Friday, March 1, 2013

Benjamin Rush Society March Debates

The March 2013 debate schedule for the Benjamin Rush Society is now out!

Inline image 1     Inline image 2

  Benjamin Rush Society-Arthur N Rupe Debate Series

March 11 @ Ohio State University Current Financial Conflict of Interest Policies Create Unjustified Obstacles to Medical Innovation and the Development of Affordable, Quality Medical Care”   Dr. Tom Stossel, MD (Harvard) and Dr. Andrew Thomas, MD (OSU)

March 12 @ Mt.Sinai Medial School, NYC “Medicare and Medicaid must be drastically changed to survive the current budget crisis and health care reform." Sally Pipes (Pacific Research Institute) Dr. Scott Gottlieb, MD (American Enterprise Institute), Dr. Chris Lillis, MD, (Doctors for America), Dr. Elizabeth Rosenthal, MD (Physicians for a National Health Plan)

March 26 @ Yale University   "Markets with Limited Government Intervention are the Best Way to Control Spending Growth in Health Care." Avik Roy, (Forbes, The Apothecary) Joshua Archabault, (Pioneer Institute of Public Policy Research), Dr. Elizabeth Rosenthal, MD (Physicians for a National Health Plan), Dr. William Sage, MD, JD,(Visiting Professor of Law at Yale Law School) 


For more information, see the BRS website.

Thursday, February 28, 2013

Hsieh Forbes OpEd on Fertility Panic and Freedom

Yesterday's Forbes (2/27/2013) published my latest OpEd, "Freedom, Not Fertility, Is The Key To A Thriving Economy".

I respond to some conservatives fretting about America's low birth rate, and discuss why it's not the government's job to promote any specific lifestyle (e.g., single vs married or childless vs. multiple-child marriage).

Tuesday, February 26, 2013

Watson and Medicine

Atlantic: "The Robot Will See You Now".

Barring regulatory barriers, we'll see increasing use of computers as helpful adjuncts to physicians.  At some point in time, computers can (and should) take over many functions currently performed by humans just as they have in other industries.

Monday, February 25, 2013

The High-Tech Future of Medicine

Henry Miller: "The High-Tech Future of Medicine".

An excerpt:
Personalized drug therapy uses biological indicators, or “biomarkers”—such as DNA sequences or the presence or absence of drug receptors—as a marker of how patients should be treated and to estimate the likelihood that the intervention will be effective. This concept is not new. It has been known for decades, for example, that persons genetically deficient in an enzyme called G6PD can experience severe and precipitous anemia if they are exposed to certain drugs.

Similarly, various ethnic groups and individuals have widely varying abilities to clear medications from the bloodstream because of differences in the activity of the enzymes that metabolize, or degrade, drugs. For that reason, drug safety and efficacy are affected by variants of genes coding for the enzymes that metabolize chemical compounds; one genetic locus, for example, is responsible for the enzymes that degrade as many as 20 percent of commonly prescribed drugs; in the population, there are a large number of variants of this gene, some of which only poorly metabolize the enzymes’ substrates.

This is important because low metabolizers clear certain drugs slowly and have more medication in their blood for longer periods of time than high metabolizers. Thus, the former might be prone to overdose, and the latter to insufficient levels of the same drug...
We have increasing ability to take advantage of new technology to create personalized therapies.  However, our current regulatory scheme (and the various ObamaCare provisions) will push doctors into more "one size fits all" treatment protocols.

Whether the pace of technological progress will stay ahead of the regulatory "drag" is still an open question.

Thursday, February 21, 2013

TPM: Four Ways Obamacare Could Still Fail

TalkingPointsMemo discusses, "Four Ways Obamacare Could Still Fail".

These include:
1) Ongoing Disapproval Of The Law
2) States Declining To Expand Medicaid
3) States Refusing To Build Insurance Marketplaces
4) Nullification Of The Medicare Cost-Cutting Board
For more details on each points, read the full text of "Four Ways Obamacare Could Still Fail".

Also, if/when the current system fails, it's not clear what will replace it.  We could move in the direction of more freedom or towards a government-run "single payer" system.  That decision will still be up to us.

Wednesday, February 20, 2013

Lipana on Medical Device Tax

Joshua Lipana writes at the blog for The Objective Standard: "Cheers to Bipartisan Support for Repealing the Medical-Device Tax".

Even if some of the supporters are driven by political expediency rather than a principled commitment to free markets, this could be a step in the right direction.

And public pressure can help in this regard.  As Milton Friedman once observed, "The way you solve things is by making it politically profitable for the wrong people to do the right things."

Tuesday, February 19, 2013

Roerig on Medical Tourism

In a 2/18/2013 blog post for The Objective Standard, Howard Roerig discusses "Medical Tourism: A Free Market Alternative to ObamaCare".

Here is the opening:
In 2009, in my home state of Colorado, a friend faced an estimated expense of $30,000 for necessary dental surgery, an amount far in excess of what he could afford. After doing some research, he opted to have the work done in Costa Rica, where he ended up paying $6,000 for the same surgery. He was treated in a facility so modern that “it looked like something out of Star Trek”; the staff all spoke fluent English; and they were friendly, competent, and supportive throughout his stays. As a bonus, he was able to enjoy two relaxing vacations in a beautiful Caribbean country. This kind of option for medical care, which has come to be called “medical tourism,” is rapidly increasing in popularity...
For certain types of non-emergency medical procedures, this option will be an enormous boon for Americans who may have an increasingly difficult time getting them through the US system in a few years.

For more details, read the full text of "Medical Tourism: A Free Market Alternative to ObamaCare".

(I also expect some entrepreneur to start a chain of floating hospital cruise ships that provide medical services in international waters, while family members can enjoy the amenities.)

Monday, February 18, 2013

Minton Interview on Health Freedom

Diana Hsieh recently interviewed Michelle Minton of the Competitive Enterprise Institute (CEI) on "Your Freedom to Eat, Drink, and Be Merry".   I've long been a supporter of her work in this area for CEI.

Here's more information from Diana:
About the episode:
 
The government heavily regulates food and drinks commonly regarded as dangerous or unhealthy. What motivates such regulations? Why are they so widespread? How can they be fought? 
Michelle Minton is the Fellow in Consumer Policy Studies at the Competitive Enterprise Institute. The issues she manages include food policy, FDA regulation of non-pharmaceuticals, alcohol regulation, and the online gambling industry. Her work has been published and cited by nationally respected news outlets such as the Wall Street Journal and USA Today, prominent magazines, and scholarly journals.

Topics:
  • The most common regulations and laws pertaining to food and drinks
  • Colorado's laws about grocery versus liquor stores
  • Federal versus state versus local regulations
  • The true purpose of these laws and regulations
  • The goal of Michelle's advocacy
  • Why we have more regulations today
  • Conservative "solutions"
  • Bad studies and sloppy journalism: the phony case against the egg
  • The accusations against Four Loko
  • Future trends, including appeals to children
  • The three-tier system of alcohol distribution
  • Bootleggers and Baptists
  • Not being in the pocket of "big business"
  • Advocating for freedom in this area
  • Economic versus moral arguments for freedom
  • Effective arguments
  • Maintaining integrity in public policy work
  • Whether to support or oppose mixed proposals
  • How to support Michelle's work

Links:

(Listen to the audio of "Your Freedom to Eat, Drink, and Be Merry".)

Sunday, February 17, 2013

Hsieh PJM OpEd on Gun Laws and Civil Disobedience

PJ Media has published my latest OpEd, "Would New Gun Laws Spark Widespread Civil Disobedience?"

I discuss why the gun issue could be so unusually volatile for America.

Here is the opening:
In his State of the Union address, President Obama doubled down on his gun-control proposals, again demanding that Congress ban so-called “assault weapons” and “high capacity magazines.” This is not a surprise. What has been a surprise are the increasingly open calls for defiance from gun owners, state legislatures, and local law enforcement. If the president’s proposals become law, he may move the country into turbulent waters we haven’t seen in many years.

Gun control has long been a controversial issue in American politics. However, there are three aspects to this issue that make this more volatile than other hot topics such as taxes, foreign policy, or abortion...
(For the rest, read the full piece: "Would New Gun Laws Spark Widespread Civil Disobedience?")

Thursday, February 14, 2013

Forbes: Cancer, Innovation and a Boy Named Jack

Forbes has a nice interview at, "Cancer, Innovation and a Boy Named Jack":
Jack is a scientist and  innovator.  And his work on creating a simple test for the identification of pancreatic, lung and ovarian cancer is simply amazing.
Here are some of his facts:
  • His test is 168 times faster than what is currently available.
  • It’s 26,000 times less expensive.  That’s not a typo.
  • And it’s potentially almost 100% accurate.
Here’s what makes it even more astonishing:
  • Jack is 15 years old.
So, I just had to speak with Jack...

Wednesday, February 13, 2013

Catron On SOTU

I didn't watch the State of the Union address. But David Catron did, and he discusses "Obama's Most Audacious SOTU Lie".

Here is the opening of his latest American Spectator piece:
It is difficult to say with certainly which of the many whoppers President Obama told tonight took the most crust to utter, but my money is going on this assertion, made a few minutes into the speech: "Already, the Affordable Care Act is helping to slow the growth of health care costs"...
(Read the full text of "Obama's Most Audacious SOTU Lie".)

Massachusetts 2013 Projections

The 2/7/2013 Boston Globe reports, "Massachusetts health care costs are heading up in 2013".
Representatives from the state’s nonprofit health plans as well as national for-profit insurers doing business in Massachusetts estimated the “medical cost trend,” a key industry measure, will climb between 6 and 12 percent this year — higher than last year’s cost bump and more than double the 3.6 percent increase set as a target in a state law passed last year.
Two observations:

1) This will likely lead for calls for more government controls over medical services (and medical service providers).

2) This is likely the future for the other 49 states under ObamaCare.

Tuesday, February 12, 2013

KevinMD Post on Doctors and Guns

I'm honored and delighted that the widely-read KevinMD.com website has reposted my Forbes piece, "Why doctors should not ask patients about guns".

The piece includes a quote from Colorado physician Dr. Matthew Bowdish.  Read the whole thing here.

Here's the link to the original Forbes piece (1/22/2013).

(Note: I don't regard myself as "conservative". The use of that word was the editor's decision.)

Monday, February 11, 2013

Adalja On Non-MDs And Licensing

Dr. Amesh Adalja notes that "Sometimes The Best Medical Care Is Provided By Those Who Aren't M.D.s" (Forbes, 2/10/2013).

From his piece:
...[F]or many conditions the expertise of a physician is not strictly required and an individual may be ably served by a nurse practitioner or the like. Expanded scopes of practice, in which a non-physician renders care independent of a physician, not only expand access to health care and have the potential to decrease the cost of healthcare, but also reflect a respect for the free market system.
Like Dr. Adalja, I support the elimination of licensing laws the unfairly restrict the ability of health professionals and patients to voluntary contract to their mutual benefit.

In a free market, patients might choose rationally some forms of medical care from an MD (and pay a higher fee) and other forms of care from a non-MD "mid-level provider" for a lower fee.  Provided that there is no fraud or misrepresentation by the provider to the patient, this can be a win-win for both parties.

(See also my related piece: "How Medical Licensing Laws Harm Patients and Trap Doctors", PJ Media, 10/1/2012)

However, we may also see state governments loosening some scope-of-practice laws for other, less-benign reasons.  The Los Angeles Times recently reported, "State lacks doctors to meet demand of national healthcare law" (2/9/2013).

The LA Times article notes:
There aren't enough doctors to treat a crush of newly insured patients. Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.
In this case, the motivation of the state of California is different.  The proposed changes in the laws are not driven by a respect for individual freedoms, but because of the growing problems of the government health program.

Patients won't be choosing between MDs and non-MDs for medical care in a free market, but instead obliged to accept care from whichever providers still willing to practice under ever-growing state control.

Considered in isolation, the specific concrete legal changes in California might be similar to genuine free-market reforms, but the larger context is very different.

Friday, February 8, 2013

A Look At The Future

Walter Russell Mead: "British Hospital Carnage a Window into US Future".

Related from NYT: "English Hospital Report Cites 'Appalling' Suffering":
The report, which examined conditions at Stafford Hospital in Staffordshire over a 50-month period between 2005 and 2009, cites example after example of horrific treatment: patients left unbathed and lying in their own urine and excrement; patients left so thirsty that they drank water from vases; patients denied medication, pain relief and food by callous and overworked staff members; patients who contracted infections due to filthy conditions; and patients sent home to die after being given the wrong diagnoses. 

“This is the story of the appalling and unnecessary suffering of hundreds of people,” Robert Francis, the lawyer appointed by the government to lead the inquiry, said at a news conference.
Right now, such conditions would be nearly unthinkable here in the US.  For now.

Tuesday, February 5, 2013

Unionized Doctors?

In the 1/29/2013 Wall Street Journal, David Leffel discussed "The Doctor's Office as Union Shop".

In particular he asked, "As new health-care laws turn physicians into service workers, why wouldn't they organize?"

I don't think this would be a good development. But we may be heading in this direction nonetheless.

Monday, February 4, 2013

Why More Non-MDs Will Be Treating Patients

The 2/3/2013 Wall Street Journal describes how, "Battles Erupt Over Filling Doctors' Shoes".

The problem of physician shortages has loomed for a while, but will get worse as more doctors retire (or cut back) and as new patients enter the system.  The problems did not originate with ObamaCare, but ObamaCare will make things worse.

This means many patients will have to wait longer for care or will be seen by various non-MD "midlevel providers" such as Physician Assistants (PAs) and/or Nurse Practitioners (NPs). 

From the WSJ article:
Many health-care experts say PAs will be in even greater demand when the Affordable Care Act expands insurance to 30 million more Americans next year. The Association of American Medical Colleges has warned that the supply of new doctors can't keep pace, due to limits on federal funding for medical residency programs, and estimates that the U.S. will face a shortage of more than 90,000 physicians by 2020, particularly in primary care and in rural areas.

The number of licensed PAs, meanwhile, has doubled in the past decade, to 86,500, and is likely to grow another 30% by 2020, according to the American Academy of Physician Assistants.

The AMA says it supports using PAs, nurse practitioners and other midlevel professionals in health-care teams as long as they are led by physicians and don't exceed their training. It says physicians must be available to consult with PAs at all times -- though not necessarily in person.
Many PAs and NPs are very good at what they do and can handle routine health issues.

As an advocate of free market reforms, I support allowing widened scope of practice for such providers, as long as it Is with the patient's knowledge and consent and as long as those providers recognize what they can handle and what needs to be "kicked upstairs" for more direct care by the MD physicians.

However, I think many patients will find that they will have to see the PA or NP out of necessity, simply because they will have no other alternative.

Given the worsening physician shortages, patients who wish to have continued access to an MD may wish to establish a firm relationship with a good primary care MD now.  And some of the new "concierge medicine" services (or the surprisingly affordable "hybrid concierge" services) may be worth investigating as well.  But the numbers of available openings will necessarily be limited.

If you wait too long, you might find that others will have beaten you in this game of medical musical chairs and your options may be more limited than you wish.  Prudent patients will wish to plan ahead sooner rather than later.

Saturday, February 2, 2013

Catron: Crony Contraception

In his 2/1/2013 American Spectator, David Catron suggests that that the HHS contraception mandate is a political payoff to Big Pharma for its support of Obamacare.

From his OpEd:
...The Wall Street Journal reported last summer that PhRMA and other industry lobbying groups coordinated with the White House to produce a multi-million dollar advertising blitz to promote Obamacare. “In particular, the drug lobby would spend $70 million on two 501(c)(4) front groups called Healthy Economy Now and Americans for Stable Quality Care.”

Moreover, as Peter Schweizer has reported, “[A]mong President Obama’s biggest financial backers are precisely the Big Pharma companies who benefit from the mandate.” And they go well beyond William Schultz and Barr Laboratories. Schweizer elaborates as follows: “Sally Sussman, head of government affairs for Pfizer, is one of [Obama’s] biggest campaign bundlers... Pfizer sells numerous contraceptives that now must be covered by health-care plans. Obama’s financial ties to the pharmaceutical industry run deep.”
But even their political pull might have limits, in the face of enormous public pressure against the mandate.

Yesterday, multiple news sources such as CNN reported, "Obama proposal would let religious groups opt-out of contraception mandate".

Here are more details from Timothy Jost, "Contraceptive Coverage And Religious Accommodation"

Stay tuned.

Friday, February 1, 2013

Thursday, January 31, 2013

Why Concierge Medicine Will Get Bigger

MarketWatch: "Why concierge medicine will get bigger" (1/17/2013).

The field is rapidly evolving, and there are now many groups offering different tiers of service (depending on how much one wants to spend).

In particular, some of the various "concierge light" models will be very attractive to patients and doctors alike.
The network One Medical Group, currently available in 5 major cities, charges just $200 annually for longer doctor visits, minimal wait time, iPhone appointment scheduling and prescription refills and other amenities. The group has slashed overhead by increasing its use of technology and cutting down on support staff. Doctors weigh in patients and take their vital statistics, which provides a good opportunity for both sides to catch up, said Dr. Tom Lee, One Medical's CEO, who holds both an MD and an MBA. "Because we’ve re-engineered our practice, we can weather most reimbursement storms," Lee said. 
Let's hope the law continues to allow these practices to thrive.

Wednesday, January 30, 2013

PJM Interview with Ryan Moore: "Carrying a Gun Saved My Life'"

PJ Media has published my interview with my friend Ryan Moore: "'Carrying a Gun Saved My Life': Meet Ryan Moore".

Ryan talks about the time he needed to use his firearm in self-defense, what he learned from the experience, and why he opposes proposed restrictions on gun magazines and so-called "assault weapons".

Although this isn't directly related to health care policy, it is an important issue in the news with life-and-death consequences for ordinary Americans.  Plus many doctors and medical organizations are chiming in on this topic.

So thank you, Ryan, for sharing your story!

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

Tuesday, January 29, 2013

Lipana on the Medical Device Tax

Joshua Lipana of Liberty Against Cancer has a couple of recent blog posts about the medical device tax, where he asked a couple of people for their opinions.

Here is Alex Epstein's response.

Here is my response.

And here are some of Joshua's earlier thoughts.

And a nice positive update on Joshua's battle against lymphoma.

Monday, January 28, 2013

RomneyCare Update

The 1/23/2013 Wall Street Journal has an update on health care in Massachusetts: "The RomneyCare Bill Comes Due".

From the article:
[RomneyCare] was supposed to save the state money. But last August Beacon Hill was forced to impose new price controls and a cap on overall state health spending because "health-care spending has crowded out key public investments," as Mr. Patrick puts it in his budget.

He's right about that: Health care was 23% of the state fisc in 2000, and 25% in 2006, but it has climbed to 41% for 2013. On current trend it will roll past 50% around 2020 -- and that best case scenario assumes Mr. Patrick's price controls work as planned. (They won't.) In real terms the state's annual health-care budget is 15% larger than it was in 2007, while transportation has plunged by 22%, public safety by 17% and education by 7%. Today Massachusetts spends less on roads, police and schools after adjusting for inflation than it did in 2007.
Hence, the need for a "huge new tax increase proposed by Governor Deval Patrick".

I'm just glad residents of the other 49 states won't see similar problems.  Oh, wait...

(Read the full text of "The RomneyCare Bill Comes Due".)

Saturday, January 26, 2013

iPhone App Connects You to Nurse or Doctor Anytime

Some progress: "New iPhone App Urgent Care Connects You To A Nurse Or Doctor Anytime".

From the article:
Urgent Care has two main functions: it’s a medical dictionary and encyclopedia, providing direct answers to medical questions, and it also provides instant access to a registered nurse and/or doctor, 24 hours a day, seven days a week. The service however is only available in the US.
The app is available for free download at the iTunes store.  (There is apparently a small fee for the medical consultation.  Also, I don't know to what extent they can offer advice that is actually useful to patients, without crossing the line into unauthorized practice of medicine.)

We're already seeing more doctors and hospital systems taking advantage of new technologies to provide telemedicine (and teleradiology) services.  For instance, patients in the ER at some small rural hospitals can now have a "virtual consultation" with a neurologist in a major urban medical center, who can then decide if they need to send the medical helicopter to transport the patient urgently to the big hospital.

In my own practice, radiologists now read MRI scans and CT scans 24/7 from multiple states, providing subspecialty expertise to hospitals that previously had to rely only on local physicians.

But we could be seeing much more of this, if regulatory barriers were lowered (including laws making it difficult to practice medicine across state lines or international boundaries).

Friday, January 25, 2013

Benjamin Rush Society Yale Debate

The Benjamin Rush Society will be presenting another health care policy debate at Yale Medical School on 2/11/2013.  It looks like a great lineup!

(Also, the recording of their 11/28/2012 debate on "social justice" and health care is now available on their website.)

More information about the Yale debate from their announcement:
The Benjamin Rush Society Presents The Arthur N. Rupe Debate Series

• Cosponsored with Yale Medical School Healthcare Improvement Group, American Medical Student Association, Graduate and Professional Student Senate and Yale Healthcare and Life Sciences Club •

BE IT RESOLVED THAT
“Markets with Limited Government Intervention are the Best Way
to Control Spending Growth in Health Care.”

February 11th, 2013, 6:30-8:30 p.m.

Pre-Debate Reception at 6:00 p.m.

In Favor
Dr. Avik Roy, MD (NYC)
Author of “The Apothecary”, Forbes
Senior Fellow, Manhattan Institute

Mr. Joshua Archambault, MPP (Boston, MA)
Director of Health Care Policy,
Pioneer Institute of Public Policy Research

Opposed
Dr. Elizabeth Rosenthal, MD (NYC)
Asst. Clinical Professor, Albert Einstein College of
Medicine; Physicians for a National Health Plan

Dr. Theodore Marmor, PhD (NYC)
Professor Emeritus of Public Policy and Management,
Yale School of Management

MODERATOR: Dr. Jack Hughes, MD. Professor of Medicine, Yale School of Medicine

Yale University School of Medicine – Harkness Auditorium
333 Cedar St., New Haven, CT, 06510
Parking is available at the Air Rights and Howard Avenue Garages.

Event is free but seating is limited. Please reserve your seat at http://bit.ly/U1OaDk
For more information or to volunteer, contact daniel.yang@yale.edu

Thursday, January 24, 2013

HIT Scam

Greg Scandlen discusses "The HIT Scam" (HIT = "Health Information Technology").

When people and businesses adopt new technology based on their own rational assessment of their needs, they can save enormous amounts of money. But when government pressures businesses to adopt new technologies with top-down government mandates, we should not be surprised when they become expensive boondoggles.

Tuesday, January 22, 2013

Hsieh Forbes OpEd: Why Doctors Should Not Ask Their Patients About Guns

Forbes has just published my latest OpEd, "Why Doctors Should Not Ask Their Patients About Guns".

My theme is that physicians should not routinely ask patients whether they own guns, because it could compromise the integrity of the doctor-patient relationship.

Here is the opening:
Should doctors ask patients if they own guns? Currently, ObamaCare bans the federal government from using patient medical records to compile a list of gun owners. But following the Newtown, CT shootings, President Obama issued an executive order clarifying that “the Affordable Care Act [ObamaCare] does not prohibit doctors asking their patients about guns in their homes.” The American Academy of Pediatrics (AAP) similarly encourages physicians to ask patients if they own firearms — in the name of protecting child safety.
As a physician, I consider this advice misguided. Instead, physicians should not routinely ask patients whether they own guns, because it could compromise the integrity of the doctor-patient relationship.
I cite Dave Kopel (who was one of many scholars who debunked the standard 43-to-1 flawed statistic about the danger of guns in the house) and also discuss the little-recognized fact that swimming pools are far more dangerous to kids than guns, yet no one asks for background checks for pool owners.

And many thanks to Dr. Matthew Bowdish for permission to quote him at the end of the piece!

(Read the full text of "Why Doctors Should Not Ask Their Patients About Guns".)

Update: Thank you, Instapundit, for the link!

Tuesday, January 15, 2013

ObamaCare Job Creation

ObamaCare will create more jobs -- at the IRS.

IBD notes the following fact in their 1/11/2013 editorial, "ObamaCare Will Make The Maddeningly Complex Tax Code Even Worse":
All told, the IRS says it needs more than a thousand new auditors and staff to cope with ObamaCare. None of that will make taxpayers' lives any easier.
There's more information about today's IRS and the tax code at the link.

Monday, January 14, 2013

Proposed New NYC Medical Payments

New York Times: "New York City Ties Doctors' Income to Quality of Care" (1/11/2013).

Another possible headline: "Government bureaucrats and doctors' union negotiate over pay incentives to reward/punish doctors for practicing a certain way in NYC public hospitals".

Welcome to the future.

In principle, paying for performance is fine. But when metrics are chosen badly (or because they're easy to measure even when they have little bearing on actual quality of care), then you're setting the stage for all manner of unintended consequences.

One example are rules to pay/not-pay based on whether patients develop a certain type of catheter-related urine infection. These rules have resulted in switching to different protocols that reduce that particular type of infection, but can cause more patient pain (which isn't measured) and elevates the risk of different kinds of bladder infection and/or injury.

Of course, this isn't a problem limited to medicine. Nor is it solely a problem of government (vs. badly run private bureaucratic organizations). But far too many of the proposed "quality measures" I've seen are the equivalent of "security theater".

Yes, I've definitely seen many cases of quackery and bad medical practice. But the response by too many policy-makers has been to advocate purportedly "objective" or "evidence based" protocols, which many doctors criticize as being too rigid or "cookbook medicine".  Bad doctors can inappropriately use their medical autonomy unwisely. But the solution is not blunt tools that reduce medical autonomy across the board.

On a personal note, my wife Diana has some thyroid problems and she's an outlier on how she responds to certain treatments. If she were treated according to the standard protocols, she'd be in constant misery. Fortunately, she was able to find a physician specializing in her type of problem and is willing to judiciously stray outside the standard guidelines. As a result, she has done well.

But in many of the new payment models, this treatment course would be presumed to be bad medicine, even though it is completely appropriate for the small but non-trivial segment of the population that doesn't respond well to the standard therapy.

There's room for constructive debate on incentive structures and their effect on medical quality. I've practiced in academia (as a salaried university medical school professor), in a large HMO (Health Maintenance Organization) where doctors were paid on a "capitated" basis, and in traditional fee-for-service private practice. All of those systems have pluses and minuses, and all of those systems can create good incentives as well as perverse incentives to "game" the system.


My big concern is that proposed payment "reforms"
will not accomplish its stated goals, but will create far more unintended consequences than its proponents realize.

Sunday, January 13, 2013

Catron on Getting Hoist By Ones Own Petard

David Catron's latest American Spectator piece describes, "A Pimp for Obamacare Feels the Pain".

Specifically, he discusses a pro-ObamaCare supporter who is also an ER physician.  But as Catron noted:
He has finally discovered what I and others told him years ago: Medicare rules are, as he apparently now realizes, “arbitrary and disconnected from reality.” He has also noticed that, when a physician runs afoul of these bureaucratic vagaries, the government is the judge, jury, and executioner. The immediate cause of his disillusionment is Medicare’s trick of performing a superficial audit of a doctor’s billing practices and, based on a hopelessly flawed statistical sampling method, accuses him of fraud.
Read more at "A Pimp for Obamacare Feels the Pain".

And BTW, there are now 106 new ACOs (Accountable Care Organizations) for Medicare patients.

Here's the downloadable list (PDF format).

Friday, January 11, 2013

Patient Tips If Your Doctor Sells His Practice

Dr. Cary Presant has just written an informative blog post, "Your doctor has sold his practice: 6 tips for patients".

Basically, more and more doctors are leaving private practice to become hospital employees.

Many will continue to practice good medicine, but the new arrangement can also create some potential conflicts-of-interest when doctors have to balance the patient's medical interests against practice requirements imposed by their new employers.

Here are some of the tips offered by Dr. Presant:
  • First, when your doctor is recommending tests or treatments or hospitalization for you, take the time to ask if you really the treatments – ask if the doctor would do the same for a family member
  • Second, ask for a second opinion to determine if you need the recommended care – this should be your standard reaction when tests are ordered
  • Third, ask the office manager and doctor is there is a performance requirement in the practice to generate more tests, treatments or admissions – these “goals” could be influencing the doctor’s decisions regarding your treatment
  • Fourth, take notes and record conversations with the doctor (on a smart phone or small tape recorder); doctors will be very honest when answering direct questions
  • Fifth, ask the doctor if the recommended treatment complies with national guidelines, or if it is different and why. Don’t know the guidelines? Take some time to research them before committing to any treatment
  • Finally, if you suspect your doctor has a conflict of interest, always get another opinion and if necessary, find another doctor in whom you have complete confidence. There are multiple online databases and forums where patients comment and critique different doctors, facilities and treatment courses – take advantage of the experiences of others. 
Also, sometimes the national guidelines may be appropriate for your particular individual case -- and sometimes they may not be.  You may need to seek additional opinions to know if the care you receive is best for you.

More than ever, it will be up to you to be your own best medical advocate.

(Read the full text of, "Your doctor has sold his practice: 6 tips for patients".)

Thursday, January 10, 2013

Freedom Vs. Central Planning

Some compare-and-contrast.

NCPA: "How Consumer-Directed Plans Affect the Cost and Use of Health Care"

Some take home points:
[E]mpirical analysis suggests that people with consumer-driven health plans are able to achieve cuts in health spending while retaining quality care.
* In 2011, about 17 percent of Americans that were covered by their employers were enrolled in a consumer-directed health plan.
* Families that switched to a consumer-directed health plan spent an average of 21 percent less on health care. 
* Two-thirds of savings came from the fact that there were fewer episodes of care; the other one-third came from less spending per episode. 
* If enrollment in consumer-directed plans increased to 50 percent, there would be an annual savings of $57 billion.
In contrast, Peter Suderman discusses "Why Obamacare's Health Care Cost Controls Won't Work".

Wednesday, January 9, 2013

Adalja on Pre-Existing Conditions

Dr. Amesh Adalja has a new OpEd in the 1/8/2013 Forbes, "If Insurance Companies Can't Utilize Pre-Existing Conditions, Then They're Not In The Insurance Business".

One excerpt:
As part of a way to mitigate against excessive risk, insurance companies may elect to not insure an individual whom they judge possesses a high likelihood of incurring costs because of a pre-existing condition.  When insurance companies are barred -- by law -- from considering pre-existing conditions in their evaluation of potential customers, what is being prohibited is the exercise of judgment. In the place of the expertise of insurance actuaries, government fiat is substituted.

This ability of insurance companies to discriminate is essential because insurance companies are, properly, in the business of making money. It is the very profitability of insurance companies that allows their continued existence and the ability of many individuals to procure insurance policies. If insurance companies ceased to be profitable, their extinction would shortly be forthcoming and all individuals would be worse off.

What this decree of the Affordable Care Act will do, and is designed to do, is completely distort the entire insurance industry by rendering  painstaking risk calculations irrelevant.
Over time, this demonization of profit and forcing insurers to cover risks without compensation will destroy private insurance. Of course, for some single-payer advocates, the destruction of the private insurance industry is a feature not a bug.

(Read the full text of "If Insurance Companies Can't Utilize Pre-Existing Conditions, Then They're Not In The Insurance Business".)

Tuesday, January 8, 2013

Your Genome, Your Data

Susan Young: "Why We Have a Right to Consumer Genetics" (MIT Technology Review, 1/2/2013)

From the article:
Because interpreting the results is so uncertain and the relationship between genetics and disease risk is sometimes weak in the first place, some critics oppose selling these tests directly to consumers. Such sales are restricted in some countries, such as France, and in a few U.S. states, including New York and Maryland.

The American College of Medical Genetics and Genomics’ stance is that the tests should be taken with guidance from an expert who can assess the validity of the results and explain the actions that could be taken in response, says executive director Michael Watson. New studies on the connection between DNA and disease or drug response are published every week. Some of these studies establish a previously unknown link; others may add more weight to a known association; yet others may contradict or disprove what was once thought to be meaningful. “The results of many of these tests are very complex,” says Plon.

Yet this “father knows best” attitude is irksome to many; surely people have a right to such data about themselves, regardless of the complexity and ambiguity of the results. “To tell somebody you don’t have the right to access information about your own biology, for any reason, is pure paternalism,” says Misha Angrist, an assistant professor at the Duke University Institute for Genome Sciences & Policy.

Moreover, most family doctors, and even many specialists, are unfamiliar with genetic tests, and those who’ve been out of medical school for several years may have no training in genomics at all. In many cases, the consumer might well be better informed...

Monday, January 7, 2013

Gorman on CO Medicaid Expansion

The 1/4/2013 Denver Post reported on CO's planned Medicaid expansion.

They also quoted Linda Gorman of the Independence Institute explaining why this is "reckless". (More information at Patient Power Now.)

Friday, January 4, 2013

Medicare Whipsaw

ER doctor "Shadowfax" describes the Medicare whipsaw for physicians: "Medicare made the rules and now punishes doctors for following them".

The unintended consequences are due to a combination of coding rules, electronic medical records, payment rules, government definitions of "medical necessity", and presumption of guilt.

Tuesday, January 1, 2013

Light Posting Notice

Blogging may be lighter than usual for a while, due to some other demands on my time.

I will continue to post about noteworthy health policy issues and commentary as they come up.

I also wanted to say "thanks" to all who have helped encourage and support my work during 2012.

Here's to a healthy, happy, and productive 2013!

Monday, December 31, 2012

Catron: Court Updates

David Catron discusses some under-the-news-radar updates on recent ObamaCare court decisions in the American Spectator. Here's the opening to his piece, "MSM Gives Us the Mushroom Treatment on HHS Mandate":
In December, there were five federal court decisions relating to Obamacare. Chances are, however, that you will have heard about only one of them...
He also discusses why the one getting all the press is probably the least significant one.

(Read the full text of "MSM Gives Us the Mushroom Treatment on HHS Mandate" for more details.)

Wednesday, December 26, 2012

Hsieh Forbes OpEd: The Battle Of The Narrative

My latest piece is now up at Forbes, "The Battle Of The Narrative: How Ordinary Americans Can Fight ObamaCare".

Here is the opening:
The 2012 election ensured that ObamaCare will not be repealed anytime soon. But opponents continue to fight back. 26 state governments have declined to establish insurance “exchanges.” 40 lawsuits are still pending against various aspects of ObamaCare. Ordinary Americans may not be able to directly affect these battles. But they can play a key role in the all-important battle of the “narrative.”

As the problems of ObamaCare inevitably emerge, the big question will be whether they will be blamed on the residual free-market elements of our health system or on the new government controls. This will be the battle of the “narrative.”
I discuss how ordinary Americans can take part in this battle for their health freedom.

(Read the full text of "The Battle Of The Narrative: How Ordinary Americans Can Fight ObamaCare".)

Tuesday, December 25, 2012

Merry Christmas

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

Monday, December 24, 2012

Private Health Care in Sweden

The Guardian reports on, "Private healthcare: the lessons from Sweden" (12/18/2012).

A couple of excerpts:
During an hour-long presentation to the Guardian, St Göran's chief executive, Britta Wallgren, says the 310-bed hospital, serving 430,000 people, outperforms state-owned rivals inside and outside the country.

She says emergency patients see a doctor within half an hour, compared with A&E waits of up to four hours in the NHS. "We took an A&E department that dealt with 35,000 patients a year and now treats 75,000," Wallgren says. "As admissions grow and we have an increasingly elderly population so must our performance improve."

Capio stresses that St Göran has low levels of hospital-acquired infections, and patient surveys record high levels of public satisfaction. It has also produced year-on-year productivity gains – something the state cannot match. Thomas Berglund, Capio's president, says the "profit motive works in healthcare" and companies run on "capitalism, not altruism".
One patient who opposed the private sector used it nonetheless:
"I am one of those Swedes who do not agree that private hospitals should exist," says Christina Rigert, 62, who used to work as an administrator in the hospital but resigned "on principle" when it was privatised a decade ago.

Now back as a patient after gastric band surgery, she says: "The experience was very good. I had no complaints. There's less waiting than other hospitals. I still do not think there should be private hospitals in Sweden but it's happening."
Note that she attacked it, even while benefiting from it.

The system is not perfect.  But it is an encouraging step in the right direction for Sweden.

Now there is an potential reverse argument some might make along the lines of, "Limited government advocates don't think government program X should exist, but they still take advantage of that service while opposing it.  So they're also being hypocritical!" (For instance, roads, schools, libraries, Post Office, Social Security, etc.)

But one key distinction is that these government programs typically use force "crowd out" (either directly or indirectly) the private options, thus leaving ordinary citizens with limited or no choice except to use the government option.

In contrast, introducing private health options into a socialist system adds choice rather than reducing it. And if over time the private choices "crowd out" the government option, I consider that a feature not a bug.


(Read the full text of "Private healthcare: the lessons from Sweden".  H/T: Dr. Matthew Bowdish.)

Friday, December 21, 2012

Binik-Thomas: Obamacare and My Daughter

Justin Binik-Thomas discusses "Obamacare and My Daughter".

An excerpt:
In May, we were blessed with a beautiful baby girl. Three of her fingers were fused together.  We understand that it will become an issue later as she grows if untreated, but there is no pain or concern in the short term. She has full control of both hands, and is able to manipulate objects and feed herself, just as any six month old would do.

There will certainly be appointments before and after treatment that include the specialist and the primary care physician. Both offices are reporting that access to doctors is becoming more difficult. Both offices are reporting decreased options for medical services and for drug therapies. There is now a two-week wait for the doctor, because most patients require two appointment slots — one for discussing existing problems and one for discussing new problems. There is a six-month wait for non-urgent visits at the specialist. Since laws do not become simpler with time, it is a certainty that wait time for medical staff will increase as new regulations are rolled out.

We have met with various medical professionals to discuss treatment options. There were several possibilities discussed, and we were able to weigh these options for the best fit: Zoe’s surgery is scheduled for the day after Christmas.

We knew that surgery was likely in the near future and chose to select a top-notch full coverage insurance plan this year.

The hospital informed us that this is a fairly new operation perfected over just the last five years. However: this surgery will “cease to be available in two years for insurance patients due to ObamaCare.” This is a quote from the flustered nurse at the hospital.
Related video interview: "ObamaCare and Your Kids: How ObamaCare Limits Health Care for Children".

Under ObamaCare, the treatment of choice for his daughter would be amputation rather than reconstructive surgery.




Just don't call it rationing. (Via Instapundit.)

Thursday, December 20, 2012

Atlas: Doctors Soon Won't Accept Medicare

In the 12/18/2012 Forbes, Dr. Scott Atlas explains that "Let's Be Honest -- Medicare is Insolvent And Doctors Soon Won't Accept It".

A few key take-home points:
Medicare is spiraling into bankruptcy, owing to both the demographics of America and the realities about health care.

An increasing proportion of doctors are already not accepting Medicare patients, and the primary reason is low payment for services.

There's an enormous difference between having insurance and achieving access to medical care.
Politicians can pat themselves on the back for guaranteeing "coverage", but their dictates cannot guarantee that patients receive actual medical care.  Coverage does not equal care.

Dr. Atlas also offers some partial reforms that can help in the interim while we continue the battle for free-market health care solutions.

(Read the full text of "Let's Be Honest -- Medicare is Insolvent And Doctors Soon Won't Accept It".)

Wednesday, December 19, 2012

Specialist Shortages

The 12/16/2012 Los Angeles Times reports, "Healthcare crisis: Not enough specialists for the poor".

As always, politicians can promise theoretical "coverage".  But they can't guarantee that patients will receive actual medical care.

It won't be long before the problems in California's government-run Medi-Cal program (which is their name for Medicaid) spread to the rest of the country.

Monday, December 17, 2012

Catron: Kathleen the Terrible

David Catron's latest piece for American Spectator discusses the arrogance and corruption of HHS secretary Sebelius.

From his piece, "Kathleen the Terrible":
Even as her Hatch Act violation came to light, she launched a program that illegally postponed Obamacare’s cuts to Medicare Advantage until after the recent election. And it hardly needs to be said that her behavior since November 6 contains no hint of moderation. Since then, Sebelius has put in place a legally dubious pay-to-play program for selecting which health carriers can ply their wares in Obamacare’s insurance exchanges, and it has been discovered that a crucial contract involving the exchanges was awarded to a company that employs a former Sebelius underling who ran the very agency that awarded the contract.
Such cronyism is a predictable result of the ObamaCare law, which gives the Secretary enormous "discretion" in implementing the law.

For more details, read the full text of "Kathleen the Terrible".

Majority of States Opt Out of ObamaCare Exchanges

In the 12/14/2012 Investors Business Daily, David Hogberg notes "26 States Decline ObamaCare Exchange".

Here's the opening:
The federal government will likely be involved in running the ObamaCare exchange in at least 30 states, 26 of which expressly declined to establish state exchanges. One health-policy expert refers to it as an "administrative nightmare" for the Department of Health and Human Services.
The article also notes that the federal government didn't expect to have to run any exchanges themselves.  I doubt this next step into government-run health insurance will go smoothly for them. (Via Instapundit.)

Sunday, December 16, 2012

McGuff and Adalja on Mandatory Flu Vaccination For MDs

ER physician Dr. Doug McGuff explains, "A physician takes his flu vaccine under protest".

Dr. Amesh Adalja offered a different take in "Universal Flu Vaccination of Healthcare Personnel: A Patient Safety Issue" and in this short letter, "Flu vaccine: Should it be mandatory?"

In a free market, many of these potentially divisive issues would be easily handled by freedom of contract between physicians and hospitals.

Friday, December 14, 2012

Young Vs. Old Doctors?

If you're a patient, should you see a younger doctor or an older doctor?

Slate discusses the pros and cons here: "Is It Better To See a Younger Doctor or an Older Doctor?"

In short, young doctors might be more familiar with the latest developments and technique.  But older doctors might have more experience with unusual or tricky cases.

(The article is also careful to note that broad statistics might not apply to specific individual young or old physicians.)

The other twist is that young doctors appear to cost "the system" more, although the exact reasons aren't clear.  It may be because they tend to order more tests to make up for their lack of clinical experience.  Or perhaps some of them are seeing the sicker, more challenging patients.

(Note the Slate article suggests the opposite, namely that older doctors create higher costs.)

The policy implications aren't immediately clear to me, but I thought this might be interesting to those thinking of selecting a new physician.

In my Forbes piece from last month on protecting yourself from ObamaCare, I do note:
[I]f you’re approaching Medicare age (65) and your current doctor will retire in a few years, consider switching to a younger doctor now. Many doctors no longer accept new Medicare patients, and this problem will worsen with anticipated Medicare payment cuts. However, most doctors will continue seeing their current patients even after they turn 65. But if you wait until after age 65 to look for a new doctor, you may have a hard time finding one.


Thursday, December 13, 2012

Democrats Oppose Medical Device Tax

The 12/12/2012 Washington Examiner notes, "Democrats urge delay for 'job-killing' Obamacare tax".

It would have been nice if they had listened to the many people who warned about this issue earlier.

Some related pieces:
Joshua Lipana, "Medical Device Tax: Immoral and Impractical" (TOS Blog, 12/10/2012).

Paul Hsieh, "The Deadly Tax on Medical Innovation" (PJ Media, 4/11/2010)

Wednesday, December 12, 2012

Adalja on Organ Markets

Dr. Amesh Adalja explains, "To Save Lives, Allow Individuals To Sell Their Organs" (Forbes, 12/12/2012).

He also reminds us that the current ban on organ sales is a bipartisan idea:
In 1984, President Reagan, with the acquiescence of the Republican-controlled Senate and Democrat-controlled House, signed the National Organ Transplant Act (NOTA), banning the sale of human organs.
Fortunately, some groups like the Institute for Justice have begun to chip away at the ban by helping to win a lawsuit permitting compensation for bone marrow donors.

It's time to build on this success.

Quick Links: Patients, Resistance, Taxes

Forbes has recently published a pair of good analyses.

Sally Pipes: "Obamacare's Cruel War On Patient-Centered Healthcare" (12/10/2012).

Grace-Marie Turner: "A Resistance Movement Rises Against ObamaCare" (12/10/2012).

Meanwhile, the New York Times reports, "New Taxes to Take Effect to Fund Health Care Law" (12/8/2012).

Tuesday, December 11, 2012

ObamaCare Privacy Nightmare

In the 12/6/2012 USA Today, Parente and Howard warn of a "Potential ObamaCare privacy nightmare".

In particular:
ObamaCare's federal exchange, however, will be very different from these earlier efforts or emerging private exchanges such as eHealthInsurance.com. In order to determine eligibilty for health insurance subsidies, the new exchange has to bring together information about you and your family from the Treasury Department and IRS, the Department of Homeland Security, the Department of Justice, as well as your Social Security number — all coordinated by the Department of Health and Human Services.

The data gathering is sensible, in the abstract. Similar information is collected when you apply for a mortgage. But when the constantly updated information is combined in a central data hub, the potential for abuse is staggering. For one thing, the hub will have all the details needed to steal identities and fraudulently access credit.
This centralized collection of medical and financial data will be a tempting target for malicious hackers.  Or for malicious government officials.

(Read the full text of "Potential ObamaCare privacy nightmare".  Stephen T. Parente is a finance professor at the University of Minnesota. Paul Howard is director of the Manhattan Institute's Center for Medical Progress.)

Monday, December 10, 2012

The Lobbyist Feeding Frenzy Expands

The 12/5/2012 New York Times describes the accelerating lobbyist feeding frenzy in anticipation of new ObamaCare rules. In particular, lobbyists are working hard to have their particular pet items included in the state-level "essential health benefits" that all insurers must sell (and that consumers subject to the individual mandate will be forced to purchase).

From the article, "Interest Groups Push to Fill Margins of Health Coverage":
Most of the roughly two dozen states that have chosen their essential benefits — services that insurance will have to cover under the law — have decided to include chiropractic care in their package. Four states — California, Maryland, New Mexico and Washington — included acupuncture for treating pain, nausea and other ailments. It is also likely to be an essential benefit in Alaska and Nevada, according to the Department of Health and Human Services...

According to proposals that the states have submitted to the Department of Health and Human Services, insurance plans will have to cover weight-loss surgery in New York and California, for example, but not in Minnesota or Connecticut. Infertility treatment will be a required benefit in New Hampshire, but not in Arizona. 

Over all, the law requires that essential health benefits cover 10 broad categories, including emergency services, maternity and newborn care, hospitalization, preventive care and prescription drugs. But there is room for variation in those categories. Whether insurance will pay for hearing aids, foot care, speech therapy and various medications will vary significantly by state.
In other words, consumers will be compelled to purchase services they may neither need nor want, based on the political clout of special interest groups.  If a lobbying group can get the state government to compel coverage of their specific desired medical condition, it's like hitting the lottery,

This dynamic has already occurred in Massachusetts, under their system of mandatory insurance.  As a result, insurance costs have risen steeply for ordinary consumers.

To make matters worse, low-cost health plans without such mandatory benefits have been forbidden by the federal government:
Gov. Dave Heineman, Republican of Nebraska, chose an insurance plan with a high deductible as his state’s benchmark, reasoning that such lower-cost plans were popular in the state. But the Obama administration recently informed him that the plan did not meet the requirements of the law, he said.
We may or may not be able to stop the law from going into effect.  But as insurance costs go up, we must remember to place the blame squarely on the shoulders of the government, and not unfairly blame the private sector.

Friday, December 7, 2012

Thursday, December 6, 2012

Quick Links: ACO Spread, Device Tax, Rate Shock

Bruce Japsen notes: "Obamacare's Accountable Care Approach Reaches 1 in 10 In U.S." (Forbes, 11/26/2012):
The new analysis from consulting firm Oliver Wyman released Monday says the growth of accountable care organizations, or ACOs, has reached up to 25 million to 31 million patients, growing beyond the 2.4 million patients in the government's voluntarily program for seniors  covered by the Medicare health insurance program for the elderly to patients in private and employer-sponsored health plans.
If patients don't like their ACO, there's always this alternative: "Medical tourism booms in Costa Rica".

Reuters: "IRS finalizes new tax for medical devices in healthcare law" (12/5/2012)

Kaiser Health News: "State Insurance Officials Raise Concerns About 'Rate Shock' For Young People" (12/4/2012).

Wednesday, December 5, 2012

A Free Speech Victory Against the FDA

The 12/3/2012 New York Times reports, "Ruling Is Victory for Drug Companies in Promoting Medicine for Other Uses".
Under the Food, Drug and Cosmetic Act, which gives the F.D.A. the authority to regulate drugs, selling a “misbranded drug,” or one that is intended to be used for purposes not listed in the label, is illegal. Doctors, on the other hand, are free to prescribe a drug for any use. The agency has argued that off-label promotion of drugs is evidence that a sales representative or company intended to sell misbranded drugs. 

In its decision, the court said this view violated the First Amendment and cited as precedent a 2011 Supreme Court decision, Sorrell vs. IMS Health. In that case, the high court, citing freedom of speech, overturned a Vermont law restricting pharmaceutical companies from using prescription data for marketing purposes. 

“The government clearly prosecuted Caronia for his words — for his speech,” the majority wrote, concluding later “the government cannot prosecute pharmaceutical manufacturers and their representatives under the F.D.C.A. for speech promoting the lawful, off-label use of an F.D.A.-approved drug.” 
Let's hope this good ruling is upheld! (Via Virginia Postrel.)

Tuesday, December 4, 2012

MedCottage Innovation

This sounds like a potentially helpful innovation for many elderly Americans and their families: "MedCottage: An 'American Solution' for Eldercare".

As Ross England describes in his blog post for The Objective Standard:
[T]he MedCottage, is a pre-fabricated, modular, and portable “three-room apartment equipped like a hospital room. There are safety rails, lighted floorboards, and a wall with a first-aid kit and defibrillator machine.” Nicknamed the “Granny Pod,” the MedCottage “runs its water, electric, and waste disposal systems off the care-giver’s home systems.”
Dupin created the MedCottage to provide an alternative for caregivers whose parents need more constant care but who, for various reasons, aren’t willing or able to resort to professional nursing homes...
For more information, see the MedCottage webpage.

Monday, December 3, 2012

Central Planning Failures

So how are the various central-planning government medical initiatives working out?

"Patient Centered Medical Homes (PCMH)" -- not so well.

In the 11/30/2012 Forbes, Leah Binder notes "A Healthcare Plan That's Failing":
A troubling study in the Annals of Internal Medicine analyzes patient-centered medical homes (PCMH), and shows essentially no cost savings and minimal if any impact on clinical outcomes. This is the latest in a series of analyses notable for their consistent conclusions that the financial impact of PCMH is -- at best -- nonexistent or inconclusive.
How about electronic medical records?

The 11/30/2012 edition of Colorado Public Radio describes, "Colorado Docs' Difficult Digital Transition:
Wilkerson: We were told by sales people that we would make more money because we’d be more efficient, and you’d be able to see more patients,  We’d be able to bill faster, get the money in the bank at the push of a button. And none of that panned out.

Reporter: Wilkerson says they were told the practice would be able to see 25% more patients, meaning: more income. But she and her partners found they actually had to cut back on the number of people they could see.

Wilkerson: For the first couple months we were really probably only seeing 50%, and then tried to rampup to 75%. I’d say I never got above 80-85% of what I’d seen before, just because it’s time consuming.

Reporter: That meant Wilkerson and her partners were taking an unexpected financial hit, right after they’d borrowed $200,000 to buy the medical records software and the computers to run it.
And ObamaCare rules driving doctors out of private practice and into becoming hospital employees?

Two quotes from the 12/1/2012 New York Times article, "A Hospital War Reflects a Bind for Doctors in the U.S." contrast the theory with practice.

Here's the theory:
Many policy experts praise the shift away from independent practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better able to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law
But here's how it works out in actual practice:
Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.
The utopian visions of central planners failed to work for the economies of the Eastern Bloc countries.  There's no reason to think it will work for American health care. 

(CPR link via Ari Armstrong.  NYT link via Dr. Donald Palmisano.)

Saturday, December 1, 2012

Catron: Could Obamacare Go the Way of McCain-Feingold?

In yesterday's American Spectator, David Catron asks "Could Obamacare Go the Way of McCain-Feingold?"

He lays out his hope that repeated legal challenges could chip away at ObamaCare in much the same that repeated legal challenges eventually undercut the McCain-Feingold campaign finance restrictions.

I hope he's right.