Thursday, December 30, 2010
Wednesday, December 22, 2010
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!
Tuesday, December 21, 2010
Friday, December 17, 2010
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.
Wednesday, December 15, 2010
So how can Medicare and Medicaid be constitutional?
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.
Tuesday, December 14, 2010
Sunday, December 12, 2010
Friday, December 10, 2010
Thursday, December 9, 2010
Wednesday, December 8, 2010
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.
Monday, December 6, 2010
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.
Monday, November 29, 2010
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.
Tuesday, November 23, 2010
Monday, November 22, 2010
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.
Friday, November 19, 2010
Wednesday, November 17, 2010
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.
Tuesday, November 16, 2010
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.”
Monday, November 15, 2010
Friday, November 12, 2010
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.
Thursday, November 11, 2010
Wednesday, November 10, 2010
Tuesday, November 9, 2010
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.
Monday, November 8, 2010
Friday, November 5, 2010
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.
Thursday, November 4, 2010
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.
Wednesday, November 3, 2010
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.
Monday, November 1, 2010
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.
Thursday, October 28, 2010
Wednesday, October 27, 2010
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.
Tuesday, October 26, 2010
ObamaCare is President Obama's problem: Don't make it your state's. This month's Health Policy Prescription.
Monday, October 25, 2010
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...)
Tuesday, October 19, 2010
Monday, October 18, 2010
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.
Thursday, October 14, 2010
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.
Wednesday, October 13, 2010
Tuesday, October 12, 2010
Monday, October 11, 2010
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.
Friday, October 8, 2010
Wednesday, October 6, 2010
Tuesday, October 5, 2010
Read more of my response here.
Wednesday, September 29, 2010
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.
Tuesday, September 28, 2010
This is a direct consequence of ObamaCare - and one that I anticipated last December in a study of Medicare Advantage.
Monday, September 27, 2010
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.
Friday, September 24, 2010
I've previously addressed this issue here.
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.
Thursday, September 23, 2010
Wednesday, September 22, 2010
Read more here.
Tuesday, September 21, 2010
Unfortunately, he errs in describing Medicaid, as I discuss at National Review Online.
Monday, September 20, 2010
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.
Friday, September 17, 2010
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.
Thursday, September 16, 2010
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.
Tuesday, September 14, 2010
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.
Monday, September 13, 2010
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.
Read the entire column here.
Thursday, September 2, 2010
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.
Wednesday, September 1, 2010
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.
Tuesday, August 31, 2010
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.
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.
Friday, August 27, 2010
More on the question of paying commissions on consumer-driven health 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.
Wednesday, August 25, 2010
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.
Sunday, August 22, 2010
Friday, August 20, 2010
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.
Wednesday, August 18, 2010
I can't say that I disagree with his plan.
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.
Thursday, August 12, 2010
Read more here.
Monday, August 9, 2010
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.
Thursday, August 5, 2010
Wednesday, August 4, 2010
Read more here.
Sunday, August 1, 2010
Read the complete blog entry at National Review Online.
Wednesday, July 28, 2010
Tuesday, July 27, 2010
Friday, July 23, 2010
Tuesday, July 20, 2010
Thursday, July 15, 2010
Wednesday, July 14, 2010
Wednesday, July 7, 2010
Monday, June 28, 2010
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.
Monday, June 21, 2010
Wednesday, June 16, 2010
Tuesday, June 15, 2010
Friday, June 11, 2010
Tuesday, June 8, 2010
Friday, June 4, 2010
Thursday, June 3, 2010
Friday, May 28, 2010
Wednesday, May 26, 2010
Tuesday, May 25, 2010
Monday, May 17, 2010
Tuesday, May 11, 2010
Friday, May 7, 2010
Thursday, May 6, 2010
Friday, April 30, 2010
Thursday, April 29, 2010
Monday, April 26, 2010
Wednesday, April 21, 2010
Tuesday, April 20, 2010
Friday, April 16, 2010
Wednesday, April 14, 2010
Tuesday, April 13, 2010
(I also wrote an entry at John Goodman's Health Policy Blog on the same topic.)
Friday, April 9, 2010
Wednesday, April 7, 2010
Thursday, April 1, 2010
Wednesday, March 31, 2010
Monday, March 29, 2010
Thursday, March 25, 2010
Wednesday, March 24, 2010
Tuesday, March 23, 2010
The Strangest New York Times Columns in Favor of 'Reform' Ever? - John R. Graham - Critical Condition on National Review Online
Monday, March 22, 2010
Friday, March 19, 2010
Wednesday, March 17, 2010
Tuesday, March 16, 2010
Putting the 'OH!' in Ohio: I'm Here Because of Natoma, Too - John R. Graham - Critical Condition on National Review Online
Monday, March 15, 2010
Friday, March 5, 2010
The President missed a "teachable moment" when he shared a woman's personal health history.