Catron: Pre-Existing Prevarication

In his 7/18/2011 AmSpec piece, David Catron lays out Obama's "Pre-Existing Prevarication".

He shows how candidate Obama (and later President Obama) twisted the truth of his mother's battle with cancer to create a politically useful -- but false -- narrative to justify his health care legislation.

I'm glad this story is getting the attention it deserves.

Quick Links: NHS, Waivers, Competition

The 7/15/2011 Telegraph reports on more problems with the British National Health Service: "NHS 'creaking at the seams' as waiting lists rise". (Via @DrAmerling.)

ObamaCare waivers are now up to 1,471.

John Goodman discusses how "Price Competition Can Lead to Quality Competition".

Helpful Health Care Negotiating Tips

Although there are a lot of problems with American health care, we still have a mixed (and thus still-partially free system).

If you want to take advantage of the freedoms we still have, here are some tips on "How You Can Negotiate Better Prices for Medical Care".

Some of their suggestions include:

Price comparison shop
Don't overplay your hand
Don't assume insurance is cheaper
Watch the clock

(Read the full text "How You Can Negotiate Better Prices for Medical Care" for more details on each of these points, plus some other tips.)

Will Colorado Follow Massachusetts?

John Graham and the Pacific Research Institute have issued a report that "shows how ObamaCare threatens the solvency of private health plans, which will significantly reduce consumer choice and increase costs. The ultimate result will likely be either a massive taxpayer bailout of private health plans or continued momentum toward a single-payer government-monopoly system."

Graham's report studies Massachusetts and Colorado. He concludes that continued government controls of health insurance will create a "cascade of insolvency", eventually destroy the private insurance market, and leave consumers with little choice but a government insurance option.

He also notes that one tactic used by statists will be to blame the insolvencies on failures of the free market, whereas they will actually be the fault of the government controls.

Of course, his analysis extends to the other 48 states -- not just MA and CO.

The report Bust or Bailout? The Future of Private Health Plans Under Obamacare is available at the PRI website. It can be downloaded here.

(Via Dr. Matthew Bowdish.)

Quick Links: IPAB, Consolidation, UK Starvation

At the 7/9/2011 Daily Caller, Chris Jacobs asks "Who am I to decide how my own health care should be handled?" (Via D4PC.)

Dr. John Mandrola notes how the government push to consolidate physicians will inevitably restrict patient choice. (Via @MatthewBowdish.)

The 7/11/2011 Daily Mail reports that the UK's National Health Service would rather let this 22-year old woman starve than perform the necessary stomach surgery.

Quick Links: Snoopers, Mandates, Medical Ghetto

The 7/11/2011 American Medical News discusses, "Why HHS abandoned 'mystery shopper' study". Short answer -- because of the public comments they received.

Most doctors are very upfront about the fact that they cannot afford to accept unlimited numbers of government patients. As the article notes:

...71% of family physicians are accepting new Medicare patients, according to a September 2010 study. Physicians also were asked how Medicare payment cuts would impact their practices. Nearly 75% said they would limit Medicare appointments, and 62% said they would stop accepting new Medicare patients.

We don't need mystery snoopers to learn this.

In the 7/10/2011 PajamasMedia, Rick Richman discusses "ObamaCare, ObamaCars, and Government-Mandated Broccoli".

Brian Schwartz at PatientPower notes that Medicaid is becoming the medical equivalent of a "ghetto" for poor Americans.

Black Ribbon Project Poster

FIRM is honored to be one of the groups, projects, and organizations fighting for free-market health care reform listed in the new Black Ribbon Project poster! (Click on the image to see it full size.)

They include:

Docs 4 Patient Care
AAPS
The Galen Institute 
The Benjamin Rush Society
Freedom and Individual Rights in Medicine
The Lucidicus Project
PatientPowerNow.org
Citizens' Council for Health Freedom
MediBid

Not pictured:
National Center for Policy Analysis

Hsieh PJM OpEd: The Coming Collectivization of American Health Care

The 7/11/2011 edition of PajamasMedia has just published my latest OpEd, "The Coming Collectivization of American Health Care".

Here is the opening:

In the 1930s, the USSR forced independent farmers into large state-run collective farms. Despite possessing some of the richest farmland in the world, these collective farms could not feed the country. By the end of the Cold War, the USSR survived only by importing Western grain. Unfortunately, the United States is about to make the same mistake in health care by collectivizing doctors and hospitals into government-supervised accountable care organizations (ACOs)...

(Read the full text of "The Coming Collectivization of American Health Care")

Note that this government-drive consolidation of doctors and hospitals into a few large provider groups is not some "bug", but rather a desired "feature", because it allows the government to more easily control what kind of medicine will (and will not) be practiced in the US.

Scherz On Spying

Dr. Hal Scherz of Docs4PatientCare has a new OpEd in the 7/6/2011 Health Reform Report on the just-cancelled government "secret shopper" program.

Here's an excerpt from, "Domestic Spying on Doctors -- Who Will Be Next?":

Although this plan is ostensibly tabled for now, we must not simply let it slide by. This type of behavior is sinister and malevolent. What were HHS and the White House hoping to discover that they already didn't know?  Physicians, of course, are limiting their practices to patients whose health insurance helps them meet their basic overhead of running a practice. If they don't stay in business, patients can't be treated.

For an Administration that has recognized that there is already a doctor shortage and that patients today have to wait longer to see a doctor, it certainly is disingenuous to make a "phony" appointment for a patient and takes a slot from someone who might desperately need it.

The greater problem is not with doctors, but with a government-run healthcare system (Medicaid, Medicare, state children's health plans) that has set reimbursements so arbitrarily low, that doctors cannot rely on it to pay the bills. The solution is not to conduct survey to gather information we already know. It is to allow patients to have financial control of their healthcare. In short, the government needs to get out of the healthcare business.

The information garnered from any potential survey would have undoubtedly been used by President Obama to blame doctors for the healthcare access problem. We could then expect a heavy handed response from the government to get doctors to behave, perhaps telling them that in order to practice medicine they must accept Medicaid patients or others on government programs. This is a formula that  Massachusetts has been trying to enact since Gov. Mitt Romney implemented his health reform plan. After that, government could instruct doctors on just about anything including edicts on how many patients they see daily.

Some may think this is farfetched or paranoid. But then again, who expected Obamacare to get this far?

Doctors are right to be mistrustful, given the Administration's lack of transparency through the health care process, including how the legislation was passed with back-room deals and how ObamaCare waivers were mysteriously granted to those with political connections.

Prediction: Look for a revival of this "secret shopper" idea after the 2012 elections are over...

Amerling: The End of Fee-For-Service Medicine

In the 7/5/2011 Health Reform Report, Dr. Richard Amerling discusses the latest attempted "reform" and what's wrong with it. Here's an excerpt from, "The End of Fee-for-Service Medicine":

The payment transition from the current fee for service to salaried status also also creates a loss of autonomy for physicians. Doctors will have no choice but to follow hospital dictates regarding length of stay, choice of medicine, and adherence to clinical practice guidelines, many of which are either obsolete or inappropriate. The practice of medicine will become textbook instead of individualized to the patient...

The payment transition from the current fee for service to salaried status also also creates a loss of autonomy for physicians. Doctors will have no choice but to follow hospital dictates regarding length of stay, choice of medicine, and adherence to clinical practice guidelines, many of which are either obsolete or inappropriate. The practice of medicine will become textbook instead of individualized to the patient...

FFS has been wrongly blamed for runaway health spending, when the real culprit is the third party system, unrestrained by meaningful co-pays or deductibles...

(Read the full text of "The End of Fee-for-Service Medicine".)

Dr. Amerling has it absolutely right. Eliminating fee-for-service will create perverse incentives for doctors and will ultimately harm patients.

Medical organizations should be left free to work out the best incentive structures that suit their particular needs and circumstances. It may include straight salary, salary-plus-productivity-bonus, or pure fee-for-service. For government to declare any one model as wrong and compelling doctors to work under its preferred system violates the rights of doctors and patients to contract to their mutual interest according to their best judgment.

Catron on Kagan

In today's AmSpec, David Catron gives a nice rundown on the debate over whether Judge Kagan should recuse herself from any Supreme Court proceedings on ObamaCare.

Read, "ObamaCare and Kagan's Conflict of Interest".

Here's a related story.

Quick Links: Wolf, Schwartz, Sidorov

Dr. Milton Wolf has a new piece in the 7/7/2011 Washington Times on signs of panic in the Obama administration over their failing policies, including the multiple ObamaCare "waivers". Read more at: "'No Drama' Obama Losing His Cool".

Brian Schwartz has a piece in the 7/6/2011 Huffington Post on problems with the Colorado SCHIP program, "Gov. Hickenlooper's Veto of SB 213 Insults Low-Income Parents".

Jaan Sidorov notes, "Parallels Between The Lessons of 'Reckless Endangerment' and the Ideological Promotion of the Electronic Health Record".

Crowdsourcing Benefits of Personal Genetic Testing

At FuturePundit, Randall Parker described how "Crowd Sourcing Identifies 2 Parkinsons Disease Genes".

Here's an extended excerpt from his post:

The folks at personal genetic testing company 23andme.com recruited Parkinson's Disease (PD) patients from mailing lists and other means and compared their genetic variants with a group of 23andMe customers who also got their genetic variants tested by 23andMe.

They used the resulting data to discover 2 more genetic variants associated with Parkinson's Disease. The results demonstrate the speed, low cost, and power of web-based recruiting to do genetic research outside the traditional academic framework.

We conducted a large genome-wide association study (GWAS) of Parkinson's disease (PD) with over 3,400 cases and 29,000 controls (the largest single PD GWAS cohort to date). We report two novel genetic associations and replicate a total of twenty previously described associations, showing that there are now many solid genetic factors underlying PD. We also estimate that genetic factors explain at least one-fourth of the variation in PD liability, of which currently discovered factors only explain a small fraction (6%–7%). Together, these results expand the set of genetic factors discovered to date and imply that many more associations remain to be found.

Unlike traditional studies, participation in this study took place completely online, using a collection of cases recruited primarily via PD mailing lists and controls derived from the customer base of the personal genetics company 23andMe.

Our study thus illustrates the ability of web-based methods for enrollment and data collection to yield new scientific insights into the etiology of disease, and it demonstrates the power and reliability of self-reported data for studying the genetics of Parkinson's disease.

You can read the whole open access Plos Genetics research report at that link.

What's cool about this: Using a web site and cheap genetic testing services people can volunteer themselves as research subjects on a scale that historically has taken far more effort to organize. This approach can scale into the hundreds of thousands, and even hundreds of millions of people. There's a big network effect where the more people who get tested the more useful genetic testing becomes.

Direct-To-Consumer (DTC) genetic testing is what made the study above possible. Whether we will be able to continue to get our DNA tested without paying for a doctor's visit and additional testing mark-ups remains to be seen. In the United States the Food and Drug Administration (FDA) is taking a dim view of DTC genetic testing.

(Read the rest of Parker's post: "Crowd Sourcing Identifies 2 Parkinsons Disease Genes".)

Here's the full PLOS Genetics paper: "Web-Based Genome-Wide Association Study Identifies Two Novel Loci and a Substantial Genetic Component for Parkinson's Disease".

I completely agree with Parker. Proposed FDA controls over the growing consumer genetic testing market not only deprive individuals of the right to learn the content of their DNA, but could also stifle the growth of new discoveries (and downstream therapies) made possible only by this sort of innovative free-market "crowdsourcing".

The FDA has no business stopping people from voluntarily sharing their genetic information with others in hopes that they might reap life-saving benefits.

(See also my July 2010 PajamasMedia piece, "Should You Be Allowed To Know What's In Your DNA?")

Lipana on the Sissel Challenge to ObamaCare

At the American Thinker blog ("ObamaCare: The Antithesis of the Founders' Vision"), Joshua Lipana posts about a recent article in The Objective Standard covering the lawsuit filed by Iraq war veteran Matt Sissel challenging the individual insurance mandate.

The TOS article, "ObamaCare v. the Constitution", was written by attorney Paul Beard of the Pacific Legal Foundation, representing Sissel. Beard covers the basic legal arguments in a fashion accessible to the layman.

Beard's piece does a nice job of covering the essential legal issues -- as well as putting a human face on what an individual mandate would mean.

Do-it-Yourself Health Reformers

David Chase has a fascinating interview with Dr. Brian Forrest, one of the best-known proponents of the "direct pay" model of primary care. Here an excerpt from, "How direct primary care reduces primary care costs":

In an age of family physicians literally not being able to give away their practices, Brian Forrest has built a successful model that is similar to the age of Marcus Welby where there was a direct relationship between a patient and their doctor. Practices such as Forrest's Access Healthcare in North Carolina run unencumbered by insurance hassles.

As word of Dr. Forrest's direct pay practice has spread, he has had a constant stream of physicians visiting his practice so others could learn how he has a successful financial model, happy patients and a sane lifestyle -- something increasingly less common in the hamster-wheel model of primary care that is prevalent in current fee-for-service based primary care practices. Dr. Forrest runs a cash-only practice sees 16 patients a day at a maximum, works a 40 hour week and takes home more than the average family physician a year with a highly satisfied patient base that pays less than those in fee-for-service, insurance models.

Dr. Forrest embodies a rapidly expanding cohort of what could be called Do-it-Yourself Health Reformers. That is, they aren't waiting around for politicians to fix what is widely understood to be the broken facets of healthcare. Rather, through their own trial and error, they are refining care and payment models that are demonstrating impressive results...

(Read the full text of "How direct primary care reduces primary care costs" for more information.)

Genuine health care reform doesn't require more government control, but rather unleashing the creativity and energy of individuals in a free market.

Update: Chase has a related article at TechCrunch aimed at businessmen and entrepreneurs covering some of these same issues: "How DIY Health Reform Can Help You Win The Talent Wars".

Update #2: Welcome Instapundit readers! Please feel free to take a look around. Our full list of published articles and OpEds (including several PajamasMedia pieces) is available here!

George Will Asks An Inconvenient Question

On ABC's This Week, George Will asks the inconvenient question, "Can Congress Require Obese People to Sign Up for Weight Watchers?"



Note how the other panelists duck, clearly uncomfortable with wanting to say "no" (because it would undercut the legal basis of ObamaCare, but also realizing what a "yes" answer would mean.

(Via Instapundit.)

Update: David Catron links to a transcript (plus commentary) of the relevant sections.

Happy July 4!

I'd like to offer my gratitude to all who have fought to protect and restore freedom and individual rights here in America. Enjoy this well-deserved holiday!

Zwelling on Medical Tourism

In the 6/22/2011 Investor's Business Daily Dr. Marcy Zwelling of AAPS discusses the rise of medical tourism.

Here's an excerpt:

For years, Canadians have crossed our northern border to access procedures not available in their government-only system, where the average wait in 2010 from seeing a primary care doctor to getting treatment by a specialist was 18.2 weeks. I don't imagine it will take long for those same patients and Americans to find their way to Istanbul or Bangkok.

While medical tourism is not appropriate for every situation or procedure, it is the wave of the future as patients look for affordable and timely care. Self-insured employers will surely look for better ways to cover their employees that don't jeopardize their businesses. It happened with the car industry back in the 1970s and is going to happen to U.S. health care.

Americans will find their way to the "best value" in health care. Sadly for American doctors and hospitals, that may soon be overseas.

(Read the full text of "Medical Tourism: A New Rx For Timely, Affordable Care".)

Quick Links: Medicare Myth, 6th Circuit, Death Star

In his 6/30/2011 Forbes post, Avik Roy debunks "The Myth of Medicare's 'Low Administrative Costs'".

In particular, Roy notes:

1) Medicare is partially administered by outside agencies
2) Administrative costs are calculated using faulty arithmetic
3) Medicare has higher administrative costs per beneficiary

(Click through to see more details on each point.)

Randy Barnett covers "Eight Things To Know About Yesterday's Sixth Circuit ObamaCare Decision".

In this 6/29/2011 Washington Examiner OpEd, US Senator Jim DeMint warns "Obamacare Death Star will strike soon". One excerpt:

In fact, Credit Suisse has told clients that forcing employers to drop coverage is "exactly what was intended" by the law. This was the main goal of many advocates of ObamaCare --to completely replace private insurance with a single-payer government healthcare system.

(Via Dr. Matthew Bowdish.)

How the FDA Impedes Innovation

GMU economics professor Alex Tabarrok discusses a disturbing example of "How the FDA Impedes Innovation".

In particular, he cites the case of the FDA using unrealistically strict criteria to reject a melanoma (skin cancer) detection device. In particular, he notes:

But even if MelaFind is not perfect today nor appropriate in all circumstances it’s exactly the type of innovation that we should encourage. Devices such as MelaFind could not only improve medical care they can reduce costs and make good quality medical care more widely available in developing countries, for example, where experienced dermatologists are in short supply.

Most importantly, innovations get better over time. But if you impede the first generation the second generation may never come into existence and, as Mandel notes, no first-generation device could satisfy the FDA's conditions. It's like refusing to give the Wright Brothers a license to fly because their first airplane only flew for 59 seconds...

By stifling promising fledgling technologies in their infancy, the FDA thus deprives us of countless future improved versions as well. But because we don't know what will never be invented, we don't know what life-sustaining benefits we're missing out on.

The FDA's policies thus represent just another (deadlier) version of Bastiat's principle of "the seen vs. the unseen".