Siegel: "ObamaCare, Now What?"

In the March 26, 2010 Forbes, Dr. Marc Siegel points out that all the new promised ObamaCare "coverage" won't translate into actual patient care.

Here's an excerpt from "ObamaCare: Now What?":

When many of the real ObamaCare changes finally do take hold beginning in 2013, my patients will find that the world of their medical care will get even worse, not better. Hospital ERs will be even more crowded with the newly insured. Doctors' offices will be swamped.

Beginning in 2013 16 million more people will be eligible for Medicaid, but where will they go for care? I don't accept Medicaid now, because it doesn't pay my office expenses, and I won't accept it then, even if the reimbursements increase slightly for two years. Without a network of specialists to refer Medicaid patients to (specialists fees will not be increased), I won't be able to work with it any more in 2013 than I am now.

In 2014 patients with pre-existing conditions will be able to obtain insurance no matter whether they are working, healthy, or sick. Many will qualify for federal subsidies. But where will this group go for care? My office practice is already full. And I must admit that once the health reform bill takes hold in a few years, if I do have an opening in my overburdened schedule I will be more inclined to see a patient with a single problem rather than a complex patient. Insurance may cover those with multiple pre-existing conditions but this doesn't mean I will be able to take care of them.

(Read the full text of "ObamaCare: Now What?")

Most doctors already understand that "coverage" does not equal "care". The rest of America will learn this lesson soon.

(Via Medical Progress Today.)

Watkins: Massachusetts Law Would Turn Doctors Into Serfs

Don Watkins of the Ayn Rand Center for Individual Rights writes about a proposed new law in Massachusetts that would compel doctors to accept patients covered by the state's "Affordable Health Plans" or else lose their medical licenses.

In other words, doctors would have to treat these patients and accept what the state determines is an "acceptable" payment or else lose their ability to practice in Massachusetts.

This is specifically designed to prevent doctors from "opting out" of the state-run insurance system. As Watkins notes, the "Massachusetts law would turn doctors into serfs".

Given that ObamaCare is closely modelled after the Massachusetts plan, expect to see Congress propose something similar at the national level once ObamaCare's failure becomes more apparent to doctors and patients. Massachusetts is again the canary in the coal mine for the rest of America.

Cancer Research and Collectivism

Scientific American notes the developing tension between modern cancer research, which is making strides in "personalized medicine" based on your specific genomic data, and the current government push towards "cost effectiness" guidelines, which encourage physicians to treat patients according to aggregate population statistics.

The article notes that "the changing policies... present 'a conundrum' for cancer work":

The first challenge is that comparative effectiveness research, by necessity, focuses on broad populations of patients. But as [Duke University researcher Amy] Abernethy pointed out, "in oncology, we take care of individuals." Newly prioritized research might turn out new results about treatments that are best for most breast cancer patients with a defective HER2 protein, for example, but many other individuals with different genetic factors might still need trial-and-error treatment until research finds what works best for them.

Government "guaranteed" health care will accelerate this push where collectivist treatment guidelines and goals are favored over benefitting the individual.

For more on this, see the piece by Dr. Jane Orient, "Forget the Trees; Look at the Forest on Healthcare":

Traditionally, medicine is practiced by physicians, one patient at a time. The outcome is assessed by that patient. The right decision is the one chosen by the patient, in consultation with the physician, based on what is optimum for that patient, considering all aspects of his circumstances. The standard of care is the Oath of Hippocrates: providing treatment for the good of each patient according to the best of the doctor's ability and judgment.

In the "reformed" delivery system, healthcare is practiced from on high by committees of "experts" pulling the strings of marionette physicians (rankings, payment rates, other incentives and disincentives) who are judged on how well they achieve population-based outcomes. Patients are like sheep in the flock, categorized by race, income level, quality-adjusted remaining years (QARYs), compliance, functional ability, diversity score, or whatever metrics the rulers adopt. Any individual can be sacrificed for the good of the whole.

One indicator that ObamaCare will be running into fiscal trouble will be calls by government officials and pundits for further "sacrifices" by patients for the sake of the collective. And for some reason, the sacrificial victim will always be you! Funny how that works...

Cash Only Physician Practice

North Carolina physician Brian Forrest runs a very successful cash-only practice. During this short video presentation, he explains how his method saves his patients money, reduces Medicare costs, preserves high quality care, and improves access:



This is truly a win-win for patients and physicians.

Of course, if a significant fraction of American physicians move to this model, we would also need to more urgently eliminate licensing laws that artificially restrict the supply of physicians.

(Via George Berger.)

Hsieh Oped at PJM: "ObamaCare: Insurers Need Permission to Survive; Citizens, to Live"

The April 25, 2010 edition of PajamasMedia has published my latest OpEd, "ObamaCare: Insurers Need Permission to Survive; Citizens, to Live".

My primary theme is that ObamaCare and other recent developments in Massachusetts bring us perilously close to what Ayn Rand calls the "ultimate inversion" where tyrannical government can do anything it please, whereas ordinary citizens can do nothing without government permission.

My secondary theme is that the Tea Party movement must move to the next level of promoting proper limited government, based on the principle of individual rights.

Here is the introduction:

Suppose our government declared that everyone had the “right” to a nice steak dinner. The government would require restaurants to sell $50 steak dinners to all comers. But to keep prices affordable, restaurants could only charge $25. No restaurant could survive long under such a scheme, and most Americans would be outraged at such a blatant violation of restaurant owners’ rights.

But that is exactly what is happening with health insurance in Massachusetts. Events unfolding now in the Bay State should serve as a warning to the rest of America of the danger ObamaCare poses to our health insurance, our health care — and ultimately our lives.

(Read the full text of "ObamaCare: Insurers Need Permission to Survive; Citizens, to Live".)

A Tiny Bit of Freedom

The April 20, 2010 Denver Post reports that a proposed Colorado law would allow health insurers to give discounts to customers who choose healthier lifestyles.

The program is still subject to numerous state regulations. So it doesn't create a free market by any means.

In a fully free market, insurers would be able to offer any prices they wished to customers, who would in turn be free to accept or reject those terms.

Many would likely choose to offer steep discounts to healthy customers (who would presumably incur smaller medical bills in the long run) as a win-win. And this would create a virtuous cycle, as insurers competed with each other to lower prices to gain healthier customers, and customers responded to these incentives by improving their health (for both financial and the usual non-financial benefits).

Still, I'm glad to see a proposal to partially reduce the levels of regulation. Insurers and patients should insist on more such proposals.

(Via PatientPower.)

Wolf Speak to "An Army Of Davids"

Dr. Milton Wolf spoke at the Kansas City tax day Tea Party, rallying citizens to become an "army of Davids":



In particular, he notes that Americans should demand that politicians (1) follow the Constitution, (2) control runaway spending, and (3) defend the free market.

Unless Americans stand up and defend the principle of properly limited government, then we will be in deep trouble. But as long as Americans like Dr. Wolf continue to speak out, we still have a chance.

(Via WolfFiles.)

Gaming The System

Under ObamaCare, both patients and insurers will game the system -- albeit in different ways.

Patients will sign up for their "mandatory coverage" when they need it, then drop it (and pay the penalties) when they don't need it.

Insurers will try to shift as many administrative expenses as possible into "medical spending" in order to meet legal requirements that a certain percentage of their revenue be spent as "medical costs".

Nor can lawmakers call these "unintended consequences". Instead, these are entirely predictable responses to government controls.

Quick Links: Bowden, Black Ribbon Project

Thomas Bowden of the ARC appears on The Mike Slater Show to discuss the destructive nature of government health care.

FIRM is glad to support Dr. Beth Haynes' Black Ribbon Project.

Colorado Updates

Brian Schwartz has some good updates on the health policy battles here in Colorado.

In particular, see:

"Tuesday, April 27: Debate on ObamaCare lawsuit, CU-Boulder"

"The 'choice' to prohibit other people's choices"

"Health information technology: benefits and problems"

The New York Insurance Laboratory

The April 17, 2010 New York Times notes that New York state government regulations over health insurance has raised its cost.

Here's an excerpt from "New York Offers Costly Lessons on Insurance":

New York's insurance system has been a working laboratory for the core provision of the new federal health care law -- insurance even for those who are already sick and facing huge medical bills -- and an expensive lesson in unplanned consequences. Premiums for individual and small group policies have risen so high that state officials and patients' advocates say that New York's extensive insurance safety net for people like Ms. Welles is falling apart.

The spiral of controls causing problems leading to calls for more controls is clear:

In 1993, motivated by stories of suffering AIDS patients, the state became one of the first to require insurers to extend individual or small group coverage to anyone with pre-existing illnesses.

New York also became one of the few states that require insurers within each region of the state to charge the same rates for the same benefits, regardless of whether people are old or young, male or female, smokers or nonsmokers, high risk or low risk.

Healthy people, in effect, began to subsidize people who needed more health care. The healthier customers soon discovered that the high premiums were not worth it and dropped out of the plans.

ObamaCare seeks to avoid this problem by the individual mandate, requiring people to purchase insurance (as in Massachusetts). The result:

But analysts say that provision could prove meaningless if the government does not vigorously enforce the penalties, as insurance companies fear, or if too many people decide it is cheaper to pay the penalty and opt out.

Unfortunately, the insurance industry lobby has argued for stricter penalites rather than free market reforms -- i.e., further infringements on individual freedoms. Unless they take a principled stand for freedom, they'll just be aiding in their own eventual destruction through this increasing spiral of regulations -- and taking the rest of us down with them.

Reiland On Cassell

Ralph Reiland, a professor at Robert Morris University in Pittsburgh PA, has written an article in praise of Dr. Jack Cassell.

It appears in the April 12, 2010 Pittsburgh Tribune Review and is also on CapMag.

Here's an excerpt from, "A Prescription Against Tyranny":

Jack Cassell is too much for some people.

He's the Florida doctor who told his patients to go elsewhere for treatment if they voted for President Obama. The message posted on his office door: "If you voted for Obama ... seek urological care elsewhere. Changes to your health begin right now, not in four years."

...Cassell told Fox News that the real purpose of his door posting was educational, not racist, and that he wasn't literally turning down patients.

"I came across the timeline for implementation of ObamaCare and I got a little discouraged when I got to next year and found that most of the ancillary services and nursing homes and diagnostic imaging, all these things start to fade away, and I felt that my patients really need to know about this, and the more I thought about it, the angrier I got until I finally felt like I'm going to put a little splash page on my front door and just get people thinking a little bit," Cassell explained.

"I think there's a real, real problem that's going on here in this country and unfortunately ObamaCare fatally compromises my ability, or any doctor's ability, to uphold the Hippocratic Oath," he continued. "I mean, I can't believe that more people aren't standing up. I think all the doctors in the United States need to take a stand on this, because pretty soon it's going to be too late."

(Read the full text of "A Prescription Against Tyranny".)

Dr. Cassell is completely right with respect to ObamaCare compromising physicians' ability to uphold the Hippocratic Oath. And I hope his actions help wake up the rest of the medical profession.

Happy Tax Day!

Homer Simpson quote of the day: "Would you look at those idiots? I paid my taxes over a year ago!"

Quick Links: Medicare, Licensing, Off-Label Uses

The 4/14/2010 Denver Post reports that more Colorado doctors are dumping their Medicare patients because of poor reimbursements.

As always, those patients have "coverage" but that's not the same as actual care.

And this problem will get worse if the 4/12/2010 Wall Street Journal article is correct on the anticipated shortage of 150,000 doctors over the next 15 years.

(This shortage is made worse by medical licensing regulations which violate the rights of willing patients and providers to contract freely for medical services without government interference.)

Conko and Arnett of CEI have a new paper, "Truth Or Consequences" on the benefits of "off-label" promotion by drug and medical device manufacturers to patients and doctors. Here's the associated press release.

Quotes From The Founders

As Americans prepare to speak out at Tea Party rallies across the country, here are a few inspiring quotes from the American founders on limited government, rule of law, and the rights of man.

(Thanks to Bill Whittle for putting these together.)

Finding Out What's In The Bill

Prior to the passage of ObamaCare, House Speaker Pelosi famously declared, "We have to pass the bill so that you can find out what is in it".

According to the April 12, 2010 New York Times, Congress is also finding out what's in the bill. Here's an excerpt from "Baffled by Health Plan? So Are Some Lawmakers":

In a new report, the Congressional Research Service says the law may have significant unintended consequences for the "personal health insurance coverage" of senators, representatives and their staff members.

For example, it says, the law may "remove members of Congress and Congressional staff" from their current coverage, in the Federal Employees Health Benefits Program, before any alternatives are available.

The confusion raises the inevitable question: If they did not know exactly what they were doing to themselves, did lawmakers who wrote and passed the bill fully grasp the details of how it would influence the lives of other Americans?

(Read the full text of "Baffled by Health Plan? So Are Some Lawmakers".)

It's almost as if Congress hastily rammed this bill through for bad political reasons, without really thinking about the consequences of their actions!

Nah...

Wolf Exposes His Congressman's Dereliction of Duty

Dr. Milton Wolf has a new OpEd in the April 13, 2010 Washington Times detailing his congressman's dereliction of duty in voting for ObamaCare.

Here's an excerpt from, "Dennis Moore must be recalled":

Instead of our elected Representatives in Congress giving us answers, they regurgitated talking points (if they could be bothered to address us at all). Instead of thoughtful, needed health care reform, they arrogantly forced upon us the largest expansion of government power and largest intrusion into our lives that our nation has ever seen.

...Mr. Moore, you refused to read the bill before foisting it upon us. You swore to us that health care rationing was not in it. When you were asked to discuss specific provisions in the bill, you said no. Your actions are worse than dishonest. They represent a dereliction of duty. You refused to perform the most basic function of your office: to read a bill before voting for it.

As a result of your dereliction, patients will suffer and lives will be lost. Because of your reckless abandonment of your duty to Kansans, families will be shattered. Your profound arrogance and cavalier disregard for the needs of your constituents make you dangerous. It's sad but true: You have not faithfully discharged your sworn duties as a United States congressional representative.

(Read the full text of "Dennis Moore must be recalled")

I'll bet the Congressman Moore was not the only one who didn't read the bill.

As we know, some Congressmen even swore an oath to uphold the Constitution, then betrayed that oath by brazenly declaring that they'll pass whatever laws they want without "worrying about the Constitution."

As voters, we must exercise our constitutional power to fire those politicians who would exert arbitrary power over us -- and replace them with men and women who respect the proper role and limits of government.

Tea Party: Then And Now

The Heartland Institute has a nice video about the Tea Parties -- then and now:

Bowden on ObamaCare and the FDA

Tom Bowden of the Ayn Rand Center for Individual Rights has two good recent pieces touching on different aspects of the health care debate.

In his blog post, "Doctors ask: 'Is this what I have to look forward to?'", Bowden discusses some poignant responses he has received from physicians in the wake of ObamaCare being signed into law.

At least some doctors are realizing that this will lead to involuntary servitude, where the fruits of their labors are regarded as someone else's automatic "right".

In his OpEd, "What About Private Health Emergencies?", Bowden dissects the inconsistencies behind the government allowing FDA rules to be bypassed in "public emergencies" but not for individual patients' illnesses.

Bowden notes:

Every life-threatening disease presents a health emergency to the individual patient. Morally, you have the right to seek the best treatment you can find. Yet our legal system denies you that right when it comes to private health emergencies.

I'm glad to see more discussion of health care issues from the ARC, and I hope their works receive the attention they deserve.

Armstrong: Keep Pushing for HSAs

Ari Armstrong explains why Americans who value quality medical care should, "Keep Pushing For Health Savings Accounts".

Here is the opening:

Despite enactment of the Democratic health law, one reform Republicans and market advocates should fight to keep alive is the Health Savings Account (HSA), which allows people to put pre-tax money into an account dedicated to health-related expenses.

Experiences my wife and I have had this week illustrate the power of paying for one's own health care, which an HSA encourages. Rather than pay a hundred plus dollars each to a doctor and an out-of-state testing facility, we each paid King Soopers $20 to test our blood cholesterol. I'm not saying this is a good substitute for seeing a doctor, but we wanted to get a test between regular doctor visits. Our actions illustrate the fallacy of claims that self-payers don't get preventive treatment. We are highly committed to doing what we can to prevent long-term health problems by taking care of ourselves and paying for preventive care.

(Read the rest of "Keep Pushing For Health Savings Accounts".)