Catron: The States Can Still Kill Obamacare

In his 7/9/2012 OpEd at American Spectator, David Catron discusses how, "The States Can Still Kill Obamacare".

Basically, ObamaCare relies on the state-run "exchanges" for consumers to purchase their mandatory insurance (if they don't receive it through their workplace). But states aren't required to establish the exchanges.

Furthermore:

The federal government can set up its own exchanges, in theory, but Obamacare stipulates that Washington would then be required to pick up the tab as well. And, as [Cato analyst Michael] Cannon goes on to point out, "The Obama administration has admitted it doesn't have the money -- and good luck getting any such funding through the GOP-controlled House."

And it gets worse. If the federal government is forced to set up an exchange, it faces yet another huge problem. As Sally Pipes and Hal Scherz write, "The text of the law stipulates that only state-based exchanges -- not federally run ones -- may distribute credits and subsidies."

Thus, if a state refuses to set up an exchange, the feds have no real ability to do so either. The states have an opportunity, therefore, to shoot a poison arrow directly into Obamacare's Achilles' heel...

(Read the full text of "The States Can Still Kill Obamacare".)

Some states are already adopting this strategy.

But as Catron reminds us, ultimately the best way to kill ObamaCare will be at the ballot box in November.

Update:  David Catron notes that Texas has joined the list of states opposing ObamaCare in this fashion.

Get Ready For the Taxes

Gateway Pundit: "Lawyers Have Already Drafted 13,000 Pages of Regulations for New ObamaTax Law".

I just think of it as an opportunity for more patriotism! (H/T: Milton Wolf.)

Quick Links: Medicaid, Privacy, UK

Kaiser Health News: "States Balk At Expanding Medicaid" (7/2/2012). Due to a combination of politics and economics.

Boston Globe: "As records go online, clash over mental care privacy" (6/21/2012)

BBC: "NHS charging and rationing 'may be needed'" (7/3/2012). Hey, let's fix the UK national health system with more rationing. And making it no longer "free"!

Hsieh Forbes OpEd: Is President Obama's Prostate Gland More Important Than Yours?

Forbes.com has just published my latest OpEd, "Is President Obama's Prostate Gland More Important Than Yours?"

My theme is that you should enjoy the same freedom to make medical decisions as President Obama.

Snarkier version of the theme: "Medical freedom for me, but not for thee."

Here is the opening:

When President Obama turned 50 last year, he made an "informed patient request" for a PSA (Prostate Specific Antigen) test. This is the blood test routinely used to screen men over 50 for possible prostate cancer. The President received his PSA test. But under ObamaCare, you may not be able to.

Now that ObamaCare has been upheld by the Supreme Court, all of its major provisions will be in force, not just the controversial “individual mandate.” This includes government medical practice guidelines that will affect millions of Americans...

(Read the full text of, "Is President Obama's Prostate Gland More Important Than Yours?")

Stossel: Obama's SCOTUS Victory Speech Translated

John Stossel translates Obama's SCOTUS victory speech into plain English.

Read the whole thing. (Via Brian Schwartz.)

Happy Independence Day!

   Happy Independence Day!

   (Regular blogging will resume tomorrow.)

List of ObamaCare Taxes

For your reference, Americans for Tax Reform has compiled this handy list, "Full List of Obamacare Tax Hikes: Listed by Size of Tax Hike" (6/29/2012).

From their introduction:

Obamacare contains 20 new or higher taxes on American families and small businesses. Arranged by their respective sizes according to CBO scores, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, their effective dates, and where to find them in the bill.

Here's the PDF version.

More Doctors' Reaction To SCOTUS

I'm seeing more reactions like this post-SCOTUS: "A Surgeon Cuts to the Heart of the ObamaCare Nightmare".

Or this picture, which is worth 1000 words (from Dr. Meg Edison).

Another Doctor Squeezed by ObamaCare

A physician colleague posted the following on Facebook, as part of a discussion of rethinking his career in the wake of the Supreme Court ObamaCare decision. Basically, the new government controls will drastically limit his autonomy to practice, force him to fire people, and shatter his dreams of owning his own small private practice.

He has given me his permission to repost this lightly-edited excerpt:

We all go into medicine for different reasons. We all believe in 'helping people,' as we all wrote in our admissions essays. But we all also have enlightened self-interests in pursuing a career in medicine.

Some of those are related to money, to scientific inquiry, take part in an endeavor worthy of respect, etc. A big part of my decision to enter the Art was also to be able to take a bigger role in guiding my life's wishes, i.e. autonomy. 

As a lowly lab tech & employee, I was frustrated being at the mercy of others. I saw medicine as a way to take control of my own life. And I love it at present given all of its current faults. I can decide how much to work, what types of patients to see, how much time I spend on certain patients, etc.

But this bill directly attacks that autonomy in ways no individual insurance company could ever. ACOs [Accountable Care Organizations] with their care rationing incentives, bans on physician-owned hospitals (i.e., there will be no new Mayo Clinics or competition to Big Hospitals), meaningful use, gold-silver-bronze plans with dictated coverage, the IPAB [Independent Payment Advisory Board], etc., all centralize decision making authority away from doctors and patients and move that to government bureaucrats whose main concerns may be costs or graft.

While the rest of the world becomes more vibrant and flexible through decentralization, this Administration has 1) identified people like me (us) as the problem and not the solution, and 2) placed itself on the wrong side of history (and freedom) by centralizing perhaps the most important decisions people will be making about their lives and some of the most important recommendations that doctors can provide to them during their time of need.

So while I can morph to make sure I still make a decent wage, how do I maintain my self-respect in a setting that doesn't value my contributions?

Second, I would respectively challenge your notion that I've come a long way in all of this. 13 years ago I was living month-to-month with little savings and feeling trapped. Now, I am up to my ears in debt, essentially living month to month with no savings. I can't afford a home. I am just a couple of paychecks away from being homeless and defaulting on loans. And I don't have any great escapes that wouldn't negative impact my family (i.e., I'm still trapped). I knew that it would be tough before it would get better.

And while I'm now beginning to see the light at the end of the tunnel where I will get ahead of the game, I have an Administration that says I have to spend six figures on electronic medical records (which of my employees do I fire to buy an EHR [Electronic Health Record]?), that will filter some (and eventually all) of my payments through a big hospital system, that says I am the problem with medicine, that taxes me to death, that has frozen with regulations and taxes my small business from hiring above 50 employees so I can compete with larger providers, that outside of medicine claims that I am not paying my fair share, that's made it more difficult for me to get a loan, that will increase the costs of insurance for my patients, that will tax me as a specialist to shuttle more money to PCPs that will take worse care (if you believe the studies) of asthma & allergy patients than I do, etc.

Up to this point in my life, I've been an optimist because I felt that I could overcome any challenge. Now, I don't see how my dream of owning my own small medical practice is possible with what's coming down the pike.

So, do I employ a bunch of NPs [Nurse Practitoners] and essentially become an administrator, do I go off the grid and open a concierge IM [Internal Medicine]/allergy practice, or do I find something else to do?

(Note: The material in square brackets [ ] are my own insertions to clarify some of his abbreviations.)

I really hope my colleague doesn't decide to leave the profession, especially not after all his years of hard work, including college, medical school, residency, and fellowship.

But I wouldn't blame him if he did.

Reynolds on SCOTUS, ObamaCare, and Legitimacy

Glenn Reynolds (aka "Instapundit") has a piece in today's Washington Examiner, "The Supreme Court, Obamacare and 'legitimacy'".

He goes through the tortured history of ObamaCare (including how it was passed), then notes: "[A]t the end of the day, the legitimacy question rests not with the Supreme Court, but with Congress and the president."

Vecchio Blasts ObamaCare

Ari Armstrong attended the 6/29/2012 anti-ObamaCare rally organized by American For Prosperity, and posted this report.

He also recorded this short speech by Dr. Jill Vecchio of Docs4PatientCare.org, explaining how ObamaCare would force her to practice substandard medicine and violate her Hippocratic Oath to patients:



Ask yourself: When the doctors who are willing to practice according to their patients' best medical interests have been driven out of the profession, what kind of doctors will be left?

We have been warned.

Post-SCOTUS: Sacrifice, Taxes, Privacy, Shortages, Voting

As one might expect, yesterday's Supreme Court decision on ObamaCare has elicited an enormous volume of commentary.   Here are a few pieces that caught my eye, with relevant excerpts:

Ari Armstrong: "Supremes' ObamaCare Ruling: Altruism In Politics" (The Objective Standard)

(Armstrong notes, "Essentially, ObamaCare turns health insurance into a gigantic wealth-transfer scheme, in which young and healthy workers are forced to buy expensive 'insurance' that in fact serves to subsidize the health expenses of others... 'Shared responsibility' is a euphemism for forced sacrifice.")

David Catron: "Supreme Court Wimps Out on Obamacare" (American Spectator)

(Catron observes, "In an utterly Orwellian opinion authored by Chief Justice Roberts, the majority held that the mandate was not a tax for purposes of applying the Anti-Injunction Act (AIA), but that it was constitutional because it falls within Congress' taxing powers...")

Loren Grush: "Individual mandate upheld: What does that mean for you and your health?" (Fox News)

(In particular Grush reports, "Another change that will eventually go into effect is the government's ability to seize your medical records. In order to make information more readily available for doctors during their appointments, the government hopes to create a national database of every person’s medical history.")

Mark Long: "Health Law's Survival Means More Demand for Fewer Doctors" (Wall Street Journal)

(Long notes, "[T]he U.S. will be more than 60,000 doctors short in 2015 — the year all those newly covered patients enter the system -- around 90,000 short five years later."  In other words, patients may have theoretical "coverage", but that doesn't necessarily mean they'll receive actual medical care.)

Milton Wolf: "Only the Voters Can Save America Now" (Washington Times)

(Wolf writes, "If Barack Obama holds the White House, and if Democrats win control of either house of Congress, then Obamacare will be unstoppable, and America will become the United States of Europe.")

And in case you missed it, PJ Media published my response yesterday: "What Should Americans Do After the Supreme Court ObamaCare Ruling?"

Hsieh PJM OpEd: What Should Americans Do After the Supreme Court ObamaCare Ruling?"

My OpEd on the Supreme Court ObamaCare ruling is now up at PJMedia:
"What Should Americans Do After the Supreme Court ObamaCare Ruling?"

Theme: Now that SCOTUS has ruled, we will have to reclaim our freedoms at the ballot box.

My three takehome points:

1) American health care will be in deep trouble in just a few years.
2) There are plenty of good ideas for free market health care reform.
3) ObamaCare must be defeated politically.

We will have our work cut out for us.

ObamaCare Upheld

The U.S. Supreme Court has ruled and it has essentially upheld ObamaCare, including the controversial "individual mandate" requiring Americans to purchase health insurance.

(They ruled it could not be upheld under the Commerce Clause but could be upheld under Congress' taxing power.)

This is obviously big news. The battleground will now shift to the political arena with enormous implications for the 2012 campaign.

 I'll have more later as I digest the torrent of news and analysis.

Pre-SCOTUS Links

A few links while we're waiting for this morning's Supreme Court ruling:

Adler and Cannon: "If ObamaCare survives, legal battle has just begun" (USA Today, 6/24/2012)

Sidorov: "Surprise, Surprise: The Patient Centered Medical Home Costs Money!" (6/26/2012)

Capretta: "Obamacare's Failings Go Well Beyond the Individual Mandate and Medicaid" (6/21/2012)

Randy Barnett: "Win or Lose, My Thanks" (Volokh Conspiracy, 6/27/2012)

WOLF: Obamacare Must Die a Political Death

Dr. Milton Wolf has a new video at the Daily Caller: "Obamacare must die a political death".




If ObamaCare is viewed as being defeated primarily by unelected judges, we will see intensifying efforts to delegitimize the Court and its ruling.

But if ObamaCare is repudiated soundly at the ballot box, and the elected officials who supported are sent packing, this will send a powerful message to those seeking to revive some form of ObamaCare (or worse).

Strangling Private Practice?

CNN reports that 17% of doctors in private practice may close shop within the next year due to a combination of factors, including "business expenses and administrative hassles, shrinking insurance reimbursements and costly malpractice insurance."

If this happens and ObamaCare is still in effect, many will join large "Accountable Care Organizations" or become hospital employees, where they will then become more beholden to their paymasters, rather than their patients.

As for what such a future would look like, see my PJ Media piece from last year, "The Coming Collectivization of American Health Care".

(CNN link via Dr. Art Fougner.)

Scherz: A Healthcare Vision For Tomorrow

Dr. Hal Scherz of Docs4PatientCare has his own pre-SCOTUS comments at TownHall.com, "A Healthcare Vision For Tomorrow".

He discusses a number of insurance reforms, legal reforms, and Medicare reforms that would move us in the direction of a fully free-market in health care.

Epstein on The FDA

Noted legal scholar Richard Epstein has a harsh critique of the FDA at, "A Taste of Government-Run Healthcare".

In particular he notes:

...As the educated cynic might observe, the FDA’s fingerprints are not on the death certificate of a child who did not take the drug that the FDA refused to approve, but those prints are quite clearly on the death certificate of a child who died from the use of an FDA-approved drug. The result is the same kind of intense political pressure that affects other safety agencies. It leads the FDA to increase one kind of error (the unavailability of drugs) in order to minimize a second (adverse drug reactions).

(Read the full text of "A Taste of Government-Run Healthcare".)

He further discusses how FDA regulations impede medical progress and endanger patients' lives.  Although Epstein doesn't advocate completely eliminating the FDA (which should be the proper endpoint), he does recommend several good partial steps that would move us in the right direction.

(Via Instapundit.)

Fogoros Book on Collectivized Medicine

While we're waiting for the Supreme Court ruling on ObamaCare, readers might be interested in the upcoming book by Dr. Richard Fogoros, "Open Wide And Say Moo! -- The Good Citizen's Guide To Right Thoughts and Right Actions Under Obamacare".

He's posting individual chapters online for reader comments.

A few chapters worth highlighting include:

"Chapter 7 – Limiting Individual Prerogatives in a Progressive Healthcare System"

"Chapter 9 – An Introduction To Herd Medicine"

 "Chapter 14 – Stifling Medical Progress"

(Note: I may not be in full agreement with every point he makes in every chapter.  But overall, Fogoros is full of very insightful observations.)

No SCOTUS Health Care Ruling Today

No ruling from the Supreme Court today on ObamaCare. Still waiting on word as to when the next set of decisions will be announced.  

Update: Health care ruling to be announced on Thursday, June 28.

Pre-SCOTUS Commentary

As we await the Supreme Court decision on ObamaCare, here are a few quick links:

Bernstein: "Whatever the Supreme Court's Obamacare Ruling, Here's a Free Market Healthcare Solution" (Forbes, 6/24/2012)

Doyle and Lightman: "Supreme Court health law ruling will only begin more debate" (Boston Herald, 6/24/2012)

Goodman: "The HMO in Your Future" (Townhall, 6/23/2012)

FWIW, this 6/21/2012 New York Times article hints that the ObamaCare ruling might come mid-week, rather than today: "Chief Justice Offers Hint at New Timing for Health Care Ruling".

But we'll find out soon enough...

Palmisano on Upcoming SCOTUS Decision

Dr. Donald Palmisano is a defender of free-market health care reforms and also a former head of the American Medical Association.

He offers his thoughts on the upcoming SCOTUS decision in this 6/23/2012 interview.

 

Wolf: After ObamaCare

Dr. Milton Wolf has some good ideas in his 6/21/2012 Washington Times OpEd, "After ObamaCare".

In particular, he opens with this observation:

Obamacare will die at least one of three deaths: judicial, political or economic. If the Supreme Court allows this abomination to stand, voters can still deliver its death blow at the polls in November. Ideally, Obamacare will, in fact, die both of these deaths because if it survives now, it will die an economic death and take America down with it. So let's prepare now for the post-Obamacare America...

He then gives 5 practical suggestions to move America in the direction of free-market health care reforms.  These include:

1) Tax fairness

2) End state insurance monopolies

3) End state licensing monopolies

4) Health savings accounts

5) End frivolous lawsuits

Read the full text of "After ObamaCare" for more details.

BTW, he has a new (non-medical) Daily Caller video as well: "Holder is Contempt-able!"

Forbes on FDA and Devices

Two recent Forbes pieces worth checking out:

"How Margaret Hamburg's FDA Causes Cancer Drug Shortages" (Avik Roy, 6/15/2012)

"Repeal of the Medical-Device Tax Is Life-Saving Legislation" (John Graham, 6/11/2012)

Backdoor Euthanasia in the UK?

If this story is accurate, it's very disturbing: "Top doctor's chilling claim: The NHS kills off 130,000 elderly patients every year" (Daily Mail, 6/19/2012).

The article discusses findings by Dr. Patrick Pullicino (a neurologist) regarding:

[T]he Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country.

It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

It can include withdrawal of treatment -- including the provision of water and nourishment by tube -- and on average brings a patient to death in 33 hours.

Of course compassionate end-of-life care for terminally ill patients is a good thing, when voluntarily chosen by the patient and/or their designee.

But Dr. Pullicino notes (and has reportedly seen first-hand) cases where patients with treatable conditions are put on the LCP pathway against the family's wishes because "because they are difficult to manage or to free up beds".  In other words, this is becoming an involuntary "equivalent of euthanasia of the elderly".

For example:

In the example he revealed a 71-year-old who was admitted to hospital suffering from pneumonia and epilepsy was put on the LCP by a covering doctor on a weekend shift.

Professor Pullicino said he had returned to work after a weekend to find the patient unresponsive and his family upset because they had not agreed to place him on the LCP.

'I removed the patient from the LCP despite significant resistance,' he said. 'His seizures came under control and four weeks later he was discharged home to his family,' he said.

(Read the full text of "Top doctor's chilling claim: The NHS kills off 130,000 elderly patients every year".)

If these reports are true, this is an alarming breach of medical ethics and a gross violation of patients' individual rights.

Fortunately, the US health system isn't at that point yet.  Yet.

(Via Dr. Richard Amerling.)

Scherz: The Schizophrenia of the AMA

In his 6/19/2012 TownHall column, Dr. Hal Scherz of Docs4PatientCare discusses "The Schizophrenia of the AMA". One excerpt:

The AMA's problems have deepened because they are not what they purport themselves to be- the spokesman for the community of physicians. How can they be when only approximately 10% of the practicing physicians in the US are members?

In contrast to the 1960's when over 75% of doctors belonged to the AMA, their influence in the medical community has waned considerably, in part because they are out of touch with the views of practicing physicians.

Obamacare is a perfect example. A recent Jackson Healthcare survey reported that 70% of doctors felt that it deserved a failing grade and 55% felt that it should be repealed -- clearly not the AMA position. Only 12 % of doctors thought that the ACA would fix healthcare.

In an effort to regain lost credibility amongst physicians, and to become more relevant, the AMA did what most people expected them to do -- they "pivoted". This involved "tough talk" and taking some oppositional positions against the "bad" parts of Obamacare, attempting to make everyone forget that they were partly responsible for this law...

However, the AMA is still fond of improper government intervention in private affairs.  For example the Los Angeles Times recently reported on the AMA's support of Bloomberg-style nanny state regulations in, "Soda taxes endorsed by AMA as a way to fight obesity" (6/20/2012).

Fortunately, the AMA does not speak for all doctors.  Instead, physicians can now seek out other professional organizations like D4PC who will fight for the interests of doctors, patients, and freedom.

Wolf on Dogs and Government

In his latest Daily Caller video Dr. Milton Wolf notes, our biggest problem isn't dogs (which the media obsessed over), but the proper scope of government.

He reminds us that the Founders intended a limited government, "deriving their just powers from the consent of the governed":

Saad: Don't Romanticize Canadian Health Care

Professor Gad Saad of Concordia University shares his insiders' perspective on Canadian health care for Americans in this 6/14/2012 piece for Psychology Today, "Don't Romanticize the Canadian Healthcare System".

Here is the opening:

As a Canadian, I am often bewildered by the American Left's utopian albeit perfectly incorrect views of the Canadian healthcare system. The general notion, as exemplified in Michael Moore's 2007 film Sicko, is that countries such as Canada and Cuba offer compassionate universal free healthcare to its citizenry while a diabolical consortium of capitalists headed by Dr. Evil runs the American system.

Let me share some important realities regarding our "free" Canadian healthcare.

He discusses 5 points, three of which are briefly summarized as follows:

1. Canadians pay exorbitant taxes for their "free care"

3. It is extremely difficult to find a family physician willing to take on new patients. Getting to see a specialist is even harder.

4. Even if you have a medical emergency, you may have to wait 8-14 hours for care.

(Each of these points, and two others, are discussed in greater detail in "Don't Romanticize the Canadian Healthcare System".)

Of course, those with special "pull" in Canada  can "jump the queue" and receive their MRI or surgery ahead the others on the waiting list. But this merely replaces "political pull" as the currency for medical services, rather than money.

Quick Links: Willey, Smith, Kerr, Cannon & Cohen

Dr. Charles Willey: "No Need For ObamaCare If Providers Are Liberated" (Investors Business Daily, 6/13/2012)

Dr. Keith Smith, "$15,000 Tonsillectomy vs. $3,050 Tonsillectomy"

Orin Kerr, "How Much Will the Ruling in the Health Care Case Matter?" (Volokh Conspiracy, 6/19/2012)

Michael F. Cannon and Diane Cohen: "Obamacare's Super-Legislature" (TownHall, 6/17/2012)

Hsieh Forbes OpEd: The Nanny State And Universal Health Care

The 6/18/2012 edition of Forbes has posted my latest OpEd, "The Dangerous Synergy Between The Nanny State And Universal Health Care".

A couple of excerpts:

The recurring theme: The government must limit our freedoms to limit overall medical costs. But this issue can only arise in “universal” health systems where taxpayers must pay for everyone else’s medical expenses...

It’s a short step from the government assuming responsibility for your diet to assuming responsibility for your overall health. Today, the government decides what you can or cannot eat. Tomorrow, the government decides what medical care you can or cannot receive.

Note that both Democrats and Republicans buy into the notion of limiting freedom to limit global health costs. One of the big proponents of this idea is former GOP Senate majority leader Bill Frist (who is a cardiac surgeon).

I also quoted a section from one of my favorite Bill Whittle's essays, "Freedom":

"The more your government restricts your options, the more you psychologically look to government to keep you safe, fed, clothed, housed and sustained.

(Read the full text of "The Dangerous Synergy Between The Nanny State And Universal Health Care".)

Note: This is my second piece at Forbes, and I'm honored to once again appear on their website.  My first piece was, "Just Who Should Control Your Healthcare Spending?" (5/16/2012).

Scherz and English on Health Insurance

In case you missed it, Dr. Hal Scherz and Dr. Jeffrey English of Docs4PatientCare had a piece in the 6/12/2012 TownHall.com, "Health Care Insurance is Not a Dirty Word".

They make the important point that what is now called "insurance" is actually badly managed pre-paid health care, and this is due to many years of bad government policy.

To move us toward genuine insurance, they suggest free-market reforms including:

...[R]emoving unnecessary mandates that insurance companies are required to have in healthcare policies and which differ in every state.

The tax treatment for health insurance policies should be the same whether the policy is purchased by an employer or by an individual.

Health Savings Accounts and high deductible insurance policies would make individuals better consumers because the financial implications of healthcare would be transparent and become their direct responsibility.

Free market ideas and products currently exist...

(Read the full text of "Health Care Insurance is Not a Dirty Word".)

Avik Roy also discusses the many problems with insurance regulations (and how that hurts patients) at his 5/21/2012 Forbes piece, "Putting the 'Insurance' Back in Health Insurance".

Finally, I discuss free-market insurance reforms in this piece from the Fall 2009 issue of The Objective Standard, "How the Freedom to Contract Protects Insurability".

Catron: Judgment Day Draws Nigh for Obamacare

David Catron discusses the upcoming SCOTUS ruling in his latest piece for American Spectator, "Judgment Day Draws Nigh for Obamacare".

Although it's notoriously difficult to "read the tea leaves" from the Supreme Court, Catron argues that "If the mandate goes, two other crucial provisions may go down as well."

He notes this simple economic fact:

While it is possible that the Court will strike down the mandate and leave the rest of Obamacare standing, it's absurd to suggest that the law could still function effectively. Such a ruling would result in a health insurance "death spiral" in which healthy people stop buying coverage and the insurance companies are left with the most expensive patients.

In fact, the Department of Justice lawyers seemed to be arguing this very point, in the hopes that the Court would therefore leave the individual mandate standing (rather than striking down the full law).

Of course, no one really knows yet how the Supreme Court will rule except for the justices and a few of their aides. But it won't be long before we all find out.

(Read the full text of "Judgment Day Draws Nigh for Obamacare".)

Big Pharma Cronyism

The 6/11/2012 Wall Street Journal discusses, "ObamaCare's Secret History".

It includes sordid details of cronyism by the drug industry, which threw its support behind ObamaCare in exchange for various political favors (such as having their way on the "drug reimportation" issue).

A teaser from the article:

The business refrain in those days was that if you're not at the table, you're on the menu. But it turns out Big Pharma was also serving as head chef, maître d'hotel and dishwasher. Though some parts of the story have been reported before, the emails make clear that ObamaCare might never have passed without the drug companies.

Thank you, Pfizer.

(Read the full text of "ObamaCare's Secret History".)

As David Catron notes, "Ironically, reimportation was a bad idea that could have been fought honestly. But Big Pharma decided on a quisling strategy. In the end, they’ll get the shaft just like their fellow collaborators in the AMA."

Wolf on the Chevy Volt

Dr. Milton Wolf takes corporate welfare in his latest video, "The Chevy Volt is a 'shocking' story".
 

That Simpsons' Canyonero is starting to look pretty good by comparison!

Oregon Health "Reforms" Need More Money

Oregon's health reforms based on "coordinated care organizations" is failing.

The 6/8/2012 Oregonian reports, "New health care groups say Oregon's reforms could sputter without more cash". From the article:

...[L]awmakers earlier this year approved ambitious reforms that would turn over the state's Medicaid-funded Oregon Health Plan to beefed-up managed care groups called coordinated care organizations.

Now, members of the new groups are crying foul after a directive Thursday that they'll receive no new funds for the additional responsibilities they've agreed to take on -- mental health care, prevention efforts, quality measurements and new patient-care staff, among others.

They say the success of the reforms is at risk because revamping the care of 600,000 people takes money.

(Read the full text of, "New health care groups say Oregon's reforms could sputter without more cash".)

In other words, doctors are noticing that they are being squeezed by government-run medicine and can't actually deliver the care they thought they could. Of course, the problem will simply worsen if the legislators decide that more budget cuts are necessary.

It's a good thing we would never try to implement such a crazy system at the national level. Oh, wait...

(Via Dr. Kathleen Brown.)

Quick Links: Scherz, Eck, Tanner, Discounts

Dr. Hal Scherz, "Health Care Insurance is Not a Dirty Word" (TownHall, 6/12/2012).

Dr. Alieta Eck: "Will Atlas Shrug?" (PDF, Journal of American Physicians and Surgeons, Vol 17 No 2, Summer 2012).

Michael Tanner: "5 ways to solve health care" (New York Post, 6/10/2012).

LA Times: "Many hospitals, doctors offer cash discount for medical bills", 5/27/2012. (Via PatientPowerNow.)

GOP Favoring Mandates?

Merrill Matthews at Forbes notes, "Some Republicans Embrace ObamaCare Mandates":

Several Republicans reportedly want to retain certain provisions in ObamaCare, not because those provisions are good policy, but because they’re popular. But if Republicans adopt the popularity standard, they will have to impose coercive government mandates that will drive up the cost of health insurance — just as they accuse President Obama and the Democrats of doing...

Matthews goes on to describe the bad consequences in greater detail.

Bad ideas are bad, regardless of which party supports them.

If GOP legislators adopt the same policies as the liberal opponents, they should not be surprised if limited government advocates view both parties as just variations on the same evil.

More Doctors Declining Medicaid and Medicare

This does not bode well for government-run medicine: "Survey: More doctors report they cannot afford to take new Medicaid, Medicare patients".

These patients may have theoretical "coverage". But they won't be able to receive actual medical care.

Freakonomics on Surgeons' Fees

The 6/6/2012 Freakonomics blog has an interesting post, "What Surgeons Get Paid, and What Patients Think Surgeons Get Paid".

They discuss a paper written by an orthopedic surgeon on public perception of surgeons' fees. Here's the money quote (both literally and figuratively):

On average, patients thought that surgeons should receive $18,501 for total hip replacements, and $16,822 for total knee replacements. Patients estimated actual Medicare reimbursement to be $11,151 for total hip replacements and $8,902 for total knee replacements. Seventy per cent of patients stated that Medicare reimbursement was "much lower" than what it should be, and only 1% felt that it was higher than it should be.

In reality, surgeons get paid on average $1,378 for a total hip and $1,430 for a total knee. Thus patients were off by an order of magnitude in their estimates! The disconnect in public knowledge seems extreme.

In short, patients -- the most important part of all of health care policy decisions -- have absolutely no clue how much doctors get paid. They think we get paid (or, at least, deserve to) about 10 times more than we actually do!

Of course, when a patient gets an artificial hip, he or she also has to pay the hospital for the OR time, the nursing care, and for the cost of the artificial hip itself.

The surgeon's fee is thus a fairly small part of the total bill. In fact, the $1,400 fee is comparable to the charge for labor (not including parts) for replacing the transmission in your automobile!

(Freakonomics link via Kelly Valenzuela.)

Scherz and Armstrong on Romney

Dr. Hal Scherz and Dr. Richard Armstrong of Docs4PatientCare discuss what Mitt Romney should do on health care if he is elected president.

They give their recommendations in this 6/5/2012 TownHall.com piece, "Romney Should Own the Healthcare Debate".

 For example:

Allowing insurance to be purchased across state lines and creating a market based model where people can shop for policies with benefits that they need and not ones that they will never use. This will drive costs down and make insurance more affordable. He supports health savings accounts and high deductible policies- both phased out under Obamacare. This creates better healthcare consumers -- something that always happens when people spend their own money instead of someone else's.

I'm not particularly optimistic that Romney would embrace the free-market health care reforms this country desperately needs.

But if he adopted the recommendations from Drs. Scherz and Armstrong, it would be a good first step in the right direction.

Wolf On Free Markets

Dr. Milton Wolf has a new video commentary at the Daily Caller, "Free market capitalism 'doesn't work.' Oh, really?"

America has a mixed economy (rather than a fully capitalist one). But to the extent we have allowed capitalism to work, it has created incredible prosperity.



Dr. Wolf also notes that capitalism is moral because it relies on the voluntary cooperation of people seeking mutual benefit, not government coercion.

As always, his videos are both entertaining as well as informative. Including the spray-on mullets.

IJ Tackles CONs

The Institute for Justice is now taking on CON (Certificate of Need) laws, using Virginia as their test case.

They've posted details at: "CON JOB: How A Virginia Law Enriches Established Businesses by Limiting Your Medical Options, and How IJ Is Going to Stop It".

IJ attorney Darpana Sheth also has a nice OpEd in the 6/5/2012 Washington Times, "Requiring higher health care costs".

Here's an extended excerpt:

Dr. Mark Monteferrante, a board-certified radiologist with more than 19 years of experience. Dr. Monteferrante specializes in interpreting images of the brain and spine. He and his team of radiologists and staff offer services in nine offices in Maryland and one in the District.

Dr. Monteferrante wants to open an office in Northern Virginia to bring his team’s special expertise diagnosing bone and joint injuries to the area. He and his team are all licensed to practice in Virginia. They have a great client base and access to capital to buy an MRI scanner, which they need in order to open a new office.

The only problem is that Virginia makes it a crime to purchase an MRI scanner without first getting special permission from the government. Under Virginia’s “certificate-of-need” program, Dr. Monteferrante must first prove to the Department of Health that there is a “need” for his radiology services and a new MRI machine in Northern Virginia. To make matters worse, existing businesses are allowed to participate in the process to oppose Dr. Monteferrante’s application.

Under Virginia’s complicated scheme, Dr. Monteferrante must submit to a lengthy and costly application process which, on average, lasts eight months and costs $20,000, plus hundreds of thousands of dollars more in consulting and attorney fees. After all that time and money, approval is far from certain...

Here's their short explanatory video:



I've practiced medicine in states without and with such Certificate of Need requirements.

These CONs jack up prices and reduce access for patients, to benefit those providers with enough political "pull" to restrict competition.

Kudos to the Institute for Justice for tackling this important issue!

Catron on Supreme Irony

David Catron's latest piece in the 6/4/2012 American Spectator discusses, "The Supreme Irony of Obamacare's Constitutional Travails".

Catron recalls how in the 2008 Democratic primaries,

...Obama repeatedly touted his opposition to an individual mandate as one of the major distinctions between his "reform" plan and that of his main rival for the nomination.

During the 2008 Democrat debates he routinely upbraided Clinton for advocating a policy that he said was fundamentally unfair: "[T]he reason people don't have health insurance isn't because they don't want it, it's because they can't afford it."

To drive home his point, he frequently employed the following mordant analogy: "If a mandate was the solution, we can try to solve homelessness by mandating everybody to buy a house." Such heresy produced denunciations from a variety of progressives, including Paul Krugman, who accused Obama of "echoing right-wing talking points."

Such criticism notwithstanding, Obama's ostensible aversion to government-imposed mandates was shared by most voters. Moreover, Obama's stated position was correct on the merits...

Of course things changed once Obama assumed office.

Perhaps it was the hubris of having won the election. Or perhaps it was political expediency. But it would be ironic if the legislation Obama hoped would seal his historical legacy was overturned because he foolishly embraced a bad idea he was shrewd enough to reject earlier in 2008.

If the Supreme Court overturns ObamaCare (and I hope it does), it would still be Obama's historical legacy -- but just not the way he intended.

(Read the full text of "The Supreme Irony of Obamacare's Constitutional Travails".)

Jenkins On Bloomberg

The 6/1/2012 Wall Street Journal has published an OpEd by Holman Jenkins on NYC's proposed new sugar restrictions, "The 5th Avenue to Serfdom".

He notes:

Here is the ultimate justification for the Bloomberg soft-drink ban, not to mention his smoking ban, his transfat ban, and his unsuccessful efforts to enact a soda tax and prohibit buying high-calorie drinks with food stamps: The taxpayer is picking up the bill.

Call it the growing chattelization of the beneficiary class under government health-care programs. Bloombergism is a secular trend. Los Angeles has sought to ban new fast-food shops in neighborhoods disproportionately populated by Medicaid recipients, Utah to increase Medicaid copays for smokers, Arizona to impose a special tax on Medicaid recipients who smoke or are overweight. New York itself, with private money, some of it from Mr. Bloomberg's own pocket, has also tried the carrot approach, dangling direct payments to encourage beneficiary families to adopt healthier habits.

So perhaps the famous "broccoli" hypothetical during the Supreme Court ObamaCare debate was not so fanciful after all. It flows naturally from the state's fiscal responsibility for your health that it will try to regulate your behavior, even mandating vegetable consumption.

(Read the full text of "The 5th Avenue to Serfdom".)

Colorado writer Steve Schweitzberger once similarly observed:

If Michael Moore has a toothache, it is not my responsibility to pay for his dentistry. If it were, then I would have the right to tell him not to eat sweets. I don’t want that kind of government-paid medical policy. Do you?

Minton On Bloomberg

Michelle Minton of CEI discusses how, "New York City Mayor Michael 'Nanny' Bloomberg Wants To Ban Super-Sized Soda".

From her post:

While the causes of the perceived obesity crisis are too complex to delve into in a blog post, it is pretty obvious that this super-sized soda ban will do nothing. First of all, there’s nothing in this proposal to prevent customers from purchasing multiple bottles of 16 ounce drinks. Furthermore, sweetened drinks in bottles greater than 16 ounces will still be available in grocery and convenience stores.

So why is he doing this? Perhaps Mr. Bloomberg is really stretched for a way to spend the $15.5 million in stimulus money? As the Heritage Foundation reported last October, the Centers for Disease Control (CDC) provided $230 million for 25 communities’ obesity campaigns. And here I thought stimulus money was meant to help struggling communities and to decrease unemployment — turns out it was really meant to make commercial that portray American companies (aka employers) as selling carbonated fat-in-a-can.

Perhaps this is just an attempt to look like a do-something-mayor in the lead up to the City’s 2013 election. Or perhaps he really wants to reduce the rate of obesity. Whatever his reasons, this type of overreach demonstrates that he either has a lack of understanding of how public policy can affect public health, a disregard for individual choice, and/or zero knowledge or complete disregard for how economies function...

(Read the full text of "New York City Mayor Michael 'Nanny' Bloomberg Wants To Ban Super-Sized Soda".)

Some of the worst statists are those who wish to "help" you by reducing your freedom for your own good.

UK Doctors Going On Strike

Business Week reports, "U.K. Doctors Vote for Strike for First Time Since 1975".

 From the article:

U.K. doctors will stage a partial strike on June 21, the first such step since the mid-1970s, after voting for action to resist proposed changes to their pensions, the British Medical Association said.

Perhaps these ungrateful UK physicians didn't get the memo from Stanford health economist Victor Fuchs declaring that "freeing" doctors from the burdens of private practice and turning them into government employees would be like "the emancipation of slaves".

I'm Glad He's Not My Brother

Dr. Milton Wolf discusses how Obama's talk of being "our brother's keeper" is just a pretext for more government control over our lives.

 From his latest video editorial, "'O, brother': Obama thinks he's your keeper":

Fatal on Repealing ObamaCare

Nathan Fatal, President of the New England Objectivist Society and a student at University of Massachusetts Amherst, recently posted the following paper: "Defend Individual Rights, Repeal ObamaCare".

He wrote this for a public policy class, and I'm honored that he chose to cite some of our work in his paper.

I very much like the fact that he connected a "hot button" political issue to more fundamental issues of individual rights and the proper role of government, with an emphasis on how problems in one's basic theory would lead to bad outcomes in practice.

For example:

If healthcare were truly a right, members of the medical field would by default be rendered the servants of those who have the “need” to obtain, but not the expertise to create, health insurance. In the event that there were not enough insurance providers, somebody somewhere would have to be forced to enter the medical field in order to be able to satisfy the right of his fellow citizens to a service which requires effort on somebody’s part. Failure on the part of the mystically inexhaustible supply of health insurance providers would thereby constitute a violation of the rights of all uninsured people.

And given the combination of the impending shortage of physicians as well as the dangerous notion of a "right" to health care, the next step may be some form of government-compelled "mandatory service" of physicians.

I'm also encouraged that at least some students feel free to openly express political views that might diverge from the stereotypical liberal "conventional wisdom".

(Read the full text of "Defend Individual Rights, Repeal ObamaCare".)

Scherz and Fogoros on USPSTF

Dr. Hal Scherz of Docs4PatientCare has a new OpEd in the 5/28/2012 TownHall.com, "A Bunch of Doctors from the Government Here To Help You".

He discusses the latest set of clinical recommendations from the government's U.S. Preventative Services Task Force (USPSTF) covering prostate cancer screening.

The money quote:

This is just the latest attempt by the USPSTF to limit effective screening methods for cancer. In 2010, they made recommendations to significantly curtail screening mammography for breast cancer in women. Now they are recommendations, but soon, when Obamacare is fully implemented, these will be policy, not suggestions, and will have the full force of law behind it. Other screening programs will soon be on the chopping block, like colonoscopy for colon cancer screening.

The reason behind this is simple. It is about money, power and control. On the UTPSTF web site, it states that over 1000 PSA tests were necessary to save a single life from prostate cancer.

Someone in Washington has decided what the value of a human life is, and what would be the acceptable cost associated with saving it. This is called “comparative effectiveness” and is what happens in a socialized healthcare system, like in England, where resources need to be allocated prudently, and healthcare is rationed. This is the essence of Obamacare -- a system where medical decisions have been taken away from patients and their doctors and transferred to bureaucrats in Washington.

Dr. Scherz also notes that President Obama had this PSA test within the past year.  So his doctors considered it appropriate.  But Obama's panel of experts don't want you to have the same level of medical care.

(Read the full text of "A Bunch of Doctors from the Government Here To Help You".)

Dr. Richard Fogoros also covers this issue in his essay, "Preventing Preventive Medicine".

He discusses the underlying methodology of USPSTF recommendations and how it will lead to "herd medicine". If the individual must be sacrificed for the good of the herd, so be it. Is this the kind of national medical system we want?

Meth War Fail

Remember how cracking down on legitimate Sudafed users was going to win the "War On Meth"?. Nope, me neither.

David Whelan: "Losing The War On Meth And Sudafed At The Same Time" (Forbes, 5/23/2012)

Quick Links: Stossel, Wolf, Pharma Cronyism

John Stossel: "Keeping Business Honest". (Townhall.com, 5/23/2012).

Lots of good stuff, including "I used to believe that licensing doctors and lawyers protected consumers, but now I realize that licensing is always an expensive restraint of trade. It certainly hasn't barred quacks and shysters."

Dr. Milton Wolf: "Our Time For Choosing" (DailyCaller video). And his related OpEd, "An all-American family feud".


Cronyism update: "GOP probe uncovers deal between Obama and drug cos" (Washington Examiner, 5/16/2012)

Scherz and Armstrong: There Will Never Be Another Mayo Clinic

Dr. Hal Scherz and Dr. Richard Armstrong of Docs4PatientCare have a new piece in Townhall.com, "There Will Never Be Another Mayo Clinic".

New ObamaCare rules will essentially make it impossible for future doctors to create innovative organizations like the Mayo Clinic or Cleveland Clinic.

Here's an extended excerpt:

The Affordable Care Act (ACA) ends local-regional physician and patient control of medical decision making by shifting them to bureaucrats in Washington while fundamentally changing healthcare delivery models and reimbursement. Hospitals are the major beneficiaries of these changes- a requirement necessary for the American Hospital Association to support this law.

The law stipulates that physicians can no longer own hospitals. It also creates a new payment model for medical services which favors hospitals. The Accountable Care Organization (ACO), is an integrated healthcare delivery model devised to control costs by issuing a single payment for an episode of care for a patient. The ACO then divides the payment "fairly" among those involved in this episode. This payment model was unsuccessful in recent trials, but was so well supported by non-clinical health care planners who had the ear of the administration, that it was included in the law. Hospitals will typically be in charge of these ACO arrangements, because they already have the infrastructure required by the government for implementation.

In anticipation of this sea change, hospitals are engaged in a "feeding frenzy", buying up predominantly primary care practices, but specialty practices too. In many cities, hospitals compete for these practices, vying for control of as many patients as possible in a community. Once achieving "critical mass", with enough primary care practices, hospitals can approach a specialty group with a Mafia style "offer that they can't refuse". They make it clear to the specialty practice that the doctors who previously sent them patients are now controlled by them. They can either take the hospital’s offer for their practice or go out of business.

The end of private practice is imminent in an ACO world. Small practices will be unable to survive. What is not advertised is that in such a system, doctors become employees. Their allegiance is no longer to their patients, but to their boss, who is interested not in treating infections, or replacing hips, but in balance sheets, and return on investment.

(Read the full text of "There Will Never Be Another Mayo Clinic". )

President Obama has attempted to sell his health plan to voters on the grounds that it would provide Mayo Clinic health quality to all Americans.

However, the Mayo Clinic has opposed some major provisions of ObamaCare on the grounds it would impair their ability to provide good patient care.

Many doctors understand that the government cannot live up to its promises.  Let's hope enough voters will as well.

Catron: Catholic Institutions Revolt Against HHS

In the 5/23/2012 American Spectator, David Catron discusses how, "Catholic Institutions Revolt En Masse Against HHS Mandate".

He summarizes:

On Monday, 43 high-profile Catholic organizations, including the Archdiocese of Washington, D.C. and the University of Notre Dame, filed suit against the Obama administration. In an open letter, the Archbishop of Washington summed up the collective position of the plaintiffs by explaining that the mandate "fundamentally redefines the nation's long-standing definition of religious ministry… HHS's conception of what constitutes the practice of religion is so narrow that even Mother Teresa would not have qualified."

As before, they are (properly) objecting to government mandates requiring them to provide contraceptive coverage to their employees.

I'm glad that the Catholic organizations are (belatedly) speaking up for their freedom.

However, David Harsanyi made the following related observation in his column, "Church of the Holy Contraception":

Perhaps the Catholic Church, which often seems to back economic "fairness" rather than market freedom, will be more sensitive to the intrusions of the state in economic choice. This episode exhibits how economic freedom is intricately tied to all other liberties. When the state creates virtual monopolies through regulatory regimes, it also gets to decide what is moral and necessary and compels everyone to act accordingly.

The Catholic organizations might not have had to file this recent lawsuit if they had previously taken a principled stance against ObamaCare before it became law.

Quick Links: Canada, Nanny State, MLR

Ontario government "slashes" fees paid to doctors, in order to save money.

(Because the government is the "single payer", the physicians basically have two choices: Like it or lump it.)

Nanny state update: "Utah High School Fined $15,000 for Selling Soda".

(But it's for the children, so it's ok.)

"Medical Loss Ratio" (MLR) mandates under ObamaCare are driving private insurance agents out of business.  (Via Brian Schwartz.)

Hsieh PJM OpEd: Dr. Orwell Will See You Now

The 5/22/2012 edition of PJMedia.com has published my latest OpEd, "Dr. Orwell Will See You Now".

I discuss the various forms of deceptive language ObamaCare advocates in and out of the government are now using to sugarcoat and obfuscate its true nature.

Terms like "affordable", "protection", "autonomy", "marketplace", and "coverage" all take on new meanings for ObamaCare supporters. They even have their own version of Orwell's famous "Slavery is Freedom".

Don't be fooled by their health care Newspeak!

See full text: "Dr. Orwell Will See You Now"

Quick Links: Privacy, Batteries, Innovation

Your medical privacy is not as secure as you might think.  (See the 5/11/2012 newsletter from Citizens' Council for Health Freedom has more details.)

Medical News Today reports, "Kids' ER Visits Due To Batteries Double".

As the OHPCenter notes, "Kudos to the Center for Injury Research and Policy for offering rational, rights-respecting recommendations to parents and electronics manufacturers regarding battery safety, and for *not* issuing a call for national safety regulation.

Grace-Marie Turner reports, "Innovation In The Health Care Sector Marches Forward".

Good News On Personal Genetic Testing

People can and do use their personal genetic data appropriately.

 From the 5/17/2012 NIH News, "NIH-led study finds genetic test results do not trigger increased use of health services":

People have increasing opportunities to participate in genetic testing that can indicate their range of risk for developing a disease. Receiving these results does not appreciably drive up or diminish test recipients' demand for potentially costly follow-up health services, according to a study performed by researchers at the National Institutes of Health and colleagues at other institutions.

(Read the full text.)

If people wish to pay to know their genomic data, they should be allowed to in order to help them manage their lives and their health better.

Related: "Should You Be Allowed to Know What’s in Your DNA?" (PJMedia, 7/15/2010)

Reliability of Clinical Practice Guidelines?

I haven't read any more on this yet, but this abstract caught my eye: "A critical evaluation of oncology clinical practice guidelines", to be presented at the 2012 meeting of the American Society of Clinical Oncology (ASCO).

Summary: Researchers reviewed 168 clinical practice guidelines for treatment of 4 common cancers (breast, lung, colon, prostate).
 
None (i.e., 0) of them met IOM (Institute of Medicine) standards for reliability or trustworthiness.

 I'm just glad mandated use of practice guidelines isn't being imposed by ObamaCare. Oh, wait...

Wolf Unleashed

Dr. Milton Wolf begins a new video series at the Daily Caller.

Here's the first installment:


And feel free to check out his blog!

Hsieh Forbes OpEd: Who Should Control Your Healthcare Spending?

The Forbes website has published my latest OpEd, "Just Who Should Control Your Healthcare Spending?" (5/15/2012)

The theme is that America needs market-based health reforms such as Health Savings Accounts which reduce costs while preserving quality medical care, not government-mandated "bundled payments" which will harm patients and literally set a price on human life.

Here is the opening:

What simple health care reform has reduced medical costs by up to 30%, while preserving quality of care? Hint: It's not government price controls or mandatory health insurance. Rather, it's letting patients decide how to spend their own health care dollars...

(Read the full text of "Just Who Should Control Your Healthcare Spending?")

I'm honored to appear on the Forbes website, and I'd like to thank readers who have shared this piece via Facebook, Twitter, blogging, e-mail, etc.

Quick Links: Scherz, Catron

A couple of good pieces that hit my news feeds today.

1) Hal Scherz, MD: "The War Against Doctors" (Townhall.com)

Dr. Scherz notes:

At a time when it is trendy to invoke the term “war” against various groups, such as the contrived, GOP “war against women” or “war against seniors”, it may appear trite to say that there is a war against doctors; but there is. This has been going on for decades and cannot be blamed on President Obama or the Affordable Care Act (ACA), but sadly, both have facilitated an escalation of this war...

2) David Catron, "Obama's Contempt for the Voters" (American Spectator)

David Catron also pointed out something I missed from a few days ago.  Obama's latest campaign ad running in some swing states trumpets various "accomplishments" ("the resurgence of the U.S. auto industry, killing of Osama bin Laden, end of the Iraq War") but curiously does not mention ObamaCare.

This is all the more reason to keep health care on the front burner of public discussion, rather than distractions such as candidates' eating dogs or purported high school misbehaviour.

Heib: ObamaCare and the Road to Serfdom

Dr. Lee Heib of AAPS chats with John Stossel on "ObamaCare and the Road to Serfdom":

Roy: Will Buying Health Insurance Across State Lines Reduce Costs?

Avik Roy asks, "Will Buying Health Insurance Across State Lines Reduce Costs?"

Short answer: It should, but it may take time for a true national market to ramp up and costs to fall accordingly.

Hence, one should be careful about preliminary studies that purportedly show no decrease in costs when limited intrastate purchases are allowed.

Objective Reporting from the LA Times

The Los Angeles Times lets you know that if you don't support ObamaCare, then you must want the US to be a backwards nation: "Global push to guarantee health coverage leaves U.S. behind".

Just a little objective reporting to help keep readers informed! (*cough* re-elect Obama *cough*)  

Update: Welcome, Instapundit readers!

LaFerrara: End Occupational Licensure

In the blog for The Objective Standard, Michael LaFerrara explains why, "It's Time to End Occupational Licensure".

From his post:

The statistics are astounding. According to Forbes’ Suzanne Hoppough, from 1960 to 2007 the percentage of U.S. workers belonging to a licensed profession rose from 4.5 percent to 28 percent. In all, writes Hoppough, occupations requiring a government license in at least one state—including dentists, plumbers, hairdressers, secretaries, librarians, wallpaper hangers, and florists—rose from 80 in 1980 to 1100 by 2008.

The economic cost is incalculable. Licensure restricts the supply of workers in the occupations affected, stifling innovation and entrepreneurship, suppressing competition, and driving up prices. And the violation of American’s rights to liberty and the pursuit of happiness are patent: We are forbidden to act or contract in accordance with our judgment, forbidden to pursue our happiness as we see fit, forbidden to earn a living in these areas unless we have permission, in the form of a license, from the state.

The professions being licensed often talk in terms of guaranteeing quality standards, but too often these are just thinly veiled pretexts to reduce competition.

The Institute for Justice has also just released a major policy paper on this topic, "License To Work" (downloadable PDF version).

They note: "[I]n the 1950s, only one in 20 U.S. workers needed government permission to pursue their chosen occupation. Today, it is closer to one in three."

Here's their associated video:

Wolf: Desperately avoiding Obamanomics and Obamacare

Dr. Milton Wolf has a new OpEd in the 5/9/2012 Washington Times, "Desperately avoiding Obamanomics and Obamacare".

He notes that the Obama administration is working hard to distract voters from their economic failure and the pending failures of their health care plan:

So what’s a president to do when his stimulus has failed and his health care takeover is even worse? Avoid them at all costs. Talk about anything else. Student loans. Birth control. Hooded sweatshirts. Heck, even talk about eating dogs.Anything besides the two issues that define his presidency and threaten our republic.

It's Obamanomics and Obamacare, the intertwined strands of evil DNA, stupid.

I don't know whether the GOP and presumptive nominee Mitt Romney will wise up to these tactics.

But American voters can and should.

(Read the full text of "Desperately avoiding Obamanomics and Obamacare".)

Scherz and Armstrong: Caution to Seniors About Obamacare

Dr. Hal Scherz and Dr. Richard Armstrong of Docs4PatientCare note, "Caution to Seniors About Obamacare -- Let The Buyer Beware".

In their 5/8/2012 TownHall.com piece, they warn that ObamaCare price controls will wreak a "medical tsunami" for older Americans.

There's a separate question (not addressed in their piece) as to whether the proper policy endpoint should be to "save" Medicare as Paul Ryan and many Republicans desire, or whether to move towards a fully-private system of health coverage for the elderly (which I favor). But the current Medicare system is unsustainable, and ObamaCare will make it more so.

(Read the full text of "Caution to Seniors About Obamacare -- Let The Buyer Beware".)

Quick Links: Georgia, FDA, Clogging MD Offices

The Georgia legislature has passed a bill ensuring that medical licensure "does not become contingent on participating in any government or private payer programs".  Go Georgia!

In contrast, see earlier blog post, "Linking Licensure to Mandatory Service". (Georgia link via Dr. Donald Palmisano.) 

Richard Ralston reminds us, "Your life not a priority for FDA" (Orange County Register, 5/4/2012)

Because new ObamaCare rules forbid patients with Flexible Savings Accounts for using that money on nonprescription drugs, many patients are clogging up doctors' offices asking for prescriptions for over-the-counter (OTC) medications:

The provision took effect in 2011, and physicians report that they now are being saddled with the task of writing otherwise unnecessary prescriptions for medications to fight the common cold, flu or allergies.

(Via @OHPCenter.)

New Massachusetts Price Controls and Bundled Payments

Avik Roy discusses Massachusetts' latest proposed health care price controls in his 5/6/2012 Forbes piece, "Massachusetts Moves Toward Health-Care Price Controls. Is America Next?"

The proposed measures include:

* Moving away from "fee for service" towards a system of "bundled payments", where hospitals and doctors receive a fixed fee for caring for a patient's medical problems

* Overt price controls, where the government can punish a hospital if it charges more than what the state considers "reasonable"

* A global cap on state medical spending, linked to the Gross State Product (state equivalent of GDP)

The "bundled payments" in particular will produce perverse incentives for doctors and hospitals.

If you're healthy young 25-year old who catches pneumonia, hospitals will love to treat you because the expected cost will be less than the "bundle" they receive, so they get to keep the difference.

On the other hand, if you are 60-year old with other conditions (e.g., diabetes or kidney trouble), some hospitals will do their best to avoid being stuck treating you. They may seek any semi-plausible excuse to transfer you to another facility. You'll become the undesirable "hot potato" patient that nobody wants.

Bundled payments thus create perverse incentives for doctors to not practice medicine and not take care of the sickest patients.

If the "bundle" for a life-saving heart surgery is, say, $40,000 then some hospitals or doctors may be reluctant to take you on as a patient if they think you'll cost them more than that. Socialized medicine advocates typically argue for government-run health care on the grounds that it "you can't put a price on human life". But bundled payments literally do put a price on what your life is worth.

(Read the full text of "Massachusetts Moves Toward Health-Care Price Controls. Is America Next?.)

Catron: White House Again Threatens SCOTUS on Obamacare

In the 5/7/2012 American Spectator, David Catron describes how the "White House Again Threatens SCOTUS on Obamacare".

Basically, Obama and his surrogates are hinting that Medicare checks might not go out if ObamaCare is overturned.

Catron notes:

By reiterating the preposterous claim that Medicare payments might be delayed if Obamacare is struck down, Berwick is participating in a predictable election year strategy that goes beyond meddling with the Court. The threat is also meant to frighten seniors.

Like the perennial Democrat claim that the GOP is secretly planning to destroy Social Security, this strategy seeks to exploit the insecurities of the elderly. Obama and his creatures want the nation's seniors to be so afraid of losing their retirement benefits and medical coverage that they will go to the polls and vote Democrat notwithstanding the President's pathetic record and the failure of his party's congressional leaders to produce a single piece of useful legislation since they returned to power in 2007.

But as Catron notes, "Ironically, it is the prospect that the Court might preserve Obamacare that should frighten seniors."

New cost-cutting bureaucracies established under ObamaCare such as the Independent Payment Advisory Board (IPAB) would establish de facto rationing.  Seniors should be more alarmed at ObamaCare being upheld, rather than it being struck down.

Let's hope Americans see through this latest ploy from the Obama administration.

(Read the full text of "White House Again Threatens SCOTUS on Obamacare".)

Quick Links: Atlas, Herzlinger, Fisher & Gross

Dr. Scott Atlas explains how, "Obamacare imperils America's women" by depriving them of choice.

Harvard health economist Regina Herzlinger, "Predicts ACOs, PCMHs Will Fail".

On the positive side, Dr. Kenneth Fisher and Dr. Lee Gross of D4PC explain the benefits of Health Savings Accounts and patient control of their own health spending in, "Prudence of a patient-centered approach" (Washington Times, 5/3/2012.)

(Note: Eventually, HSA's should be fully privatized without taxpayer support.  Any public funding should be only a transitional step towards a fully private system.)

Hsieh PJM OpEd: Government-Funded Medical Research Is Hazardous to Your Health

PJMedia has just posted my latest OpEd: "Government-Funded Medical Research Is Hazardous to Your Health".

My theme is that growing problems of sloppy science and ethical misconduct in medical research could be dangerous to American patients.

Furthermore, the combination of government-funded research and government-mandated practice guidelines based on that research will increasingly foist bad medical treatments onto unsuspecting patients.

For details, read the full text of "Government-Funded Medical Research Is Hazardous to Your Health".

Linking Licensure to Mandatory Service

The 5/1/2012 New York Times reports that new lawyers in New York state must work 50 hours for free, on terms specified by the government in order to get their licenses to practice.

From the article:

Starting next year, New York will become the first state to require lawyers to perform unpaid work before being licensed to practice, the state’s chief judge announced on Tuesday, describing the rule as a way to help the growing number of people who cannot afford legal services.

The approximately 10,000 lawyers who apply to the New York State Bar each year will have to demonstrate that they have performed 50 hours of pro bono work to be admitted, Chief Judge Jonathan Lippman said. He said the move was intended to provide about a half-million hours of badly needed legal services to those with urgent problems, like foreclosure and domestic violence.

The Freakonomics Blog asks a very natural question: "What would happen if newly minted doctors were similarly seconded into pro-bono work?"

Given the anticipated upcoming physician shortage, I would not be surprised to see similar proposals mandating physician service as a requirement of medical licensure.

It might take the form of mandatory pro bono work or mandatory acceptance of Medicare/Medicaid patients. Both Canada and the state of Massachusetts have proposed variations in the past, although they were never enacted into law.

Or to paraphrase the old saying: "First they came for the lawyers. But I wasn't a lawyer so I didn't speak out..."

Quick Links: Employer Dumping, HSAs, Scherz

NCPA notes, "Job-Based Health Coverage to Become Even More Expensive under Affordable Care Act".

Basically, under ObamaCare there will be enormous incentives for employers to dump their workers onto government-run "exchanges" to purchase insurance.

John Goodman discusses HSAs in this 5/1/2012 Daily Caller piece, "Power To The Patient".  He discusses the RAND Corporation study showing how patients with HSAs save as much as 30% on their medical expenses without compromising quality of care or outcomes.

Dr. Hal Scherz of D4PC asks, "Is Medical Care A Right?" (TownHall.com, 5/1/2012) He notes that the proper role of the government is to get out of the way and allow patients to seek (and physicians to provide) medical care in a free market according to their best individual judgment and individual conscience. 

(Dr. Scherz frames it in terms of "responsibility", but I typically prefer to frame it in terms of freedom.)

Future Doctors in Canada and the US

The Canadian newspaper Globe and Mail warns that, "The professional-class bubble is bursting".

With respect to physicians in Canada they note:

But young doctors face the same squeeze as young lawyers. Like law school, medical school is so competitive that today’s students need advanced training and graduate degrees in order to get in. By the time they qualify as doctors, they’re well into their 30s, with $180,000 in debt.

And the expectations of medical students are also disconnected from reality. The trouble is that doctors have just one big client – government – whose ability and willingness to pay is shrinking fast. The booming consumer demand for medicine doesn’t necessarily translate into jobs. Even though hospitals need extra surgeons, they aren’t hiring them because they can’t afford to expand operating-room time.

Of all the general surgeons who finished medical school at the University of Toronto in the past two years, only 15 per cent have found work. The rest are pursuing further training, in hopes that something will eventually open up.

Things aren't quite this bad in the US. But as government directly or indirectly imposes further restrictions on how doctors can practice and what they can get paid, we'll see more bright young people decide not to become physicians.

As a current benchmark, Huffington Post reports that already, "Nearly Half Of Doctors Regret Going Into Medicine: Survey".

And if we keep discouraging the best young minds from becoming doctors, who will take care of you when you get sick in 10 years?

Quick Links: Preparing, Death Panels, Moore's Law

Some useful references: "Preparing For Socialized Health Care". (Via @OHPCenter.)

Walter Russell Mead: "Are Death Panels Making A Comeback?"

Why is that, "Moore's Law Doesn't Apply to Health Care Technology"?

Three critical differences between the tech and health care sectors highlighted by Dr. J. Deane Waldman, Professor of Pediatrics, Pathology & Decision Science at the University of New Mexico.:

1) Regulatory oversight that is completely focussed on compliance. "It discourages risk-taking and innovation," Deane said.

2) Health care doesn't have the same financial reward system. Facebook isn't about to pay $1 billion for the latest hot-ticket item in imaging and informatics.

3) And, finally, Deane said, "Security always trumps information sharing, and so better, faster linkages are constrained because of security concerns, most of which are bogus."

Curious how that the increased government interference in the health care market reduces the degree of innovation.

(Related thoughts on Moore's Law in health care: "The Deadly Tax on Medical Innovation", PJMedia, 4/11/2010)