Wednesday, October 2, 2013

McArdle On Faulty Obamacare Conventional Wisdom

Megan McArdle discusses, "11 Pieces of Obamacare Conventional Wisdom That Shouldn’t Be So Conventional".

Some of the interesting items on her list include:
1. Once Obamacare goes into effect, it will be impossible to substantially cut it back.
2. Accountable Care Organizations are certain to bring down overall health spending.
4. Emergency room use will decline.
5. People can game the system by going without insurance and then buying it when they get sick.
11. Obamacare will make bankruptcy a thing of the past, at least for the people who gain coverage. 
Click through to read more discussion of each of those (and other) items.

Tuesday, October 1, 2013

Physician Summit 2013: Speaker Profiles

The upcoming Physician Summit 2013 conference has posted their speaker profiles.

I won't be able to attend, but they have a good lineup, including Dr. Lee Gross and Dr. Kathleen Brown.

Click through to learn more about their program and how to register.




Speaker Spotlight The Physicians Summit 2013 is ramped up and underway for November 1-2 in Dallas.

We are pleased to present our Speaker Spotlight series — overviews of some of the excellent speakers you will hear at the Summit. In this, our first Speaker Spotlight installment, we’re honored to introduce Dr. Lee Gross, M. D., Co-Founder of Epiphany Health, National Executive Board member of Docs4PatientCare, and tireless champion for freedom and innovation in medical care and delivery.

It is also our honor to spotlight Kathleen M. Brown, M.D., Dermatologist, and owner of Oregon Coast Dermatology as our second speaker for the summit.

Monday, September 30, 2013

Hsieh Forbes OpEd: "Why The Federal Government Wants To Redefine The Word 'Cancer'"

October 2013 will be Breast Cancer Awareness Month.

Hence, it's apropos that Forbes has just published my latest OpEd on this topic, "Why The Federal Government Wants To Redefine The Word 'Cancer'".  Here is the opening:
The federal government wants to reduce the number of Americans diagnosed each year with cancer. But not by better preventive care or healthier living. Instead, the government wants to redefine the term "cancer" so that fewer conditions qualify as a true cancer. What does this mean for ordinary Americans — and should we be concerned?...
I discuss the reasons behind the proposed redefinition, why it could matter from a political (as well as medical) standpoint, and implications for both patients and doctors.

I'd like to thank Dr. Milton Wolf for providing the quote at the end!

(Read the full text of "Why The Federal Government Wants To Redefine The Word 'Cancer'".)

Sunday, September 29, 2013

Who's Exempt From ObamaCare

Here's a surprisingly long list of people exempt from the ObamaCare individual mandate.

According to this article in The Atlantic, the list includes:
  • You’re uninsured for less than 3 months of the year
  • The lowest-priced coverage available to you would cost more than 8% of your household income
  • You don’t have to file a tax return because your income is too low (Learn about the filing limit.)
  • You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
  • You’re a member of a recognized health care sharing ministry
  • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
  • You’re incarcerated, and not awaiting the disposition of charges against you
  • You’re not lawfully present in the U.S.
There are also the following "hardship exemptions":
  1. You were homeless.
  2. You were evicted in the past 6 months or were facing eviction or foreclosure.
  3. You received a shut-off notice from a utility company.
  4. You recently experienced domestic violence.
  5. You recently experienced the death of a close family member.
  6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
  7. You filed for bankruptcy in the last 6 months.
  8. You had medical expenses you couldn’t pay in the last 24 months.
  9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
  10. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
  11. As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.
  12. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.

And as Dr. Hal Scherz reminds us in his latest OpEd, "Healthcare Reform For Thee, But Not Me", those with political "pull" are also seeking their own waivers and exemptions.

Saturday, September 28, 2013

Friday, September 20, 2013

Khullar on Carrots and Sticks

New York Times writer (and medical student) Dhruv Khullar discusses how, "Medicine is More than Carrots and Sticks".

Here is the opening:
“Did you take it out yet?” my supervising physician asked me, referring to the urinary catheter I placed in a patient several days before. “You know they’re keeping tabs on that now?”
I did know. We had recently discussed performance metrics during morning rounds, and were taught that prolonged urinary catheterization caused many hospital-acquired infections. Hospitals were now being penalized for that sort of thing.
Several months before, I had attended a conference where there was a heated discussion about whether to tie reimbursements to how well physicians managed hemoglobin A1c levels – a marker of blood sugar control in diabetic patients. Some argued doctors would pay closer attention to diabetes control. Others thought they would simply select healthier, more compliant patients to make their jobs easier.

Suddenly, a stately gentleman stood up and the room fell silent. I recognized him as one of the most distinguished faculty members at my medical school, a legend that physicians across the state consulted on their most difficult cases.

“What on earth are we teaching these young doctors?” he asked, exasperated.

He stressed that a physician’s responsibilities — to avidly manage diabetes or blood pressure, to promptly remove a urinary catheter, to ensure patient compliance with medications — come not from incentives, but from a sacred duty we assume upon entering the profession. Overemphasizing the former while underemphasizing the latter, he argued, does a disservice to the medical profession and to our patients...
Yet all the "pay for performance" incentives are leading to precisely this kind of sterile, "cookbook" medical care.

This is one of the disturbing facets of American medicine under ObamaCare that I also discuss in my recent PJ Media piece, "How Big Medicine Will Affect Patient Care".

Thursday, September 19, 2013

Hsieh PJM OpEd: "The Eyes of Big Medicine: Electronic Medical Records"

PJ Media has published Part 3 of my 4-part series on the changing face of American medicine under ObamaCare, "The Eyes of Big Medicine: Electronic Medical Records".

I discuss the ObamaCare mandate for physicians to implement electronic medical records (EMRs), how this can harm patient care, and the government's agenda in using EMRs to control doctors.

Earlier articles in the series:
Part 1: "Your Future Under Obamacare: Big Medicine Getting Bigger".
Part 2: "How Big Medicine Will Affect Patient Care".

Tuesday, September 17, 2013

Catron on Obamacare's Latest Useful Idiots

David Catron adds labor unions to the list of "Obamacare's Useful Idiots".

They join the "not-very-exclusive society of organizations and individuals duped by the White House into supporting Obamacare" but now learning the error of their ways, including the American Medical Association, Big Pharma, the American Hospital Association, and Catholic Health Association.

Hey, at least misery loves company!

(For more details, read the full text of "Obamacare's Useful Idiots".)

Monday, September 16, 2013

Senator Milton Wolf?

Dr. Milton Wolf is reportedly considering running for the US Senate, challenging incumbent Pat Roberts in the 2014 GOP primary.

On his blog, he unveiled this catchy new logo:




If you want to learn more about his views, you can read his many columns at the Washington Times or watch his Daily Caller videos.

If Dr. Wolf decides to run, this could be a very exciting political development.  He is a practicing radiologist who's been "in the trenches" in the battle against ObamaCare. He has strong Tea Party roots, and is not beholden to the current GOP establishment.

I've featured many of his columns on the FIRM blog and they're worth reading. Although, I don't necessarily agree with all of his views on every issue, Dr. Wolf's candidacy could potentially move the country in the right direction.
It's time to stop Barack Obama

White House to Unions: No Waiver For You!

Washington Post: "Obama administration denies labor’s request for health care waiver".

Related story from Politico: "W.H. rejects labor’s bid for Obamacare exemption".

Sunday, September 15, 2013

"Giving" Commercial

This is a really well-done commercial from Thailand, entitled "Giving".

As Gawker says, "This three minute commercial puts full-length Hollywood films to shame".

Friday, September 13, 2013

Baehr: Is America Ready for Obamacare?

PJ Media has published part 2 of Rich Baehr's series on insurance under ObamaCare: "Is America Ready for Obamacare?"

He discusses specific answers to common questions about what Obamacare means to consumers.

Tuesday, September 10, 2013

Hsieh PJM OpEd: "How Big Medicine Will Affect Patient Care"

PJMedia has just published part 2 of my 4-part series on changes in American health care: "How Big Medicine Will Affect Patient Care"

Here is the opening:
The first article of this series described how the ObamaCare law is fueling the rise of government-controlled Big Medicine. This second article will take a closer look at how Big Medicine will control how what medical care patients can receive.
I discuss how government controls over health spending will lead to controls on the health care you may be able to receive. These controls interpose the government between the doctor and the patient, endangering the doctor-patient relationship.

Saturday, September 7, 2013

Direct Primary Care National Summit

This conference also looks interesting: "Direct Primary Care National Summit".

I won't be able to make it, but others might find it worthwhile.

Thursday, September 5, 2013

New John Lewis Essay

At The Objective Standard blog, Jared Rhoads reviews a newly-published essay by the late John Lewis, "There is No 'Right' to Healthcare".

From Rhoads' review:
Lewis describes two basic and conflicting views of rights in America today. One is the idea of rights as entitlements to goods and services. The other is the idea of rights as moral prerogatives to freedom of action.

The first view holds that if a person has an unmet human need—a need that could be satisfied by some good or service—then it is incumbent upon others who are able to satisfy that need to do so. In other words, needs impose duties.
Lewis explains that this view fails in two important ways. First, because human needs are boundless, the consistent application of the notion that needs impose duties would lead to
an endless creation of duties, and to ever-increasing government control over the lives of citizens, precisely because there is no end to the needs that one person may demand that others satisfy.
The other main problem, Lewis explains, is that imposing duties upon one person in the name of satisfying the unmet needs of another inescapably violates the rights of the first person. Applying this to health care, Lewis writes, “There is no right to medical care because there is no right to coerce medical professionals to provide it.”
I've just purchased the Kindle edition of the book, Medical Ethics, 2nd Edition (edited by Michael Boylan of Marymount University), and I look forward to reading the Lewis essay (as well as the other chapters)!

Baehr On Consolidation

Rich Baehr will also have a multipart series of articles on ObamaCare at PJMedia for the month of September.  His focus will be on changes in the insurance industry, whereas mine will be on changes in medicine and practice.

Here is his first piece, "Obamacare and the Consolidation Wave".

Key point: It is inevitable that many people who currently have insurance will wind up in new plans with new doctors.

Wednesday, September 4, 2013

Hsieh PJM OpEd: "Big Medicine Getting Bigger"

PJ Media has published my latest OpEd, "Your Future Under Obamacare: Big Medicine Getting Bigger".

This will be part 1 of a 4-part series on the changing face of American medicine, and what patients can do about it.  In part 1, I discuss how new laws are spurring the growth of government-controlled "Big Medicine".

Here is the opening:
Recently, there’s been an enormous shakeup in three traditionally stable professions — law, education, and medicine. But where law and education are moving towards decentralization and greater consumer control, medicine is moving in the opposite direction — towards greater centralization and less consumer (patient) control.

Why? Because the upheavals in law and education are being driven by market forces. In contrast, the upheaval in medicine is being driven by new government controls. Hence, Big Law and Big Education are struggling, while Big Medicine is growing.

This series of articles will discuss how the ObamaCare health law is fueling the rise of Big Medicine, what this will mean for patients, and how patients can respond to best protect their medical care...
(Read the full text of "Your Future Under Obamacare: Big Medicine Getting Bigger".)


Future installments will appear each Wednesday during the month of September at PJ Media.

Tuesday, September 3, 2013

Unions Increasingly Unhappy with ObamaCare

David Catron: "Unions to Get Yet Another Obamacare Break?"

Avik Roy: "White House Considers Awarding Obamacare Subsidies, Intended For The Uninsured, To Labor Unions"

The Hill: "Labor union frustration boils over with president on ObamaCare"

The unions are increasingly unhappy with ObamaCare.  Ideally, they should recognize that the law is fundamentally flawed, rather than merely asking for an additional special subsidy to sweeten the deal for themselves.  Which is why I'm not crying too many tears for their latest complaints.

After all, those subsidies will be coming from our pockets.

Saturday, August 31, 2013

Physicians Summit 2013

The upcoming Physicians Summit 2013 looks like a great event.

The conference will occur November 1-2, 2013 in Dallas, TX.  Participants can earn up to 17.25 hours of CME credit.  Go to the website for more information.

(I won't be able to attend because of my work schedule but I thought I'd list the lineup of topics and speakers below for those who might be interested.)

Keynote Speaker: Grace-Marie Turner

Featured participants include:
Dr. Lee Hieb, orthopedic surgeon, past president of AAPS, free-market author and lecturer... Dr. G. Keith Smith, anestheologist and pioneer in market-based, transparent pricing models, recently interviewed on Fox Business Channel's John Stossel show... Dr. Beth Haynes, Executive Director, Benjamin Rush Society, founder, Black Ribbon Project, Executive Board Member, D4PC, frequent speaker on how the free-market maximizes benefits for doctors and patients... Dr. Farid Naffah, anestheologist, author of the national attention-getting article "The Risks and Perils of Obamacare," and recently interviewed on FBN's Gerri Willis show...Howard Neiswender, expert in private practice and personal legal issues... Dr. Reed Wilson, cardiologist and internist, founder of Private Practice Doctors, medical consultant, and frequent guest on national media... Dr. Lee S. Gross, family medical physician, published cardiology and diabetes expert, and free market activist... Myra Roberts, CPA, CVA, AEP, estate and financial planning services to private practices, high net worth individuals, estates, and trusts... Dr. Arlen Meyers, MBA, President and CEO of SoPE, former Harvard-Macy Fellow, Fulbright Scholar, and named as one of the 50 most influential healthcare executives of 2011 by Modern Healthcare Magazine... Dr. Jeffrey Segal, neurosurgeon, CEO of Medical Justice, expert in minimizing litigation and online reputation management... others to be announced...
Topics to be fully explored during lectures, presentations, panels, and workshops include:
• Practical instruction on how to save practices from the onslaught of the new healthcare law and regulations
• Learning from those who have figured out how to practice medicine in a way that they love, is lucrative, and with much less hassle
• Getting back to what you went into medicine for — helping patients while receiving a fair compensation for your expertise
• Analysis of a for-profit surgical center that outperforms and undercharges non-profit hospitals
• Why and how doctors make great entrepreneurs
• Adopting a primary care practice model that's affordable for the uninsured and underinsured, and which you can ease into without having to stop taking insurance and Medicare...until and unless you want to
• Review of several practices that charge cash for time...for less than insurance co-pays
• Learning how to help local small businesses care for their employees by partnering with you and self-insuring
• Partnering with local diagnostic and imaging centers to provide your patients the best deal—creating win-win medicine
• Private Practice organizational structures and capital preservation
• To what end has Obamacare been designed to fail, why, and what's next?
• Maintaining a secure digital presence, both professionally and personally
• And much more...



































Friday, August 30, 2013

Mead: High Deductible Plans Creating Health Care Slowdown

Walter Russell Mead notes: "High Deductible Plans Creating Health Care Slowdown".

Although I don't think we should be seeking global "cost control" as a primary goal, individuals spending their own money based are doing precisely that. 

From his post:
So, these savings have little to do with Obamacare either way. Instead, they stem from exactly the kind of high-deductible, catastrophic plans that the ACA seeks to limit. The data simply points to a very intuitive principle: one of the best ways to make overall health care spending go down is for more individuals to spend less on it.
For many people, a high-deductible plan coupled with Health Savings Accounts allows them to best protect their health and their pocketbook according to their best individual judgment of their needs.

Thursday, August 29, 2013

Final Regulations For Obamacare Individual Mandate

Avik Roy: "White House Publishes Final Regulations For Obamacare's Individual Mandate -- Seven Things You Need To Know".

The bullet points include:
1. You pay a fine if your spouse and kids are uninsured
2. Pretty much any employer-sponsored plan meets the mandate’s requirements
3. The mandate fine is small, and will have even less impact over time
4. The IRS can’t go after you if you don’t pay the fine
5. Many older individuals will be exempt from the mandate
6. If you don’t file a tax return, you’re exempt
7. ‘Members of recognized religious sects’ and American Indians are also exempt
(See the full text of his piece for more details on each point: "White House Publishes Final Regulations For Obamacare's Individual Mandate -- Seven Things You Need To Know".)

Wednesday, August 28, 2013

Hsieh Forbes OpEd: "How Much Will Your Life Be Worth Under Obamacare?"

Forbes has published my latest piece, "How Much Will Your Life Be Worth Under Obamacare?"

Here is the opening:
How much will your life be worth to the federal government under ObamaCare? Less than you might think. We can make an educated guess by looking at which medical screening tests the government U.S. Preventive Services Task Force (USPSTF) considers worthwhile...
I also discuss problems with one-size-fits-all government medical recommendation, and how President Obama and his doctor knowingly violated guidelines set by his own federal task force.

(For more details, read the full text of "How Much Will Your Life Be Worth Under Obamacare?")

Tuesday, August 27, 2013

Catron: Sorry, Obamacare Isn’t Better Than ‘No Plan’

A core principle of medicine is "Primum non nocere" or "First, do no harm".

David Catron latest column explains how Obamacare has rendered U.S. health care far more dysfunctional than it was before "reform" was passed.

For details read his piece, "Sorry, Obamacare Isn't Better Than 'No Plan'".

Monday, August 26, 2013

Cronyism Update

The Hill reports, "ObamaCare's architects reap windfall as Washington lobbyists".

From the article:
Veterans of the healthcare push are now lobbying for corporate giants such as Delta Airlines, UPS, BP America and Coca-Cola, and for healthcare companies including GlaxoSmithKline, UnitedHealth Group and the Blue Cross Blue Shield Association...

The voracious need for lobbying help in dealing with ObamaCare has created a price premium for lobbyists who had first-hand experience in crafting or debating the law.

Experts say that those able to fetch the highest salaries have come from the Department of Health and Human Services (HHS) or committees with oversight power over healthcare.

Demand for ObamaCare insiders is even higher now that major pieces of the law — including the healthcare exchanges and individual insurance mandate — are being set up through a slew of complicated federal regulations...

(If you can stomach the sordid details, read the full text of "ObamaCare's architects reap windfall as Washington lobbyists".)

Saturday, August 24, 2013

The Holy War Over Obamacare

Both conservative and liberal religious groups are trying to claim that God is on their side on the political fight over ObamaCare: "The holy war over Obamacare".

Friday, August 23, 2013

Thursday, August 22, 2013

Wednesday, August 21, 2013

Armstrong Interviews Umbehr On Concierge Medicine

Ari Armstrong has just published the following interview: "Dr. Josh Umbehr on the Concierge Medicine Revolution".

They discuss various models of direct pay and concierge medicine, including pros and cons.  I especially liked Dr. Umbehr's advice to patients on how to best protect their medical freedom.

I highly recommend reading the full interview!

Tuesday, August 20, 2013

Friday, August 16, 2013

Massachusetts Update

Walter Russell Mead describes the latest from MA, "Romneycare Falters in Massachusetts".

Here's the opening:
Pundits on both sides of the political spectrum have noted that health care outcomes in Massachusetts are among the best indicators for Obamacare that we have, given the ACA’s similarity to Romneycare. Now a new study is out on MA health care, and it doesn’t paint a pretty picture...

Thursday, August 15, 2013

Quick Links: Limits, Subsidies, Rap

WSJ: "Many Health Insurers to Limit Choices of Doctors, Hospitals"

CA Health Line: "Half in Individual Market Will Qualify for ACA Subsidies in 2014"

ABC News: "Michelle Obama Promotes Healthy Living With New Rap Album"

Bourque on Adverse Selection

At The Objective Standard blog, Stephen Bourque discusses why "The Solution to 'Adverse-Selection' in Health Insurance is Selfish-Selection".

One critical point:
Insurance is a product that certain businesses produce for trade and profit. Insurance companies price their product by assessing risks and accounting for many variables involving the market and their customers. Insurance companies and their customers (properly) deal with each other voluntarily, by mutual consent to mutual advantage. Insurance, properly speaking, is a kind of voluntary contract.
The coverage for “pre-existing conditions” that insurers are forced to provide is, strictly speaking, not insurance at all.
(For more, read the full text of "The Solution to 'Adverse-Selection' in Health Insurance is Selfish-Selection".)

Monday, August 12, 2013

Shared Patient Appointments

With the worsening doctor shortage, some medical centers are resorting to "shared patient appointments".

Blogger-physician Dr. Wes explains:
As health care reform kicks in to high gear, a new innovation in health care delivery is being touted at Cleveland Clinic: shared patient appointments. On the surface, this idea seems so efficient and social as patients with similar medical problems sit around in a group therapy session that masquerades as health care. After all, with the large influx of new patients to our health care system underway and the limited health care personnel resources available, the push for such a model was inevitable.

But many Americans are also noticing another disturbing trend: higher insurance premiums to offset the cost of those who do not have sufficient resources to pay for their care.  While the reality of our higher health care costs demand that the added costs be paid by someone, I suspect most of those who will be paying higher premiums didn't think they'd have to "share" their physician appointments with others...
BTW, these become more popular in Massachusetts after the imposition of Romneycare, as described by the Boston Globe in 2008.  Some patients found it better than waiting a long time to see a doctor, others have serious problems with the lack of privacy.

Looks like the rest of the country is starting to catch up to Massachusetts.

Thursday, August 8, 2013

HHS Survey

Some friends recently received this request from the Department of Health and Human Services (HHS) to participate in a survey.

























They chose to decline, sending the interviewer away when he appeared on their doorstep.

My friends had two concerns: (1) How confidential is there information and (2) Is that $30 coming from taxpayer pockets?  I share their concerns.

Wednesday, August 7, 2013

Dr. Wes: A Case Of Fraud

Cardiologist/blogger "Dr. Wes" described an interesting medical ethics dilemma in his recent blog post, "A Case of Fraud".

In short, a cardiologist had to choose between doing what was right for the patient vs. following Medicare rules.

I don't know how often this happens. And I'm glad this particular doctor fulfilled his responsibility to his patient.

But we'll see more of these conflicts as Medicare imposes increasingly restrictive rules on how physicians are allowed to practice.  Many current doctors will still quietly do the right thing for their patients. But over time, we'll see a new generation of doctors more willing to comply with government edicts even if it goes against their Hippocratic Oaths to work for their patients' best medical interests.

And this isn't just abstract theorizing.

Some day, you might be that patient in the cardiac cath lab. On that day, you'd better hope you have a doctor still willing to act in your best interests.

(Read the full text of "A Case of Fraud".)

Tuesday, August 6, 2013

Amerling on Unaccountable Care Organizations

Dr. Richard Amerling of AAPS discussed "Unaccountable Care Organizations" in his latest OpEd. 

An excerpt:
How is the ACO different from the HMO? The difference is merely cosmetic. The ACO is composed of physicians, other “providers,” and administrators. It contracts with the Center for Medicare and Medicaid Services (CMS) to provide care for selected beneficiaries. It receives a lump sum per patient per month from which all care is to be provided. Money not spent on care (“profit”) is split evenly between the ACO and CMS.

Money spent in excess of the “bundled” payment is a loss to the ACO. The ACO can also receive incentive payments for achieving (and reporting) certain “benchmarks” such as lowering blood pressure or cholesterol level. These “quality” indicators, which are based on large population studies, will almost certainly lead to over-treatment of individuals, particularly the elderly.

Like HMOs, ACOs will face very strong incentives to cherry pick the healthy and to limit access to specialty care, procedures, expensive drugs, and hospitals. These incentives are devastating to the truly ill. And the ACO is accountable to CMS, not to the patient!...
(Read the full text of "Unaccountable Care Organizations".)

Monday, August 5, 2013

NYT on Transparency and Tourism

Two pieces from the New York Times caught my eye recently:

Tina Rosenberg (7/31/2013): "Revealing a Health Care Secret: The Price"

(Includes a lengthy discussion of price transparency and the detailed look at how this helps the Surgery Center of Oklahoma provide good service at lower costs for patients.)

Elisabeth Rosenthal (8/3/2013): "For Medical Tourists, Simple Math"

(Includes discussion of how medical tourism can allow patients to receive excellent care at lower cost.)

I'm glad these ideas are getting wider attention!

Sunday, August 4, 2013

Armstrong on His Wife's Experiences with Uterine Fibroid Embolization

Ari Armstrong has a nice write-up of his wife Jennifer's good experience as a patient with one of my partners.

Jennifer had pretty bad symptoms related to uterine fibroids.  Fortunately, my partner Dr. Brooke Spencer was able to offer "Uterine Fibroid Embolization" treatment, without risky surgery.




















For more details, see the full text of his post, "My Wife's Experiences with Uterine Fibroid Embolization".

I'm glad things worked out so well for Jennifer!

Wednesday, July 31, 2013

Kellogg on ObamaCare

James Kellogg has a nice overview of what's coming down the pike in his Grand Junction Free Press OpEd, "Obamacare is unhealthy for America".

Tuesday, July 30, 2013

Quick Links: Docs Avoiding Medicare, Patients Avoiding ObamaCare, Fat In NZ

Wall Street Journal: "More Doctors Steer Clear of Medicare: Some Doctors Opt Out of Program, Frustrated With Payment Rates and Mounting Rules" (7/28/2013).

From the article:
The number of doctors who opted out of Medicare last year, while a small proportion of the nation's health professionals, nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services, the government agency that administers the program. Other doctors are limiting the number of Medicare patients they treat even if they don't formally opt out of the system.
NPR: "Canvassers For Health Coverage Find Few Takers In Boca Raton" (7/29/2013)

BBC: "South African chef 'too fat' to live in New Zealand" (7/27/2013)

According to the New Zealand government, "It is important that all migrants have an acceptable standard of health to minimise costs and demands on New Zealand's health services..."

Monday, July 29, 2013

Catron on IRS and Hypocrisy

David Catron's latest American Spectator piece, "IRS: Obamacare for Thee but Not for Me".

Here's the opening:
Among the most offensive features of the ironically titled "Affordable Care Act" is its designation of the Internal Revenue Service as the main enforcer of the law’s many mandates, taxes, penalties, and reporting requirements. It exponentially increases the power of a group of bureaucrats notorious for repeatedly abusing their authority. Now, highlighting the growing gulf between the government and the governed that has become the hallmark of the Obama era, these IRS enforcers are asking their congressional representatives to spare them the indignity of enrolling in Obamacare’s insurance exchanges...

Roy/Ungar Forbes Twitter Chat on ObamaCare

Forbes recently hosted a Twitter chat, with Avik Roy and Rick Ungar fielding question from their followers.

Here's the link to the transcript.

Here's the question I asked, with their answers:





Friday, July 26, 2013

MA to Link Medical Licensure to Electronic Medical Records "Meaningful Use"

Coming soon -- new licensure controls in Massachusetts.

PhysBizTech reports, "Rule links meaningful use with medical licensure":
Starting in 2015, doctors in Massachusetts will have to show health IT meaningful use proficiency as a condition for medical licensing.

By the medical society’s estimate, [Massachusetts Medical Society President Ronald]Dunlap said, "probably 70 or 80 percent of physicians in the state using computers are probably adept, yet at least more than half of them would not meet the meaningful use standard."
MA State Senator Richard Moore gives the government rationale:
My feeling is that every physician and nurse practitioner and others who are primary care providers need to be involved in and utilizing health information technology, and if they’re not, then I don’t think they're practicing safe medicine.
In other words, another government mandate rammed down the throats of practicing physicians in the name of "safety".   Of course over time, mandated electronic records will be used to ensure that doctors are practicing according to government guidelines -- which may or may not be what's in the best interests of the patient.

(Via @MedEconomics.)

Thursday, July 25, 2013

WSJ on the New York Model

WSJ: "Obama's New York Model"

They note:
The real news is that New York ruined its individual insurance market two decades ago by imposing the same regulations that ObamaCare is about to impose on every other state. If the Empire State's premiums do now fall, it will be because the Affordable Care Act partially deregulates New York insurance.
Incentives matter.  (Via Dr. Richard Amerling.)

Wednesday, July 24, 2013

Hsieh Forbes OpEd on Zimmerman and Responsible Concealed Carry

Yesterday's Forbes published my latest OpEd, "The Single Most Important Lesson Gun Owners Should Learn From The George Zimmerman Case".

Here is the opening:
I am a gun owner. I support the 2nd Amendment and the right to self-defense. Although I’m not a police officer or a gun expert, I am one of the 8 million Americans with a concealed weapons permit. And the most important lesson I’ve learned from the George Zimmerman case is, “Don’t go looking for trouble”...

Monday, July 22, 2013

Wednesday, July 17, 2013

Adalja on The Right to Terminate One's Life

Dr. Amesh Adalja discusses an important right in his latest Forbes piece, "Does The Right To Life And Liberty Include The Right To Terminate One's Life?"

He asks:
What underlies the belief that it is the prerogative of the State to interfere with the doctor-patient relationship to forbid a physician from assisting in the suicide of a patient who has no meaningful chance of recovery?
In particular, he contrasts that with:
The view that a person is not a sovereign individual provides the false philosophical underpinning for this viewpoint, nullifying the right to liberty. Opponents of assisted suicide place sovereignty outside the individual and view individuals either as the property of a supernatural deity or mere vassals of the State. To them, assisting with suicide is interfering with “God’s plan” or the “interests of the State” and therefore criminal. Any appeal to individual rights falls upon the deaf ears of those to whom the concept of individual rights is meaningless.
I agree with Dr. Adalja's position.  (I know many of my conservative friends will disagree.)

As far as implementing such a right, I do think it's entirely appropriate for the state to make sure that any cases of purported assisted suicide are indeed such, rather than murder disguised as assisted suicide.  For instance, some proponents support protocols where the patient must take one final affirmative action (such as pressing a button on a machine) to complete the act. Similarly, the state has an interest in insuring that any agreement for assisted suicide was made by a patient with sound mind and full understanding of the meaning of his choice (i.e., that he is giving genuine informed consent to the procedure).

Furthermore, such a right does not mean that physicians should be compelled to offer this service, just because a patient requests it. Physicians should be free to decline to perform this for reasons of personal conscience (unless they've made contractual agreements otherwise). But this is true of any medical procedure.

But these are discussions of how to implement a proper law. The broader principle of the right to one's life and the full implications of that are covered nicely in Dr. Adalja's piece.

Tuesday, July 16, 2013

Catron on Smoker Penalty Snafu

David Catron points out in his latest American Spectator piece that ObamaCare snafus will mean that non-smokers will involuntarily subsidize the health costs of older smokers

In effect, this is caused by a combination of price controls and bad software implementation.

From his piece:
Last week the Associated Press reported, “In yet another health care overhaul delay, the administration has quietly notified insurers that a computer system problem will limit penalties that the law says the companies may charge smokers. A fix will take at least a year.” How will this force non-smokers to subsidize smokers? Well, from the perspective of insurance carriers, smokers are high-risk customers. They get sick more often than non-smokers and their maladies are typically serious and expensive. So, if insurance companies want to remain solvent and they can’t charge smokers higher rates, they will have to increase premiums for everyone.
For more details on how this can create an unintentional benefit for smokers, read the full text of "Latest Obamacare Foul-Up Favors Smokers".

Thursday, July 11, 2013

Less Than 99 Days

Washington Post: "Obamacare starts in 99 days. These 99 things need to happen before then".

I'm going to go out on a limb and predict that they won't all get done in time.

Tuesday, July 9, 2013

Fumbles and Failures

David Catron discusses, "Another ObamaCare Fumble".

Here's the opening to his piece:
The White House says the decision, announced last Tuesday, to delay implementation of Obamacare’s employer mandate was made because “a dialogue with businesses” revealed the need to reduce the reporting burden it placed on employers. This tale is enough to make a cat laugh. This crew doesn’t do “dialogue.”
Your BS detector badly needs a tune up if it didn’t start buzzing when Valerie Jarrett blogged, “We’re listening.” The delay is obviously due to the ineptitude of the Obama administration, and this is the fourth major provision of PPACA to be repealed or delayed for the same reason...
The Heritage Blog offers this related list, "Obamacare's Dirty Dozen Implementation Failures".

Monday, July 8, 2013

Dr Kravtiz' Innovative Surgery Practice

Great story of how innovation and transparent pricing create a win-win for both patient and doctor:

"For the uninsured, Dr. Alan Kravitz knows a way to beat the pain" (Pittsburgh Post-Gazette, 7/7/2013).

(Via Dr. Amesh Adalja.)

Monday, July 1, 2013

IBD On Medical Record Privacy

Investor's Business Daily: "Think NSA Spying Is Bad? Here Comes ObamaCare Hub" (6/25/2013)

As always, the government says, "Trust us -- we won't misuse this data".

But privacy experts discuss reasons to be skeptical.

Wednesday, June 26, 2013

Hsieh Forbes OpEd: "4 Questions To Ask During The Upcoming ObamaCare PR Blitz"

Forbes has just published my latest OpEd, "4 Questions To Ask During The Upcoming ObamaCare Public Relations Blitz".

Here is the opening:
The battle over ObamaCare will reignite soon, and the next front will be the war for public opinion. The American public remains deeply skeptical of the new law. Many Americans say they will not sign up for insurance in the new “exchanges” scheduled to open October 1, 2013. As a result, the Obama administration is preparing a high-profile public relations blitz to again sell the law to the public.

Here are 4 talking points ObamaCare advocates will attempt to promote — and 4 questions Americans should ask in response...
 I cover 4 topics, including:
1) "Free" benefits
2) "Coverage"
3) "Rights"
4) "Reform"
Plus there's a 5th bonus question at the end!

For more details, read the full text of "4 Questions To Ask During The Upcoming ObamaCare Public Relations Blitz".

Tuesday, June 25, 2013

The Coming Propaganda Campaign

David Catron discusses the "Get Covered America" campaign to get people to sign up for ObamaCare insurance.

One point he raises:
During the health reform debate, we were repeatedly told by the White House, congressional Democrats, and their media allies that there were teeming millions of uninsured Americans crying out for coverage. Why, then, are these hapless wretches not already lining up to sign up? If our uninsured problem were so desperate, why do we need Enroll America to round up and herd people through the exchanges? The answer to that question has long been obvious to those of us who bothered to do our homework — America’s uninsured problem was largely a work of fiction...
For more, read the full text of his piece, "Get Shafted America!"

On a related note, CNBC reports "Two-Thirds of Americans Don't Know If They Will Insure Under Obamacare".

Also, Secretary of Health Sebelius is trying to co-opt the NFL into becoming shills for ObamaCare.

This is just the beginning of the propaganda campaign to sell ObamaCare to a skeptical public.

Monday, June 17, 2013

Friday, June 14, 2013

Mataconis on Organ Transplants

Doug Mataconis: "Organ Transplants, Medical Ethics, And Children".

Like Mataconis, I don't blame Sarah's parents for pursuing every legal option to save her life.  Their job is to be her advocate.  I hope Sarah does well with her new lungs.

However, I am concerned that the judge's ruling could unleash new waves of litigation for future organ transplant decisions, and/or lead to a process where organ transplant decisions are wrongly swayed based on the political optics.

Thursday, June 13, 2013

Med Students in the New System

Washington Times: "Medical students' prognosis unclear with 'Obamacare'; many don't understand law".

Includes quotes from Dr. Beth Haynes of the Benjamin Rush Society and Docs4PatientCare:
“The interaction I have with students — they’re young and enthusiastic, and I don’t think they’ve had that much real-life experience understanding what lies ahead,” said Dr. Haynes, who also serves as senior policy analyst for Docs 4 Patient Care, which opposes the president’s health care law. “More physicians are going to become employees instead of small-business owners, and I have no problem with that decision, but then you’re getting to be more like civil servants.”

Not that there’s anything wrong with that, but Dr. Haynes and other physicians worry that the nation’s straight-A students aren’t pulling all-nighters in order to work someday for the medical equivalent of the Department of Motor Vehicles.

“What kind of individual is going to want to enter the medical school under those circumstances?” said Dr. Haynes. “That’s the concern of where things could be headed.”

Here's a video of Dr. Haynes discussing this in more detail on CNBC.

Tuesday, June 11, 2013

Catron on Sebelius and Lobbying

I have a lot of stuff on my plate right now, so blogging might be light for a while.

In the meantime, you can read David Catron's latest: "Has Sebelius Violated the Anti-Lobbying Act?"

Friday, June 7, 2013

McArdle on Young Invincibles

Megan McArdle asks, "Are Young, Single Adults Expecting Obamacare to Cost So Much?"

One excerpt:
Most young childless adults in most states could purchase catastrophic insurance right now for about the cost of a cell phone data plan.  They have not done so.  Maybe this is because they don't realize how cheaply they can acquire bare-bones coverage.  Or maybe they have a hard time fitting even $100 a month into a tight budget. The monthly take-home for someone making $32,000 a year and living in a major city is probably something under $2,000.  As I well recall, carving an extra $100 out of that is not easy.

Leave aside the hardship we may be imposing on them by requiring them to purchase insurance (or pay a penalty that will eventually sum to hundreds of dollars).  What are they going to do when they find out that they have the option of paying a fairly large sum for very modest coverage, or a really difficult amount for the kind of insurance that they thought they were going to get for practically free?  Keep in mind that California's exchange has actually been more aggressive about trying to keep rates down than most states will be.
Will [Wilkinson] implies that they probably won't buy.  I am agnostic.  The individual mandate is now the law of the land, and Americans are pretty law abiding.  Also, people clearly like having health insurance; they opt for more generous coverage even when it's not cost effective, and unions will give up almost anything else to protect health benefits.  This may be enough to get the healthy youngsters joining the exchange.
But then again, it may not.  And if they don't, that's going to be a really big problem.  Without the subsidies from "young invincibles" paying $150 a month for almost nothing, the older, sicker part of the insurance pool will have to pay more.  The healthier ones may eventually decide that they simply can't afford it; better to pay the fine, tolerate the tiny risk of a huge ER bill, and count on the fact that you can always sign up for insurance if you get sick.  Rinse and repeat until the only people in the market are incredibly expensive to cover.  This is what has happened to the current individual market in the State of New York, where everyone is theoretically able to buy insurance in the individual market, except that no one could possibly afford it...

We'll find out soon enough.

Tuesday, June 4, 2013

Monday, June 3, 2013

Obama Administration PR Blitz Coming

NPR reports on the coming ObamaCare PR blitz, "Obama's Next Big Campaign: Selling Health Care To The Public".

A couple of interesting excerpts:
But with the sign-up date approaching fast, the administration's efforts have already stumbled. Health and Human Services Secretary Kathleen Sebelius has repeatedly asked Congress for money to implement Obamacare.

Republicans have repeatedly said no, while they vote to repeal the law.

Without the money she wanted from Congress, Sebelius tried to fundraise for an independent group called Enroll America that is focused on implementing Obamacare. When Republicans heard that she was asking insurance companies and health care providers to donate millions of dollars, they cried foul.
And:
There's another key part of this campaign: Sicker and older people without insurance may be eager to sign up Oct. 1. But to make the system work financially, young and healthy people who don't need much medical care have to get into the pool, too.

So you can expect administration officials around the country to give lots more commencement speeches this season, telling captive audiences of 20-somethings: Congratulations on your diploma. Now make sure to sign up for health coverage in the fall.
As I noted in a recent PJ Media piece, ObamaCare depends on the willing participation of young people (and others) who will be harmed by the law.  Naturally, many are skeptical.

Friday, May 31, 2013

8 Minutes Per Patient

The New York Times medical writer Dr. Pauline Chen discusses how doctors in training are now spending on average only 8 minutes per patient each day.

Some excerpts from her piece, "For New Doctors, 8 Minutes Per Patient":
[R]esearchers found that interns were devoting about eight minutes each day to each patient, only about 12 percent of their time...

The dramatic decrease in time spent with patients compared with previous generations appears to be linked to new constraints young doctors now face, most notably duty hour limits and electronic medical record-keeping. The study found, for example, that interns now spend almost half their days in front of a computer screen, more than they do with patients, since most documentation must be done electronically...

When finally in a room with patients, they try to speed up their work again, but by limiting or eliminating altogether gestures like sitting down to talk, posing open-ended questions, encouraging family discussions or even fully introducing themselves.

“We have to ask ourselves if spending more time on electronic medical records than with patients is time well spent,” said Dr. Leonard S. Feldman, senior author of the study and assistant professor of medicine and pediatrics at the Johns Hopkins School of Medicine. “If you’re only spending eight minutes talking to and examining a patient, something is certainly going to be missing.”
The article also notes that this will set a pattern for how these young doctors practice in the future:
A young doctor’s experiences during training strongly influence how he or she treats patients once in practice. In addition, because observation of diseases and their myriad manifestations is critical to building a doctor’s clinical skills, some worry that today’s young doctors won’t have had enough interactions with patients to be able to recognize the more subtle signs and symptoms of disease or of impending emergencies when they begin practicing on their own.
The newest generation of doctors may thus be more reliant on standardized protocols, and less adept at independent clinical judgment.

The combination of government-mandated work hour limits and mandated electronic medical records could change American medicine for decades to come -- and not necessarily for the better.

(Read the full text of "For New Doctors, 8 Minutes Per Patient".)

Thursday, May 30, 2013

The Direct Pay Model Spreads

The Bangor Daily News reports: "South Portland doctor stops accepting insurance, posts prices online".

Some excerpts:
...[T]he decision to do away with insurance allows Ciampi to practice medicine the way he sees fit, he said. Insurance companies no longer dictate how much he charges. He can offer discounts to patients struggling with their medical bills. He can make house calls.

"I'm freed up to do what I think is right for the patients," Ciampi said. "If I'm providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense"...

Even with the loss of some patients, Ciampi expects his practice to perform just as well financially, if not better, than before he ditched insurance. The new approach will likely attract new patients who are self-employed, lack insurance or have high-deductible plans, he said, because Ciampi has slashed his prices.

“I’ve been able to cut my prices in half because my overhead will be so much less,” he said.
Before, Ciampi charged $160 for an office visit with an existing patient facing one or more complicated health problems. Now, he charges $75...
You can see the prices he charges on his website.

Another benefit to patients:
That time is crucial to Ciampi. When his patients come to his office, they see him, not a physician’s assistant or a nurse practitioner, he said.

“If more doctors were able to do this, that would be real health care reform,” he said. “That’s when we’d see the cost of medicine truly go down.”
(Read the full text of "South Portland doctor stops accepting insurance, posts prices online".)

For more on benefits of this "direct pay" model (or related "concierge" model), see my Forbes piece: "Is Concierge Medicine The Correct Choice For You?"

Tuesday, May 28, 2013

Cochrane on Doctor Owned Hospitals

University of Chicago economist John Cochrane makes some great points about crazy pricing in traditional hospitals. And why ObamaCare has restrictions on doctor-owned hospitals. (Hint, it's at the insistence of traditional hospitals who want to suppress competition).

Read the full text of his post, "Doctor-owned hospitals".

(Via Marginal Revolution.)

Thursday, May 23, 2013

Hsieh PJM OpEd: Is Obamacare's Fatal Flaw Taking Effect?

Yesterday's PJ Media has published my latest OpEd, "Is Obamacare's Fatal Flaw Taking Effect?"

I discuss how ObamaCare requires voluntary cooperation of people who will be harmed by the law -- which gives Americans a powerful weapon.  Don't be a willing accomplice to a law you don't support!

I'd also like to thank Dr. Megan Edison for allowing me to quote her.

Update: I'm also encouraged by the fact that some former supporters of the law appear to now be having second thoughts: "Unions break ranks on ObamaCare" (The Hill, 5/21/2013)

Wednesday, May 22, 2013

Trusting the Navigators?

WSJ: "Role of Health-Law 'Navigators' Under Fire":
At a private briefing with federal officials last month, committee aides say they were told there would be no criminal background checks for navigators or requirements that they hold a high-school diploma.

"Because navigators and assisters will have access to personal and sensitive information such as Social Security numbers and tax returns, we believe they should be held to the same hiring standard as U.S. Census and [Internal Revenue Service] employees," who get Federal Bureau of Investigation background checks, wrote Rep. Darrell Issa (R., Calif.), the chairman of the committee, and two other Republican members in a letter to the department.
In light of recent events, perhaps the government "navigators" should be held to even higher standards than IRS employees.

Monday, May 20, 2013

Catron on IRS and Medical Records

David Catron asks, "Has the IRS Already Seized Your Medical Records?"

I was particularly struck by this section:
You will note that the person from whom these records were stolen was not a doctor or a nurse, but a data analyst who was carrying around huge amounts of medical information on a laptop. And this is where you should begin to have real fears for your privacy. Your medical records, once the province of highly trained medical professionals, are now routinely accessed by all manner of individuals uninvolved in your medical treatment. And many of these individuals are not closely supervised by medical professionals. Indeed, many of the people who have access to your medical records are not supervised by anyone.

For example, if you visit the ER tonight, the hospital will send a claim to your insurance company. Before that happens, however, a diagnosis code must be assigned to your record. Who does that? Typically, it is someone in her pajamas who uses a laptop to remote into the hospital’s IT system from home after the kids are in bed. She is not a physician or a nurse, yet she peruses your records, interprets your doctor’s notes, and then chooses an ICD-9 code from a drop-down box. It is likely that no one employed at the hospital has ever met this person in the flesh. Hospitals increasingly connect with such contract coders via outside agencies.

Assuming this coder is completely honest and very productive, as are most of them, what happens if her eldest son is addicted to narcotics and knows that she has routine access to the names, dates of birth and Social Security numbers of thousands of people? He has a golden opportunity to commit identity theft. All he has to do is wait until she forgets to lock her screen when she gets up to toss a casserole into the oven or run to the bathroom. If he is computer savvy, and what adolescent isn’t, he can access and steal your information in a matter of minutes. Such opportunities arise every minute of every day, all across the nation.

The point here is not that electronic medical records are inherently bad. It is rather that, in their mad rush to pass Obamacare and the stimulus package, the President and his accomplices on Capitol Hill mandated clunky, insecure systems that can be abused by politicized government agencies, mismanaged by innocent but incompetent bureaucrats, or even breached by the kid next door...

(Read the full text of "Has the IRS Already Seized Your Medical Records?")

Thursday, May 16, 2013

More IRS-Health Record Problems?

Health Care IT News: "IRS faces class action lawsuit over theft of 60 million medical records"

 Scott Gottleib (Forbes): "The IRS Is Accessing Your Health Records. You Trust Them?"

Also from Gottleib: "Suit Alleges IRS Improperly Seized 60 Million Personal Medical Records"

In the second piece, Gottleib quotes from the complaint:
“These medical records contained intimate and private information of more than 10,000,000 Americans, information that by its nature includes information about treatment for any kind of medical concern, including psychological counseling, gynecological counseling, sexual or drug treatment, and a wide range of medical matters covering the most intimate and private of concerns,” the complaint states.

“Despite knowing that these medical records were not within the scope of the warrant, defendants threatened to ‘rip’ the servers containing the medical data out of the building if IT personnel would not voluntarily hand them over,” the complaint reads.
(Of course, the validity of these complaints presumably still needs to be established in court.)

Wednesday, May 15, 2013

Hsieh at PJM: Did the White House Try to Get a Conservative Columnist Canned?

PJ Media published my latest short blog post, "Did the White House Try to Get a Conservative Columnist Canned?"

I appreciate Dr. Milton Wolf's willingness to let me quote him in this piece. As he notes, what once seemed implausible, today seems possible.

I applaud Dr. Wolf's tireless advocacy efforts and always enjoyed reading his columns.  (We differ on some issues, but I agree with much of what he writes, especially on health care policy.)  I also want to give the Washington Times credit for ignoring that kind of government "hint".

Plus, it's in my self-interest to ensure that other radiologist-activists don't draw the wrong kind of government attention.  Hence, I very much appreciated today's Instapundit link.

If you haven't done so, you should check out Milton Wolf's website!

Quick Links: York, Samuelson

Byron York: "IRS scandal raises fears about enforcing Obamacare".

Robert Samuelson: "Overselling ObamaCare".

Tuesday, May 14, 2013

Catron on Grand Old Poseurs

In his latest American Spectator piece, David Catron explains why advocates of free-market health reform should not regard Republicans as their unconditional allies.

His piece, "The Grand Old Poseurs" discusses problems with positions taken by federal and state Republican officials including Speaker of the House John Boehner and Senate Minority Leader Mitch McConnell and Ohio governor John Kasich.

Catron is more optimistic about some new blood such as Senators Ted Cruz and Rand Paul. (For me, the jury is still out.) 

I'm definitely all in favor for holding our elected officials' feet to the fire on this issue, regardless party affiliation.

(For more details, read the full text of "The Grand Old Poseurs".)