Will Your Doctor Quit?

In this 8/12/2012 Forbes piece, Dr. Marc Siegel asks: "Will Your Doctor Quit? Obamacare Foretells Mass Exodus From Patient Care".

Dr. Siegel cites surveys demonstrating widespread physician discontent with ObamaCare, to the extent that many physicians are thinking of quitting.

There's no way to know (yet) how many physicians will actually follow through on such sentiments. And of course, much will depend on the results of the November 2012 election.

But I do know from personal experience that many doctors are quietly thinking about "exit strategies" to leave clinical practice if ObamaCare is not repealed. They may not talk about it with their patients, but they are talking about it with fellow physicians.

Maybe it's time that more Americans start asking this question as well.

(Read the full text of "Will Your Doctor Quit? Obamacare Foretells Mass Exodus From Patient Care".)

Will Paul Ryan Destroy Medicare? And Should He?

Now that Paul Ryan has been selected as the GOP VP nominee, we're hearing lots more discussion about his plans for revamping Medicare.

I do think it's important to keep in mind a few key facts about Ryan and Medicare:

* Medicare in its current form is unsustainable.

* Obama's plans for Medicare include draconian cost controls, including the infamous IPAB board which will use the power of the purse to impose de facto rationing. As I wrote last year for PJMedia:

If the IPAB sets the reimbursement rate for services below the cost of providing it, then hospitals and doctors could no longer afford to offer such services — even if the services are medically best for their patients. Life-saving medical procedures we currently take for granted, such as PET scans to detect early cancers or minimally invasive methods to safely open up blocked vital blood vessels without risky surgery, might no longer be available.

Although those services might still theoretically be "covered" by Medicare, in practice doctors would no longer offer them, and their patients would no longer be able to receive them.

* Paul Ryan will be lambasted by the Left as wanting to "end Medicare as we know it".   But David Catron reviews some of the dismal facts about the future of Medicare in his 8/13/2012 American Spectator piece "Paul Ryan as the Great Destroyer" and concludes:

All of which suggests that ending Medicare "as we know it" is a pretty good idea. How then, would Paul Ryan go about cleaning it up?

* If anything, Ryan's proposed systems of vouchers and premium supports don't go far enough.  That's because his stated goal is to "save Medicare", rather than to eliminate it as a government program.

* There are groups like Docs4PatientCare that also support some of the same intermediate-range ideas as Paul Ryan.  But they also frame their proposals in the broader context of "[u]ntil Medicare as we know it is phased out and the transition to private health insurance is accomplished".  In other words, they envision completely eliminating government interference in the health care market for senior citizens.  This is a praiseworthy goal which I fully support.

* Hence, Ryan's plans for Medicare do not go as far as I (or Docs4PatientCare) envision.  The current Obama approach will cause Medicare to crash in a catastrophic fashion.  The Ryan approach may buy it more time, but would leave in place an enormous government entitlement program.  Instead of either of those approaches, we should aim to end Medicare as a government program, but through a controlled landing rather than a crash.

* Hence, Paul Ryan's ideas may move us part way in the right direction, but not as far as we should go.   If the Romney/Ryan ticket wins the election, free-market advocates will still have much more work to do.

More Medicaid Woes

In the 7/31/2012 American Thinker, Dr. Zane Pollard warns, "Save American Medicine and Save Your Own Life".

In his piece, he discusses the frustrations he experiences daily dealing with the inflexible government Medicaid bureaucracy. Here's one example:

Recently, I operated on a 4-year-old who had esotropia (crossed eyes). I had obtained prior approval from Medicaid to do her surgery. On the day of surgery, I went to touch base with the child and family just before and noticed that the condition had changed since the original office visit. I now needed to perform a different surgery from that for which I had originally obtained permission.

The surgery went well, and the child had a very good result. Medicaid told me that since I had performed a surgery different from what I had requested, they were going to pay me nothing. In fact, the surgery that I performed was less costly to Medicaid than what I had originally requested.

Each of us, as a patient, trusts his physician to do the best humanly possible for him. We trust our doctors to change their minds to give what they feel is the best treatment at the time of delivery. How can anyone go to a doctor and trust him or her to do the best for us if the doctor knows that by changing the plan, he or she might be penalized?

Even worse, much of ObamaCare's expansion in "coverage" will involve moving people on the government Medicaid rolls.  Medicaid is already notorious for underpaying doctors (such that they lose money on each patient they see.)

In other words, Medicaid punishes doctors medically and financially. 

How long will doctors wish to keep working when their virtues are held against them?  And when these doctors leave medicine, what kind will remain?

(Read the full text of "Save American Medicine and Save Your Own Life".)

Another Canadian Warns Americans

James Hancock (an Canadian who now lives in the US) made the following comments about Canadian health care on Diana's blog.

He has graciously given me his permission to repost this slightly edited version here:

Welcome to Canadian healthcare folks, where 80% of all taxes from all levels of government got to healthcare and related fields. Where a hip replacement takes more than a year. Where chemotherapy takes 1 1/2 months of your 6 months to live. Where they're considering death panels like the father of socialized medicine, the UK.

By 2020 Canada's healthcare system will consume 120% of taxation. There are virtually no family doctors left because the pay is horrible and if you go to emerge and you're not dying on the gurney, it will take you at least 3 hours to see a doctor.

I sprained my ankle once. It took 4 hours to see the doctor to have him send me to x-ray. It took 2 hours in radiology to get the x-rays and then another 4 hours to see the doctor to look at the x-ray and tell me it wasn't broken (very bad sprain that might have been more).

Cut in my hand that got infected, 3 hours to see a doctor for a prescription for antibiotics.

2nd degree burns to my foot because of a corn pot tipping over, 3 hours to see a doctor for which the doctor prescribed pain killers that I'm allergic too, for which I told him directly I was allergic and my file also said so.  Another 3 hours to get a different prescription because I refused to leave until he fixed it. In the mean time, I'm just about passing out in pain.

The only people that get good medical coverage in Canada are celebrities. Even rich people have to come to the US for good healthcare because it's illegal to buy private healthcare in Canada. (soon to be overturned by the supreme court as a violation of our freedom of association, so Canada is about to get more free healthcare while the US gets less!) Everyone else waits, and waits and waits.

Get your passports ready folks! You're going to be going to Singapore and India for healthcare in the US soon.

James also pointed me towards this related recent news story: "Wait times for patients 'worsening'" (CBC News, 6/19/2012).

We have been warned.

Catron on Obama's Concept of "Fairness"

David Catron has a new piece in the 8/8/2012 American Spectator, "A Gut Check on What Obama Means by 'Fairness'".

Catron notes the hypocrisy of a president preaching "fairness", yet electing to avail himself of medical tests and procedures that likely would not be available to the general public once ObamaCare legislation is fully implemented.

For instance, President Obama was allowed to receive a CT colonography test (which can detect early colon cancers with much less risk than traditional colonoscopy). But Medicare denies coverage to senior citizens on the grounds that it's too costly and not a sufficiently-proven technology.

As Catron notes:

Take a moment to consider that. The President of the United States, a public servant paid by the taxpayers, followed the advice of his taxpayer-paid doctors that he should have a taxpayer-paid CTC.

Yet his health care commissars, also paid by taxpayers, have decreed that that it is too expensive to provide this very test to actual taxpayers when they retire and sign up for the Medicare program for which they have been paying all their working lives.

This perverse system, it should be remembered, is not merely presided over but taken advantage of by a man who incessantly lectures these very taxpayers about "fairness."

(Read the full text of "A Gut Check on What Obama Means by 'Fairness'".)

I'd also like to thank David Catron for citing my earlier Forbes piece on prostate cancer testing in his column and for promoting the FIRM blog!

Hsieh Forbes OpEd: The Federal Government's War On Medical Innovation

Forbes has published my latest OpEd, "The Federal Government's War On Medical Innovation".

I discuss how the government is hampering the development of life-saving medical technology through two methods: new taxes and FDA regulation.

Here is the opening;

The federal government is waging a stealth two-pronged war on medical innovation. And it will cost not just American jobs, but American lives.

The first prong is through new taxes. Recently, the Cook Medical company announced that it was canceling plans to open new factories because of the impending ObamaCare tax on medical device manufacturers scheduled to take effect in 2013. The 2.3% tax on total sales (not profits) will cost Cook $20 million dollars a year. As a result, the company will not be opening five plants that would have employed up to 300 people each.

Cook is not the only medical device company affected by the tax. Stryker (which makes artificial joints) will cut 5% of its workforce. Medtronic has announced the tax will cut into its investments in future products. Jonathan Rennert, chairman of Zoll Medical (which makes advanced cardiac defibrillators) has stated that the tax will mean “less innovation, fewer jobs, and fewer lives saved.”

The second prong of the war on innovation is through regulations...

I'd especially like to thank Cynthia for allowing me to quote her response to the FDA official who admitted to delaying the approval of digital mammography machines.

(Read the full text of "The Federal Government's War On Medical Innovation".)

Quick Links: Medicaid, PSA, Unnecessary Tests

"Nearly A Third Of Doctors Won't See New Medicaid Patients" (Kaiser Health News, 8/6/2012).

One big question is whether the government will compel doctors to see Medicaid/Medicare patients, perhaps as a condition of retaining their medical licenses.

"Metastatic disease reduced in PSA screening era" (American College of Physicians, 8/7/2012)

PSA screening may or may not be right for any individual patient. But doctors and patients should decide the medical appropriateness for themselves, rather than having a one-size-fits-all guideline imposed upon them by the federal government.  (And ICYMI, "Is President Obama's Prostate Gland More Important Than Yours?")

"Beware legal ramifications of unnecessary tests" (Medical Economics, 7/25/2012)

In other words, if a doctor orders a test deemed "unnecessary", they could be sued.  Of course, if they don't order one of those tests that in retrospect might have detected a serious problem, they can still be sued for "delay in diagnosis". 

So doctors face a potential"damned if you don't, damned if you do" medicolegal scenario with these "unnecessary" tests.  (Via Dr. Art Fougner.)

UK National Health Service Branch Bans Paperclips

Although it sounds more like a headline from The Onion, this story is apparently real: "NHS health and safety chiefs ban 'dangerous' metal paper clips".

From the article:

Manchester NHS Trust officials made the decision to stop the use of the metal stationary item after a member of staff cut their finger using one.

In a memo to staff, it was warned that the use of metal fasteners was 'prohibited' and the offending clips must be 'carefully disposed of immediately'.

'Due to recent incidents, NHS Manchester has decided to immediately withdraw the use of metal paper fasteners,' explained the memo featuring an accompanying picture of a paper clip - just to avoid any confusion.

   

'Please ensure any that remain in use be replaced by similar plastic fasteners. 'The use of metal fasteners is prohibited and must be carefully disposed of immediately. Thank you for your co-operation.'

The ban applies only to the employees of that NHS branch, not to the general public.

In other words, the NHS staff aren't considered competent to use metal paperclips safely. But they are deemed competent to make life-and-death medical decisions for UK residents.

Let's just hope no one tells NYC Mayor Bloomberg about this.

(Via @debbywitt.)

The Unreliability of Cross-Country Comparisons

One of the common criticisms levelled against American health care is that we supposedly spend too much money for such poor results. Typically, critics will also cite international comparison to show that the US fares poorly relative to other countries on a variety of supposedly objective metrics.

However, this recent paper from AEI by Frech, Parente, and Hoff provide some important context: "US health care: A reality check on cross-country comparisons".

In particular, they note that we have to be extremely careful about using standard OECD metrics such as infant mortality, life expectancy, and "premature mortality".

A few excerpts from their article:

For example, babies who are not viable and who die quickly after birth are more likely to be classified as stillbirths in countries outside the United States, especially in Japan, Sweden, Norway, Ireland, the Netherlands, and France. This is especially likely for babies who die before their birth is legally registered...

In the United States, however, nonviable births are often recorded as live births, making the US infant mortality rate appear misleadingly high. In a detailed study of medical records and birth and death certificates in Philadelphia, Gibson and colleagues found that infant mortality had been overstated by 40 percent, merely as a result of these nonviable births that were recorded as live births...

Furthermore:

There is another problem with using infant mortality to represent health care efficacy. US physicians often go to great efforts—at the prenatal and postnatal stages—to save a baby with poor survival chances. The additional prenatal care an American doctor provides may improve the odds of the live birth of a baby with poor survival chances, who is then likely to require extensive neonatal care.

Accordingly, the US uses substantially more neonatal intensive care units (NICU) than other industrialized countries. In this case, the additional health care may actually worsen reported infant mortality rates and misleadingly suggest poor care in the United States.

In other words, our willingness to expend greater resources on expensive neonatal care is held against us as a "proof" of our "inefficiency"!

Similarly, life expectancy comparisons can be skewed by differences in lifestyle as well as differences in accidents/trauma.  But even though such differences can be important, they don't necessarily reflect on the quality of a country's medical care system once a patient becomes ill.

The authors also point out this problem with mortality statistics:

Mortality data are an inadequate proxy for health system performance for another reason: they measure years of life, but do not reflect the quality of that life...

The OECD report, however, treats all years of life as the same, regardless of health status... The OECD report sticks with raw LE [Life Expectancy] —rather than using quality-adjusted versions—because of the wider availability of unadjusted LE data, but at the expense of conceptual accuracy.

As a result, the OECD report attributes no value to expenditures that permit people to enjoy a better life by, for example, being able to work or to be functional longer; it correlates expenditures only with mortality. Thus, money spent on knee replacements, for instance, would appear to be inefficient in that it does not decrease mortality, despite the obvious advantages of improved mobility and prevention of falls. Therefore, it is difficult to see mortality alone as an accurate measure of health system efficiency.

The US health care system does have some genuine problems as a result of decades of government interference.  And there is some validity to the argument that we spend money inefficiently -- a problem arising in large part by the government-driven third party payment system which creates perverse incentives to overconsume.  But these problems can be addressed by free-market reforms such as Health Savings Accounts.

And we should be especially careful not to base health policy on flawed statistical comparisons that paint us in a falsely bad light relative to other countries.

(Read the full text of "US health care: A reality check on cross-country comparisons".)

More Massachusetts Medical Controls

The 8/6/2012 Wall Street Journal has published an update on health care in Massachusetts, "RomneyCare 2.0".

They make two key take home points:

* Costs keep spiralling out of control

Health costs -- Medicaid, RomneyCare's subsidies, public-employee compensation -- will consume some 54% of the state budget in 2012, up from about 24% in 2001. Over the same period state health spending in real terms has jumped by 59%, while education has fallen 15%, police and firemen by 11% and roads and bridges by 23%.

* In response, the state will impose more overt controls over how doctors can practice medicine

[A]ll Massachusetts doctors, hospitals and other providers must register with a new state bureaucracy as a condition of licensure -- that is, permission to practice. They'll be required to track and report their financial performance, price and cost trends, state-sanctioned quality measures, market share and other metrics.

As the WSJ notes, this new "Health Policy Commission" will have the power to "to ensure that total Massachusetts health spending, public and private, grows no more than projected gross state product through 2017".  (Emphasis theirs)

Basically, if a doctor or hospital spends too much on a patient's care, they could be punished.

How hard will your doctor fight for your medical interests, if his medical license and his very livelihood are endangered whenever he spends more money than the government considers appropriate? Will he still be willing to order the MRI you need or prescribes the stronger (but more expensive) antibiotic to stop your life-threatening infection?

Of course the government will claim: "'We're not telling the doctors how to practice medicine -- that's still the physician's job. We're only establishing global economic guidelines. The doctor still makes the day-to-day medical decisions on his or her patients".

But in reality, the government will be using the power of the purse and the power of licensure to co-opt doctors into becoming its proxy agents of rationing.

As always, trends in Massachusetts under RomneyCare will foreshadow what will happen to the rest of the country under ObamaCare.  In particular, get used to hearing the term, "Accountable Care Organization".

(Read the full text of "RomneyCare 2.0".)

Quick Links: Defensive Medicine, Genetic Exceptionalism, Doctors Quitting

"The Vicious Cycle of Defensive Medicine".

From personal experience, I know that many ER doctors practice defensive medicine as a necessary evil in today's litigious society. (Via @sonodoc99)

"Misguided Genetic Exceptionalism".

Doctors should let patients have the choice to know about the genome, especially if it will give them valuable information about their disease prognosis.

"34% of doctors will leave profession within 10 years".

It's hard to know how reliable such reported numbers are.  Plus many doctors may consider quitting, but ultimately decide against it.  However, this is a disturbing news trend.

How the FDA Slowed Innovation for Breast Cancer Patients

The 8/2/2012 Wall Street Journal reported on a former FDA doctor under critical scrutiny for blocking approval of potentially more precise mammograms for 4 years(!).

Here is the opening of their story, "FDA Figure is Under Fire":

A Food and Drug Administration scientist blocked the approval of potentially more precise digital mammography machines for several years, a pattern that is coming under scrutiny after recent revelations that the man's computer was being monitored by the agency.

Robert C. Smith is being criticized by some breast-cancer doctors as well as some in the FDA for not approving the new machines during his nearly four-year tenure as a medical officer in the agency's radiological-devices branch.

(Read the full text of, "FDA Figure is Under Fire". If the link doesn't go to the full story, you can enter the article title into a Google search window, which will yield a link that takes you to the full text.)

The WSJ notes:

Five mammography machines using digital technology were approved by the FDA's radiological devices branch before Dr. Smith joined it. None were approved during his tenure. Six were up for approval in that time. There is no way of knowing whether any women had cancers advance because of the delays of digital technology

Smith's actions were especially frustrating for breast cancer specialists like Dr. Etta Pisano.  Pisano noted of Smith, "He began putting in obstacles to approval that were unreasonable" once he had the bureaucratic power to do so. 

(Dr. Pisano was co-author of a 42,760-patient study that appeared in the 2005 New England Journal of Medicine that demonstrated the reliability of digital mammography and showed that it was "'significantly better' than film in finding cancer in women under 50 and those before or during menopause".)

Dr. Smith's lawyer claims that Smith was merely following proper FDA procedure.  Smith's contention is that too many medical device manufacturers have an improper "cozy relationship" with FDA regulators, whereas Smith was merely being "an honest and rigorous regulator".

If that's true, that's alarming.  It would be bad enough if Smith were a rogue, overzealous regulator.  It would be even worse if Smith represents how the system is supposed to work.

As one breast cancer survivor noted in an online comment:

I just realized that if this particular bureaucrat had continued in his position, I probably wouldn't be here. My 3 year anniversary is coming up, so perhaps I should send him a "thank you for moving on" card.

But how many more Dr. Smiths are still at the FDA, delaying other vitally-needed medical innovations for American patients?

Another Medical Test Obama Got But You Might Not

A just-published article demonstrates that CT colonography is a good test for Medicare-age patients.

From the July 2012 issue of the American Journal of Roentgenology: "CT Colonography of a Medicare-Aged Population: Outcomes Observed in an Analysis of More Than 1400 Patients"

CT colonography is an excellent way of detecting early colon cancer (or excluding it), without the risks of a traditional colonscopy.

BTW, this is another medical test that President Obama was able to receive, but which many ordinary Americans with government medical insurance cannot: "President Obama Gets Virtual Colonoscopy (CT Colonography) But Medicare Denies CTC Coverage to Seniors".

(Related: "Is President Obama's Prostate Gland More Important Than Yours?", Forbes, 7/5/2012)

Hsieh Lecture on Medical Licensing Laws

My 20-minute lecture on "Milton Friedman and Medical Licensure" has now been posted:



I covered three main subjects:

* Milton Friedman's views of medical licensure
* Licensure and competence
* Licensing laws and ObamaCare

Towards the end, I cite Dr. Milton Wolf as one of the people promoting some good free-market reforms to move us in the right direction.

Thanks to Amanda Teresi-Muell for organizing this special Liberty On the Rocks event, as part of a commemoration of Milton Friedman's 100th birthday!

And thanks to Ari Armstrong for recording the video and for doing the video editing to intersperse the images of my slides within the footage!

(Note: I don't agree with Friedman on several issues. Friedman was not a fully-consistent advocate of free-market economics.  But on the topic of medical and occupational licensure, he was very good, and I wanted to highlight his excellent thinking on this particular topic.)

The Feds Can Regulate Your Stem Cells

FDA update: "U.S. District Court rules that stem cells are drugs".

From the article:

Treatments in which stem cells are harvested from bone marrow and injected straight back into the same patient are deemed part of routine medical practice - not regulated by the US government. But if the cells are subjected to more than "minimal manipulation", the FDA maintains that the therapy becomes a "drug", which must be specifically approved for use.

It's not quite, "All your cells are belong to us". But it's getting there...

Related: "Ruling frees FDA to crack down on stem cell clinics".

LAT Covers Concierge Medicine

The 7/29/2012 Los Angeles Times has a surprisingly balanced portrayal of the growing practice of "concierge medicine".

Here are some excerpts from their article, "Annual retainer fee buys patients more time with their doctors":

Concierge doctors often provide a comprehensive physical and extra screenings, as well as helping coordinate their patients' care with specialists or when they go to the hospital. Most doctors continue to take insurance, but others only take cash.

Everyone deserves to be healthy, but healthcare is a business, [Dr. Matt] Jacobson said. Unless they pay for it, everyone doesn't have the right to choose their provider, he said."

Some people view going to a private school as the most important thing," he said. "This is the same thing. Some people view healthcare as very important. They are going to cut their cable bill to see the exact doctor they want."

Similarly, the article discussed how it helped Dr. Robert Saltman:

He went from seeing between 20 and 25 patients a day to seeing between eight and 14, and he doubled the length of the appointments. Now, Saltman said he has the time to be proactive with patients and emphasize prevention and lifestyle changes. He hired a younger doctor to care for the primary care patients who chose not to pay the retainer.

Saltman said he didn't become a concierge doctor to increase his income. "I did it to continue to do something I love without being resentful," he said.

I especially liked this explanation from Dr. Saltman's patient Mitch Waks on the morality of choosing a concierge doctor:

Waks said he can justify the ethical dilemmas of paying his doctor extra for personalized medicine even as so many lack basic healthcare. "Is it bad that I am able to buy a BMW rather than a Chevy?" he said. "I don't think so."

Concierge medicine can be a win-win for both doctors and patients.

Doctors are able to practice good medicine according to their best judgment and conscience. Patients receive quality care with a minimum of interference from third parties such as the government or government-controlled insurance companies. I'm glad that more American patients and doctors are exploring this option.

(Read the full text of "Annual retainer fee buys patients more time with their doctors".  Article link via Dr. Matt Bowdish.)

Bizarre Drug IP Incentives

Bizarre economic incentives in drug IP laws can create unusual "unexpected consequences".

Here are more details at this Freakonomics.com post, "Why Do Patent Holders Sometimes Pay Patent Copiers?"

Quick Links: HSA, Catron, PSA, MA

Brian Schwartz: "Insurance with HSAs gain popularity, but authorities want to ban them".

David Catron: "Another Obamacare Mandate Runs Afoul of the Courts" (American Spectator, 7/30/2012).

Medical News Today: "Study: No PSA Tests, Advanced Cancer Triples" (7/30/2012, via Dr. Art Fougner).

WBUR: "Mass. Aims To Set First-In-Nation Health Care Spending Target" (7/30/2012, via @OHPCenter). Yes, this is a proposal for the government to set a hard cap on overall medical spending. Just don't call it rationing.

Reminder: Lecture Tomorrow on Medical Licensing

Reminder: For those in Colorado, I'll be one of two speakers tomorrow at Liberty on the Rocks event on Milton Friedmam.

My talk will be 30 minutes, on "Milton Friedman and Medical Licensing".

The event is free, 5:30 pm to 7:30 pm, 31 July 2012.

Directions and details here:

Celebrate the Life of Dr. Friedman With LOTR!

To celebrate the philosophy of liberty and to honor Dr. Friedman on what would have been his 100th birthday, Liberty on the Rocks is hosting an educational event complete with networking, cocktails and appetizers, and rousing discussions from two local liberty advocates and experts.

The War on Drugs

What did Dr. Friedman think about the War on Drugs? Hear from local lawyer and liberty activist David K. Williams, Jr., who will share the views espoused by Milton Friedman on this critically important subject.

Medical Licensing

Throughout his career, Dr. Friedman was adamant about the need for ending medical licensing of doctors. Hear from local radiologist and liberty activist Dr. Paul Hsieh to learn about Milton’s view on this topic, and the economic and moral reasons behind his crusade.

RSVP to this FREE event today!  https://www.facebook.com/events/140634582739255/

Location: 

Independence Institute

727 E. 16th Ave., Denver, Colorado 80203

Thank you, Amanda Teresi-Muell, for organizing this!

Taxing Medical Innovation

More on the pernicious effects of the tax on medical devices: "Indiana company scraps plans for expansion over ObamaCare device tax". (Fox News, 7/27/2012).

Taxing medical innovation will cost jobs. And it will also cost lives, in the forms of devices that won't be invented, but could have.
 
For more on this, see my PJMedia piece from 2010, "The Deadly Tax on Medical Innovation".

NYT Notices Coverage Doesn't Equal Care

The 7/28/2012 New York Times reports, "Doctor Shortage Likely to Worsen With Health Law".

I was especially struck by the fact that they finally recognize that "coverage" does not equal health care:

[In the Inland Empire region of California,]President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now...

Experts describe a doctor shortage as an "invisible problem." Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

And by the way, which fields don't have a shortage?  The fields that are less regulated (and thus more free-market), namely plastic surgery and dermatology:

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. 

(Read the full text of "Doctor Shortage Likely to Worsen With Health Law".)

The government is trying to find ways to "fix" the problem, but their proposed solutions unlikely to solve the problem.

And given that their policies are driving many doctors to consider quitting medicine or retiring early, I don't forsee this situation changing in the near future.

Fogoros Book Complete

Dr. Rich Fogoros has completed all the chapters of his book, "Open Wide And Say Moo! – The Good Citizen's Guide To Right Thoughts and Right Actions Under Obamacare".

Here's the complete first draft.

Although I don't necessarily agree with all his points, he makes numerous excellent observations about the ominous new direction of American medicine, and what we can do to turn it around.  His book is thought-provoking and definitely worth reading.

IBD: Could ObamaCare Make The Uninsured Problem Worse?

John Merline of Investors Business Daily asks, "Could ObamaCare Make The Uninsured Problem Worse?" (7/25/2012)

In particular, the combination of a relatively weak individual mandate/tax, other insurance regulations (guaranteed issue, community rating), and economic incentives that will cause many employers to drop workplace coverage could drive up the number of uninsured Americans.

 In other words, further government regulations to "solve" a problem will actually make things worse.

Totally unsurprising. (Via Instapundit.)

PIA Interview On Surviving ObamaCare

Diana has uploaded the audio of my interview with her from last night:  

On Wednesday evening's episode of Philosophy in Action Talk Radio, I interviewed my own Dr. Paul Hsieh on "Surviving Socialized Medicine."

If you missed the live broadcast, you can listen to the audio podcast. You'll find that posted below, as well as on this episode's archive page: Talk Radio: 25 July 2012.

Talk Radio: Episode: 25 July 2012

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• Duration: 37:04
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Wednesday Radio Interview: Surviving Socialized Medicine

On Wednesday evening (tonight), I'll be a guest on philosopher Dr. Diana Hsieh's live internet radio show, Philosophy in Action, to discuss "Surviving Socialized Medicine."

• What: Philosophy in Action Talk Radio: Surviving Socialized Medicine
• Who: Dr. Diana Hsieh, with Dr. Paul Hsieh, plus live callers
• When: Wednesday, 25 July 2012, 6 pm PT / 7 pm MT / 8 pm CT / 9 pm ET
• Where: Philosophy in Action's Live Studio

With ObamaCare confirmed by the Supreme Court, what can a person do to preserve his health under America's increasingly socialized system of medical care?

To join the live broadcast and its chat, just point your browser to Philosophy in Action's Live Studio a few minutes before the show is scheduled to start.

By listening live, you can call the show with your questions and experiences, as well as post comments and questions in the text chat.

If you miss the live broadcast, you'll find the audio from the episode posted here: Philosophy in Action Talk Radio: 25 July 2012.

Join us on Wednesday evening for an engaging discussion of "Surviving Socialized Medicine"!

Quick Links: Hentoff, Turner, Wolf

Nat Hentoff: "What Still Shocks Me About ObamaCare" (RealClearPolitics, 7/24/2012, via @sonodoc99)

Grace-Marie Turner: "How Much Is The Obamacare Mandate Going To Cost You?" (Forbes, 7/24/2012)

Dr. Milton Wolf: "Stop!! Obamatime!" [video] (Daily Caller, 7/23/2012).  Come for the satire, stay for the radiologist dance moves!

Hsieh PJM OpEd: Media Underplays Successful Defensive Gun Use

PJMedia has just published my latest OpEd, "Media Underplays Successful Defensive Gun Use".

My theme is that American journalists should report the whole truth about defensive gun use by law-abiding citizens rather than burying that fact.

Here is the opening:

On February 28, 2012, an angry 28-year-old gunman entered a medical office building in Colorado Springs and took three women hostage. After a three-hour standoff, the police shot him, and he died later that evening at a local hospital. The hostages were unharmed.

Yet the two largest newspapers in the state took two very different approaches in reporting the heroic actions of one of the clinic physicians, Dr. Jeff Ferguson, a legally armed civilian...

(Read the full text of "Media Underplays Successful Defensive Gun Use".)

On a personal note: The recent murders in Aurora, CO, were unspeakably evil, and my thoughts are with the victims and their families.  Some of the wounded are at the hospitals where I work and the doctors and medical staff are doing everything they can for them.  I want to offer my best thoughts for the patients' successful recoveries.

Catron: The IRS Illegally Expands Obamacare Tax Credits

In the 7/23/2012 American Spectator, David Catron describes how "The IRS Illegally Expands Obamacare Tax Credits".

As Catron notes, the feds will attempt an end-run around the law by distributing certain monies through federal "exchanges" even if the law as written only allows the states to do so.  This would nullify the attempts of various anti-ObamaCare governors to block the law at the state level by declining to establish state-run exchanges.

But even if the legal problems are clear-cut, we now know the courts will not likely uphold legal challenges to such actions. Instead, they'll likely defer to what they regard as the will of the legislature.

US Supreme Court Chief Justice made that very clear when he wrote: "It is not our job to protect the people from the consequences of their political choices."

Which means it really comes down to the voters in November.

Update: Catron notes that two Congressmen have introduced a bill to try to stop this maneuver.

Hsieh Lecture: Milton Friedman and Medical Licensing

I'll be speaking next week at Liberty on the Rocks on "Milton Friedman and Medical Licensing".

Save the date: 31 July 2012.

The event is FREE, 5:30 pm to 7:30 pm.

Directions and details here:

Celebrate the Life of Dr. Friedman With LOTR!

To celebrate the philosophy of liberty and to honor Dr. Friedman on what would have been his 100th birthday, Liberty on the Rocks is hosting an educational event complete with networking, cocktails and appetizers, and rousing discussions from two local liberty advocates and experts.

The War on Drugs

What did Dr. Friedman think about the War on Drugs? Hear from local lawyer and liberty activist David K. Williams, Jr., who will share the views espoused by Milton Friedman on this critically important subject.

Medical Licensing

Throughout his career, Dr. Friedman was adamant about the need for ending medical licensing of doctors. Hear from local radiologist and liberty activist Dr. Paul Hsieh to learn about Milton’s view on this topic, and the economic and moral reasons behind his crusade.

RSVP to this FREE event today!  https://www.facebook.com/events/140634582739255/

Location: 

Independence Institute

727 E. 16th Ave., Denver, Colorado 80203

Thank you, Amanda Teresi-Muell, for organizing this!

Quick Links: Minton, Cochrane, UK

Michelle Minton: "More FDA Control Does Not Mean More Safety" (CEI, 7/18/2012)

John Cochrane: "Forget About the Mandate. Let’s Fix Health Care" (Bloomberg, 7/12/2012)

UK update: "Thousands could lose their sight as NHS cuts cataract surgery by a quarter" (Daily Mail, 7/15/2012)

Civilian Responses to Active Attackers

[This is a bit off-topic for my usual health care blogging, but I'm exercising bloggers' prerogative.  --PSH]

If you ever find yourself in a mass-shooting incident, how can you safely respond?

My friend Ari Armstrong discusses this with his father Linn Armstrong (a firearms instructor here in Colorado) on what unarmed -- and armed -- civilians can do. For instance, unarmed civilians could throw their movie theater drinks and any available objects en masse at a shooter, thus disorienting him.

Here's the full blog post by Ari and the related video, "Civilian Responses to Active Attackers":




FWIW, my group practices at two of the big trauma hospitals in Denver that received casualties from the Colorado shooting, The Medical Center of Aurora (TMCA) and Swedish Medical Center.

I was off-duty that night, but when I came in early that morning I talked to one of the ER doctors at TMCA who helped treated these patients.  He and his colleagues were worn out after a long and busy night, but they did a terrific job under enormous pressure.

The Accelerating Collectivizing of American Medicine

The July 19, 2012 Washington Post reports, "Health-care law driving doctors away from small practices, toward hospital employment".

A few excerpts from the article:

During a hearing before the House Small Business Committee on Thursday, health-care professionals explained that the shift has already been picking up momentum in recent years, driven largely by growing regulatory and administrative burdens, rising malpractice costs and declining reimbursements from insurers -- all of which they say have hit small practices especially hard. Consequently, doctors are shying away from the traditional solo practitioner model in favor of employment at large hospitals...

Now there's an additional catalyst physicians say may expedite the decline of small practices -- the Patient Protection and Affordable Care Act, passed in 2010 and recently approved by the Supreme Court.

For starters, PPACA made Accountable Care Organizations -- referring to groups of providers that take responsibility for the care for an entire patient group -- an official part of the Medicare program this year, giving hospitals added incentive to scoop up physician partners.

"Because of bundled payments and other measures in the law, hospitals want to make sure they have enough primary care physicians, particularly, as well as specialists that they can have in their Accountable Care Organizations so they can participate," Dr. Jerry Kennett, senior partner at Missouri Cardiovascular Specialists in Columbia, Mo., told lawmakers.

But the law also comes with new regulations and non-compliance penalties that could further deter doctors from self-employment...

Bear in mind, this is not some "unintended consequence". From my July 2011 PJMedia piece, "The Coming Collectivization of American Health Care":

The Obama administration regards this collectivization of medical providers as a desirable outcome, not merely some “unintended consequence.”

As Obama health advisor Nancy-Ann DeParle wrote last year in the Annals of Internal Medicine, the new law will “accelerate physician employment by hospitals and aggregation into larger physician groups” and “physicians will need to embrace rather than resist change.”

Translation: “Doctors should get with the program — or else!”

Furthermore, such collectivization is merely a continuation of a much older strategy. 

Jonah Goldberg’s book Liberal Fascism described how the Roosevelt administration sought similar consolidations of American agriculture and business during the New Deal. As Goldberg noted:

[If] you want to use business to implement your social agenda, then you should want businesses themselves to be as big as possible. What’s easier, strapping five thousand cats to a wagon or a couple of giant oxen?

Similarly, it will be much easier for the federal government to regulate 100 large ACOs than 10,000 small private practices.

Once doctors are herded into ACOs, they will become increasingly accustomed to simply following orders from ACO administrators (who in turn will be proxies for government health bureaucrats).

The New York Times recently reported that after physicians became hospital employees, they became much more accepting of government controls over health care than their counterparts in private practice...

If a physician freely decides to join a large multispecialty group practice (or become a hospital employee) based on his own best professional judgment and individual practice preferences, this is not necessarily bad. 

But when the government tilts the playing field to drive doctors out of small private practices into these more easily-regulated large entities, that's a different matter altogether.

As Dr. Jay Parkinson observes, this really means that "bureaucrats determine the business model of a doctor’s practice".

Under such a system, doctors lose the freedom to practice how they best see fit.  When that happens, patients lose the freedom to receive the care their doctors deems most appropriate.

Do we want that kind of medical system?

Employers and ObamaCare

As ObamaCare continues to be phased in, some are asking "Will your employer abandon health coverage under new law?"  (Via Dr. Art Fougner.)

Companies with more than 50 employees will be required to provide health insurance for their workers or else face financial penalties.

CNN reports, "Trying to duck health care's employer rules? Don't bother".

Perhaps companies already employing more than 50 people will have a hard time finding loopholes around the law.

But you can be sure that many companies who only have 45-49 employees will try pretty hard not to grow to the size where they exceed 50 and thus be subject to the law.

Given the tough economy, the last thing we need is further incentives for companies to not hire willing workers.

Krening: What ObamaCare Means to Me

Our friend (and cancer survivor) Hannah Krening discusses the patient's perspective on government-run health care at, "What ObamaCare Means to Me".(TOS blog, 7/18/2012)

Here's an excerpt:

Should my cancer return, will I have access to the expensive but vital drugs that boosted my depleted red and white blood cell counts and kept my chemotherapy and radiation treatments on schedule and thus more effective? What restrictions will my doctor face in prescribing treatment, and what restrictions will I face in obtaining it? No one knows.

Until government gets out of the health-care business and starts protecting rather than violating the rights of providers, patients, and insurers to contract voluntarily in a free market, my greatest fear is not that I might need treatment in the future—that I could deal with. My greatest fear is that if I do need treatment, I won’t be permitted to receive it.

(Read the full text of "What ObamaCare Means to Me".)

This could be you, your mother, your sister, or your wife.

Health Care Sharing Ministries

The 7/8/2012 USA Today highlighted, "Health care sharing ministries offer insurance alternative".

Basically, these are voluntary cooperatives in which members (typically of a shared religious affiliation) agree to help cover each others' medical costs in case one of them gets sick. The details vary from group to group, but overall:

In these ministries, members pay a monthly fee that gets dispersed to a member who needs help paying medical bills. Depending on the ministry, the money may go directly to the family in need or through the ministry.

Most of those who opt to belong lack affordable insurance through an employer. Ministry members must attest they are good Christians and live life accordingly.

Such mutual aid arrangements are an excellent idea. In a fully free society, we'd likely see more of such arrangments.

I also discussed these private arrangments in my article, "How the Freedom to Contract Protects Insurability" (The Objective Standard, Fall 2009):

In fact, many Americans have already formed private pools in which members voluntarily share each other’s health-care costs.

For instance, more than 100,000 American Christians are members of “health-care sharing ministries”—arrangements whereby members pay a monthly fee to the ministries, which in turn distribute that money to other members facing expensive medical bills. Such groups typically accept members who meet certain religious and lifestyle requirements regardless of preexisting medical conditions.

Unfortunately, these health-care sharing ministries currently cannot guarantee payments to their members, because the government would then treat them as insurance companies and subject them to myriad onerous state and federal regulations that specify what prices they may charge, what benefits they must offer, and which customers they must accept.

The only thing preventing individuals from creating their own contractually binding risk pools today is the government.

All Americans (religious or otherwise) should be left free to form such voluntary mutual aid societies as they see fit.

Quick Links: Armstrong, Catron, HSAs

Ari Armstrong: "No, Edolphus, Health Care is Not a 'Right' or a 'Privilege'" (TOS blog, 7/16/2012)

David Catron: "No, Professor Gruber, Obamacare Won't Boost the Economy" (American Spectator, 7/16/2012)

Paul Howard: "What happens to Health Savings Accounts (HSAs) now?" (Medical Progress Today, 7/12/2012).  Short answer: "Regulations are slowly strangling HSAs"

FDA Spies On Dissenting Scientists' E-Mails

The 7/14/2012 New York Times reports that FDA spied on its own scientists' e-mails as well as external critics of the agency:

While federal agencies have broad discretion to monitor their employees’ computer use, the F.D.A. program may have crossed legal lines by grabbing and analyzing confidential information that is specifically protected under the law, including attorney-client communications, whistle-blower complaints to Congress and workplace grievances filed with the government.

Sure, I trust them to protect my health.

(Via Instapundit.)

Scherz and Koriwchak: The Health Information Technology Boondoggle

Dr. Hal Scherz and Dr. Michael Koriwchak of Docs4PatientCare have a new TownHall OpEd, "The Health Information Technology Boondoggle".

When electronic medical record systems are selected by hospitals and physicians in response to clinical needs, based on free-market principles, they can be tremendously helpful in improving efficiency and patient care.

But when they are imposed by fiat by the government, they won't help doctors treat patients. It would be like the government telling you what kind of cellphone and data plan you must have, regardless of your actual needs.

But these health IT systems will help the government more closely track whether doctors are adhering to government practice guidelines.

Hence, they represent the next step in government control of American medicine.

More Under-The-Radar ObamaCare Provisions

So what else is in the ObamaCare law?

This 7/12/2012 piece from Kaiser Health News lists, "Ten Things You Didn't Know Were In The Affordable Care Act".

Two in particular that caught my eye:

New specifications on which sorts of advanced wheelchairs for Medicare must be rented vs. purchased.

States will have to specify in death certificates whether the deceased had diabetes or not.

I'm just glad the new regulatory overhead will be a minimal burden on honest Americans.

Doctors Bowing Out

Dr. Jordan Grumet describes how, "Doctors are quietly and incrementally bowing out".

An excerpt:

Physicians are looking for a way out. They are becoming businessman, social media entrepreneurs and commentators, writers, reformers, and career coaches. They are retiring early and cutting their hours. I spend less time in the clinic than ever before. Each year I replace some of my office time with non clinical revenue generating activities. The joy of patient care is being overshadowed by regulation. We are quietly and incrementally bowing out...

In the end, it will be American patients who suffer as a result.  

Related: This recent Daily Caller piece notes that, "83 percent of doctors have considered quitting over Obamacare".

Moreover, CNN reports that independent solo physicians are dying breed. 

Economic and political pressures are going to drive the remaining doctors into large group practices (or to become hospital employees), where their practice patterns can be more easily tracked by regulators via mandatory electronic medical records.  This will likely also accelerate the trend of some doctors bowing out of the new system.

Patient-Centered Health Care In Jeopardy

RealClearPolicy discusses how ObamaCare guarantees higher costs by outlawing the affordable health care revolution. (Via Stephen Bailey.)

Related: "Just Who Should Control Your Healthcare Spending?"

KevinMD Post: How Will ObamaCare Affect Prostate Cancer Screening?

The widely-read medical commentary website KevinMD.com has just reposted my OpEd, "How will ObamaCare affect prostate cancer screening?"

(It originally appeared at Forbes.com under the title, "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.

Or a 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 "How will ObamaCare affect prostate cancer screening?" at KevinMD.com.)

Thank you, Dr. Kevin Pho, for reposting this piece. And thank you, Forbes, for allowing republication!

Doctors In Portugal Go On Strike

BBC news (7/11/2012) reports that Portugese doctors are going on strike under that country's government-run health system.

I'm just glad this could never happen here in the US.

Quick Links: UK, HSA, TX Medicaid

UK rationing update: "Hospitals 'letting patients die to save money'" (Telegraph, 7/8/2012).

Flopping Aces: "ObamaCare – Killing Health Savings Accounts", 7/8/2012. (Via Dr. Art Fougner.)

Medicaid update: Fewer Texas doctors willing to accept Medicaid (Fort Worth Star-Telegram, 7/8/2012)

Armstrong D4PC Congressional Testimony

Dr. Richard Armstrong, Chief Operating Officer of Docs4PatientCare, testified before Congress earlier today on the negative effects ObamaCare will have for patients and doctors.

Here's a downloadable PDF copy of his testimony, discussing how ObamaCare will harm the doctor-patient relationship.

Update: Here's the final version of Dr. Armstrong's testimony below (thanks to Dr. Beth Haynes):

Mr. Chairman, members of the committee, ladies and gentleman; it is an honor to speak with you today on behalf of Docs4PatientCare and thousands of practicing physicians nationwide who share our deep concern about the effects of the Affordable Care Act upon the practice of medicine and specifically upon our relationship with patients.

You have my written testimony and the attached information.  In the interest of time I will depart from the written documents.  In response to the question…how does this law affect the physician-patient relationship?  The answer is…it destroys it.

This has been developing for many years, but this law truly makes it crystal clear.  In fact, Dr. Donald Berwick, the former head of CMS has written that for this law to work…”the traditional physician-patient dyad must end.”

All of you on this committee see your doctor from time to time.  What do you expect from the visit?

You’d like a friendly compassionate doctor who will listen to you, examine you and talk to you.  The doctor will call on extensive training and experience to devise a plan that you both agree upon and understand.

Your doctor simply wants to do what their training has prepared them to do…listen to your history, do a physical exam, discuss the findings and recommend a plan.

Unfortunately, that is not how things are going in medicine.

To illustrate how things are changing, I’d like to share some stories.

Electronic medical records systems have been touted as a “cure” for many of the problems in our health care systems today.  Unproven and untested, these claims are simply not true.

During a recent sales demonstration at my hospital, the presenter, a physician’s assistant, took 30 minutes to demonstrate how to document the patient encounter with their system.  The process  was unfriendly to both patients and doctors.

One of our primary care physicians asked…”how do you propose that I do this in the 15 minutes that I normally have with patients?”

He answered….”The goal is to reach at least a level 3 visit.”

I’ll say that again…”The goal is to reach at least a level 3 visit.”

In other words, the billing trumps the medical care.

He added…”So, you have your nurse enter the history data, you fill in the physical exam data, make the plan and move on to the next patient.”

Really?   Where in these 15 minutes do you talk to the patient or listen to the patient…you, the doctor?

As a patient, how do you feel?  Did you develop a relationship or are you part of an assembly line?  I think that most of us know the answer and it should make us both sad and angry.

And then there is this account of a fellow physician’s recent experience taking her father to visit his new primary care doctor:

This is her story…

“I took my father, 80 years old and living independently,  to meet his new internal medicine physician yesterday.

I sent ahead a brief summary of his history, list of meds, and request that he do a physical exam, since it had been well over three years since it was done.

After introducing himself, he immediately announced that federal 'guidelines' no longer allow regular exams. An exam allows only listening to hearts, lungs, and bowel sounds (with patients sitting, mind you) - and does nothing else unless there was a specific complaint to justify it. I asked if anemia (which my father has) justified a rectal exam - he said no.  He of course quoted repeatedly the US Preventive TASK Force recommendations as one of the standards. He recited the statistics and the 'societal' cost arguments.  He had it down; a perfectly 'useful idiot'.

He said he only does 'evidenced based' medicine. In fact, he had just been to a conference to confirm the validity of his positions.  I did not engage him - it was not appropriate with my poor father sitting there listening to how he is too old for……well, anything.

Eventually, to pacify me, the doctor went through the motions of the rectal exam (after having to leave the exam room to get gloves and lubricant, which are of course, of no use to him).  I doubt he even knows how to do a rectal, since my Dad (who has had many) hardly felt it. “

Again, guidelines trump medical care.

This is the reality of Obamacare.  There is no care.  This law, supported by organized medicine, has been consistently opposed by Docs4PatientCare and AAPS.

Things do not need to be this way. We need not turn our doctors into government drones.  But, under a government controlled one-size-fits all plan, that is what we can expect and what we are witnessing nationwide…today.

Physicians are being buried under increasing financial and bureaucratic burdens.  Time is literally stolen from direct patient interaction, destroying the physician-patient relationship and fragmenting patient care.

This does not have to occur.  American physicians need to be free to do what they have been trained to do…excel at practicing medicine.

American patients need to be free to choose health insurance plans and medical treatments that suit their needs, not something coerced by a central authority.  This is simply impossible under the suffocating burden of the Affordable Care Act. 

Thank you for the invitation to speak with you today.  I’ll be happy to entertain your questions.

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."