Diana Hsieh Podcast on EMTALA

Diana's internet radio segment on the EMTALA law went well yesterday! For those interested in listening to the segment, here's her description and the links:

Do people have a right to emergency medical care?

On Sunday's Philosophy in Action Radio, I answered a question on emergency medical care. The question was:

Do people have a right to emergency medical care? EMTALA (a.k.a. the Emergency Medical Treatment and Active Labor Act) is a federal law that requires emergency rooms to stabilize any patient with an emergency medical condition, regardless of the patient's ability to pay. Is that proper? Is that the same as a right to medical care?

My Answer, In Brief: EMTALA violates the rights of doctors, based on the false premise of a "right" to health care. In practice, it's a disaster for doctors, hospitals, and the working poor. Ultimately, only scammers and advocates of government-controlled medicine benefit by it. Download or Listen to My Full Answer:

• Duration: 22:21
• Download: MP3 Segment

Tags: Altruism, Charity, Egalitarianism, Emergencies, Ethics, Free Society, Justice, Law, Law, Medicine, Politics, Poverty

Links:

• FAQ on EMTALA
• Cato Institute: Medicare's Origin: The Economics and Politics of Dependency by Charlotte Twight
• American College of Emergency Physicians: On EMTALA and The Uninsured
• Health Care Is Not a Right by Leonard Peikoff
• The Objective Standard: Moral Health Care vs. "Universal Health Care" by Lin Zinser and Paul Hsieh
• The Objective Standard: Health Care and the Separation of Charity and State by Paul Hsieh
• Freedom and Individual Rights in Medicine (FIRM), particularly its articles
• The History of Health Care Costs and Health Insurance by Linda Gorman

To comment on this question or my answer, visit its comment thread.

A podcast of the full episode – where I answered questions on taxes versus slavery, infanticide after abortion, emergency medical care, and more – is available here: Episode of 12 May 2013.

You can automatically download podcasts of Philosophy in Action Radio by subscribing to Philosophy in Action's Podcast RSS Feed:

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About Philosophy in Action Radio

Philosophy in Action Radio applies rational principles to the challenges of real life in live internet radio shows on Sunday mornings and Wednesday evenings. For information on upcoming shows, visit the Episodes on Tap. For podcasts of past shows, visit the Show Archives.

Upcoming Diana Hsieh Podcast on EMTALA

My wife Diana Hsieh will be covering the EMTALA law (Emergency Medical Treatment and Active Labor Act) as one of the topics in her "Philosophy In Action" radio show tomorrow morning.

Here's the question she'll be answering:

Question 3: Emergency Medical Care

Do people have a right to "stabilizing medical care"? EMTALA (a.k.a. the Emergency Medical Treatment and Active Labor Act) is a federal law that requires ERs to stabilize any patient with an emergency medical condition, regardless of the patient's ability to pay. Is that proper? Is that the same as a right to medical care? Does it matter that EMTALA only applies to emergency rooms that accept Medicare patients?

The other topics she'll be covering include "taxes vs. slavery", the Gosnell infanticide case, and how to work with an uncommunicative boss.

For more details on how to listen live (or listen to the podcast later), go to her page.

McArdle on Medical Innovation

Megan McArdle asks, "Has Medical Innovation Slowed Down?"

The teaser sentence:

The good news is that health care costs aren't rocketing away like they used to. The bad news is that drug discovery has slowed down too.

Benjamin Rush YouTube Channel

The Benjamin Rush Society (soon to be renamed the Benjamin Rush Institute) has a new YouTube channel.

According to executive director Dr. Beth Haynes:

You can now access all of the debates from the 2012-2013 academic year - the latest of which is on the issue of Maintenance of Certification. The full video of this particular is debate lengthy -- 2 hours. A volunteer is preparing a transcript from which I will work on creating an abridged version - but as that won't be available for several weeks, I wanted to make the full length version available now...

This topic is picking up steam, sparking initiatives in state medical societies(one example attached), a law suit, and news articles, a survey of physicians asking them to report actual costs for recertification, and vigorous discussion on various internet platforms.

I am thrilled that the work of BRS is relevant beyond medical school campuses, and able to provide medical students a place to get involved now.

 Kudos to Dr. Haynes for her great work!

Hsieh Forbes OpEd on 3D-Printed Guns

This isn't directly related to health care policy, but it's a hot topic that's been in the news lately.  Plus it's one of my other public policy interests, so I'm exercising blogger's privilege to post about it anyways!

Yesterday's Forbes published my latest OpEd, "Why 3D-Printed Untraceable Guns Could Be Good For America".

Here is the opening:

In the past few days, Forbes writer Andy Greenberg broke a pair of dramatic stories on Cody Wilson’s quest to build an untraceable plastic gun using commercially available 3D-printing technology. First, Greenberg published exclusive photos of the completed firearm, then he reported on a successful test firing of a live .380 cartridge.

Although the technology is still in its infancy, Wilson’s innovation has already sparked heated debate. Some gun rights advocates (including Wilson) argue this means current gun laws will soon be obsolete. They welcome the fact that home hobbyists may soon be able to build functioning firearms without any background check or government record. Others are alarmed, concerned that this would enable criminals to more easily obtain firearms. Congressman Steve Israel has already stated his intent to modify current laws to ban such guns.

However, Congressman Israel may be too late. Once thousands of motivated hobbyists start downloading open source gun designs and posting their refinements, we’ll likely see rapid technical advances. But Cody Wilson’s real impact on America may not be technological but political — and in a good way...

(Read the full text of "Why 3D-Printed Untraceable Guns Could Be Good For America".)

Update: I've gotten some helpful feedback on this piece.  I should make clear that I don't support government overreach with bad laws.  But neither do I support the anarchists who wish to misuse this technology to violate individual rights either. Instead, I regard this as a good opportunity to promote limited government as the proper alternative to both statism and anarchism. If I was insufficiently clear on this earlier, I apologize!

More Reactions to Oregon Study

Some more worthwhile commentary on the Oregon study:

David Catron: "Obamacare Pimps Smear Lipstick on Another Pig"

Megan McArdle: "How the Oregon Study Should Change Our Thinking"

More Lessons From the UK

Diana Furchtgott-Roth writes in RealClearMarkets: "For An Obamacare Preview, Look To England"

Oregon Surprise

Slate has just reported, "Bad News for Obamacare: A new study suggests universal health care makes people happier but not healthier".

Here's opening to the Slate piece:

In 2008, the state of Oregon initiated an ambitious health care policy that allowed researchers to shed light on the effects of guaranteeing Medicaid coverage for low-income adults. The results have been closely followed in large part because insurance for the poor is a major component of the Affordable Care Act—aka Obamacare—that will soon be rolled out across the country.

A study published on Wednesday in the New England Journal of Medicine reports that—at least as far as health outcomes are concerned—the Oregon Medicaid experiment hasn’t lived up to the hopes of many universal care advocates. Two years after getting randomly assigned to Medicaid coverage, recipients fared no better than a control group of uninsured, low-income Oregonians in tests for hypertension, cholesterol, and diabetes treatment—all medical conditions that can be managed with proper care. The Medicaid recipients did report much lower rates of depression and—perhaps relatedly—were much less likely to be on shaky financial footing than those in the control group. But the Oregon study’s findings indicate that the claim that universal health care on its own will make Americans healthier, at least in these particular dimensions, may be wishful thinking.

Here's the direct link to the NEJM article: "The Oregon Experiment — Effects of Medicaid on Clinical Outcomes".

Haynes: Almost All Americans Lack Health Insurance

Dr. Beth Haynes of the Benjamin Rush Society has a nice OpEd in the 4/29/2013 Huffington Post, "Almost All Americans Lack Health Insurance".

She adds much-needed conceptual clarity in the discussion over health policy by discussing the nature of genuine insurance, as opposed to our current system.  From her piece:

What is insurance? Think about your auto, life and homeowner's insurance. Each of these is designed as a means to pay for unexpected, unpredictable, very expensive occurrences outside of the control of the policyholder. Insurance is a means of financially protecting people from the risk of unlikely but high-cost events. To build up sufficient funds, the insured pays a premium calculated on their specific chance of experiencing a covered event. Insurance companies can only stay solvent if what they take in as premiums is greater than what they pay out in claims (plus business expenses and a competitive profit).

So what is it we have that we call health insurance but isn't? We have the prepayment of medical expenses. We expect our "insurance" to cover predictable, relatively inexpensive events like health maintenance checks, minor illnesses and injuries -- and to pay for them with minimal out of pocket spending. Under Obamacare, these expectations will be mandated by law. The new law actually makes it illegal for insurance companies to charge individuals premiums equal to their risk of making claims. It's like having a law requiring homeowner's insurance to pay for lawn care, house painting and water heater replacement, while at the same time prohibiting the companies from operating an actuarially sound business.

Instead of genuine insurance, we are moving towards a system of bad pre-paid care.

For more details, read the full text of "Almost All Americans Lack Health Insurance".

And by the way, under Dr. Haynes' leadership, the Benjamin Rush Society has been sponsoring an excellent series of debates on important health policy issues.  Go check out their website for details and videos!

Wolf: "Not Obamacare, but Patientcare"

Dr. Milton Wolf offers some good ideas to move America's health care system in the right direction in his latest Washington Times OpEd, "Not Obamacare, but Patientcare".

I'm an especially big fan of #1, 2, 4 and 5:

Tax fairness
Insurance portability 
Health savings accounts
End government monopolies 

Read the full text of "Not Obamacare, but Patientcare" for more details.

(As a side note, ultimately I believe programs like Medicare, Medicare Advantage, and Medicaid should be fully privatized. The government's job is to protect individual rights and freedoms, not provide entitlement programs. But these programs cannot and should not eliminated overnight. And there's ample room for debate on the precise timing/method for such privatization.)

Catron: "Can One Iraq Vet Stop Obamacare?"

David Catron has a nice article on Matthew Sissel's legal challenge to ObamaCare based on the Origination Clause, "Can One Iraq Vet Stop Obamacare?"

A couple of excerpts:

This 32-year-old artist, businessman, and holder of the Bronze Star is the plaintiff in Sissel v. U.S. Department of Health & Human Services, which Sissel sees as “a battle for my liberty — my freedom to live out my life to the fullest.” This is the only remaining lawsuit that has any chance of bringing down the entire health care law. His lawsuit, which was filed in July of 2010, was put on hold during the run-up to last June’s Supreme Court decision to uphold most of Obamacare. Ironically, that controversial ruling gave his case a new lease on life. 

And:

A variety of constitutional scholars have of course weighed in on the Sissel case. Last September Georgetown Professor Randy Barnett wrote, “If any act violates the Origination Clause, it would seem to be the Affordable Care Act. The Supreme Court has never approved the ‘strike-and-replace’ procedure the Congress employed here. This challenge might be a good opportunity to discover whether the Origination Clause is part of the ‘Lost Constitution,’ or whether it is still a part of the written Constitution that Congress must obey.”

(For more details, read the full text of "Can One Iraq Vet Stop Obamacare?")

Sissel also discusses his reasons in his earlier OpEd in the Christian Science Monitor:

I proudly served our country in the Iowa Army National Guard as a combat medic, spending two years in Iraq and eventually being awarded the Bronze Star. I mention that experience in order to drive home this point: While I am proud to have served my state and my country as a volunteer, I object to being conscripted into a federal health-care program that is at odds with basic constitutional principles of individual rights and limited government.

I see my lawsuit as a battle for my liberty – my freedom to live out my life to the fullest without costly, one-size-fits-all dictates from the government. I am fighting the command-and-control health-care plan in order to safeguard the health of our Constitution and the freedoms it protects for me and for all Americans.

Lewis On ObamaCare and Business Strategy

Certified financial consultant David Lewis asks small business owners, "Is Your 'Obamacare Strategy' A One-Way Ticket To Audit Hell?"

The IRS will be looking hard at businessmen trying to evade their ObamaCare requirements.

I've done a lot of reading about the health law's effects on doctors and patients, but know relatively less about how it affects the business community. Given that the law is expected to reach 1/6th of the US economy, I'm glad to read material from those with knowledge in this area.

Hsieh Forbes OpEd: Big Brother Has A New Face, And It's Your Boss

Forbes has just published my latest OpEd, "Big Brother Has A New Face, And It's Your Boss".

I discuss how government policies linking employment to health insurance create a powerful incentive for your boss to control his costs by controlling your lifestyle.

My takehome point:

...[I]t’s wrong for the government to use economic carrots and sticks to induce private employers to become enforcers of healthy behavior. This is just a subtler form of “nanny state” controls, such as NYC mayor Michael Bloomberg outlawing soft drinks he considers unhealthy.

And once employers start monitoring employee behavior on the grounds of “health costs,” there’s no end to the potential meddling. Who will be the next politically disfavored group after smokers or the obese? Do we want bosses discouraging their employees from owning guns or enjoying mountain biking on the weekends? This is a dangerous road.

(Read the full text of "Big Brother Has A New Face, And It's Your Boss".)

Haynes on MOC

Dr. Beth Haynes is quoted in this article, "Maintenance of Certification: A New Way to Control Docs?"

Many physicians worry that requirements like that are just thinly veiled attempts by hospitals, academics, and associations — what Kunkle calls healthcare’s “artificial aristocracy” — to control the way doctors work and interact with the healthcare system, not just how effectively they treat patients.

“If you think about lawyers, they pass the board once, that’s it,” says Beth Haynes, a family doctor in San Francisco and executive director of the Benjamin Rush Society, the physicians’ group that’s putting on the debate at the University of Pennsylania... Haynes is referring to the bar exam, of course. “That’s what we used to with board certification. It was a lifetime mark of achievement, period. But now it’s becoming this very intrusive way of trying to tell people how to practice. … It’s just complete micromanaging of physicians.”

$800 Heart Surgery

AFP: "In India, 'no frills' hospitals offer $800 heart surgery"

Using pre-fabricated buildings, stripping out air-conditioning and even training visitors to help with post-operative care, the group believes it can cut the cost of heart surgery to an astonishing 800 dollars.

Quick Reads: Catron, Held

I'm on the road for a few days and won't be blogging much. In the meantime, check out:

David Catron: "GOP at Fault for Obamacare Train Wreck?"

Twitchy: "Ophthalmologists walk out of Obamacare talk at national medical meeting"

Catron: Wheels Come Off Obamacare

David Catron discusses the growing recognition of serious ObamaCare implementation problems in his latest American Spectator piece, "Wheels Come Off Obamacare".

He discusses the problems in several arenas including the state "exchanges", the CLASS act, the "basic health plan", and the medical device tax.

Read the full text of "Wheels Come Off Obamacare" for more details.

Scherz on Circumnavigating Obamacare

Dr. Hal Scherz of Docs4PatientCare has a new OpEd, "Circumnavigating Obamacare".

He discusses how new ObamaCare "navigators" will be displacing independent insurance agents. Of course, these navigators will not necessarily be working for the customer, but will be beholden to the government that pays their salaries.

For more details, read the full text of "Circumnavigating Obamacare".

Medicare and Longevity

At Forbes.com, Christopher Conover asks an interesting question: "If Ray Kurzweil Lives Forever, Should Medicare Pay for His Health Care?"

Vecchio Policy Brief

Dr. Jill Vecchio is now a Healthcare Policy Fellow for tge Centennial Institute in Colorado.

She's written a health policy brief aimed at the general public entitled, "So You Want Affordable Care? Common Sense from a Practicing Physician".

I haven't read it yet, but I look forward to doing so!

BRS Debate on MOC

The Benjamin Rush Society has announced its next debate on health policy, scheduled April 20th in Philadelphia on maintenance of certification (MOC).

Here's the text of their announcement:

BE IT RESOLVED THAT

“Maintenance of Certification requirements fail to improve the quality of medical care while placing unnecessary burdens on physicians.”
 

IN FAVOR

Paul Kempen, MD, PhD (Cleveland, OH) Anesthesiologist; alternate delegate, Ohio State Medical Association; Board member, Academy of Medicine of Cleveland and Northern Ohio

Andrew Schlafly, Esq. (Far Hills, NJ)
Attorney at Law; General Council, AAPS 

OPPOSED
Martin Levine, DO, MPH (Bayonne, NJ)
Family Practice
Former president, American Osteopathic Association 

TBA

MODERATOR: Dr. Stanley Goldfarb, MD, Assoc. Dean, Perelman School of Medicine 

Saturday, April 20, 2013, 6:00 p.m.
Pre-Debate Reception at 5:30 p.m.

Perelman School of Medicine, University of Pennsylvania
Smilow Center for Translational Research - Arthur H Rubenstein Auditorium  
3400 Civic Center Blvd., Philadelphia, PA 19104

Parking is available at Penn Tower Garage 1 Convention Boulevard
Google Map: http://tinyurl.com/DebatePkngUPenn

Event is Free but seating is limited. Please reserve your seat at

http://tinyurl.com/BRSdebate-UPenn

For more information or to volunteer, contact Perry Evangelista, at perryev@mail.med.upenn.edu

Beth Haynes, MD
Executive Director, Benjamin Rush Society

Mitchell's Case For Optimism

Blogger Dan Mitchell offers a little bit of hope in his piece, "Why We Should Be Optimistic about Repealing Obamacare and Fixing the Healthcare System".

Here's the opening:

I’m going to make an assertion that seems utterly absurd.

The enactment of Obamacare may have been good news.

Before sending a team of medical attendants to cart me off to a sanitarium, allow me to elaborate. I’m not saying Obamacare is good policy. After all, I’ve written over and over again that it is a budget-busting boondoggle that will exacerbate our real healthcare crisis of third-party payer.

What I am saying, though, is that Obamacare may turn out to be a major political mistake for the left, one that sets the stage for sweeping free market reforms.

Basically, he argues that as ObamaCare problems unfold, we stand a chance at rolling back bad legislation -- if we can persuade voters that the problems are due to government interference in the marketplace (and not because of the "free market").

I basically agree with him. Our work won't be easy.  But it is an achievable goal, if we're willing to exert the necessary effort.

For more details, read the full text of "Why We Should Be Optimistic about Repealing Obamacare and Fixing the Healthcare System".

(Related: "The Battle Of The Narrative: How Ordinary Americans Can Fight ObamaCare".)

Quick Links: Vermont, Scherz

Vermont update: "Vermont doctors say health care reform will take away private practice". (Via Dr. Art Fougner.)

Dr. Hal Scherz on "Unintended Consequences" in medical training and in health legislation.

Medical Emergencies at 40,000 Feet

As a change of pace from health policy, I thought I'd blog about this interesting article from The Atlantic on "Medical Emergencies at 40,000 Feet".

A few excerpts:

Studies by the airlines and ground-based medical support services have found that a health care provider is available and responds in upwards of 80 percent of in-flight medical events. The truth is, though, that many health care providers find themselves attending to issues they don't see in their medical practices, and most have no specialist knowledge about aviation medicine or the medical resources aboard the plane. If asked, many health care providers will volunteer to help, especially if no one else is available, and this can lead to problems...

In addition to the goodwill of travelling physicians, all the major carriers in the U.S. have, for at least the past decade, also relied on ground-based physicians and nurses with experience in emergency care and additional training in aviation medicine. Based at centers including MedAire in Phoenix, the University of Pittsburgh Medical Center's STAT-MD program, the Mayo Clinic Aerospace Medicine program, and sometimes an airline's internal medical department, these experts work with the flight crew and volunteer health care providers on board over radio or satellite telephone to assess and stabilize sick passengers, to guide the decision whether to divert the airplane, and to organize the medical response on the ground...

According to Dr. Claude Thibeault, medical advisor to the IATA, "If you are caught in a medical emergency on-board, the first thing you should do is to ask if the airline has access to ground medical support. If so, then ask the flight attendant to call them immediately."

I've never been asked to respond to a medical emergency while flying.  But my brother (also a physician) has, and he said it was a bit nerve-wracking having to decide whether or not to divert the plane to the nearest airport.

(Read the full text of "Medical Emergencies at 40,000 Feet".)

CO Exchanges in Trouble

Katie Kerwin McCrimmon: "Tech troubles could hobble health exchange"

From the article:

Colorado’s health exchange is supposed to debut in just six months, but having the technology ready by Oct. 1 may be an impossible task.

Critical problems threaten the system, ranging from a lack of coordination with the state’s technology office and historic problems with state IT systems to poor oversight by exchange managers and contractors and the potential for serious conflicts of interest among those charged with creating the complex multi-million dollar exchange system...

Read the full text of "Tech troubles could hobble health exchange" for more details.

(Via Scott K.)

Quick Links: Doctors Retiring or Opting Out

MedPageToday: "More Docs Plan to Retire Early".

And what about those doctors remaining?

Sally Pipes notes in Forbes:"Fed Up With Obamacare, Doctors Increasingly Prefer Cash For Care"

HSAs Survive For Now

Merrill Matthews notes, "Health Savings Accounts Will Survive ObamaCare -- At Least For Now" (Forbes, 3/27/2013).

This is a little bit of good news!

Doctor Shortages Worsening

More on the upcoming doctor shortages and some consequences:

NY Daily News: "The doctor will see you...never".

Forbes: "Amid Doctor Shortage, Hospitals Turn To Dwindling Supply Of Nurses, Physician Assistants".

Kaiser Health News: "Group Appointments With Doctors: When Three Isn't A Crowd".

Hsieh Forbes OpEd: Is Concierge Medicine The Correct Choice For You?

Forbes has just published my latest OpEd, "Is Concierge Medicine The Correct Choice For You?"

I discuss the benefits of this practice model for both patients and doctors as well as dispelling some myths.

(Some of this material is drawn from my recent SnowCon 2013 talk, "Concierge Medicine: The Last Bastion of Health Care Freedom").

Denver-area readers might also be interested in this related recent short piece in 5280 Magazine:
"The Doctor Is (Always) In".

Quick Links: Catron, Scherz

David Catron offers his thought on the 3rd birthday of ObamaCare: "Obamacare: The World's Ugliest Toddler".

Dr. Hal Scherz asks a question that perhaps you should also ask: "Is Your Doctor Really A Doctor?"

Mead on Medical Breakthroughs And Smart Policy

Walter Russell Mead has a nice blog post on "Medical Breakthroughs And Smart Policy".

One excerpt:

The world is in the early stages of a golden age of biotech innovation, one that has the potential to revolutionize everything from health care and manufacturing to energy production. And the biotech revolution will build on and add to the infotech revolution that has been shaking the world for the last 50 years. The 21st century will be more different from the 20th than the 20th was from the 19th. And the 22nd century will be something else again, if we don’t kill ourselves en route.

VM never gets tired of pointing this out for one very simple reason: wonks who don’t keep the innovative dynamism of our age at the forefront of their minds as they think up new policies are likely to do more harm than good. Trying to build elaborate models for the future of healthcare based on today’s delivery systems and economic models is as futile as trying to build a national transportation model in 1830 based on the success of the Erie Canal.

I addressed a related issue in a 2010 PJMedia OpEd, "The Deadly Tax on Medical Innovation":

ObamaCare could thus strangle many promising developments in their cradles before they ever reached the marketplace, such as new cancer treatments, handheld diagnostic equipment, nanotechnology, etc.

And the worst aspect is that we will never know what new technologies could have been developed and how many lives they could have saved — an example of Frederic Bastiat’s principle of the seen and the unseen. As with any exponential process, small changes in the rate of growth will have a dramatic effect on the final total after twenty years.

I encourage folks to read the full text of Mead's "Medical Breakthroughs And Smart Policy".  (Via Instapundit.)

Wolf: Happy Birthday, Obamacare

Dr. Milton Wolf has a new OpEd in the 3/22/2013 Washington Times, "Happy birthday, Obamacare".

He discusses some of the initial lies and false promises used to sell the health law to the public 3 years (and the subsequent reality), including:

“[N]o matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period.”

“If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”

Obamacare will “cut the cost of a typical family’s premium by up to $2,500 a year.”

Dr. Wolf is not celebrating the 3-year birthday of the law.  Nor am I.

(For details, read the full text of "Happy birthday, Obamacare".)

Related story from Investor's Business Daily: "ObamaCare Turns Three: 10 Disturbing Facts Americans Have Learned".

Update: Link was broken, now fixed!

Adalja On Medical Marijuana

Dr. Amesh Adalja has a new OpEd, "Medical Marijuana Opposition Is Support Of Socialized Medicine" (Forbes, 3/20/2013).

One nice passage:

Laws against physicians prescribing marijuana—in the remaining 30 states that have not legalized it for medicinal (or recreational) use and by the federal government—are tantamount to the government dictating how medicine should be practiced, shoving its force-wielding hand in between a patient and physician.

What is paradoxical is that the same individuals who forcefully—and quite rightly—oppose the presence of the government in the healthcare realm in the form of the individual insurance mandate, bureaucratic requirements, restrictions on health care savings accounts (HSAs), pre-existing condition rules and the like, often are the most vociferous opponents of allowing marijuana to be used medicinally.

In reality, there is no difference between the government forcing its way into an operating room determining what operation a specific condition requires, and forcing its way into a doctor’s office to prohibit the prescription of a substance that a physician, after weighing the evidence in the context of a patient’s symptomatology, deems appropriate.

 (Read the full text of "Medical Marijuana Opposition Is Support Of Socialized Medicine".)

Quick Links: Catron, Scherz, Preston

David Catron: "Obama Shafts Poor and Minority Seniors Again" (American Specatator, 3/18/2013).

He notes that, the "[l]atest cuts in Medicare Advantage hits those who can least afford it."

Dr. Hal Scherz: "Why Pay Physicians Anything At All For Providing Healthcare?" (Townhall, 3/18/2013).

(As Dr. Megan Edison astutely observed, "Why all this attention to 'doctor pay' when it is only 8.6% of healthcare costs? Because controlling doctors by changing their compensation structure is how to control 1/5 of the American economy.")

Bryan Preston: "Thanks to ObamaCare, You May Soon Get Serious Medical Treatment from People Who Lack Medical Training" (PJMedia, 3/7/2013)

Hospitals Buying Doctors

In the 3/15/2013 Forbes, Scott Gottleib explains that, "Hospitals Are Going On A Doctor Buying Binge, And It Is Likely To End Badly".

One point:

The doctors will get squeezed but the real misfortunate will befall patients. We will increasingly be getting our medical care out of busy, hospital-run clinics. Our doctors will be salaried employees, more beholden to the rules that hospitals erect to manage their activities than the medical practices that they once owned.

He also has a related Wall Street Journal piece, "The Doctor Won't See You Now. He's Clocked Out".

In this piece, he observes:

Big government likes big providers. That's why ObamaCare is gradually making the local doctor-owned medical practice a relic. In the not too distant future, most physicians will be hourly wage earners, likely employed by a hospital chain.

Why? Because when doctors practice in small offices, it is hard for Washington to regulate what they do. There are too many of them, and the government is too remote. It is far easier for federal agencies to regulate physicians if they work for big hospitals. So ObamaCare shifts money to favor the delivery of outpatient care through hospital-owned networks.

Note that the patient becomes the least important party in this new system.

McArdle on Antibiotic Resistant Bugs

Megan McArdle warns, "Worried About Incurable Tuberculosis? Stand By for Incurable Everything".

Read the whole thing.

Also, Diana covered this topic in her 2/17/2013 podcast segment on, "Antibiotic Resistance in a Free Society".

Doctor Training Crunch

The Wall Street Journal reports, "More Medical Students Are In the Pipeline, but Too Few Residencies Await Them":

U.S. medical schools are expanding to meet an expected need for more doctors due to the federal health law. With at least 12 new schools opening and existing ones growing, enrollment is on track to produce 5,000 more graduates a year by 2019.

But medical educators are cautioning that those efforts won't do anything to alleviate a doctor shortage unless the number of medical residency positions rises as well. The number of federally funded residencies has been frozen since 1997...

 In other words, don't expect the doctor shortage to be alleviated in the near future.  (Via Dr. Richard Amerling.)

The Benefit of Direct Pay Models

Some of these "direct pay" models could be of enormous benefit to patients and doctors, while preserving health care freedom.

One important take-home point is that "direct pay" (sometimes known as "concierge medicine") isn't just for the wealthy.  Rather, there are many options evolving in the marketplace suitable for middle-class and poorer patients.

BTW, I'll be talking about this topic in greater depth in my lecture tomorrow for SnowCon 2013 entitled, "Concierge Medicine: The Last Bastion of Health Care Freedom".

Here's the abstract of the talk:

As the ObamaCare health law is phased in, patients will be increasingly subjected to government controls dictating what care they can receive and when. Fortunately, many doctors are responding by moving into various type of "concierge medicine" and "direct pay" practices where they can still treat patients according to their own best judgment relatively free from such government constraints.

This talk will discuss the rapidly growing field of concierge medicine, the various concierge models, why many patients can benefit from it, how to evaluate a concierge practice, and how and why patients can help defend the morality of concierge medicine. 

Scherz: Connecting The Dots

Dr. Hal Scherz of Docs4PatientCare has a new TownHall.com OpEd, "Connecting the Dots on Healthcare".

He makes a couple of important points, including that the current system will fail in a way that will lead to a push for government-run "single payer" care.

He also notes:

Another piece of the puzzle is hospitals. Their powerful lobby made sure that very favorable provisions were included in the ACA, giving them an unfair market advantage. They are consolidating, merging with other hospitals and  purchasing physician practices, leaving some areas of the country short of physicians in private practice. They are creating entities called Accountable Care Organizations -- similar to the capitated HMOs of the 1990s, only much worse. Anti-trust laws are being relaxed or ignored entirely to accelerate this process. The ACO is better suited to deliver government run healthcare because physician behavior is easier to regulate.

(Read the full text of "Connecting the Dots on Healthcare".)

Age-Based Rationing in Sweden?

Reader J.W. alerted me to this story in the Swedish news about apparent age-based considerations in drug subsidies.

Using Google translate, the article is entitled: "Age weighed in medicine bill" (March 10, 2013).

From the translated version:

Niklas Hedberg, head of the new drugs on the TLV, believes that there is an unfortunate wording, but that the work complies with legislation stipulating that they must weigh each consequence of a drug subsidy. 

-For us it is a very complex issue, the starting point is that society's resources for drugs is limited and we are commissioned to be those that prioritize the allocation between different patient groups. Since the legislation has made clear that we must weigh up different principles, and we will take account of drugs in a society holistically, says Niklas Hedberg. 

Would you expect that retirees actually costs if they survive? 

-What is unfortunate is that you can get the picture that it just is a matter of age, it only concerns pensioners. But I think your question is good and it is also very complex. Should we take into account that a patient can start working or not? It is then output effect comes into play.Consumption effect is always when you extend the life of a treat. 

Are pensioners lives worth less? 

-Everyone's health is valued as much, but the calculation model allows perched on top gives the socio-economic perspective, an added benefit of the treatments that allow the patient group can start working again.

In effect, those who are deemed more productive to society will be given higher priority in the national health system than those who are considered a net drain.

This is a nearly-inevitable outcome when medical care (and the system of payments) is considered a collective good that must be allocated accordingly.

The US isn't at this point yet.  But there are intellectuals and policy writers laying the groundwork for similar rationing here.

(One example is this article, "Principles for allocation of scarce medical interventions", co-authored by former Obama administration health policy advisor Zeke Emanuel, brother to former Obama chief of staff Rahm Emanuel.)

Catron: GOP Governors Squander SCOTUS Victory

An unfortunate update from David Catron: "Eight GOP Governors Squander SCOTUS Victory".

He reminds us that the 2012 Supreme Court decision

...dealt the Obama administration an important defeat on one of the two primary issues decided, namely whether the federal government has the right to withhold all matching funds from a state that fails to expand Medicaid according to the dictates of the unpopular health care law.

Medicaid is a joint state-federal program, yet a provision of Obamacare required the withholding of all federal funds from noncompliant states. The plaintiffs argued that this was so coercive that it amounted to an unconstitutional “commandeering” of the states. Seven of the nine justices agreed. This victory, despite the Court’s ruling that the individual mandate is somehow a tax, was viewed by many as an opportunity for GOP governors to thwart implementation of an integral component of the law.

To the disgust of Obamacare’s opponents, however, eight GOP governors have nonetheless decided to comply with the law’s Medicaid provision. Arizona’s Jan Brewer, Florida’s Rick Scott, Michigan’s Rick Snyder, Nevada’s Brian Sandoval, New Jersey’s Chris Christie, New Mexico’s Susana Martinez, North Dakota’s Jack Dalrymple, and Ohio’s John Kasich have all caved. Even worse, several of these people have been vocal opponents of Obamacare and govern states that participated in the lawsuit that produced the Court’s favorable ruling.

 He discusses the fiscal implications, then adds:

What makes this so infuriating is that these Republican governors are waving the white flag after winning a hard fought legal battle in order to escape this very dilemma.

 (For more details, read the full text of "Eight GOP Governors Squander SCOTUS Victory".)

BRS Interview with Dr. G Keith Smith

From Dr. Beth Haynes of the Benjamin Rush Society:

Alex Chamessian of the Duke chapter of the Benjamin Rush Society has set up the opportunity for all of us to watch Dr. Keith Smith, co-founder and managing partner of the Surgery Center of Oklahoma, via live web conference  tomorrow March 7 @ 12 PM EST.

The Surgery Center of Oklahoma is a physician-owned hospital which is changing healthcare in a positive direction. Check out their drastically reduced prices which they post on their website. I hope you can join us for this live presentation.

More information from Alex Chamessian:

Here is a great video introductino to Dr. Smith

http://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi

I'd like to invite all the BRS chapters to join us live:

https://www.youtube.com/user/dukebrs?feature=mhee

To participate in the Q&A on Google Hangout, people should sign up here with their Google accounts:

http://www.eventbrite.com/event/5708526356

Best,

Alex Chamessian, MS3

Duke University School of Medicine

Quick Links: Catron, Scherz, Brase

David Catron: "Privatization Shellacs Obamacare Model".

Dr. Hal Scherz: "Healthcare and Politics Do Not Mix".

Twila Brase: "The Obamacare exchanges aren't 'marketplaces'".

Benjamin Rush Society March Debates

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

     

  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.

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).

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.

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.

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.

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."

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.)

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:

• Michelle Minton's work at CEI
• The Wages of Sin Taxes by Christopher Snowdon and Michelle Minton (PDF)

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

• Duration: 58:26
• Download: Standard MP3 File (20.1 MB)

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?")

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...

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.

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.)

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.

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.

The Exodus Continues

Bruce Japsen: "1 In 10 Doctor Practices Flee Medicare To Concierge Medicine" (Forbes, 1/30/2013).

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.

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.

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.

Quick Links: Creative Destruction, ACOs

Dr. Eric Topol on The Creative Destruction of Medicine: "Hospitals, Office Visits of Little Use in the Future". (Via Dr. Richard Amerling.)

John Goodman: "ACOs and the Nationalization of Healthcare".