Roy: How Obamacare Will Make Health Savings Accounts More Costly

In his 4/27/2012 Forbes blog post, Avik Roy explains, "How Obamacare Will Make Health Savings Accounts More Costly".

It hinges on how the Obama administration defines "actuarial value".

Given the nature of HSA's (which are designed to allow consumers to pay larger amounts than in conventional insurance premiums in exchange for greater control over how that money is spent), this will make HSA's "actuarial value" look artificially low via these government yardsticks.

Read the whole piece for more details, including why this moves us in the wrong direction away from free-market reforms.

Schwartz CPR Interview on the Colorado Trust

Brian Schwartz recently appeared in this Colorado Public Radio piece, "Health Care Ads: Public Interest, or Advocacy?"

Schwartz discussed the Colorado Trust and its advocacy of greater government involvement in health care, offering a free-market counterpoint. You can listen to the audio or read the transcript.

Related: "Don't Trust the Colorado Trust" by Brian Schwartz, Boulder Daily Camera, 3/31/2012

Universal Health Care = Policing Your Diet

AFP reports, "Hungary to punish diabetics if they don't stick to diet":

Hungarian diabetics who fail to stick to their diet will be deprived of more modern treatments from July, under a government decree published Monday aimed at cutting health spending.

This is the logical outcome of government-run health care: "Because we have to pay for your health care, we have to control what you can eat or drink".

(For more on this, see my OpEd in the 1/7/2009 Christian Science Monitor, "Universal healthcare and the waistline police".)

Scherz On Tort Reform And Liability

Dr. Hal Scherz of D4PC has a new OpEd in TownHall.com, "Trial Lawyers and Insurance Cos are True Beneficiaries of Medical System".

One of his key takehome points is that ObamaCare fails to address a critical cause of skyrocketing health costs -- "defensive medicine" and the dysfunctional tort system.

The system doesn't just affect the relatively few patients injured by negligent physicians. Instead, everyone pays in the form of higher costs from unnecessary tests and treatments.

I do a lot of emergency radiology, so I've spoken at length with good ER doctors who are essentially compelled to order extra x-rays, MRIs, and CT scans that aren't medically necessary -- but legally necessary to protect themselves from frivolous lawsuits.

And this problem extends to nearly every specialty in medicine.

Fixing the broken legal system would go a long ways towards helping reduce health care costs, without compromising quality.

Quick Links: FFS, CER, Employer Mandates, Expensive Drugs

Greg Scandlen: "Is Fee-For-Service the Problem?"

Short answer, "No, it's the 3rd-party payor system". (Via Brian Schwartz.)

Kathryn Nix of Heritage: "Comparative Effectiveness Research Under Obamacare: A Slippery Slope to Health Care Rationing"

Jim Blasingame discusses how employer mandates in ObamaCare will hurt small businesses.

Avik Roy, "Stifling New Cures: The True Cost of Lengthy Clinical Drug Trials". (H/T: Dr. Richard Amerling.)

Catron: Obama Snookering Seniors Before Election

David Catron has a new American Spectator piece, "Obama's Latest Plan to Snooker Seniors".

He describes the fiscal games the Obama Administration is playing to ensure that seniors don't feel the pain of politically-unpopular cuts to the Medicare Advantage program until after the November election.

The vehicle is a sham "demonstration project" of dubious legality. For details, see Catron's piece and this related New York Post article, "An $8 billion trick?"

Update: Related piece by Avik Roy, "The Obama Campaign's $8 Billion Taxpayer-Funded Medicare Slush Fund".

Haynes On Affordable Health Care

Dr. Beth Haynes of the Black Ribbon Project recently gave this short talk to the Silicon Valley Tea Party Patriots (4/15/2012).

She discusses how freedom of choice will create abundance and affordable access to health care:



(Note: Dr. Haynes told me that the video clip omitted her acknowledgement to Alex Epstein and the Center for Industrial Progress for guidance/inspiration on this talk, so she asked that I include it in this blog post.)

Barnett Rebuts Cost-Shifting Myth

Randy Barnett has a nice discussion on, "The Myth That the Individual Mandate Addresses Cost Shifting by the Uninsured, Part 2: 'Bronze Plans' Are Not the Same As Catastrophic Coverage".

Based on his discussion, it appears that some of the Supreme Court justices understand these economic issues. Let's hope enough of them do.

Perry: Mayo Clinic Offers Insurance For Canadian Patients

Mark Perry notes, "U.S.-Based Mayo Clinic Offers Three Medical Insurance Programs for Canadian Patients".

From his blog post:

The Mayo Clinic in Rochester, MN, has introduced two new insurance programs. That wouldn't be very newsworthy except that the insurance programs aren't being offered to Americans, they're being offered to Canadians, who already have access to "free" medical care in their home country...

According to the Mayo Clinic, 25% of the international patients they serve every year are from Canada. And why is an American hospital/clinic serving so many Canadians?

According to this news report about Mayo's insurance programs for Canadians, "the publicly funded health system in Canada decreases the choices available to patients, and can also result in delayed diagnosis and treatment. That's why, within the national system, it's good to offer choices for those who need diagnosis confirmation or even treatment for serious illness."

Curious how the Mayo Clinic recognizes the problems in Canadian health care that apologists like Michael Moore fail to mention...

Why Science Whistleblowers Are Ignored

The 4/20/2012 Wall Street Journal highlighted a little-known but widespread problem in cancer research in their article, "Lab Mistakes Hobble Cancer Studies But Scientists Slow to Take Remedies".

(If the article link doesn't work, you can paste the title into a Google search window to get access to the full piece.)

Basically, hundreds of cancer cell samples in scientific laboratories are either contaminated or misidentified -- which casts doubt on the reliability of any subsequent scientific results. The WSJ piece notes:

Cancer experts seeking to solve the problem have found that a fifth to a third or more of cancer cell lines tested were mistakenly identified -- with researchers unwittingly studying the wrong cancers, slowing progress toward new treatments and wasting precious time and money.

Even worse, the more conscientious scientists warning about this problem are being ignored by their colleagues:

...[R]esearchers who yelled loudest were mostly ignored by colleagues fearful such a mistake in their own labs would discredit years of work.

Leaders in the field say one of the biggest obstacles to finding a cancer cure may not be the many defenses nature affords malignancies, but the reluctance of scientists to address the problem.

Dr. John Masters, a professor of experimental pathology at University College London, warns that such misidentification of tumor cells (and unwillingness of senior scientists to address this problem) could have serious downstream impact on medical care for patients:

But when seeking cancer treatment for a specific tumor, he said, such mistakes "are an utter waste of public money, charity money and time." Worse, he added, "It may be causing drugs to be used which are inappropriate for that particular type of cancer."

Masters put his finger on the core issue:

The whole ethos of science is to strive for the truth and produce a balanced argument about the evidence. Yet, all this crap is being produced.

These scientific and ethical problems with cancer research are just part of a bigger problem in biomedical research.

The New York Times recently reported on the alarming rise of inaccurate (or sometimes outright fraudulent) results being published in respectable medical journals, which then required retraction once the errors (or misconduct) were discovered. The two medical journal editors investigating this phenomenon "reached a troubling conclusion" that there was a much broader "dysfunctional scientific climate".

One critical question is how much government funding of science is contributing to this problem. As Bill Frezza wryly noted on Twitter: "$5B/yr to unaccountable tenured academics. What could go wrong?"

University of Tennessee law professor Glenn Reynolds (aka Instapundit) similarly noted, "There's lots of government money. That leads to corruption."

Forbes columnist David Shaywitz shows how this corruption plays out in the university science labs:

...[T]here's often a circular quality to academic research, where a particular model system, or particular enzyme, or particular brain region, or particular analytical approach becomes very trendy, and then it takes on a life of its own.

He concludes:

At the end of the day, I suspect that the problem involves some combination of the law of small numbers, the appeal of narrative, the structural advantages of reinforcing dogma, and the difficulties of publishing negative results that might challenge it, especially if the dogma was advanced by senior leaders in the field who tend to play critical roles in reviewing papers for high-profile journals and in selecting which new research gets funded.

While the process may ultimately be self-correcting (and I certainly believe that science "works"), the cycle time for this can be a lifetime (literally -- in some cases I've heard it said you need to wait for someone to pass away before contrary ideas can truly gain traction).

As a result, scientific dissenters and whistleblowers raising inconvenient questions about the integrity of the published results are too easily ignored or branded as troublemakers.

One of the reasons that many Americans no longer trust politicians' pronouncements about "global warming" (or "global climate disruption" as it's now called) is because they've seen how a similar dynamic has seemingly led to unsound scientific and policy conclusions. Americans are rightly skeptical of politicians' claims that "the science is settled".

It's bad enough if government funding helps promotes bad climate science. But if government funding is also contributing to the corruption of American biomedical research, then American patients may pay the ultimate price in the form of lives lost due to flawed or ineffective medical treatments.

(Related post: "Bad Science, Bad Medicine?", 4/18/2012.)

Wolf on Mandates, Sebelius, and Kansas

Dr. Milton Wolf has a new OpEd in the 4/20/2012 Washington Times, "Kathleen, I’ve got a feeling you’re still in Kansas".

He notes that too often both Republicans and Democrats favor mandated insurance benefits, even though such compulsory spending hurts innocent people. He offers some informative contrasts between highly-regulated health insurance and less-regulated auto insurance:

Kansans are allowed to purchase car insurance directly from any provider across the country, and you won’t find state mandates that force your auto insurance company to cover windshield-wiper blade replacements or oil changes. You also won’t find tax penalties that coerce you into buying auto insurance through your employer rather than on your own, but that’s another story.

So which is more effective at keeping costs lower and serving Kansans - the big-government health insurance mandates or the auto insurance free-market approach? Is there a single person who believes we have an auto insurance crisis in America?...

State mandates, by their very nature, eliminate competition. It’s ironic that supporters of mandates don’t realize - or perhaps they do - that their approach creates oligopolies within each state where only a few large companies can operate and artificially drive up prices. The free-market approach, on the other hand, opens the door to innovative companies like Geico and Progressive, which have revolutionized auto insurance.

Every state faces this dilemma between destructive but poll-driven big-government mandates and demonstrably effective free-market reforms...

(Read the full text of "Kathleen, I’ve got a feeling you’re still in Kansas".)

Insurance companies get a bad rap from the public. Some of it is deserved, if they fail to live up to their contractual obligations -- but that's not "greed", that's fraud.

In a free market, honest insurance companies provide a valuable service, allowing customers to share risk on mutually agreeable terms. Some people will want lean "catastrophic only" coverage with lower premiums, whereas others may wish a more "gold plated" plan that covers more services (but has correspondingly higher premiums).

The beauty of a free market is that it allows prospective insurance customers to find other like-minded people to voluntarily share the risks they want, without compelling others to do so against their will.

For more on this, see: "How the Freedom to Contract Protects Insurability" (The Objective Standard, Fall 2009).

Quick Links: Tourism, Marketing Referrals

The New Yorker discusses the rise in medical tourism.

Should you be concerned about, "The Surprising Secret Behind Doctor Referrals"?

Quick Links: Discounted Surgery, Canadian Laundry, Faux Transparency

Economist Mark Perry discusses a nice innovation, "Markets in Everything: Market-Based, Deeply-Discounted Surgery for Cash, Payable in Advance". (Via Kelly V.)

Canadian health care update: "Hospital tells patients to do own laundry". (Via Dr. Art Fougner.)

Drs. Scherz and English of Docs4PatientCare: "Obamacare: We Need a Earmark to Treat that Disease". Faux "transparency" will be a vehicle for stealth rationing.

Bad Science, Bad Medicine?

The 4/16/2012 New York Times published a disturbing article, "A Sharp Rise in Retractions Prompts Calls for Reform".

Basically, they discussed the alarming rise of inaccurate (or sometimes outright fraudulent) results being published in respectable medical journals, which then require retraction when the error (or misconduct) is discovered.

As they investigated the source of the problem, two medical journal editors,

...reached a troubling conclusion: not only that retractions were rising at an alarming rate, but that retractions were just a manifestation of a much more profound problem -- "a symptom of a dysfunctional scientific climate”...

Although the system of peer review is supposed to minimize this from happening, the article notes the following factors making the problem worse:

* "[S]cience has changed in some worrying ways in recent decades — especially biomedical research, which consumes a larger and larger share of government science spending"

* "To survive professionally, scientists feel the need to publish as many papers as possible, and to get them into high-profile journals. And sometimes they cut corners or even commit misconduct to get there."

* "The higher a journal's impact factor, the two editors found, the higher its retraction rate."

That last item is especially eye-opening. In other words, some of the most prestigious journals (such as The New England Journal of Medicine), have the highest retraction rates. Yet these are supposed to be the most authoritative sources for "clinical practice guidelines".

This leads to the following disturbing conclusions:

1) As Glenn Reynolds notes, "There's lots of government money. That leads to corruption."

2) This bad science will be used to set "clinical practice guidelines" for physicians. This goes under various names such as "evidence based medicine". But the guidelines are only as good as the science -- which is becoming demonstrably less trustworthy.

3) Under Obamacare there will be an increasing push for doctors to adhere to these "practice guidelines", or face financial penalties. So in other words, government-funded science and government-mandated medical practice standards will increasingly foist bad treatments onto an unsuspecting population.

Let's hope that ObamaCare is overturned by the Supreme Court (or repealed by Congress) before it's too late.

Catron: Will the Supreme Court Let the Death Panel Stand?

In the 4/16/2012 American Spectator, David Catron asks, "Will the Supreme Court Let the Death Panel Stand?"

In particular, he notes that if the Supreme Court strikes down just part of ObamaCare (such as the individual mandate), then the de facto IPAB rationing board could still wreak havoc for America's elderly patients.

Catron observes:

...IPAB will in theory only propose Medicare cuts, but its recommendations will take effect automatically unless Congress and the President intervene with some alternative to its recommendations. This means that the welfare of patients will inevitably take a back seat to the political exigencies of the moment.

Indeed, the political dynamics of the 2012 election cycle are already dictating the actions or lack thereof by both the Republicans and the Democrats where IPAB is concerned. Knowing full well that the bill hasn't a prayer of going anywhere in the Senate, the GOP-controlled House of Representatives passed a measure repealing IPAB last month. And the President, who doesn't want to spend time talking about death panels in the run-up to November 6, has declined to appoint anyone to the panel.

IPAB thus creates the mechanism for de facto rationing, while giving elected officials a veneer of "plausible deniability" for those cuts.

(Read the full text of "Will the Supreme Court Let the Death Panel Stand?")

Hsieh RCM OpEd: "The Best Congress Money Can Buy?"

The 4/16/2012 edition of RealClearMarkets.com has published my latest OpEd, "The Best Congress Money Can Buy?"

According to NPR, a Congressman on a powerful House committee can raise up to an extra $250,000 in campaign funds from lobbyists because of his political power over the federal tax code or affected industries. In effect, this is the going "market rate" for his level of political influence.

To eliminate this corrupt "market", we shouldn't be trying to "limit money in politics". Instead, we should limit government, so that it can no longer interfere with a genuine free market.

Here is the opening:

What's the going market rate for a friendly Congressman?

Of course, it's illegal to bribe a legislator. But according to recent episodes of the NPR shows Planet Money and This American Life, Congressmen on powerful committees have a much easier time raising money for their campaign war chests than members of less-powerful committees. And this political clout can be measured in precise dollar amounts...

(Read the full text of "The Best Congress Money Can Buy?")

Wolf: The Ghost of Kathleen Sebelius Lives

Dr. Milton Wolf asks, "What's the matter with Kansas? The ghost of Kathleen Sebelius lives".

In particular, he notes how short-sighted politics results in both liberals and conservatives supporting health care mandates, such as mandatory insurance coverage for autistic children, which drive up costs for everyone.

Liberals, of course, have no problems with forced redistribution of wealth to appease favored constituencies. Unfortunately, conservatives too often go along, either so they don't appear "heartless" -- or because they believe in similar forced redistributions (differing perhaps only in their preferred recipients).

Dr. Wolf correctly notes:

As the government health insurance mandates expand, the cost of insurance to Kansas families increases. This is unavoidable. The statists solution to the problem they've created is to impose still more mandates to help the people who were victimized by the first round of mandates. It's a vicious cycle but there's a better way.

Eliminate all insurance mandates. Allow Kansans -- free Americans -- to purchase whatever insurance they choose...

(Read the full text of "What's the matter with Kansas? The ghost of Kathleen Sebelius lives".)

When politicians play the game of doling out ever-increasing favors to their pet special interest groups, the end result will be political and economic bankruptcy. This is a losing game for all of America.

As "Joshua" the computer noted in the movie War Games: "The only winning move is not to play."

Scherz: IPAB Is Real Life Computer Worm

In his 4/12/2012 Townhall.com column, Dr. Hal Scherz of D4PC discusses, "IPAB -- A Real Life Computer Worm Affecting Your Government".

One important point:

But do not be fooled into believing that [IPAB] will affect only Medicare. Private healthcare spending will be reduced as well. IPAB has been given the power to reduce ALL healthcare expenditures, including private insurance.

How might this occur? Once the state insurance exchanges are established, they will be under direct federal oversight and a variety of regulations will go into effect, including price controls. Additionally, private insurance rates follow Medicare rates in the market place, so actions by IPAB to reduce reimbursement will have an indirect effect on the private market.

He notes that if the Supreme Court does not throw out the whole of ObamaCare, then it will be up to Americans to vote for political leaders who will.

Why Obamacare Expands the Deficit

This topic has become a recent hot political item following the Mercatus Center report.

Here's the original author's response to the ongoing debate: "Why Obamacare Expands the Deficit: Charles Blahous Rebuts His Critics"

Medicare Double-Counting

The Mercatus Center has posted a great video on the economic smoke-and-mirrors behind ObamaCare's Medicare numbers, "Health Care Bill: Double Counting Doubles the Crisis":



Of course, if a private businessman pitched a similar business plan to investors, he'd be thrown in jail for fraud. But it's apparently ok if the government does it.

(Via COHP.)

Positive Alternatives to ObamaCare

If ObamaCare is actually struck down by the US Supreme Court, it will be crucial for free-market advocates to have a positive alternative to propose.

Fortunately, there are many people working on precisely this issue. Here are a few that have been proposed:

Avik Roy, "The Tea Party's Plan for Replacing Obamacare".

Sally Pipes, "The Pipes Plan: The Top Ten Ways to Dismantle Obamacare". (Introduction viewable at Scribd.)

Docs4PatientCare, "The Physician's Prescription for Health Care Reform"

I don't necessarily endorse every element of all of these plans. But they all contain excellent ideas that would move us in the right direction towards a full free market in health care.

An in a free market, we'd see all sorts of innovations and improvements, such as affordable "concierge" medicine: "Concierge Doctors: They're Not Just for the Super-Rich Anymore".

IRS Getting The Goods

The Hill reports, "White House has diverted $500M to IRS to implement healthcare law".

In other words, the IRS is getting more goodies so that they can better get the goods on you if you don't follow the health care laws.

From the article:

The Obama administration has plowed ahead despite the legal and political challenges.

It has moved aggressively to get important policies in place. And, according to a review of budget documents and figures provided by congressional staff, the administration is also burning through implementation funding provided in the healthcare law.

The law contains dozens of targeted appropriations to implement specific provisions. It also gave the Department of Health and Human Services (HHS) a $1 billion implementation fund, to use as it sees fit. Republicans have called it a “slush fund."

HHS plans to drain the entire fund by September -- before the presidential election, and more than a year before most of the healthcare law takes effect. Roughly half of that money will ultimately go to the IRS.

Although we won't know how the Supreme Court will rule on ObamaCare until June, it's almost as if the Obama administration is trying to push through implementation of much of the law while they still can.

Or to borrow a cancer metaphor from David Catron, they're trying to get the bad law to "metastasize" as quickly as possible into as many nooks and crannies of Americans' lives in order to make it harder to undo in the future.

Radical excision of ObamaCare can't come soon enough -- either by the Supreme Court or at the ballot box. (The Hill link via Dr. Matthew Bowdish.)

Update: Investor's Business Daily offers their own observations in, "Army Of IRS Enforcers Can't Make ObamaCare Legitimate":

Cost: Half a billion dollars, paid for off-the-books by taxpayers through a massive $1 billion Health and Human Services slush fund that got tucked into the bill.

The only conclusion from this stealth move is that the Obama administration expects massive noncompliance from taxpayers with its unpopular mandate.

And that raises questions about its legitimacy as a law. Passed through trickery, bribery and without a bipartisan majority, ObamaCare is already on shaky ground...

When vast numbers of people refuse to obey a law, there's a problem with the law... ObamaCare ultimately boils down to the public's willingness to accept its mandate. That they haven't and that President Obama's only weapon of persuasion is to threaten them speak volumes about the law's viability.

UK Blues

A couple of stories from the UK:

"Surgery bans elderly patient over her carbon footprint" (Telegraph, 4/3/2012)

"Sentenced to death for being old: The NHS denies life-saving treatment to the elderly" (Daily Mail, 4/6/2012)

The US isn't in such dire straits yet. Let's hope we never get there.

Roy: Medicaid's Cruel Status Quo

In a 4/5/2012 Fox News OpEd, Avik Roy discusses "Medicaid's Cruel Status Quo".

As he notes, Medicaid patients have theoretical "coverage", but often lack ability to receive actual care. Even worse, ObamaCare "doubles down" by expanding Medicaid as its vehicle for increasing "coverage", thus making current problems worse.

Roy offers more details in his policy paper, "The Medicaid Mess: How Obamacare Makes It Worse".

Eventually, Medicaid can and should be privatized. Proposals such as "block grants" to states could be a helpful intermediate step, if they eventually lead to complete privatization. But ultimately, in a fully free society those who need medical care but cannot afford it should rely on private charity.

(Fortunately, in a fully free society health care costs would also be much lower, thus enabling many to afford basic care.)

Legal Risks of Going Paperless

As more physicians and medical offices move (voluntarily or involuntarily) to electronic medical record systems, they should be aware of these "Legal risks of going paperless".

Cochrane: Free Market Reforms

In the 4/2/4012 Wall Street Journal, University of Chicago professor John Cochrane offers several constructive free-market reforms that would move the American health care system in the right direction.

He gives details in, "What to Do on the Day After ObamaCare".

Some ideas he discusses include:

* Eliminate preferential tax treatment of employer-provided health insurance
* Eliminate expensive mandated benefits
* "Premium support" for Medicare and Medicaid
* Eliminate legal barriers to training new physicians
* Eliminate anti-competitive "certificate of need" requirements for equipment

All of these would move us in the proper direction of more freedom and less government intrusion in health care. If ObamaCare is overturned by the Supreme Court, it's important that free-market supporters be ready to propose positive ideas as an alternative.

For more details, see the full text of "What to Do on the Day After ObamaCare".

(Note: "Premium support" for Medicare and Medicaid can should be a step towards full privatization of these programs, not another permanent government entitlement program.)

Scherz: Clinical Perspective on ObamaCare

Dr. Hal Scherz of Docs4PatientCare reviews, "Obamacare and The Supreme Court – the Clinical Perspective" (TownHall, 4/3/2012).

In particular, he warns what will happen if ObamaCare is not overturned by the Supreme Court:

All actions always have consequences -- whether intended or unintended. The result of Obamacare will be less doctors working, which means that the guarantee of increased access to healthcare is a false promise. Your insurance card will only provide a place in line. It means that the Patient Centered Outcomes Research Institute will decide what treatment you will get. It means that the Secretary of Health and Human Services will tell your doctor how to practice medicine.

On this current path, the private practice of healthcare will disappear within the next 10 years, as physicians sell their practices to hospitals, afraid that they can no longer afford to stay in business. More than 50% of doctors now work for hospitals. Obamacare suspends antitrust regulations so that hospitals can consolidate doctors’ practices into a single entity -- an accountable care organization (ACO). Under such an arrangement, the doctors work for the ACO and not for the patients.

There already are rumblings coming from Washington suggesting that physician licensure needs to be nationalized in an attempt to compel doctors to see patients on Medicare and Medicaid and avert the mass exodus that is expected when reimbursement rates are slashed in the coming years.

Such nationalization of the medical profession would be a disaster for patients and doctors alike.

(Read the full text of "Obamacare and The Supreme Court – the Clinical Perspective".)

HSAs At Risk?

Roy Ramthun asks, "Do Health Savings Accounts Have a Bullseye on their Back?"

Short answer: "Probably". But we'll know more soon.

Liberals And Conservatives Flip-Flopping On The Mandate

Avik Roy remembers how many liberals once hated the individual mandate.

And how many conservatives once supported it.

ObamaCare Without The Mandate

Andrew Sullivan asks, "What happens if the mandate is ruled unconstitutional but the rest of the law is left intact?" It's not a pretty picture. (Via Dr. Art Fougner.)

Avik Roy discusses a similar example, "Want to See a Health Insurance Death Spiral? Visit Washington State"

Schwartz: Don't Trust The Colorado Trust

In the 3/31/2012 Boulder Daily Camera, Brian Schwartz explains, "Don't trust the Colorado Trust".

Schwartz rebuts some of the fallacious "cost shifting" arguments they make in support of ObamaCare. In particular, the cost shifting from the uninsured is relatively small compared to the cost shifting caused by Medicaid, Medicare, and various mandated insurance benefits. Yet the Colorado Trust is in favor of all of these programs.

As he notes:

Don't be fooled. Mandatory insurance isn't about personal responsibility or reducing cost-shifting. It's about using politically-controlled health plans to advance political control of your medical care.

(Read the full text of "Don't trust the Colorado Trust".)

Arguing Over Who Gets The Goodies Under UK Rationing

Journalist Christine Odine raises the uncomfortable question about health rationing in the UK, "Why should fat people take precedence over the elderly in the NHS?"

When the government is in charge of health care, it will inevitably lead to arguments about who receives medical care and whose care is denied. Which means, those with the most political clout (or with politically popular diseases) will get their care at the head of the rationing line -- at the expense of those without such clout. If you have an unpopular disease, you're out of luck.

Let's hope we don't get to that point here in the US.

Quick Links: Armstrong, Incentives, Free Rider Myths, Opportunity

At the TOS blog, Ari Armstrong notes how, "Force Begets Force Under Health Mandates".

More performance measure FAIL: "Hospital pay incentives fail to help patients".

Avik Roy: "Myths of the 'Free Rider' Health Care Problem".

(Note: I don't necessarily support some of Roy's proposed alternatives to EMTALA unless they are part of a transition to total elimination of government interference in health care. Voluntary charity can and should be the method that the truly need receive emergency health care if they cannot otherwise afford it.)

Investor's Business Daily: "If The Court Dumps ObamaCare, Republicans Must Be Ready"

(I especially like how the article offers politically-realistic free-market reforms that would move our country's health system in the right direction.)

Hsieh PJM OpEd: "ObamaCare's Other Infringements"

PJ Media has published my latest OpEd, "It's Not Just the Mandate: ObamaCare's Other Infringements".

Here is the opening:

ObamaCare supporters were hit with more bad news recently when the Congressional Budget Office announced that the health care law would cost nearly twice the original estimates: $1.76 trillion over ten years rather than $940 billion. Of course, such "unexpected" cost overruns are nothing new for government programs. When Medicare was passed in 1965, it was predicted to cost $12 billion by 1990. In reality, it cost a whopping $110 billion, almost 10 times more than predicted.

But the escalating economic costs of ObamaCare will pale in comparison to the escalating losses of freedom.

The infringement of personal freedom receiving the most attention lately has been the "individual mandate" requiring Americans to purchase health insurance. This issue is at the heart of the current legal challenge before the U.S. Supreme Court.

But ObamaCare imposes numerous other mandates and controls, including the following...

(Read the full text of "It's Not Just the Mandate: ObamaCare's Other Infringements".)

Post-SCOTUS Commentary: Wolf, Rhoads, Simberg, LA Times

As one might expect, there's been lots of analysis and commentary of the Supreme Court arguments over ObamaCare.

In general, pundits opining on how SCOTUS will rule on ObamaCare reminds me of the TV commentators discussing how an NFL referee might rule when his head is under the instant replay hood. It's an interesting way to fill air time. But no one but the ref really knows what the final decision will be.

That said, I did want to flag a few pieces that caught my eye:

Milton Wolf, "Obamacare's inescapable death march" (Washington Times, 3/28/2012)

(Note: I agree with Milton that ObamaCare will eventually fail, even if the Supreme Court doesn't overturn it. The big questions would be how long will it take, how hard will the politicians try to prop it up with even worse laws, and how many more people will they harm in the process.)

Jared Rhoads, "Two more encouraging things from the oral arguments on the individual mandate" (Center for Objective Health Policy, 3/28/2012)

Rand Simberg, "The White House/Media Cocoon on ObamaCare" (PJ Media, 3/28/2012)

Los Angeles Times, "Supreme Court appears poised to nullify entire healthcare law"

I'm sure there will be lots more commentary to follow!

SCOTUS Day 2

Here are some links and commentary on the Day 2 arguments at the Supreme Court, concerning the individual mandate.

WSJ, 3/27/2012: "Conservative Justices Challenge Government Over Health Law"

NYT, 3/27/2012: "Hard Questions From Justices Over Insurance Mandate"

Fox News, 3/27/2012: "Health care law endures tough questioning from swing justice at Supreme Court showdown"

Multiple websites have copies of the audio and transcript for those who are interested.

Quick Links: Mandatory Medicare, Medicaid and ERs, Picture

Quin Hillyer discusses the latest in Hall vs. Sebelius.

As of now, the federal courts have ruled that if someone wishes to opt out of Medicare, they must also give up all their Social Security benefits (which would place a heavy financial burden on many senior citizens). In other words, the courts have stated that because Medicare is an "entitlement" that one must accept those benefits (and corresponding restrictions). But the legal challenge against this rule has moved forward another step.

US News: "Medicaid Patients Go to ERs More Often".

As many have observed, Medicaid patients have "coverage", but have a difficult time getting access to actual medical care. Thus, they are still using ERs for primary care. This problem will only get worse as ObamaCare expands "coverage" by expanding Medicaid.

Avik Roy: "Here, in one graphic, is what’s wrong with American healthcare"

SCOTUS Rundowns

The 3 days of ObamaCare arguments before the US Supreme Court start today. Here are a few helpful links for those wanting to follow the action:

Doug Mataconis, "ObamaCare Goes Before The Supreme Court: A Preview".

Center for Objective Health Policy: "Guide to SCOTUS Review of Health Reform Law" (and PDF version).

Wall Street Journal: "Liberty and ObamaCare" (3/22/2012)

David Catron: "Supreme Court Primer: How the process works for oral arguments"



(Direct YouTube link.)

WSJ: Is Concierge Health Care Worth It?

The 3/23/2012 Wall Street Journal has some helpful tips for those considering signing up for a "concierge" physician: "Is Paying for 'Concierge' Health Care Worth It?"

The article discusses some questions to ask including:

Is this right for me?
Will you take my insurance?
What happens if I get sick while I'm out of town, or while you're on vacation?
Do you make house calls?
How will you handle my medical records?
What if I change my mind or don't like the service?

(Read the full text of "Is Paying for 'Concierge' Health Care Worth It?")

Beware that some states (like Oregon) are trying to restrict this practice model, by requiring these doctors to register their practices with the state's insurance department on the grounds that they're accepting fees for the promise of future medical care.

(WSJ link via Dr. Art Fougner.)

McBride: Courts, ObamaCare, and Limited Government

Attorney Katelynn McBride of the Institute for Justice has nice OpEd in the 3/23/2012 Minnesota Public Radio News entitled, "Health care law shows why we need courts to guard against government overreach".

In her piece, she makes some key points about the courts and limited government:

It does not appear that the supporters of health care reform gave any serious consideration to the law's constitutionality, a question that is scheduled for three days of argument before the U.S. Supreme Court next week. The unseemly process by which the law was enacted, and the apparent failure to consider its profound constitutional concerns, are precisely why we need an engaged judiciary to review and, when necessary, check the power of the Legislature...

The Constitution was designed to prevent runaway government like we have today and to account for the fact that, as Thomas Jefferson warned, "The natural progress of things is for liberty to yield and government to gain ground." The Framers knew perfectly well that legislatures are not inclined to recognize limits on their own authority.

When they do not, it is the job of the courts to enforce the Constitution. Increasingly, however, courts are not doing that job. A study by the Institute for Justice last fall found that the Supreme Court struck down just two-thirds of 1 percent of federal laws enacted between 1954 and 2002...

(Read the full text of "Health care law shows why we need courts to guard against government overreach".)

We don't know how the US Supreme Court (SCOTUS) will decide after they hear arguments next week. But they do hold in their hands the future of 1/6th of the US economy -- and our essential freedoms.

For a nice flowchart on the upcoming SCOTUS arguments scheduled for March 26-28, 2012, please see this nice one-page infographic by the Center for Objective Health Policy (PDF or JPG).

Elder: ObamaCare Still a Disaster

In the 3/22/2012 TownHall.com, Larry Elder observes, "ObamaCare Still a Disaster -- No Matter How the Supreme Court Decides".

One excerpt:

...In addition to the excise tax on medical device manufacturers, ObamaCare imposes many more taxes, including the following: an individual mandate excise tax for adults who don't purchase "qualifying" health insurance; an employer mandate tax for those companies who don't offer health coverage; and a surtax on investment income -- making the rate as high as 43.4 percent on gross income from interest, annuities, royalties, net rents and passive income for families making more than $250,000.

Given this, will we see the same private-sector investments in the health care field, as ObamaCare imposes ever more regulations designed at increasing "accessibility" and "controlling costs"?

Elder also discusses how ObamaCare won't control costs, either. And will create a "brain drain" similar to what has already happened under Great Britain's socialized system.

Read the full text of "ObamaCare Still a Disaster -- No Matter How the Supreme Court Decides".

Wolf on ObamaCare After 2 Years

Dr. Milton Wolf gives a retrospective review of ObamaCare 2 years after its passage into law in the 3/21/2012 Washington Times, "Obamacare: It's a big, disastrous deal".

Some of the lies told about ObamaCare by its supporters include:

You can keep your own insurance
Taxes will not be raised
Premiums will go down
It will create jobs

For details of these broken promises and more, read the full text of Washington Times, "Obamacare: It's a big, disastrous deal".

There's a damned good reason that the Obama administration is not taking the opportunity to trumpet the 2-year anniversary -- because they know it's a huge political loser.

Let's make sure they remember this come November 2012.

CO Doctors Limiting Medicare Patients

The 2/28/2012 Boulder Daily Camera reported that, "Colorado docs often refuse or limit new Medicare patients".

From the article:

Colorado Public News called family, general practice and internal medicine physicians across the state, using the nation's official website that lists thousands of doctors the site claims treats patients on Medicare. Of 100 contacted, only 34 said they would readily accept a new patient.

Of the remainder, 40 said they would not add a new patient on traditional Medicare. Another 26 limit new clients, making decisions on a case-by-case basis, or placing patients on waiting lists of up to six months. That adds up to 66 -- or two-thirds -- refusing or limiting new patients...

Dr. Jonathan Zonca, of Ascent Family Medicine in Denver, is taking new Medicare patients. But he said he hesitated after figuring out that Medicare had paid half of what other insurance plans did, over three years.

"That's a real hard way to make money and pay our staff and pay our rent, especially in Denver -- it's pretty expensive rent," he said.

Medicare also pays more slowly than other insurance plans...

(Read the full text of "Colorado docs often refuse or limit new Medicare patients".)

Remember, Medicare is "single payer" government health care for the elderly. But Medicare doesn't pay enough to allow doctors to take good care of their patients. And the proposed "payment reforms" have been a failure.

Yet there are still many who want to expand this dysfunction government model to encompass all of American health care.

(Via Brian Schwartz.)

Quick Links: Amerling, Palmisano, IPAB, End of Private Insurance

Dr. Richard Amerling: "The Clouded Utopian Vision For Healthcare Ignores Reality".

Dr. Donald Palmisano: "Repeal IPAB Now".

D4PC Signs on to Coalition Letter Concerning Dangers of IPAB. You can read the letter here.

Sally Pipes: "The End of Private Health Insurance In America".

Whole Truth Commercial

The group AmericanDocs4Truth.org has produced a clever commercial, responding to the infamous "Granny" video promoted by the leftists. This is the 60-second short version:



Here is the 4:30 longer version:



For more information on some free-market reforms that would move America in the right direction, see this 12-point plan by Dr. Jane Hughes.

(Eventually, we should privatize all government health programs including Medicare and Medicaid and get the government completely out of health care, except for protecting individuals against force or fraud. Dr. Hughes' proposals would be an excellent start in this direction.)

Catron: Of Obamacare and Appeals to Supreme Beings

David Catron has a new American Spectator piece, "Of Obamacare and Appeals to Supreme Beings".

In his OpEd, Catron lays out the various spurious legal arguments being made by the Obama administration to support their health care plan. Let's hope the justices see past all the smoke and mirrors and uphold Americans' individual rights.

Quick Links: Employment, Awakening, Washington Medicaid

Michael Randall tells his personal experience of problems caused by government linking health insurance to employment.

(And I very much appreciated his citing my earlier PJM piece, "Free Market Lessons from Contraception Fight".)

Dr. Meg Edison of Docs4PatientCare has created a nice short video, "Awakening of the American Doctor":



Dr. Doug Perednia discusses, "Denying payment for unnecessary emergency room visits". In particular, he highlights the perverse thinking behind the new guidelines in Washington state:

So here's the actual logic underlying this new Washington Medicaid initiative:

* ER docs and hospitals are required by federal law to see and evaluate anyone who walks in – at their own expense if necessary.

* If a Washington State Medicaid patient walks into the ER with a non-emergency and the doctors and hospitals see them as required by law, Medicaid will refuse to pay on premise that the provider are "abusing the system" and being lousy "stewards of care and safety and the public resources"

* Since the doctors and hospitals are abusing the system by simply being there and doing what the federal government has said they must, they should not even be allowed to try to bill the patient directly for the visit.

Quick Links: Ethics Corruption, White House, MA Costs, CA Shortages

Dr. Jeffrey Singer does a nice job discussing, "The Coming Medical Ethics Crisis". The subtitle: "How the government is putting the medical profession -- and your health -- at risk". (Via Brian Schwartz.)

Here is the White House PR strategy to defend ObamaCare in the coming weeks.

NPR and Kaiser Health News report that Massachusetts legislators still trying to figure out how to reduce rising health costs. Their solution: More government controls.

California legislators realizing that "coverage" doesn't equal actual care.

Losing Your Insurance

The Washington Times reports, "Health care reforms could cost 20m work coverage".

This is based on information from the Congressional Budget Office and the Joint Committee on Taxation. Basically, President Obama's claim that "you could keep your insurance if you like it" won't apply to millions of Americans.

At best, workers dumped from their current plans might be able to scramble for some sort of coverage on government-run exchanges. But those policies will be loaded with expensive mandates on terms dictated by government and/or special interest groups with "pull" to determine what's considered an "essential benefit". People will have to pay for services they might not otherwise choose in a genuine free market (such as in vitro fertilization services or alcoholism treatment).

Furthermore, to save money these "qualified" (i.e., government-approved) plans will likely have to omit coverage for various services the government has decided are unnecessary, such as screening mammograms below age 50 or PSA prostate tests for men. The latest addition to this list of "nonessential" benefits will likely be annual Pap smears for cervical cancer screening). Through these exchanges, the government -- not you and your doctor -- will determine what's "essential" and what's "nonessential" to your health.

Forcing people out of their current coverage and into government-run insurance allows the Left to pin the blame on the "free market", while essentially herding Americans into state-run medicine.

Don't let them get away with this slippery sleight-of-hand.

The Myth of the Free-Market American Health Care System

At the Forbes blog, Avik Roy discusses "The Myth of the Free-Market American Health Care System".

His basic point is an important one that bears repeating: America does not currently have a free-market medical system. In particular, he notes:

In reality, per-capita state-sponsored health expenditures in the United States are the third-highest in the world, only below Norway and Luxembourg. And this is before our new health law kicks in...

The thing to remember in America is that we have single-payer health care for the elderly and for the poor: the two costliest groups. In addition, the relatively healthy middle class has heavily-subsidized private health insurance, in which few individuals have the freedom to choose the insurance plan they receive. Neither of these facts commend the American health-care system to devotees of the free market.

Avik Roy does praise statist elements in some other countries' health systems, such as Switzerland and Singapore -- which I disagree with. But those are topics for a separate day.

(Via Dr. Matthew Bowdish.)

Quick Links: UK Elders, IPAB, Costs

The 3/14/2012 Telegraph reports that in the UK National Health Service, "More than half care home residents denied basic care". (Via Kelly V.)

Dr. Jane Orient asks, "Is the payment board a death panel?" (Washington Times, 3/8/2012)

The Washington Examiner reports on the latest CBO report detailing how ObamaCare will cost far more than originally projected.

WOLF: Democrats Sneak Uncle Sam Into Your Bedroom

Dr. Milton Wolf has a new OpEd out in the 3/12/2012 Washington Times, "Democrats sneak Uncle Sam into your bedroom".

In particular, he highlights the hidden cronyism behind many mandates and entitlement progrms. Any mandate to provide "free" birth control helps Big Pharma just as a ban on incandescent light bulbs is a giant payoff to companies like GE that want people to buy their more expensive "green bulbs".

Wolf also notes:

There's another pattern here. Politicians are like drug dealers. Once you’re addicted to freebies, you suddenly realize the free lunch is not so free. Like the drug dealers, the politicians want your money, to be sure, but what they really covet is your submission. They love telling you what to do and they always claim it’s for your own good.

(Read the full text of "Democrats sneak Uncle Sam into your bedroom".)

More people are waking up.

Should You Trust Practice Guidelines?

A big part of ObamaCare projected savings is based on physicians adhering to "practice guidelines", using so-called "evidence based medicine". These sound good in theory -- after all, what doctor wants to be against "evidence"?

But how solidly grounded are these guidelines?

A 2009 article from The Journal of the American Medical Association (JAMA) sounds a cautionary note, "Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines".

The article opens:

Clinical practice guidelines are systematically developed statements to assist practitioners with decisions about appropriate health care for specific patients' circumstances.​ Guidelines are often assumed to be the epitome of evidence-based medicine. Yet, guideline recommendations imply not only an evaluation of the evidence but also a value judgment based on personal or organizational preferences regarding the various risks and benefits of a medical intervention for a population.

But after going through cardiology practice guidelines issued from 1984 to September 2008, they conclude:

Recommendations issued in current ACC/AHA clinical practice guidelines are largely developed from lower levels of evidence or expert opinion. The proportion of recommendations for which there is no conclusive evidence is also growing.

In particular, many guidelines are just expert "opinion", which may be subject to classic problems of bias, group-think, or conflict-of-interest:

The presence of a large proportion of recommendations with no supporting data from randomized clinical trials requires careful judgment by guideline authors. In such circumstances, the potential for authors' conflicts of interest, real or perceived, may be important. Recommendations based only on expert opinion may be prone to conflicts of interest because, just as clinical trialists have conflicts of interests, expert clinicians are also those who are likely to receive honoraria, speakers bureau, consulting fees, or research support from industry.

Government officials are pushing doctors to follow published guidelines as if they were some sort of "gold standard", yet many of them are lead not gold. (JAMA link via Dr. Art Fougner.)

Dr. Richard Amerling and co-authors make a similar point in their 2008 article, "Guidelines have done more harm than good":

Practice guidelines have proliferated in medicine but their impact on actual practice and outcomes is difficult, if not impossible, to quantify. Though guidelines are based largely on observational data and expert opinion, it is widely believed that adherence to them leads to improved outcomes. Data to support this belief simply does not exist. If guidelines are universally ignored, their impact on treatment and outcomes is minimal.

The incorporation of guidelines into treatment protocols and performance measures, as is now common practice in nephrology, increases greatly the likelihood that guidelines will influence practice and hence, outcomes. Practice patterns set up this way may be resistant to change, should new evidence emerge that contradicts certain recommendations.

Even if guidelines are entirely appropriate, a 'one-size-fits-all' approach is likely to benefit some, but not all. Certain patients may be harmed by adherence to specific guidelines. Guidelines certainly do not encourage clinicians to consider and treat each patient as an individual. They are unlikely to stimulate original research. They are created by a process that is artificial, laborious and cumbersome. This all but guarantees many guidelines are obsolete by the time they are published. Guidelines are produced with industry support and recommendations often have a major impact on sales of industry products.

See also his related 2011 AAPS talk:



Under ObamaCare, government will attempt to enforce standardized medical practice amongst physicians through various financial carrots and sticks, such as government-sanctioned "Accountable Care Organizations".

Dr. Donald Berwick (President Obama's former head of Medicare) has explicitly said as much on multiple occasions. For example:

The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized, individualized decision making.

And this:

I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care.

In other words, he and his allies want government to dictate how physicians can practice, because they think they know what's best for you as a patient. They wish to be able to override the judgment of your personal physician who actually knows your medical history, your symptoms, your drug allergies, and your individual preferences.

There's mounting evidence that federal nutrition guidelines have made Americans less healthy, rather than more healthy.

Should we trust the government to do any better in foisting centralized clinical practice guidelines on American physicians?

Texas Doctors Opting Out of Medicare

The 3/9/2012 Houston Chronicle reports, "More Texas doctors opting out of Medicare". Only a few states track this particular statistic, but I suspect this reflects a nationwide trend.

As for why conscientious physicians might wish to opt out, Dr. Kathleen Brown explains in her recent essay, "Exiting the Game".

Note: The federal government makes it difficult for patients and doctors to opt out of Medicare. If a patient wants to opt out of Medicare and seek their own private arrangements with willing physicians, they may lose their Social Security benefits -- something many seniors can't easily afford.

Conversely, if a doctor wishes to completely opt out of Medicare, then they basically have to give up all Medicare reimbursements for 2 years. So effectively, they have to be willing to sever relations with all their Medicare patients, even if they just want to work out a non-Medicare arrangement with one patient for one particular operation or treatment.

(There is a way in which doctors can sometimes take Medicare and other times not, but to do so they have to agree to accept less than the Medicare rates, which is already pretty low. Interested readers can find details at, "Medicare Participation Options for Physicians".)

More broadly, the government has a deliberate policy of making it difficult for patients and doctors to engage in private contracts outside of Medicare. Attorney Kent Brown covers this in, "The Freedom to Spend Your Own Money on Medical Care: A Common Casualty of Universal Coverage".

Hsieh PJM OpEd: Free Market Lessons from Contraception Fight

PJMedia has published my latest piece, "Free Market Lessons from Contraception Fight".

I discuss how the controversy over contraception coverage has made apparent three lessons about America’s current health care system and why we need free-market health care reforms:

1) Health insurance should be uncoupled from employment.
2) Mandated benefits will become political footballs.
3) We must fight for freedom as a principle.

For more details on each of these three points, read the full piece.

Quick Links: IPAB, Heritage, Fuchs

Today's theme: Know thy enemy.

Grace-Marie Turner: "President Obama Wants to Strengthen Medicare Rationing Board". (Via Dr. Art Fougner.)

Heritage: "The 10 Terrible Provisions of Obamacare You May Not Have Heard Or"

NYT: "An interview with Victor Fuchs on health care costs". Stanford (emeritus) health care economist applauds the coming end of private practice.

The Hidden Costs of Cost Control

In her 2/29/2012 Atlantic blog, Megan McArdle discusses, "What Cutting Health Care Costs Looks Like".

Basically, stricter cost control measures by hospitals shifts some of the work onto unpaid family members as patients are discharged far earlier than they would have in the old days.

McArdle cites her own mother as an example, recently released from the hospital after undergoing treatment for a ruptured appendix:

Thankfully, my mother is basically healthy -- except that she requires someone to hook up her IV antibiotics twice a day, and because she can't drive or move around much yet, she really needs someone nearby most of the time. It's been no problem for us -- my editors have been incredibly understanding, and I've spent many hours working from her hospital room on my laptop. But how many other people have this flexibility?

This, mind you, is for a relatively benign condition. In my extended family, I've seen elderly patients with terminal cancer sent home to die with families who hadn't any ability to cope with a patient that sick. The poorer and less educated you are, the more likely this is to happen, because you don't have the knowledge -- or the social capital -- to work the system and get a few extra days...

One way to think about it is that we made a policy choice to save money by turning family and friends into parahealth professionals. In my case, I think that's the right choice: I'm happy to take care of my mother, and I understand the cost pressures that made this desirable.

The problem is, most people didn't participate in that choice. There was no public debate over whether we should send elderly patients home in terminal condition to families with no training as health workers. We just said "let's cut hospital costs!" and everyone said "Yay!" and then some folks in a back room decided that this was the way to do it...

(Read the full text of "What Cutting Health Care Costs Looks Like".)

So when we talk about "cost shifting", we should keep in mind some of the invisible cost-shifting created by government policies that induce hospitals to discharge patients quickly -- and sometimes arguably too quickly.

(Via Instapundit.)

Surprise! Electronic Medical Records Increase Costs

The 3/5/2012 New York Times reports, "Digital Records May Not Cut Health Costs, Study Cautions".

From the article:

The promise of cost savings has been a major justification for billions of dollars in federal spending to encourage doctors to embrace digital health records.

But research published Monday in the journal Health Affairs found that doctors using computers to track tests, like X-rays and magnetic resonance imaging, ordered far more tests than doctors relying on paper records.

(Read the full text of Digital Records May Not Cut Health Costs, Study Cautions".)

Of course, electronic medical records (EMRs) can be of enormous benefit to doctors and patients, when freely chosen by physicians in response to their actual on-the-ground needs. But when EMRs are imposed by government mandate, we shouldn't be surprised if they don't have the predicted benefits.

However, EMRs will allow the government to more easily monitor physician practice patterns.

I predict that the rising costs related to EMRs will thus be used as a pretext by the government to further limit what tests and treatments physicians can order for their patients. This means government bureaucrats will be increasingly decide what tests and treatments patients can receive, potentially overriding the physicians who are actually responsible for that patient's care.

But just don't call it rationing.

Quick Links: Death Spiral, E-Smoking, Canadian Drugs

Investor's Business Daily: "ObamaCare Is Designed To End Private Insurers" (3/2/2012)

Ryan Krause: "Bureaucrats Demand You Stop Smoking... and Stop Not Smoking, Too"

Globe and Mail: US FDA interferes with Canadian patients' drug supply. Note that, "Health Canada completed its own inspection later that month, and found no issues with the company’s Canadian products." (2/19/2012)

(Here's a copy of the FDA warning letter to Novartis, the parent company of Sandoz Canada.)

SCOTUS ObamaCare Flowchart

Jared Rhoads of the Center for Objective Health Policy has created a nice infographic for anyone planning to follow the Supreme Court hearings on Obamacare later this month.

Rhoads explains: "At the core is a flow chart that shows what the key questions are and how they interrelate. On the margins I give an indication of some of the arguments that we'll probably hear, along with some other useful tidbits."

Here is the link to the infographic.

Here's a downloadable PDF suitable for printing, distributing as flyers, etc.

Thanks, Jared!

Frezza: The Nanny State and Your Waistline

In the 3/5/2012 RealClearMarkets, Bill Frezza discusses the latest nanny-state obsession with citizens' waistlines: "Too Fat? Too Thin? Progressive Policies Can Fix That!"

From his OpEd:

The logic behind government efforts to control Americans' mass body index is as impeccable as it is insidious. If health care is a "right" to be paid for by the taxpayer, and "access" to this right is being jeopardized by the runaway costs associated with a "disease" called obesity, then the food that you stuff in your face is no longer a personal preference but a critical matter of fiscal necessity.

Sugar is the latest demon, since it appears that years of government advice on the consumption of saturated fats has turned out to be wrong. A broad-based campaign is underway, spearheaded by zealots like Professor Robert Lustig of the University of California, to get the federal Food and Drug Administration to regulate sugar as it does other "addictive poisons"...

At the other end of the scale, "scientists" are urging government action to ban skinny models to curb anorexia, a self-induced malady that affects far too many young women with self-esteem problems. Apparently, the fashion industry's penchant for thinness, which you might think would be hailed by obesity warriors, is a public menace that needs to be controlled. First Amendment be dammed, we have a crisis here and we cannot let corporate greed trump public safety!

(Read the full text of "Too Fat? Too Thin? Progressive Policies Can Fix That!")

As Robert Heinlein once said: "The human race divides politically into those who want people to be controlled and those who have no such desire."

Unfortunately, the first group is in charge -- until we muster up the gumption to kick them out of office.

Related OpEds:

Milton Wolf, "Is This Still America?", Washington Times, 2/27/2012.

Paul Hsieh, "Universal healthcare and the waistline police", Christian Science Monitor, 1/7/2009.

Supreme Court Must Strike Down All of Obamacare

In the 2/24/2012 Washington Times, Phil Kerpen explains why, "Supreme Court must strike down all of Obamacare".

If only the individual mandate is struck down, the other provisions of ObamaCare (including requirements that insurance companies take all comers regardless of pre-existing conditions yet only charge them the same as healthy applicants) would destroy private insurance in the US. Of course, for some leftists, this would be a feature not a bug.

But if we don't want this country to back into a government-run "single payer" system by default, we need to scrap the entirety of ObamaCare. And we need to let our elected officials know where we stand.

Quick Links: Exiting, Privacy, IJ, Sudafed

Dr. Kathleen M. Brown discusses how doctors can practice good medicine by "Exiting the Game".

Linda Gorman and Amy Oliver critique a proposed Colorado medical database: "Bill would compromise patients' medical privacy".

The Institute for Justice asks, "Does the ObamaCare individual mandate make contracts unenforceable?"

Paul Crowley satirically tweets: "US crackdown on crystal meth means Sudafed is hard to buy. But meth is easy to buy; here's how to make Sudafed from it."

Direct link to article (PDF): "A Simple and Convenient Synthesis of Pseudoephedrine From N-Methylamphetamine".

Vecchio Video Series on ObamaCare

Dr. Jill Vecchio, the head of the Colorado chapter of Docs4PatientCare (and a fellow radiologist!), has recorded an informative set of videos on ObamaCare and what it means to all Americans.

One important point: the current system is not a free-market but rather a mixed system with some free-market elements but also enormous amounts of government regulation. Forthcoming additional government controls to be imposed by ObamaCare will not solve our current problems but rather make them worse. In contrast, there are many good free-market reforms that would lower our costs and improve our health care quality.

Part 1 -- Coverage:



Part 2 -- Costs, section A:



Part 3 -- Costs, section B:



Part 4 -- Employers and Exchanges:



Part 5 -- Doctors and Patients:



Part 6 -- Constitutional Issues:



Part 7 -- Real Health Care Reforms:



(Note: Overall I found these extremely informative.)

Why Hospitals Are Employing Doctors

Why are more doctors giving up private practice and seeking instead to become hospital employees?

This article in the 2/26/2012 Pittsburgh Tribune-Review discusses why, "Hospitals woo physicians away from private practices".

From the physician's point of view:

...[S]ome physicians tire of running a business and sell their practices to a hospital system for "the sigh of relief that they can just take care of patients," said Dr. Leo McCafferty, president of the Allegheny County Medical Society and a Shadyside plastic surgeon with an independent practice.

Being employed by a hospital can be good when government mandates make remaining in private practice more difficult.

A hospital offers a consistent paycheck even when government reimbursements for Medicare and Medicaid are cut back, experts say. Billing and negotiating with insurance companies is complicated. And health systems have the money to invest in electronic record systems, which the government mandates.

"It's difficult for solo doctors and smaller groups to incur the expense of creating infrastructure to meet the goals of the government," [Dr. Frank] Civitarese said.

Yet from the hospital's perspective, physicians are still a cash cow:

Each doctor can bring millions of dollars annually to a health system, according to a 2010 study by Merritt Hawkins, a physician search and consulting company in Irving, Texas.

On the low end, a pediatrician can generate more than $850,000 a year for a hospital while earning a salary of $171,000, the study shows. On the high end, a neurosurgeon can be worth more than $2.8 million in hospital revenue while earning $571,000 a year. In the middle are family practice doctors, which earn $173,000 on average but can generate more than $1.6 million a year for a health system.

(Read the full text of "Hospitals woo physicians away from private practices".)

Of course, hospital-employed physicians are generally expected to keep their patient within the system that employs them, which may or may not necessarily be in the patient's best medical interest.

Hospital-employed physicians thus serve two masters -- their patient and their employer. This has the potential to create conflicts of interests for physicians (depending on the exact terms of their employment contract). Whether this will ultimately compromise patient care remains to be seen.

(Link via Donna Rovito.)

UK Holding Back Cancer Drugs

The 2/25/2012 Telegraph reports, "New cancer drugs being held back to save Government money, says GlaxoSmithKline boss".

From the article:

GlaxoSmithKline chief executive Sir Andrew Witty warned that... governments were now seeking to go further in an effort to achieve even bigger savings -- and he highlighted Britain's decision to delay new cancer treatments.

"The bit I'm much more frightened about is that what's now beginning to become clear is that, in addition to price reductions, governments are delaying the approval of innovative new drugs," he said.

"So a second way they can save money, they think, is 'Let's just not buy the next round of innovation'.

"Cancer in the UK is a good example where we're seeing oncology drugs being systematically delayed from introduction and reimbursement.

The net result:

He warned that drug companies may soon no longer find it worthwhile to seek approval for their products in Britain.

"The regulation is such in this country that it is not worthwhile for the drug companies making the effort of actually negotiating with our regulatory authorities for the sale of their products in the UK. It is a complete loss-leader for them – waste of time," he said.

"We are going to have a situation in the UK where drugs are not available for our patients. It is a disaster. Someone just needs to sort this out."

(Read the full text of "New cancer drugs being held back to save Government money, says GlaxoSmithKline boss".)

Besides showing the pernicious effects of government control over over drug development, the article also demonstrates one of the problems with government-mandated "cost effectiveness" restrictions.

In a free market, some innovations are going to cost a lot in the beginning. Remember how expensive first-generation DVD players were? Or the first home computers?

But as early adopters start buying these products, they create an increasingly-robust market which then creates economies of scale which drives down the price -- making them increasingly affordable to later users.

Imagine if a government agency had stopped DVD manufacturers from selling (and early adopters from buying) their products on the grounds that they were too expensive and insufficiently "cost-effective". This would have short-circuited the market forces at the outset, thus depriving later consumers of the ability to purchase these items at future lower prices.

The big question is how long it will be before US regulatory agencies start doing the same thing as is already happening in the UK? And will American patients take this lying down, or will they stand up against it?

Wolf: Is This Still America?

Robert Heinlein once wrote: "The human race divides politically into those who want people to be controlled and those who have no such desire."

In his latest Washington Times OpEd, Dr. Milton Wolf shows which half is in charge of this country: "Is this still America? Control freaks assault the land of the free".

Read the whole thing.

Gorman Critiques HA on Massachusetts

Linda Gorman of the Independence Institute critiques a recent Health Affairs article praising the RomneyCare plan in Massachusetts.

In "What Were They Thinking at Health Affairs?", she debunks several misleading arguments from the Health Affairs piece.

Gorman notes:

Unfortunately, in several cases the authors fail to inform readers that their results are contradicted by other, possibly more reliable, sources of information. They also neglect to put some of their results in proper context. Some examples:

* Failing to mention that although the nonelderly adults in the telephone survey samples reported a drop in emergency department (ED) use from 2006 to 2010, data from other reputable sources suggest that total ED visits have risen.

* Failing to mention that the "strong and sustained gains in the share of nonelderly adults in Massachusetts who reported their health as very good or excellent" are similar to the gains reported by all American adults.

* Misrepresenting the historical record with the claim that the "Massachusetts 2006 health reform initiative did not tackle the high cost of health care in the state." Readily available sources clearly show that reform proponents expected it to reduce health care costs.

* Asserting that "access to health care in the community is better than it was in 2006," without reporting on evidence that contradicts this conclusion.

* Inappropriately limiting the definition of "affordability" to out-of-pocket expenses, while ignoring higher premiums, fees, and taxes.

* Concluding that the survey evidence "is suggestive of important improvements in the effectiveness of the delivery of health care in the state" and implying that this is due to RomneyCare despite noting, three times on one page, that "our data did not allow us to isolate the impact of reform from that of changes in other factors during the study period."

RomneyCare supporters are still trying to spin the Massachusetts plan as a success. Fortunately, not everyone is buying that spin.

Online Markets In Medical Care

John Goodman discusses the growing online market for medical services in his 2/25/2012 TownHall.com piece, "Can Health Care Be Bought and Sold on eBay?".

Services such as MediBid allow patients to find elective services such as knee replacement at discounts of up to 50%. In effect, this marketplace allows patients to engage in a domestic equivalent of "medical tourism".

Unfortunately, Goodman notes that this sort of innovation is being threatened by ObamaCare regulations -- yet another reason to repeal ObamaCare.