required for elderly patients.

As part of the study, inspectors dropped by dozens of hospitals unannounced. They found patients shouting or banging on bedrails desperately trying to get the attention of a nurse. At one hospital, inspectors identified bed-ridden patients that hadn’t been given water for over 10 hours.

The upcoming austerity measures will only amplify maladies like these.

The NHS is broken -- and not in some superficial way that a simple tweak would fix. The incentives are wrong. The government's main priority is keeping costs low -- not providing quality care. Patients can't choose how they receive their care -- it's one-size-fits-all medicine. And the entrenched NHS bureaucracy has no reason to improve efficiency.

For more details (and implications for the US), read the full text of "The Ugly Realities Of Socialized Medicine Are Not Going Away".

Bolick: Obamacare's Other Unconstitutional Provision

Clint Bolick of the Goldwater Institute discusses, "Obamacare's Other Unconstitutional Provision".

In particular, he addresses the many problems with the Independent Payment Advisory Board (IPAB):

Three features combine to make IPAB's regulatory power unprecedented: its decisions are largely uncontrollable by Congress, its actions are unreviewable by the courts, and -- amazingly -- the agency's existence is virtually unrepealable.

Ordinarily, the delegation of legislative power to regulatory agencies is accompanied by numerous safeguards. First, as a matter of separation of powers, courts require that the delegation of regulatory powers be guided and restricted by "intelligible standards." Second, most regulatory powers are exercised through the administrative rule-making process, which provides for public notice and comment. Third, both Congress and the courts can review the rules. Finally, of course, Congress can repeal the agency or change the delegation of power. None of those safeguards are present with IPAB...

One interesting point:

The law says that certain proposals are off-limits, including any that "ration health care, raise revenues or increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility requirements."

[However,] crucial terms such as "rationing" are undefined, and the requirements are confusing and contradictory. Elsewhere, the law directs IPAB to "protect and improve Medicare beneficiaries’ access to necessary and evidence-based items and services." So IPAB is not allowed to ration health care, but it must decide which services are "necessary and evidence-based" -- which, of course, is rationing.

(For more details, read the full text of "Obamacare's Other Unconstitutional Provision".)

As financial pressures mount on Medicare, this de facto rationing will occur even if IPAB bureaucrats claim it's not rationing.

Fortunately, there's growing opposition from members of both political parties to this radical empowering of IPAB. Let's hope it's enough.

Dorin: Why Your Doctor Will Not Be Happy Under ObamaCare

Dr. Adam Dorin discusses, "Five Reasons Your Doctor Will Not Be Happy Working Under the Yoke of Obamacare".

Specifically, he cites the following factors:

1. Technology Gone Wild
2. The Ghost of Donald Berwick
3. Medical Coding Monopoly
4. The Downgrading of the Medical Degree
5. Misrepresentation

(For more details on each point, read the full text of "Five Reasons Your Doctor Will Not Be Happy Working Under the Yoke of Obamacare".)