Happy New Year! Health Policy Video Update

Merry Christmas & Happy New Year!

I'll be taking a break until January from blogging (although I might throw in the odd comment or two at John Goodman's Health Policy Blog).

There might be a redesign coming at this blog - either video or audio added every week or two.  Also, I'm likely to focus a little more on the deal-flow in the health-care sector, instead of just the straight health-policy angles.

Until then, have a healthy and happy holiday and New Year.  Remember, every day is one day closer to the repeal of Obamacare!

Where the Nanny Statists Begin, the Trial Lawyers Surely Follow

I've written more than once about the so-called "Happy Meals ban." Well, it's got legs.  This nonsense bagan last spring in San Mateo County.  The notion is that if the government forbids  fast-food restaurants from using toys and similar items to induce kids to order meals there, childhood obesity will fall.  As I anticipated at the time, this will likely become a windfall for trial lawyers.

Myth of the Massachusetts Mandate

Remember the Massachusetts health reform, signed by Gov. Mitt Romney in April 2006? Some Obamacare cheerleaders (including the President) insist that it was the forerunner of Obamacare (and Gov. Romney is having a heck of a time distancing himself from it).

There is a media myth that the individual mandate (that you must pay a fine if you don't buy government-approved health insurance) is critical to the law's so-called "success".  Well, it's not true.

If Obamacare is Unconstitutional, Why Aren't Medicare & Medicaid?

A federal judge in Virginia has ruled that the individual mandate in Obamacare is unconstitutional. The “Minimum Essential Coverage Provision” has no basis in the powers delegated to Congress by the Constitution, according to Virginia Attorney-General Ken Cuccinelli, and Judge Henry E. Hudson has agreed.

So how can Medicare and Medicaid be constitutional?

On An Interstate Compact for Health Insurance

As well as playing a key role in the upcoming defeat of Obamacare, states can seize the initiative on framing the real health reform that will replace it.  One commendable option is an interstate compact for health reform.

After all, Congress has had many opportunities to reform health care, and it has failed again and again.  It's time to get the federal government out of the health-insurance business.

Read this month's Health Policy Prescription here.

On Sebelius' & Holder's Defense of Obamacare

Today's Washington Post ran an op-ed by Kathleen Sebelius, U.S. Secretary of Health & Human Services, and Eric Holder, U.S. Attorney-General.  In it, they trot out the same old arguments that we've heard many times before, and debunked.

More on the Insanity of the Medicare Payment System

I can’t move on from the previous post without noting a fascinating article in the weekend Wall Street Journal: “Assembling the Global Baby,” by Tamara Audi & Arlene Chang (December 11-12, 2010).

Reflections on the Insanity of the Medicare Payment System

Over at the John Goodman Health Policy Blog, Dr. Goodman and Prof. Reinhardt (amongst others) are debating how Medicare pays people.  Here's my take: It is insane.

Speech today

Off to speak on Obamacare to Economic Prosperity Institute at Sonoma State University, so no pearls of wisdom on the blog today.

Obamacare's Unintended Consequence of the Day: Higher Drug Prices for Kids' Hospitals

The New York Times reports on another unintended consequence of Obamacare: Higher drug prices for childrens' hospitals.  (The structure of the article itself is fascinating: One anonymous politician who voted to impose Obamacare on the nation told the reporter that this results from "an honest mistake in drafting."   Sick kids will lose access to medicines because of politicians' incompetence, but they don't even bother to defend their not reading or understanding the legislation anymore.)

Indeed, government controls designed to reduce drug prices usually result in higher prices, a result I discussed in a study written a few years back (available here).  Lower drug prices result from less government control, not more.

Are Your State Politicians Serious About Defeating Obamacare? A "Litmus Test"

Last month’s elections demonstrated convincingly that the American people are already fed up with Obamacare, the March legislation that gives the federal government control over our access to medical services. Anti-Obamacare Republicans took the majority in the House of Representatives and increased their numbers in the U.S. Senate.

Most people believe that President Obama will not listen to the American people and repeal his own legislation. This makes final defeat of Obamacare unlikely before a future president takes office in January 2013, at the earliest. The federal government, however, relies on states to do Obamacare’s dirty work.

Medicare Already Limiting Seniors' Access to Care, As Will Obamacare

The Washington Post reports on physicians' reducing the number of appointments they'll give to seniors enrolled in the traditional Medicare monopoly.

What is needed is rigorous measurement of this phenomenon – like the Canadian Fraser Institute’s measurement of waiting times for specialist and hospital care under the government monopoly up there. Obviously, the U.S. government would never fund such research.

December 7 Speech: Alternatives to Obamacare in Contra Costa County, Northern California

I'll be speaking in Contra Costa County on December 7, 6-8 p.m., on alternatives to Obamacare.  It's free and there'll be plenty of time for Q&A.  Round up your friends and neighbors. Register here.

Thanksgiving Break Until Next Monday

Enjoy your vacation!

Health IT and Airport Scanners

Greg Scandlen has sounded a warning about government-dictated health IT.  He points to a scholarly article which demonstrates that health IT can make delivering medical care more dangerous than otherwise.  Mr. Scandlen points out that vendors of health IT are hungry for government hand-outs, which will be significant under Obamacare.

Will Health Reform Save Lives?

Over at the John Goodman Health Policy Blog, Mr. Goodman points out the absurdity of thinking that "uninsurance" is a useful predictor of health status.  Because most uninsured people are uninsured for only a few months, it's not a useful explanatory variable.  Frictional uninsurance is linked to unemployment.  If individuals owned their own health insurance, the problem would be a lot smaller.

One commenter believes that Obamacare's exchanges will help, because people will own their own policies as long as they're in an exchange.  However, you only get the subsidy if you choose your plan from whatever set is available through the state-based exchange.

Competition in Hospitals

I'm involved in an interesting discussion on hospital mortality and the perverse nature of competition amongst hospitals over at John Goodman's Health Policy Blog.

What's Wrong with Long-Term-Care Insurance? Medicaid is one Answer

Medicaid is the single largest payer for long-term-care (LTC) insurance.  That's an important part of the explanation for difficulties in the private market, as I discuss at John Goodman's Health Policy Blog.

Restoring Obamacare's Medicare Cuts

I was thinking of writing this but Ron Bachman of PricewaterhouseCoopers beat me to it.  Mr. Bachman advocates restoring Obamacare's cuts to Medicare by taking the money from the state-based exchanges, which come online in 2014.

It's a great idea.Although the exchanges don’t start running until 2014, it is critical that those who would profit from them (health-IT vendors and consultants, dominant insurers, etc.) do not invest business-development resources in them. Unfortunately, this is already happening.

Changes in Survival: The US in International Comparison

Linda Gorman dissects a study published in Health Affairs, which asserts (among other things), that U.S. health outcomes suffer from a lack of government spending!

I really enjoyed the straw man that Ms. Gorman quoted: “The findings undercut critics who might argue that the US health care system is not in need of major changes.”

Debunking Richard Cohen: How Does the U.S. Health-Care System Stack Up?

Richard Cohen had an extremely ill-informed column in the Washington Post, which Tom Miller of the American Enterprise Institute handily demolishes: Debunking Richard Cohen: How Does the U.S. Health-Care System Stack Up?

Why Don't Doctors Help Patients Shop for Drugs?

Because they don't know themselves how much drugs cost. And health plans don't pay them to know this information or do anything about it.

Although the health plans don’t pay doctors to help patients “shop for medicines,” I have learned that they will pay doctors to switch their prescriptions from branded to generic. Of course, this entire struggle between health plan and brand-name drugmaker is entirely invisible to the patient, and, therefore, likely results in perverse outcomes.

I participate in the discussion over at John Goodman's Health Policy Blog.

Who Killed Primary-Care Practice?

It wasn't just Medicare and private health plans, as I note at John Goodman's Health Policy Blog.

O-Day is January 1, 2014

That's the date Obamacare really sinks its teeth into American health care.  What are the tactics for repeal until then?

I pitch into the debate at National Review Online.

American Health Care & American Productivity

One of the great myths about American society is that our lack of a “universal” health plan harms our competitiveness. Even Lee Scott, former CEO of Wal-Mart, a company that has introduced some headline-making innovations in health benefits for its workforce and customers, bemoans the cost of U.S. health care as a burden on the economy.

On the other hand, we don’t hear Mark Zuckerberg complaining that Facebook’s health care costs are preventing him from competing against foreign social-media businesses.

Prices of Medical Goods and Services

Dr. John Goodman is discussing the policy community's failure to appreciate the role of prices in health care.  I've pitched in, over at his blog.

On the Republican "Alternatives"

With the glow of victory still fresh, it’s a little unseemly to start criticizing the Republicans already on their proposals to replace Obamacare.

But we would not be in the fix we are today if a previous Republican regime had reformed (or eliminated) the employer-based exclusion of health benefits from taxable income. Or, to put it in other words: The federal government should give the American people the health-care dollars that it currently gives our employers.

Republican leaders really muddy this issue.  To wit: Karl Rove's advice in yesterday's Wall Street Journal.

Read the entire post at National Review Online.

San Francisco Bans Toys in Restaurant Meals

In a purported attempt to reduce childhood obesity, San Francisco's Board of Supervisors has voted to ban toys and similar inducements that restaurants use to promote kids' menus.

This is the result of lobbying by the city's bloated and ambitious public-health bureaucracy, and a completely wrong-headed investment of political energy, as I wrote in the local newspaper back in September, when the ban was first proposed.

Health Care Freedom: 2 Out of 3 Ain't Bad

The Freedom of Choice in Health Care Act was on the ballot in three states. This is the model legislation that asserts the unconstitutionality of Obamacare's individual mandate. Before last night, it had already passed as statute or constitutional amendment in six states.

Yesterday's victory in Arizona (55% to 45%) "upgrades" the previously passed statute to a constitutional amendment. Yesterday's victory in Oklahoma (65% to 35%) overides the incumbent governor's previous veto. The measure was defeated in Colorado, but by a narrower margin of 47% to 53%.


All in all, yesterday was a great day for health freedom.

Election Gives States Momentum to Defeat Obamacare

Yesterday’s election resulted in a resounding setback for Obamacare. The federal government takeover of Americans’ access to medical services will suffer significant setbacks in the new Congress. While Congress works towards repeal, states have to choose whether to enable or obstruct Obamacare, which will further pummel states’ fiscal situations.

On Interstate Sales of Health Insurance

I'm involved (over at John Goodman's Health Policy Blog) in a discussion on interstate sales of health insurance.

I’ve been ambivalent about this before, but I square the circle by proposing that states negotiate an interstate compact for health insurance. Others have explained to me that there is no prohibition on their doing so. Plus, there is enough collaboration via National Association of Insurance Commissioners (NAIC) and NCOIL (National Conference of Insurance Legislators) that they could figure this out (if they wanted to) without explicit Congressional permission.

Read more here.

Obamacare Should Be An Issue in California Governor's Race

But both Meg Whitman and Jerry Brown are all but ignoring it.  Read my column in the San Francisco Examiner here.

Beware the National Commission on Fiscal Responsibility & Tax Reform

I don’t think that too many people are taking President Obama’s National Commission on Fiscal Responsibility and Tax Reform very seriously. Most free-marketers believe that it is a mechanism to put lipstick on a significant tax hike, or add a national Value-Added Tax (VAT) to the taxman’s toolbox. Certainly, the 75 groups from whom it has heard (as reported on July 1) are largely pro-tax, pro-spending outfits.

Nevertheless, it was a little startling to read in the Wall Street Journal (Damian Paletta, "Key Tax Breaks at Risk as Panel Looks at Cuts," October 25, for non-subscribers who cannot access the link) that the Commission might propose eliminating “the ability of employees to pay a portion of their health-insurance tab with pretax dollars” (Damian Paletta, “Key Tax Breaks at Risk as Panel Looks at Cuts, October 25, 2010).

From a purely economic standpoint, this is a trivial issue.

Should Your State Establish An ObamaCare Health Insurance "Exchange"?

In a few words: Amost certainly not.  It will cost tens of millions of dollars to operate for no benefit whatsoever.  And states with the best intentions will be led astray by Secretary Sebelius and her ObamaCrats.

ObamaCare is President Obama's problem: Don't make it your state's.  This month's Health Policy Prescription.

Sharia-Compliant Canadian Public Hospital?

This may be the strangest Canadian health-care story I've every read.  Not only do my countrymen suffer under government monopoly health care, but the government appears to be imposing sharia law in one hospital in Kingston, Ontario.

A man, his wife, and newborn, were expelled from the maternity ward because a muslim woman was also there and breastfeeding her child.  Men who are not relatives are not permitted to be present under such circumstances, apparently, in this taxpayer-funded hospital.

So, they were sent to a private room and then received a bill for $750!  (I wonder what would have happened if a non-muslim woman had made the same demand...)

Antitrust: The U.S. Vs. Michigan Blue Cross Blue Shield

Today's news of the overreaching federal state brings reports of antitrust action by the US Department of Justice against Blue Cross and Blue Shield of Michigan.  The purported violation? As Michigan's largest health plan, BCBS was able to persuade hospitals not to charge lower fees to any other carrier.  According to the story, other health plans paid hospitals 25 percent more than BCBS.

ObamaCare is Not Repealing Itself

Last week we learned that Jay Angoff, the ObamaCrat in charge of regulating private health insurance, has decided to allow health plans to underwrite (that is, charge actuarially fair premiums) for child-only policies.  This, of course, is in response to the fact that insurers have pretty much stopped writing such policies since the first wave of ObamaRegs swept over private health insurance on September 23.

We also recently learned that Kathleen Sebelius, the U.S. Secretary of Health & Human Services, has granted waivers allowing employers of an estimated one-million (largely low-income) workers a year to comply with the new ObamaRegs. This resulted from a spate of reports of those employers dropping coverage entirely.

So, is ObamaCare repealing itself? Read more at John Goodman's Health Policy Blog.

An Easy Way to Reduce Medicare Fraud

Congratulations to the FBI for busting the biggest Medicare fraud operation yet discovered.  An Armenian gang defrauded Medicare of a reported $163 million.  A key enabler of the fraud was the theft of 2,900 Social Security numbers, which the fraudsters used to bill Medicare for fake medical services.

While Medicare fraud will never be eliminated, there is a straightforward way to dramatically reduce it - immediately.  And it wouldn't need investigation by police, either.  Instead, it would rely on Medicare beneficiaries themselves.  Voucherization is the solution.

ObamaCare & Medicaid Speech: Polished Video on YouTube

On October 7, I was back in Washington, DC as a guest of the Galen Institute and the Institute for Policy Innovation, discussing the ObamaCare's harmful effect on states' Medicaid budgets.  I addressed California's Medi-Cal program.

Is Your State Suing ObamaCare? New Website Keeps you Posted

It's hard to keep track of all the ObamaCare lawsuits.  Fortunately, the Independent Women's Forum has launched a new website that does just that: Healthcarelawsuits.org.  (Hat tip to John Goodman.)

New York Times Reluctantly Notes Seniors Losing Medicare Benefits; Denies It's A Problem

This morning’s editorial in the New York Times notes that “some of the private health plans that participate in Medicare will be dropping out next year, but don’t blame health reform.” Indeed, according to the Times, “the Medicare Advantage market remains strong.” Well, maybe — but that’s only for 2011.

What the Times avoids is the fact that Obamacare’s Medicare Advantage cuts don’t start until 2012, after which time private plans will be collapsing left, right, and center.

Read my entire post at National Review Online.

Yesterday's Panel Discussion in DC on ObamaCare & Medicaid

Here is the video: A little grainy but very educational.  Speakers are Christie Herrera of American Legislative Exchange Council,  Marc Kilmer of Maryland Public Policy Institute, and me.  Grace-Marie Turner of Galen Institute and Merrill Matthews of Institute for Policy Innovation hosted.

Speaking Tomorrow in DC

I'm off to the airport now to fly to DC to speak at Institute for Policy Innovation (IPI) on "Medicaid and ObamaCare". Registration is free and they'll be livestreaming video starting 09:30 a.m. EDT.

Public speech tomorrow!

Yours truly will be speaking at two the Institute for Policy Innovation's briefing on Medicaid & ObamaCare on October 7 at the Capitol in Washington, DC.  Please register here.  I'll be talking about California's Medi-Cal program.

Sebelius Vs. Wall Street Journal (and the Truth)

Apparently, The Wall Street Journal enjoys sacrificing valuable real estate on its editorial page to serve as bait for politicians who traffic in misinformation about ObamaCare. Witness last week's op-ed by Kathleen Sebelius, U.S. Secretary of Health & Human Services. We know that the WSJ accepted her op-ed to trap her, because it rebutted her claims in a subsequent editorial, which makes entirely valid criticisms — but there’s more.

Read more of my response here.

Yet Another Vacation

Too close to the last one I know, but this one will be short.  Out of touch and out of country until October 5.  No blogging, tweeting, Facebooking, etc.

InsureBlog: Another ObamaCare© Myth Debunked

"ObamaCare imposes a tax on the sale of your primary residence of 3.8 percent."  I have heard this myth many times, often in conservative "grassroots" environments, and was planning to debunk it today.  I guess I'm not the only one who was hearing it.  Hat tip to the good folks at the InsureBlog, who note that there is enough (rotten) read meat in ObamaCare that we should not have to make things like this up.

InsureBlog points us to the Tax Foundation's debunking of this myth.  As I suspected, this derives from a misunderstanding of the actual tax hike, which is a newly increased Medicare tax of 3.8 percent on households with incomes of $250,000 or more.

The real harm that this tax will do to our nation's prosperity is not that the government will skin you when you sell your home.  It is that the higher rate is not only on salary or other labor income, but on capital gains and other types of investment income.  This will inhibit capital formation and pull down economic growth.

According to Stephen J. Entin and colleagues at the Institute for Research on the Economics of Taxation (IRET), this Medicare surtax will reduce GDP growth by 1.3 percent annually, and bring about reduced wages.

Massachusetts' 2nd Largest Carrier Drops Medicare Advantage

Harvard Pilgrim Health Care will bail out of Medicare Advantage, causing 22,000 seniors in Massachusetts to lose their Medicare benefits, according to the Boston Globe (hat tip to Avik Roy).

This is a direct consequence of ObamaCare - and one that I anticipated last December in a study of Medicare Advantage.

Orange County Register Opposes California Health-Insurance Exchange

The Orange County Register has editorialized against the two bills that would establish a health-insurance "exchange" under ObamaCare in California.  I had a lengthy interview with the writer last week and the editorial quotes me at length, for which I'm grateful.

These are the bills which we urge Governor Schwarzenegger to veto by September 30.  The OCR, rightly, calls the exchange a "poison pill."

Read more here.

FDA: Cash-Strapped Crusader or Bloated Bureaucracy?

A letter I wrote to the Wall Street Journal, referring to my latest study of the FDA, and the harms it causes.

SEIU Protects Criminals Working as Home-Health Aides

Los Angeles Times has a devastating feature on the union protecting criminals whom the state sends in to take care of disabled people dependent on Medi-Cal.

I've previously addressed this issue here.

Providing Health Care to Trapped Chilean Miners

The miners who survived the collapse of the mine in Chile have some unique health challenges.  I'm involved in a discussion of the economics of it over at John Goodman's Health Policy Blog.

The GOP Pledge on Health Care: "Repeal" is Great, "Replace" Needs Work

Let’s start with the good news: The GOP has pledged to repeal Obamacare “immediately” (see page 27 of the Pledge), which means it will be the first legislative order of business on Monday, January 3, 2011, if the GOP takes the House.

When it comes to “replace,” however, the Republican alternative is still significantly malformed. Indeed, there’s more than a whiff of big-government Republican in it. It completely ignores the single most important reform to private health insurance: Amend the tax code to give individuals, instead of our employers, ownership of our non-taxable health dollars.

Read my entire response at National Review Online.

Column in The Hill: ObamaCare Will Reduce Choice of Health Plan

Addressing only the issue of the Medical Loss Ratio, I demonstrate how ObamaCare will lead to less choice amongst health plans: My op-ed in The Hill.

What is the Future of Unionized Government Retiree Benefits?

I gaze into my crystal ball over at John Goodman's Health Policy Blog.

Governor Schwarzenegger Should Veto the Health-Insurance Exchange Bills

This month's Capital Ideas column explains how the legislation proposing ObamaCare's exchanges for California would reduce choice and increase costs, urging governor Schwarzenegger to veto it by September 30.  It's a beefier version of my San Francisco Examiner op-ed from a few days ago.

Read more here.

Orszag Versus Medicaid

Peter Orszag, former director of the White House Office of Management and Budget, has landed a gig as a contributing editor to the New York Times. On Sunday, he had an interesting article arguing that Medicaid funding was raiding public finances that should go to higher education.

Unfortunately, he errs in describing Medicaid, as I discuss at National Review Online.

Will Our Children Be Better of Than We Are? Productivity in Health Care and Other Sectors

In a recent poll, two thirds of respondents stated that they thought that their children would have a lower quality of life than they themselves.  One problem is that health spending is devouring so much of our incomes, but productivity is not increasing.

I suppose that this may be fundamental, to some degree I think that there are significant limits to increasing the productivity of a primary-care practitioner. (Although there is a lot of technological innovation in health care waiting to explode if and when the government gets out of the way, so I may be wrong).

However, there are some parts of health care where productivity has increased dramatically, e.g. cardiac surgery. (Indeed you only have to go back a few decades for longitudinal measurement to become meaningless, because the practices were so different.)

Read the entire thread at John Goodman Health Policy Blog.

Today's AP-GfK Poll Shows ObamaCare Still in the Tank

The Associated Press has engaged in a little journalistic malpractice in reporting the latest poll that it produces with GfK Roper. According to reporter Alan Fram, “Obama is winning increased public approval for health care . . .“

Well, no: In the actual poll, 41 percent of respondents reported “total support” to the question, “In general, do you support, oppose, or neither support nor oppose the health care reforms that were passed by Congress in March?” (p. 47), the same result as in the March poll. Plus, the shares of respondents who ”strongly support” versus “somewhat support” are within one percentage point of where they were in March.

To find the ”increased public support” that Mr. Fram reports, you have to go back to September 2009, when ”total support” was only 34 percent. All the positive movement took place between September and October, after which it hovered around 40 percent until a significant bump to 45 percent in June 2010, now vanished.

Read my entire column at National Review Online.

San Francisco's Fast-Food Toy-Ban Good for Bureaucracy, Not Waistlines

A few weeks ago, Santa Clara County passed a measure intended to reduce child obesity by fining restaurants for offering toys as part of meal promotions. San Francisco has responded with a similar measure that won’t help the kids slim down, but is guaranteed to fatten up already-bloated government.

The real force behind this legislation is the Public Health Department, which has been growing for the past three years, fueled by the Healthy San Francisco program. This program taxes small businesses, primarily restaurants and retailers, that can’t afford to offer health benefits.

The public health bureaucracy devoured $36 million of these taxes, for fiscal year 2008-09, while spending only $11 million reimbursing medical providers and pharmacies. The rest went to nonmedical spending, including $8 million on salary and benefits for new bureaucratic positions.

Read my entire column at the San Francisco Examiner.

ObamaCare Will Dramatically Reduce Choice in Private Health Insurance

One of the ways in which ObamaCare will reduce individuals’ and businesses’ choices of health insurance is through regulating the Medical Loss Ratio (MLR), a relatively simple concept: Take the amount of dollars an insurer spends on medical care and divide it by the total premiums. For example, if an insurer earns $10 million in premiums and spends $8.5 million on medical claims, its MLR would be 85 percent. Under ObamaCare, policies that cover large businesses will have to achieve an MLR of 85 percent, while those for small businesses and individuals will have to achieve an MLR of 80 percent.

That shouldn’t be too hard, should it?

Actually, the MLR can be quite complicated – especially when the government gets involved. Suppose, for example, an insurer invests in information technology that it gives to providers in its network in order to improve co-ordination of care. Is that a medical cost? Also, health insurers pay taxes. Although these taxes are obviously not medical costs, is it appropriate for the government to punish an insurer that pays higher taxes, which are revenue to the government?

Read my entire analysis in the latest Health Policy Prescription.

California's ObamaCare Health-Insurance "Exchange" Will Slash, Not Boost Choice

California is "leading the nation" once again.  Unfortunately, it's galloping in the wrong direction, with the Legislature passing bills to establish a health-insurance "exchange" to allow politically appointed bureaucrats to decide what health plans Californians will be able to get under ObamaCare.

Gov. Schwarzenegger would be well advised to veto the legislation, as I've written in a column in the San Francisco Examiner.

Read the entire article here.

Doctors and Patients Need Medical-Malpractice Reform

Several states have shown how to reign in an industry of medical-malpractice litigators that is out of control.  In a recent op-ed in the Orange County Register, my colleague Lawrence McQuillan and I describe and advocate the most important ones.

Read the entire column here.

On Vacation until September 13, 2010

Please fight the good fight without me!

Did Senator Baucus's "Experts" Read the Bill?

I doubt that it surprises anyone that Senator Max Baucus did not read the ObamaCare bill that he navigated through the Senate, but we should all be surprised that he has no shame in admitting it in a town hall meeting that he hosted last week with the U.S. Secretary of Health and Human Services (HHS), Kathleen Sebelius. Indeed, he appears proud of the fact that he did not “waste” time reading the bill, but delegated it to “experts.”

Many of the bill’s supporters have been walking away from it recently. An August 19 report on “A Communications Perspective” for ObamaCare, prepared for the pro-ObamaCare lobbying group Families USA (and leaked to Politico.com), significantly reframes the mission of ObamaCare’s supporters.

Read more here.

"Three "R's" Against ObamaCare

My colleague Jeff Anderson has coined a winning slogan for the continuing struggle against Obamacare: “Repeal and replace.” But there’s another R: resist!

Anticipating repeal, governors have significant opportunities to put sand in the gears of Obamacare. Two have recently taken exemplary action: Read more here about Governor Heineman of Nebraska, governor Pawlenty of Minnesota and what governor Schwarzenegger should do in California.

Reforming Health Insurance Via "Citizen Benefits"

There is nothing better about living on the north side of the Golden Gate Bridge than receiving my printed copy of National Review, taking it to my Marin County hot tub (not the one criticized by George H. W. Bush), and reading it aloud to chardonnay-sipping liberal friends.

Unfortunately, I nearly dropped my brie when I found a fundamental flaw in Reihan Salam and Scott Winship’s proposal for a “Leaner Welfare State” in last week’s issue.

Salam and Winship propose replacing the welfare state with “citizen benefits.” Their conclusion that the welfare state needs dramatic reform is solid. I also agree (as do all conservative health-policy analysts) with their recommendation to amend the tax code to give individuals command of our health-care dollars, instead of allowing employers to have monopolistic control over them.

Unfortunately, the authors also give the government too much power over the alternative, and their proposal violates fundamental principles of effective regulation of insurance.

Read the entire comment here.

Washington Examiner Column: ObamaCare and the Right to Health Care

President Obama has made no secret of his belief that health care should be "a right for every American." This moral argument for reform was no doubt among the strongest offered by Obamacare's proponents.

Unfortunately, Obamacare doesn't guarantee a right to health care. Instead, it undermines that right by subverting Americans' freedom to obtain the health care they prefer.

Read the complete column at the Washington Examiner.

Are Carriers or Brokers To Blame for Conflict Over Consumer-Driven Health Plans?

Greg Scandlen and I might be judging the information differently, or have different information about the same situation. There has definitely been conflict between brokers and carriers on this question. I think that I am more tolerant of the carriers’ version of the conflict than Greg Scandlen is.

More on the question of paying commissions on consumer-driven health plans.

Are so-called Consumer-Driven Health Plans Really Consumer Driven?

I am losing confidence that Qualifying High Deductible Health Plans coupled with Health Savings Accounts are actually “consumer-driven health care”. I have the same skepticism about other so-called consumer-driven plans.

Here’s why: I have a QHDHP and an HSA and am enrolled in a plan in the California small-group market. Until this year, I paid all medical costs up to the deductible. In 2010, the rates increased significantly and the carrier started covering more preventive care. I went for an annual physical (which I amd convinced I do not need) and did not pay one penny out-of-pocket. However, I am in the same “consumer-driven health plan” as I was in 2009.

Because I have a contact at the carrier, I called him and asked why they had done this. Here is what he said.

Whis is More Obese, San Francisco's Kids, or its Government?

Imagine this scene a year or two in our future: An inspector from the San Francisco Department of Public Health spots something shiny behind a restaurant freezer. He pulls out a plastic Iron Man™ action figure, which the manager claims belongs to his son. No dice – they haul him downtown for using toys to lure kids into his restaurant.

If Supervisors Eric Mar, David Campos, and David Chiu have their way, this embarrassing spectacle of political overreach will become reality. Their stated goal is to reduce childhood obesity, but will it work?

Read more in this month's Capital Ideas.

Should the State Dictate Hospitals' Nurse-Staffing Ratios?

No: Ratios condemn patients to inferior care. An op-ed by Dr. Robert Hertzka and me in the San Diego Union Tribune.

"The Avastin Mugging"

The Wall Street Journal carried a devastating editorial on “The Avastin Mugging”. The WSJ editorial board rightly challenges the Food and Drug Administration’s Oncology Drug Advisory Committee (ODAC) for threatening to take away breast-cancer patients’ right to use Avastin.

The editorial also cites disturbing evidence that ODAC’s reviewers considered not just safety and efficacy but price, which is not within the FDA’s mandate. However, the $88,000 annual cost that the editorial cites as “reflecting the costs of development and production” neglects an important component of pharmaceutical costs – complying with the regulatory burden of the FDA itself!

I recently published a study based on decades of research that leads to the conclusion that even a one-year delay in legal access to the many new medicines available costs about 200,000 American patients their lives. Congress believes the solution is to throw more money at the FDA, which it did via the 1992 Prescription Drug User Fee Act (PDUFA). Under this regime, renewed every five years, the number of personnel conducting drug reviews doubled, from 1,300 to 2,600, between 1992 and 2007. Last year, the agency as a whole exceeded its hiring targets. The FDA’s spending on the regulation of human drugs in 2009 was $802 million, and the president’s 2011 budget demands $1 billion, an increase of 20 percent over two years.

Despite such growth, the FDA is slowing down. In 2008, the average time to approval lengthened to almost 18 months from just 12.3 months the previous year. The FDA drives up the cost of innovation then uses the high cost of innovation as an excuse to punish innovators by requiring them to jump every higher regulatory hurdles.

That bureaucratic feedback loop may be good for the FDA but is certainly harmful to patients who need new medicines sooner rather than later.

ObamaCare is Already Creating More Uninsured Americans

I received an e-mail from a fan that goes like this:

I've decided to not renew my coverage when the bill comes in for the 4th quarter. I currently pay $320/mo for a $2500 deductible BCBS plan. I have an HSA and have saved up a fair amount of money in it. Pretty good deal. So why drop it?

1. I have never even come close to meeting my deductible. Everything I have done since HSAs came in has been paid for from my HSA. In fact, never in my life have I ever incurred more than $2,500 in medical expenses in one year. The odds are that will not change, even though I am older.

2. I expect a pretty substantial increase in my premiums, but it doesn't really matter. I would make the same decision anyway.

3. If I guess wrong and my health does change, I will be able to sign up for the new federal risk pool - but ONLY after I have been uninsured for six months. I might as well get started on that six month qualifying period now while I am still healthy.

4. There is no penalty for doing this. The federal risk pool is not allowed to charge me more than standard rates.

5. Meanwhile I will be able to save $4,000 a year on insurance premiums, which is no small matter these days that I am semi-retired.

6. I will not be able to contribute additional money to my HSA, but my income is low enough now that there is virtually no tax advantage to making an HSA contribution. My main tax issue today is the payroll tax, and the HSA has no effect on that.

So, I am joining the ranks of the uninsured. Thank you, Mr. Obama.

I can't say that I disagree with his plan.

Medicaid Grows As Fast In Boom Times As Busts

Monday's bailout of government unions threw yet more federal dollars at Medicaid. But why? The government wants you to think of Medicaid, like other welfare programs, as a sort of "automatic stabilizer." However, Medicaid has grown consistently, in both good times and bad. It's growth is not counter-cyclical.

Read more here.

ObamaCare's New Website Explained

A few days ago, President Obama gave a demo of the new ObamaCare website. Here's my more accurate version:

Will Harry Reid Call For ObamaCare's Repeal?

In a July 21 letter to U.S. Secretary of Health & Human Services, the Senate Majority Leader complained that ObamaCare's cuts to Medicare will "result in a net reduction in payment to Nevada's hospitals when they are unable to absorb such a cut." Furthermore, he questions the method used by the government to caclulate payments to hospitals, and is "very concerned about potential effects on beneficiary access if this regulation is finalized without adjustment."

Did Senator Reid finally read the bill, almost four months after passing it and a year after masses of Americans began to demand that Congress do so?

Read entire article here.

Offline Until Next Week

I'm in San Diego for the Annual Meeting of the American Legislative Exchange Council. So: No blogging. For updates from ALEC follow johnrgraham on Twitter.

Harry Reid Has Second Thoughts About ObamaCare

In a July 21 letter to U.S. Secretary of Health and Human Service Kathleen Sebelius, the Senate Majority Leader complains that ObamaCare’s cuts to Medicare will “result in a net reduction in payment to Nevada’s hospitals when they are unable to absorb such a cut.

Read more here.

Did Judge Tauro Kill ObamaCare?

On July 8, a federal judge in Boston, Joseph Tauro, took it upon himself to find the Defense of Marriage Act (DOMA) unconstitutional. His decisions in two cases might have unwittingly facilitated the legal challenges to Obamacare.

Read the complete blog entry at National Review Online.

States Are Right to Shun ObamaCare's High-Risk Pools

One of ObamaCare's first major cash flows was scheduled to start on July 1: $5 billion to bail out states' so-called "high-risk" pools until January 1, 2014. A full 22 states want nothing to do with it: A drastic choice in times of broken budgets, but nevertheless the right choice. Read more here.

Is ‘Reimporting’ Drugs the Right Prescription?

I challenge Ramesh Ponnuru, at National Review Online.

The Return of the "Public Option"

It never really went away. My take on Rep. Woolsey re-introducing the "public option," at John Goodman's Health Policy Blog.

New Study of FDA Regulatory Monopoly

The press release and full study are here.

CastroCare in Crisis

I look at forthcoming disruptions in Cuban and U.S. health care at John Goodman's Health Policy Blog.

My op-ed on Medicare reform in Atlanta Journal-Constitution

Medicare "doc fix" is no fix: Medicare needs systemic remedies ajc.com

Adverse Selection in ObamaCare and RomneyCare

Will ObamaCare suffer the same problem of adverse selection that RomneyCare does? An exchange of views in the Wall Street Journal prompts my latest blog entry at John Goodman's Health Policy Blog.

Medical Tort in the States

Using colleagues' research, I rank all 50 states according to their medical-malpractice laws and other tort laws relevent to health policy: This month's Health Policy Prescription.

Should the State Decide How Many Nurses Hospitals Must Hire

Yes, if you want a major nurses' union to have its way. No, if you want patient-centered health care. This month's Capital Ideas.

Healthy San Francisco's Job-Killing Taxes to Live On

The U.S. Supreme Court has denied the Golden Gate Restaurant Association’s appeal of a 9th Circuit decision that permits San Francisco to levy a punitive tax on businesses to fund its public-health bureaucracy.

I’ve previously challenged research produced at UC Berkeley, which concluded that the ordinance did not cost jobs. Plus, I’ve noted the job-killing effects of the Healthy San Francisco program in a series of blog-entries (here, here, and here).

The GGRA had argued that the city ordinance violated ERISA, the federal law that regulates job-based benefits. But that is all water under the bridge. Kathleen Sebelius, U.S. Secretary of Health & Human Services has formed a (small and exclusive) mutual admiration society for government-run health care with Gavin Newsom, Mayor of San Francisco, so this decision will surely be welcomed by her and all ObamaCare-backers.

Does this judicial failure to overturn a mandate in San Francisco allow us to handicap the success of the lawsuits against ObamaCare’s national mandate? Unlikely: The San Francisco lawsuit relied on a federal law, ERISA, whereas the anti-ObamaCare lawsuits rely on the U.S. Constitution.

Plus, ERISA is not really a very effective law, as I’ve written about previously. Strategically, it’s a weak foundation to rely upon, for those who advocate individual choice in health care.

The Bipartisan Medicare "Doc Fix"

Is a short-term fudge that harms medicine and reveals Republicans' inability to take risks on health reform, as I write at John Goodman Health Blog.

How is the Senate's "Doc Fix" Paid For?

By hiking taxes and raiding hospitals, as I write at National Review Online. Hardly a good start for Republicans who want to repeal ObamaCare.

You'll Lose Your Insurance Broker, Too

Ok, everybody knows that they're likely to lose their health benefits, despite what the president has mistated again and again. But insurers are having to cut back commissions to brokers to comply with new ObamaCare regulations, as I discuss at StateHouseCall.

Single-Payer Fanaticism: Is Rwandan Health Care Better Than U.S.?

Yes, suggests the New York Times, in a remarkable article which I dissect at National Review Online.

Hope for Consumer-Driven Health Care? Venture Capitalists Think So

Two recent reports have made me question my pessimism about consumer-driven health care under ObamaCare. My take over at StateHouseCall.

Congress Can Never "Fix" The Medicare "Doc Fix"

And the American Medical Association's multi-million dollar advertising campaign won't change that: This month's Health Policy Prescription.

Orthopedic Surgeons Vs. Insurers in Idaho

The U.S. Department of Justice has settled antitrust allegations against a small group of orthopedic surgeons in Idaho. I suggest that the federal antitrust jurisdiction is inappropriate, at StateHouseCall.

The Crusade against the Happy Meal | The Daily Caller

My latest column, at The Daily Caller.

"Redeeming Health Reform" Video is Up

Americans for Free Choice in Medicine hosted a panel presentation at the National Press Club in Washington, DC on May 10. The great speakers included yours truly. Video is now available here.

Government Health Plan Let You Down? There's Always Wal-Mart

My take on Wal-Mart's British subsidiary selling cancer drugs at cost to patients denied care by the National Health Service.

Cops Bust Hamburglar! Santa Clara County's Toy Ban

This month's Capital Ideas column, addressing Santa Clara County's banning toys with Happy Meals.

Consumer-Driven Health Care or Government-Driven Health Care At Home?

My short comment on a good article in the New York Times.

Repealing ObamaCare is Only the Beginning

My op-ed in the Washington Times.

Beyond ObamaCare: The 9th & 10th Amendments and The "Right to Health Care"

This month's Health Policy Prescription.

Health Reform's War on the States

My op-ed in the Washington Times

California's Collaboration with ObamaCare: Not So Fast!

Although the governor is committed to seeking federal funding for new high-risk pools, the Legislature might not go along. I relate my conversations with California's HHS Secretary and the Executive Director of the agency in charge of the high-risk pool at State House Call.

Schwarzenegger: The First (and Last) Republican Governor for Obamacare

How much harm can he do, with eight months left in office? My analysis at National Review Online

Are Jeff Bezos & Crew Carey Investing in ObamaCare or Consumer-Driven Health Care?

It's tough to know, as I discuss at StateHouseCall.

We Don’t Call People on Welfare “Employed”; So Why Call People on Medicaid “Insured”?

My latest entry at John Goodman's Health Blog (similar to PRI's latest Capital Ideas).

Leave Medical Liability Change To States

One policy that Republicans have wrong is to invite Congress to legislate medical malpractice. I and some colleagues challenge this idea in Investor's Business Daily

Hey, Illinois: Regulate Your own Health Insurance!

Responding to a strange plea from Illinois politicians, U.S. Senators put forward a bill to accelerate ObamaCare's federal take-over of health insurance: My comment at State House Call.

Repeal & Replace: Don't Be the Last on the Bandwagon

Ytesterday, I spoke abou repealing ObamaCare and replacing it with patient-focussed reform, at an event hosted by Gov. George Pataki and with Steve Poizner, the California Insurance Commissioner, who are hardly right-wing extremists. Read about it at National Review Online

Let's Face It: Nobody Will Ever Fully Understand This Bill

In the face of repeal, the defensive phase of Operation ObamaCare is becoming clearer: Just keep telling people they need more time to understand it. I give some examples at National Review Online

Italian Lessons for U.S. Health Care?

While the U.S. is surrendering more health decisions to the central government, other countries are going the other way. I discuss a private versus public hospitals in the Italian region of Lombardy, over at StateHouseCall.

Let the Gaming Begin: How the Sick Will Suffer under Obamacare

Outlawing actuarially sound premium guarantees that health plans will compete by avoiding the sick: Critical Condition on National Review Online.

Repeal! Replace! But With What?

Those who argue for repeal have a winning case; but they need an equally simple alternative reform: This month's Health Policy Prescription.

(I also wrote an entry at John Goodman's Health Policy Blog on the same topic.)

Lunch with Nancy Pelosi - More on the "Slacker Mandate"

I had lunch with Speaker Pelosi the other day, and I believe that she misunderstands the nature of the "slacker mandate" which compels parents to put their "children" (as defined until they turn 26) on their health plan as dependents. Blog posted at Critical Condition on National Review Online

Private Health Insurance Death Spiral Will Begin on September 23

The "slacker mandate", which compels employers to bear their employees' "children"'s medical costs until they turn 26, will cause a death spiral of private health insurance, as I write at John Goodman's Health Blog.

Redundant Consumer Protection in Obamacare

It's already illegal for insurers to "drop" sick patients: Has been for years.

Who'll Cover Unwed Children's Children?

There's been a lot of discussion about the "slacker mandate" in ObamaCare: Covering "children" until their 26th birthday. I untwist a previously undiscussed twist in that provision, over at National Review Online

San Francisco Chronicle interviews yours truly on ObamaCare

Three questions asked, and answered. (Yes, I did find one positive thing in the bill, but only under duress!)

The Health Bill's Cost to State Budgets

What the CBO did not score. This month's Health Policy Prescription.

Repeal: The Historical Record

Can the new health "reform" law be repealed? I discuss the historical record of repeal, at National Review Online

The Strangest New York Times Columns in Favor of 'Reform' Ever? - John R. Graham - Critical Condition on National Review Online

The Strangest New York Times Columns in Favor of 'Reform' Ever? - John R. Graham - Critical Condition on National Review Online

Health "reform" and Hawaii's state budget

Hawaii will one of the states that will suffer most from the loss of health-insurance premium taxes. My op-ed in the Honolulu Star-Bulletin.

130+ Economists: Health "Reform" Kills Jobs

Over 130 economists sent a letter to President Obama and the Congress explaining that the massive tax hikes contained in health reform will kill jobs and capital investment. (Yes, I am one of them.)

New Study Analyzes Effect of "Reform" on States' Premium-Tax Revenues

It's not good.

Putting the 'OH!' in Ohio: I'm Here Because of Natoma, Too - John R. Graham - Critical Condition on National Review Online

Why is Natoma Canfield uninsured? Some blame falls to Ohio's insurance regulations: Putting the 'OH!' in Ohio: I'm Here Because of Natoma, Too - John R. Graham - Critical Condition on National Review Online

This Idea Gets Only One Star

My analysis of Prof. Paul Starr's health-reform recommendation in the New York Times: This Idea Gets Only One Star

What President Obama Should Say to Mrs. Natoma Canfield

What President Obama Should Say to Mrs. Natoma Canfield - John R. Graham - Critical Condition on National Review Online.

The President missed a "teachable moment" when he shared a woman's personal health history.

Did You Hear About Blue Cross Cutting Rates 20%?

Probably not, but it's just as true as the headlines that scream about the 39% increase. Government discrimination against individual ownership of health insurance is the real cause of volatile changes in premium: This month's Capital Ideas.

More on Buying Health Insurance Across State Lines - John R. Graham - Critical Condition on National Review Online

More on Buying Health Insurance Across State Lines - John R. Graham - Critical Condition on National Review Online. You don't need Congress to mandate it.

What Are Republicans Talking about When Republicans Talk about 'Buying Health Insurance Across State Lines'? - John R. Graham - Critical Condition on National Review Online

What Are Republicans Talking about When Republicans Talk about 'Buying Health Insurance Across State Lines'? - John R. Graham - Critical Condition on National Review Online. Sometimes, I'm not sure that even they know.

Nicholas Kristof Hosts Straw Man of the United States to Talk Health Reform

Nic Kristof argues that Australia and Sweden have better health care than the U.S.. But he doesn't appreciate that, in some ways, they have less government control that the U.S. Nicholas Kristof Hosts Straw Man of the United States to Talk Health Reform

Electronic Health Records and Government Health Care

A toxic mix, as the Ontario experience shows: My comment at State House Call.

Subjecting Health Insurers to Federal Antitrust?

Subjecting health insurers to federal antitrust laws would achieve nothing: My latest Health Policy Prescription.

New York Times Debunks the Uncompensated-Care Myth

New York Times Debunks the Uncompensated-Care Myth - John R. Graham - Critical Condition on National Review Online

More on Anthem Blue Cross California Rate Hikes

A number of possible reasons. (Anthem's "greed" isn't one of them.)

What's Behind Anthem Blue Cross' California Rate Hikes?

Adverse selection, caused by new state regulations, I suggest.

California's New HMO Regulations

It's a supreme irony that California has just imposed HMO regs that its Medi-Cal program could never achieve, and a state senator re-introduces a single-payer bill!

Next Step for Health Freedom: How about a Constitutional Amendment? - John R. Graham - Critical Condition on National Review Online

Next Step for Health Freedom: How about a Constitutional Amendment? - John R. Graham - Critical Condition on National Review Online

The Premier of Newfoundland's Heart Surgery

As everyone now knows, the premier of Newfoundland is coming stateside for heart surgery, which is fodder for the health-care debate by soundbites. What we don't yet know is who is paying for it.

Medicare & Medicaid Melt Down in Michigan

Thoasnad of doctors have stopped practicing in the state: My take over at StateHouseCall

'Extending the Life of Medicare'? Good Luck with That - John R. Graham - Critical Condition on National Review Online

'Extending the Life of Medicare'? Good Luck with That - John R. Graham - Critical Condition on National Review Online

"A Showdown of Corporate Oligopolies"?

UnitedHealth Group versus a consortium of New York hospitals: My take at StateHouseCall.

What Health Reformers Could Learn from the Market for Cosmetic Surgery

What Health Reformers Could Learn from the Market for Cosmetic Surgery

The Rich Get Richer, in the Senate Medicaid Reform

Forget the "Cornhusker Kickback", the federalization of Medicaid proposed by the Senate will increase the incidence of fraud, waste, and abuse. It also gives more federal fiscal leverage to rich states. This month's Health Policy Prescription.

Mainstream-Media Spin on Brown Victory & Health Care - John R. Graham - Critical Condition on National Review Online

Mainstream-Media Spin on Brown Victory & Health Care - John R. Graham - Critical Condition on National Review Online

From Health 'Reform' to Government-Retiree Bailout - John R. Graham - Critical Condition on National Review Online

From Health 'Reform' to Government-Retiree Bailout - John R. Graham - Critical Condition on National Review Online

More Medicare Patients Dropped

More Medicare Patients Dropped - John R. Graham - Critical Condition on National Review Online

A Danish With Your Health IT?

Just because Denmark may have successully implemented health IT, it doesn't follow that the U.S. can, too.

Medicare for All or Medicare for None? - John R. Graham - Critical Condition on National Review Online

Medicare for All or Medicare for None? - John R. Graham - Critical Condition on National Review Online