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Wednesday, December 28, 2011

113,000 Californians to Lose Medicare Advantage Benefits

A recent article discussing Obamacare's elimination of Medicare Advantage for entire communities in California quotes yours truly extensively.  Read the entire article here.

Over Regulation Reduces Choice in Health Insurance: An Update

Earlier this year, the Pacific Research Institute published a study demonstrating one way that Obamacare will dramatically reduce Americans’ choice of health insurance. By encouraging states to pass laws giving politicians control of health plans’ premiums, Obamacare creates incentives for politicians to impose populist limits that threaten health plans’ solvency.

Furthermore, common measurements and tools used to determine whether health insurance is “competitive” are deeply flawed, leading even well-intentioned regulators astray as they seek to control the cost of health insurance. This month's Health Policy Prescription incorporates new data to test whether the conclusions of the earlier study persist. It finds that they do.

Read the updated article here.

Thursday, December 15, 2011

Lights Out Until December 28

I am taking pre-Christmas vacation.  Benjamin Rush Society national office, blogging, research, and general online presence is off until December 28.

Merry Christmas; and I look forward to picking up where I left off on December 28.

Thursday, December 8, 2011

The CLASS Act: Time to Repeal It.

I was recently interviewed for an article asking why won't Congress repeal the CLASS program, a part of Obamacare that the U.S. Secretary of Health & Human Services has dictated cannot proceed.  The CLASS program was an unsound long-term care benefit that independent analysts had recognized as impossible since the beginning.

The CLASS program has only been killed because Congress, in an extremely rare example of probity, required the Secretary of HHS to determine that CLASS would be actuarially sound for 75 years. If Congress had required this of the rest of Obamacare, the whole thing would have been administratively rescinded at the same time

Read the entire article here.

Obamacare Will Drive Health Insurers Out of Business: Good or Bad Outcome?

Over at Forbes.com, a liberal blogger has finally confessed the truth - Obamacare will lead to a government-monopoly, so-called "single-payer" system.  It's led to a spirited response amongst my Forbes.com colleagues.

Read my contribution here.

Wednesday, December 7, 2011

Health Care Mingle Jingle in San Francisco, December 8

I've been spending a lot of my time lately on a new project focusing on innovation in HIT (health information technology).  My office is in San Francisco, so I'm in the right place.

I belong to the Health Technology Meet-Up Group, which is having a very interesting event in San Francisco on Thursday, December 8 - the "HealthCare Mingle Jingle".

Part conference, part holiday social, the Mingle Jingle is an all-day event with presentations by innovative, new, health IT firms, followed by a reception.  If you can only make it to the reception, the organizer tells me that you are welcome.

The event is in the San Francisco Financial District.   More information and details are at this link.

Friday, November 18, 2011

Can the PayPal Mafia Fix Health Care?

Last week, the Health 2.0 venture Practice Fusion held its second annual Connect conference in San Francisco. Practice Fusion is an exciting business for a few reasons:
  1. It provides a free electronic health record (EHR) to physicians and allied health providers.
  2. It's completely independent of the "legacy" health-care business. (Competitors include stalwarts AllScripts and Cerner).
  3. It's attracted investment from Peter Thiel's Founders Fund and similarly enterprising tech venture capitalists.  It's now got $40 million of capital.
  4. It's lead by a classically heroic entrepreneur: Ryan Howard ran the company on his own credit card for four years, nearly missing payroll, and was only saved by a legal payout related to a motorcycle accident).
  5. It got Dr. Farshad Mostafari, MD, the National Coordinator of Health Information Technology, to give a speech (via Skype) praising private enterprise in Health IT.  And he's an Obama appointee!
There's a lot to like about Practice Fusion.  Read the entire article at Forbes.com's The Apothecary.

Friday, November 4, 2011

VC's & Rolodexes: Bad Metaphor

This may not actually be blogworthy, but I've been doing some research on a project looking at the how venture-capital investment in biotech and medical devices is influenced by the regulatory environment and keep reading about how a good venture capitalist has a big, fat, thick Rolodex.
What kind of a metaphor is that?

I've met a few VCs in my day and none of them have a Rolodex - nor a manual typerwriter nor green eyeshades!

Time to change the metaphor!

Thursday, November 3, 2011

Two New Articles Profile Benjamin Rush Society

Readers know that I am now the Executive Director of the Benjamin Rush Society, a society of medical and pre-med students.  Two recent articles have profiled the Society:

  • Avisk Roy of Forbes.com's The Apothecary blog asks whether the Society can change medical education - here.
  • Philanthropy Magazine's John J. Miller featured the Society in an article about the growth of student societies in professions heavily impacted by government - here.

Health Care in Texas Under Rick Perry

The Fort Worth Star-Telegram carried my op-ed discussing Rick Perry's limited-government approach to health policy.  Read it here.

Monday, October 31, 2011

Health Spending and the "Supercommittee"

Less than a month remains before the Joint Select Committee on Deficit Reduction, popularly known as the Supercommittee, must submit a bill to Congress that will cut the deficit by at least $1.2 trillion in ten years. By design, everything is on the table.

While the Supercommittee is unlikely to achieve substantial cuts in federal health spending, it has the opportunity to take a historic step in uniting both Republicans and Democrats in reform that give Medicare (and, indirectly, Medicaid) patients, more control of their own health dollars.


Where do we find the room for compromise? Remarkably, it lies in President Obama's deficit-reduction proposal.  Don't believe me? Read more in October's Health Policy Prescription.

Virginia Attorney-General Cuccinelli on Medical Malpractice

In a compelling op-ed in the Washington Post, Virginia Attorney-General Ken Cuccinelli has challenged Republican U.S. Senators who have introduced a federal bill to limit medical-malpractice liability.

Thursday, October 20, 2011

955 Pages of Rules to "Eliminate" Excessive Federal Health Regulations

I kid you not.  The U.S. Secretary of Health & Human Services, Kathleen Sebelius, has announced that "It’s time to cut the red tape.  Our new proposals eliminate unnecessary and obsolete standards and free up resources so hospitals and doctors can focus on treating patients.”

And they've done this by issuing six new regulatory documents, ranging in length from just five pages up to 696 pages.  The total number of pages in all six documents? 955!

If this is what reducing red tape looks like, I'd hate to see what they do when they decide they need more regulatory wrapping.

U.S. Senator David Vitter Must Decide Which Side of Big-Government Health Care He's On

Earlier this month, U.S. Senator David Vitter (R-LA) ostentatiously accepted a petition with over 1.6 million signatures demanding the repeal of Obamacare. Good for him. But Senator Vitter is inconsistent in his response to big government in health care. When it comes to prescription drugs, he has frequently proposed legislation that expands the power of the federal government in questionable and irresponsible ways.

Read the entire column at National Review Online.

Wednesday, October 19, 2011

CLASS Act: An $86 Billion Puzzle

In a late Friday “data dump,” the U.S. Secretary of Health & Human Services, Kathleen Sebelius, announced that the long-term-care program established under ObamaCare, the Community Living Assistance Services and Supports (CLASS) program, would not come into effect.

This humiliating reversal was expected. Late September, the U.S. Department of Health & Human Services turned the lights out at the CLASS offices and reassigned the staff. It has long been understood that CLASS was impossible.

Read the entire article at John Goodman's Health Policy Blog.

Tuesday, October 18, 2011

Radio Interview on Collapse of CLASS Long-Term-Care Program

Here is the audio of a conversation I had with Mark Carbonero of KION-AM in Monterey County, California.

Prostate Cancer, Mammography, & Avastin: How to Choose?

There is a flurry of reactions to a draft recommendation from the U.S. Preventive Services Task Force. Although not formally released, the USPSTF is now recommending against PSA tests for prostate cancer. The American Urological Association, on the other hand, continues to assert that the PSA test is appropriate preventive care. (Ann McDonald of Harvard Medical School’s publishing arm has a nice summary of the reaction to the news.) The USPSTF previously sparked controversy in 2009, when it bumped up the recommended age for mammography from 40 to 50 years of age.

What type of health system would best respond to constantly evolving information like this?

Read the entire column at John Goodman's Health Policy Blog.

Thursday, October 13, 2011

Radio Interview with My Technology Lawyer

I return to the My Technology Lawyer radio show on October 13 at 1 p.m. PDT/4 p.m. EDT.  The show is broadcast live on the Internet and archived, too.  Please follow this link to listen.

Topics include: Health reform and prices of health stocks, the forthcoming Supreme Court hearing on Obamacare, Obamacare's state-based exchanges, and alternative reforms once Obamacare is repealed.

Monday, October 10, 2011

What's Next? Mitt Romney As A Space Lizard Commanding An Alien Fleet?

If your ears can handle the explosions, please have a look at Rick Perry's latest ad opposing Romneycare.  By the end of it, I half expected Mitt Romney to peel off his human skin and stand revealed as a space lizard commanding the alien invasion of our mother planet.  Let's hope that this ear-splitting ad motivates some people to investigate substantive criticism of Romneycare.

Wednesday, September 28, 2011

Lou Dobbs Show 4:35 EDT/1:35 PDT Today

I will be a guest on Lou Dobbs' syndicated radio show today at 4:35 p.m. EDT/1:35 PDT.  Please go to the show's website to find your local station.  (If it's archived I'll link to that later.)

Thursday, September 22, 2011

Rick Perry's Texas: It's Better to Create More Jobs Than More Medicaid Dependents

As Texas governor Rick Perry makes a splash in the Republican presidential primaries, one place where people are looking for evidence of poor executive leadership is his record on health care. Fellow conservatives have focused on his 2007 executive order that girls entering grade 6 should receive a vaccine, Gardasil™, which protects against the Human Papilloma Virus (HPV).

A criticism that will likely carry more weight as the campaign develops is Perry’s record on Medicaid and the uninsured. We see this in an article written by Noam N. Levey in the Los Angeles Times, which declared that Texans’ access to health care is “withering” under Perry. As Levey notes, Texas has the highest rate of uninsured in the nation, over one quarter of the population. This is important, but not in the way Levey believes.

Read the entire article in this month's Health Policy Prescription here.

Two New Ventures Simplify Consumer-Driven Health Care

A friend of mine who made a lot of money use to tease me when I (constantly) expressed shock at how simple so many successful business ideas are. “All great businesses are simple,” he said. Here are two in the healthcare space: Bloom Health and ZocDoc.
Although disrupting different parts of the value chain, the two ventures have some similarities. First, each just received a big chunk of capital. Bloom Health, initially funded by VCs in 2009, was taken over by WellPoint, Inc., and two other (non-profit) Blue Cross Blue Shield license-holders. ZocDoc just raised Series C funding from Goldman Sachs, having raised a total of $95 million.

Read the entire column at Forbes.com: The Apothecary here.

"Preparing for the Exchanges"? You Might as Well Prepare for the Unicorn Stampede

What is the biggest waste of effort in American health care today?

I’d suggest it is the hustle and bustle to establish PPACA’s Health Benefits Exchanges. The health insurers’ trade association, AHIP, has an entire educational series on “preparing for exchanges.” The likelihood of exchanges being up and running by January 2014 is vanishingly close to zero. Indeed, they may not exist at all except in very few states – whether or not President Obama wins re-election.

Read the entire article at The Health Care Blog.

Tuesday, September 20, 2011

Benjamin Rush Society Events at Duke University & Hampden-Sydney College

The Benjamin Rush Society, a national society of medical students of which I am Executive Director, will be hosting two events in the next few days.  If you are in Durham, NC or Hampden-Sydney, VA, please join us on September 23 or September 26!

Thursday, September 15, 2011

What Should Rick Perry Say About Gardasil?

The Republican presidential primaries have been temporarily hijacked by a single incident in Rick Perry’s decade-plus tenure as governor of Texas. Despite Michele Bachmann’s ludicrous claim that Gardasil causes mental retardation, let’s recall that not one single schoolgirl was vaccinated by the offensive executive order: The legislature overturned it long before the school year began.

Furthermore, the executive order did not comprise a mandate.

Wednesday, September 14, 2011

Obamacare Exchanges Are Limping Into Oblivion

Back on July 29, I wrote a blog entry explaining why I believe that any health insurance exchange, whether compliant with ObamaCare or not, is unlikely to thrive without huge subsidies. Recent days have brought forward new evidence that even the massively taxpayer-financed ObamaCare exchanges are facing even bigger problems than previously understood.

Tuesday, September 13, 2011

Graham Promoted To Additional Responsibilities

I should explain why I'm not writing on a daily basis anymore.  I trust I'll be able to get back to writing more frequently, but I have been given a new opportunity and additional responsibilities at Pacific Research Institute.

As well as continuing in my role as Director, Health Care Studies, I have been appointed Executive Director of the Benjamin Rish Society, a national society of medical students and physicians.  The Benjamin Rush Society's website (which is soon to undergo significant renovation) expains its mission.  The website is here.

These new duties will take up much of my time for the next few weeks.  Nevertheless, the monthly Health Policy Prescriptions and periodic blog entries will continue.

Thursday, September 8, 2011

Obamacare's Exchanges Are Well and Truly Dead on Arrival

Yesterday, I sort of suggested that we could finally dispose of the matter of health insurance exchanges. 

Well, today, courtesy of Investors' Business Daily's David Hogberg and the Cato Institute's Michael Cannon, we learn that federal exchanges will not be able to funnel the gusher of refundable tax credits to indviduals who enrol in them.

Effectiveness of DTC Advertising

It has been a while since I've written about physician-pharmaceutical industry relations or DTC (direct-to-consumer) advertising.  My last major article, arguing that promotion and communications by pharmaceutical manufacturers is socially beneficial, is available at this link.

Many criticize the notion that advertising can have any value to patientss.  But a new study by three marketing professors from European business schools shows that research into advertising effectiveness is important.

In their article, reported at this link, they conclude that advertising for breast cancer is too "gender salient". That is, it is too "pink".  As a result women shirk from the ads, rather than learn from them.

Although the research appears to cover ads mostly sponsored by governments and charities, it nevertheless bears upon pharmaceutical companies' DTC advertising.  As we (hopefully) enter an era of personalized medicine, we should also be entering an era of more personalized DTC advertising.

As these European professors have shown, pharmacological R&D must be accompanied by research into effective communications.

Wednesday, September 7, 2011

Health Insurers' In States' Crosshairs

The Orange County Register published an op-ed by me, which describes the effects of states' emerging rules imposing political control of health-insurance premiums, which are prompted by Obamacare.  The op-ed is at this link.

The column is based on a my study, which PRI recently published, available at this link.

Why Don't Health Insurance Exchanges Work?

Health insurance exchanges! Can there possibly be anything more to say about them?  I have previously triangulated around the issue of generic exchanges, and focused my analysis on the negative consequences of Obamacare-compliant exchanges.

Over time, I've become more skeptical about exchanges in general, and the most voal supporters of so-called "free-market" exchanges (such as Utah's) have actually influenced me towards this position.  Their arguments really are not compelling.

Perhaps this will be my final word on exchanges.  Please go to this link to read August's Health Policy Prescription, "Why Health Exchanges Don't Work".

Friday, August 19, 2011

Vacation Until September 6

Hiking the glaciers of Montana until September 6.  I look forward to blogging again when I return.

Independent Payment Advisory Board Op-Ed in San Francisco Chronicle

My column critiquing IPAB came out today in SF Chronicle. It is gated until tomorrow, but I will be travelling so I thought I'd post it now.  See http://tinyurl.com/3v9jczy.

Friday, August 12, 2011

Out of Pocket (Again)

Travelling on business until next Thursday: Likelihood of blogging close to nil!

Tuesday, August 9, 2011

How Obamacare Threatens Health Plans' Solvency

My column in Investors Business Daily is here.

Massachusetts: Consequences of Political Control of Health Premiums

My column in the Worcester Telegram is here.

The Utah Health Exchange: A Retort to the Rebuttal

Professor Norman Thurston of the Utah Department of Health has decided to rebut my criticism of the Utah Health Exchange.  His article is posted at Forbes.com: The Apothecary.

Prof. Thurston repeatedly charges that I mischaracterize the Utah Health Exchange (UHE) and present false information.

Monday, August 1, 2011

Offline Until August 5

I'll be travelling on business until August 5 and not blogging until I return.

Big Pharma’s Falling R&D Investment Helps Small Biotechs - 07/29/2011 - The Burrill Report

BDO has a new report that examines Big Pharma's cuts to its R&D budget, and investigates the trade off between cutting internal R&D and filling the pipeline by doing deals with smaller firms.
(This is the subject of a research project that I hope to execute within the next year.)

Obamacare Threatens Solvency of Colorado's Health Insurers

Obamacare encourages states to impose too much political power over health plans.  My column in the Pueblo Chieftain is here.

Why Don't Health Exchanges Work?

previous entry reported and discussed the lackluster — basically non-existent — results of the Utah Health Exchange, and promised to explain why unsubsidized exchanges are unlikely to attract significant numbers of beneficiaries from the small-group market. The answer, I believe, is pretty straightforward: The administrative costs of operating an exchange plus the administrative costs to a small business of migrating to the exchange are almost certainly greater than the administrative costs of participating in the traditional small-group market (or taking account of other “work arounds” promoted by some insurance producers). Therefore, unless an exchange is subsidized from non-exchange sources (as per Obamacare), it will not attract many participants.

While straightforward, this conclusion is not necessarily intuitive.

Read the entire column (and comments) at John Goodman's Health Policy Blog.

Thursday, July 28, 2011

A New Bargain for Drug Approvals - But for the Wrong Reason

The Wall Street Journal recently ran an op-ed by Professors Michelle Boldrin and S. Joshua Swamidass that proposed "A New Bargain for Drug Approvals" (July 25).  They recommended that the Food and Drug Administration allow new medicines to be used after they had been demonstrated "safe," but not necessarilly "efficacious."  I liked the article, and agree that the reform which they recommend would be very beneficial. However, I have a philosophical problem with one of their reasons.

Wednesday, July 27, 2011

Why the Utah Health Exchange is No Model for Health Reform

The Utah Health Exchange is the model some conservatives believe can be used to push back against Obamacare. Witness the Wall Street Journal (July 16) soundly rejecting regulatory guidance on what the Administration is now calling "Affordable Insurance Exchanges," but encouraging governors to get on the exchange bandwagon, in the hope they can build free-market exchanges that will blunt Obamacare's worst effects.

80% of Employers Concerned About Health Reform’s Administrative Obligations; 30% Think Exchanges Will Offer Worse Coverage

A new survey by Lockton, Inc.’s Health Reform Advisory Practice reports that 80 percent of respondents are concerned about federal health reform’s additional administrative obligations.

Read my entire article at Forbes.com: The Apothecary.

Thursday, July 21, 2011

The U.S. Government Will Like the Express Scripts-Medco Takeover

Medco traded at a ten percent discount to the deal terms all day Thursday, reflecting skepticism that the U.S. government will let the deal happen. I don't see why. The government favors concentration in the health sector.

Read my latest column at Forbes.com: The Apothecary.

PPACA's Raid on the Medicine Cabinet

There has been a lot of discussion of the Independent Payments Advisory Board (IPAB) lately, including pretty heated testimony at the House of Representative Energy & Commerce committee in the last few days.

IPAB is the primary vehicle whereby the Paient Protection and Affordable Care Act (PPACA) will deny new medicines to Medicare beneficaries, in a futile attempt to contain costs.
The Washington Times ran my column on IPAB.  Read the entire article here.

Wednesday, July 20, 2011

Health Benefit Exchanges: Regulations Versus Reality

Although Ohio governor John Kasich apparently deludes himself into believing that he can take federal grant money to establish a Health Benefits Exchange, but then somehow design an exchange that does not comply with Obamacare's regulations, most other governors have a more realistic perspective.

That is why the U.S. Department of Health & Human Services' recent release of 347 pages of regulatory guidance on exchanges is both exasperating and probably futile.  My analysis concludes that only about one third of Americans will be living in states that have imposed exchanges by the law's deadline.

Read the entire analysis in this month's Health Policy Prescription.

UnitedHealth Group's Earnings Call

I participated in UnitedHealth Group's earnings call today.  My conclusions:
  • Optum will continue to make well focused acquisitions;
  • UNH will continue to keep quiet about its lobbying efforts to shape the post-PPACA landscape;
  • Public budget crises will make the Medicaid managed-care business look much less attractive than it has been; and
  • UNH and (most) Wall Street analysts continue to ignore the likelihood of PPACA’s defeat, either through the Supreme Court or the election of a new president in 2012.
Read my entire column at Forbes.com: The Apothecary.

Friday, July 15, 2011

Are U.S. Doctors Overpaid?

From Professor Christopher Conover at the American Enterprise Institute blog.

I’ve always known that doctors have a lower ROI on education than MBAs, for example, but I did not know it went all the way back to 1990, and (presumably) a good number of years before that. A related question that might be one way to address the question of the high share of health spending in GDP in the U.S. versus other countries might be to look at the cross-section of ROIs for different professions, rather than the longitudinal (time-period) ROI within the U.S.

To put it another way: The labor value of professionals is very difficult to measure. Many physician specialties (especially GPs) are limited in their ability to increase productivity. However, because the U.S. has been (until the last few years) more economically free than most other developed countries in Europe, Canada, Australia, etc., managerial professionals have been able to increase their productivity relatively faster in the U.S. than those countries.

Ergo, we may observe that the ROI gap between medicine and other professionals has increased faster in the U.S. than other countries. Nevertheless, if it is driven by productivity, professor Baumol’s insight leads us to conclude that physician pay in the U.S. must become increasingly higher than physician pay in other developed countries to compensate, thereby contributing to the higher share of GDP on health spending.

Wednesday, July 13, 2011

Big Government and Health-Care Stocks: A Happy Marriage?

What with the underwhelming market response to my previous article discussing the effect of the 2010 federal Patient Protection and Affordable Care Act (PPACA) on health insurers, I was pretty astonished (and relieved) to see Citigroup equity strategist Tobias Levkovich state many of the concerns which have occupied me.

Please read my latest column at Forbes.com's The Apothecary.

Wednesday, July 6, 2011

Bust or Bailout? The Future of Private Health Plans Under Obamacare: With A Focus on Massachusetts & Colorado

San Francisco (June 30, 2011) -- A new research study released by the Pacific Research Institute (PRI), a California-based free-market think tank, shows how ObamaCare threatens the solvency of private health plans, which will significantly reduce consumer choice and increase costs. The ultimate result will likely be either a massive taxpayer bailout of private health plans or continued momentum toward a single-payer government-monopoly system.

Bust or Bailout? The Future of Private Health Plans Under Obamacare was authored by PRI director of Health Care Studies, John R. Graham. Noting that the 1996 federal Health Insurance Portability & Accountability Act (HIPAA) also lead to consolidation of health plans, Graham concludes that “Repealing ObamaCare and replacing it with reforms that put the American people, instead of government, in charge of health dollars, is the recommended way to avoid either outcome. ”

Tuesday, July 5, 2011

Capped Federal Matching Funds: Washington State's Bipartisan Medicaid Reform

It’s a short law with big potential: SB 5596, signed by governor Christine Gregoire at the end of May, is only three pages long. Nevertheless it puts Washington State on a path to Medicaid solvency and sets an example for California and the nation.

Remarkably, the law, sponsored by conservative Republican senator, Linda Evans Parlette, passed with unanimous support in the state Senate and Assembly. Needless to say, the state’s Democratic legislators and liberal governor took some political risks in endorsing it. But we have to be careful in describing what SB 5596 achieves.

Wednesday, June 29, 2011

Leavitt: Most States Won't Have Exchanges by Deadline

Former U.S. Secretary of Health & Human Services Mike Leavitt has announced that most states will not have Health Benefits Exchanges up and running by January 2014, when PPACA requires that they be covering patients who will have lost their employer-based benefits.

My readers have known this since April 8 (see here).  If you want to know how health reform is really working out, I encourage you to register for updates via one of the links at the left masthead.

Jim Bohannon Interview

I had the privilege of a full hour on the Jim Bohannon Show last night.  We spoke about the Medicaid crisis facing the country, and how to reform this out of control program.  Listen to the audio here.

Wednesday, June 22, 2011

Medicaid Reform - Clinton Style!

Medicaid reformers should adopt the model of successful welfare reform, as signed by President Clinton.  Read my column in the Buffalo Daily News here.

Friday, June 17, 2011

Federal Health Reform and Stock-Market Returns of Health Insurers

I was amazed to see how well the for-profit health insurers did during the build up, passage, and rollout of the new law.  Read the entire article here.

Path Dependency in Medicare Reform

I first learned about path dependency when studying physics — but it surely applies to public policy, too. Despite the scholarly disputations about health reform, what drives most voters are not questions about the solvency of Medicare or beneficiaries’ access to care, but fear of change. Arguments will not change this fact: People change when the pain of not changing becomes greater than the pain of changing, but not before.

This can be the only explanation for the majority of respondents to polls (described here) which ask the foolish question whether “Medicare should remain as it is today” versus Paul Ryan’s proposed reform.

Read the entire blog entry at John Goodman's Health Policy Blog.

Wednesday, June 15, 2011

Connecticut's New, Ineffective Law Politicizing Premiums

Last week, an overwhelming majority of Connecticut legislators passed a bill, SB-11, that would give the executive branch the power to decide whether health plans should be allowed to increase their premiums at rates that keep pace with medical costs. Health plans may be a politically attractive target, but giving politicians the power to approve premiums causes other problems – and doesn’t even hold down rate increases.

Health plans are largely pass-throughs, paying medical claims from providers whose charges have been rocketing skyward. Read the entire article at Forbes.com: The Apothecary.

The Grim Reality of Medicare Reform

As one of the first conservatives to criticize Paul Ryan’s Medicare reform, I was pretty excited to read Andrew McCarthy’s spirited attack against the very existence of Medicare. According to McCarthy, it’s a wholesale scam, and he doesn’t mind telling everyone because he’s neither running for office nor responsible for getting anyone else elected.

Sure, I’ll admit I had the urge to jump up and down and pump my fists in the air. But then I read Henry Olsen’s warning about alienating blue-collar voters, and I decided that while McCarthy’s scorched-earth approach may be the right one for the conservative patriot to adopt when challenged by al-Quaeda or the Taliban, it might not be quite the thing for dealing with the median American voter, who desperately clings to the increasingly exposed false promise of Medicare.

I think we have a bigger problem than has yet been recognized. Read the rest of this article at National Review Online.

Thursday, June 9, 2011

State Implementation of Federal Health Reform: Panel Presentation

Here is the video of the panel presentation by me and Christie Herrera of the American Legislative Exchange Council in Seattle a couple of days ago.  We were speaking at the 9th Annual Health Care Conference, produced by the Washington Policy Center.

Medicaid is easier to fix than entitlement programs | Anonymous | Op Eds | San Francisco Examiner

My column on Senator Coburn's Medicaid reform bill, at the San Francisco Examiner.

Thursday, June 2, 2011

Will There Be Health Benefit Exchanges By 2014?

Despite advice from most free-market analysis, some Republican governors are executing the Patient Protection and Affordable Care Act (PPACA) by establishing Health Benefits Exchanges. These governors dislike PPACA, but they believe that exchanges can be vehicles for more choice than the federal law anticipates.

But I think that the real news is how much difficulty states that want to implement PPACA as fast as possible are having.  Read the entire article at John Goodman's Health Policy Blog.

Wednesday, June 1, 2011

A Pfizer Break Up? Maybe Not Such A Great Idea

My second column at Forbes.com's The Apothecary blog discusses whether breaking up Pfizer (like almost everyone on Wall Street wants to do) is really such a good idea.

Read it here.

Why Medicaid Should Be Easier to Fix Than Entitlements

Congress remains gridlocked on many important issues but not every politician is afraid to challenge the unsustainable growth of Medicaid. Consider S. 1031, by U.S. Senator Tom Coburn.

This measure would increase local control over Medicaid spending and improve the incentives that have led politicians to trap ever more low-income citizens in poverty and the poor access to care that characterizes this top-heavy system.

Medicaid is often described as an “entitlement,” but that is wrongheaded. Medicaid is welfare, targeted at low-income Americans. And Medicaid should be easier to fix, politically, than two other troublesome programs.

Thursday, May 26, 2011

Ryan's Medicare Reform: More, Please

A few months ago, News Corporation launched a new publication, The Daily, which is designed specially for the iPad.  Regrettably, I don't have an iPad, but the editor ran my column anyway.  It's about Paul Ryan's and the House Republicans' Medicare reforms (and especially timely in the wake of Republican defeat in the Congressional special election in New York a couple of days ago).

Now, I can fantasize that everyone whom I see playing with his or her iPad is reading my column.  If you don't have an iPad, you can read it here.

Wednesday, May 25, 2011

Will Kathy Hochul Vote to Repeal Obamacare?

The surprise victory of the Democratic candidate in NY-26’s special election yesterday teaches a curious lesson: Seniors who rose up against Obamacare’s Medicare cuts at town-hall meetings in the summer of 2009 appear to have risen up against Paul Ryan’s Medicare plan in the spring of 2011.

Or maybe they didn’t. Read the entire post at National Review Online.

Friday, May 20, 2011

If Air Travel Worked Like Health Care



This may be the best health-care video ever!  By Jonathan Rauch of National Journal.

Thursday, May 19, 2011

Comparative-Effectiveness Research: How Many Lives Will It Cost?

I write a lot over at John Goodman's Health Policy Blog.  For every original post, I also write about half a dozen comments on others' posts.  I don't usually share the latter here.

However, I was interested to see Dr. Goodman's take on a new paper published by the Center for Medicines in the Public Interest, an outfit which is often tagged as simply a mouthpiece for Big Pharma.  Here's what I wrote:

Wednesday, May 18, 2011

Governors Declining Health Benefit Exchanges

I was interviewed in a story for Health Care News about states whose governors are declining to implement Obamacare Health Benefits Exchanges.  Read it online here.

Massachusetts En Route to Single-Payer Health Care

Mitt Romney has thorwn himself in front of a buzzsaw with his continuing defense of his 2006 health reform in Massachusetts.  The other day, the Wall Street Journal editorial board sharply criticized Mr. Romney's approach.  In a letter by yours truly that the WSJ published today, I noted another problem with the Massachusetts reform: It amplified political incentives that have put the solvency of Bay State health plans at risk.  Read the letter here.

For non-subscribers, the text is copied below:

Tuesday, May 17, 2011

Who Is The Republican Health Care Candidate?

The Wall Street Journal and most NRO writers have pretty much written off both Mitt Romney and Newt Gingrich as acceptable Republican presidential candidates because of perceived weaknesses on health care. Health care has become the third rail of American politics — just not the way we used to understand it.

Until recently, a Republican could churn out crowd-pleasing sound bites about fixing health care but never put the pedal to the metal by investing political capital in a serious proposal for reform. Republicans understood that when the talk turned to health care, Democrats won the debate and Republicans lost. It was just a fact of life. Not anymore.

A Pfizer Break Up? That Would Be Something

I have been afforded the great privilege of a perch at Forbes Online from which to communicate my perspective on events where health policy and healthcare finance intersect.  Avik Roy, an equity research analyst at Monness, Crespi, Hardt & Co. in New York City, has invited me to collaborate with him on his blog, The Apothecary, which has been hosted by Forbes for a few months.

What I intend to contribute at The Apothecary is somewhat different than what you'll read in my other media, because I'll be bringing financial analysis to bear on the healthcare space (although not ignoring what the politicians and bureaucrats are doing, of course.  Any healthcare enterprise's success will depend largely on government action.)

Many Wall Street analysts have been after Pfizer, Inc., to restructure and refocus for years.  Under new CEO, Ian Reid, they think they've finally got someone whom they believe can get the job done.  But others think that Big Pharma should grow by acquisitions, instead of shrinking by spinning off divisions.  How credible is it that Mr. Reid will take the latter course?  Read my entire blog entry here.

Mission Impossible: Medicare's Independent Payment Advisory Board

Thos of you who can read 1,500 words will have already read the longer version of this in the recent Health Policy Prescription.  But for thos who prefer a slightly shorter version of my analysis of Obamacare's Independent Payment Advisory Board (IPAB), the new agency that will decide whether granny gets a "blue pill" or a "red pill," please see this blog post over at John Goodman's Health Policy Blog.

Monday, May 16, 2011

Friday, May 13, 2011

Mission Impossible: Medicare's Independent Payment Advisory Board

The Independent Payment Advisory Board (IPAB) is a new bureaucracy established by Obamacare that will limit Medicare beneficiaries’ access to certain medical goods and services—especially new prescription drugs.

Key Points:
• IPAB puts Medicare beneficiaries’ access to prescription drugs and certain other medical goods and services under control of a board of 15 presidential appointees, while leaving decisions about other medical goods and services under control of Congress.

• IPAB will be called upon to cut much more Medicare spending than officially estimated, because physicians and hospitals are highly likely to succeed in restoring the cuts that Obamacare imposes upon them.

• IPAB could deny Medicare beneficiaries access to every innovative prescription drug introduced every year, but still have little effect on Medicare spending.
• As long as Congress exerts political control over Medicare beneficiaries’ access to medical care, all treatments and providers should be treated equally, which implies that IPAB should be abolished.
Read this month's Health Policy Prescription here.

Wednesday, May 11, 2011

Obamacrats Play Chicken Little — Again

The Obamacrats published a "research brief" attempting to prove that the flood of uninsured people in emergency rooms is driving the health crisis. It upset me because the author appears to be skilled at crunching numbers and I hate it when those skill are abused for political gain. Anyway, the Obamacrats keep trafficking this myth because it feeds the line that we need "universal" coverage to control health costs.

Well, I printed it out and was planning to write about it, but Michael Cannon of the CATO Institute beat be to the punch. Read his analysis at the folliwing link: HHS Plays Chicken Little — Again.

Monday, May 9, 2011

Politicians Cannot Control Health Costs

My column in the Orange County Register, opposing California legislation that would give politicians the power to review health-insurance premiums, is here.  It argues that politicians cannot control health costs; that rate-review laws are ineffective; and that the experience of Massachusetts demonstrates that giving politicians' this power in the age of Obamacare is incredibly risky.

Wednesday, May 4, 2011

Shooting the Messenger: California’s Proposal to Control Health Plans’ Rate Increases

California legislators are considering a bill, AB 52, that would give the executive branch the power to decide whether health plans should be allowed to increase their premiums at rates that keep pace with medical costs. Health plans may be a politically attractive target, but giving politicians the power to approve premiums causes other problems — and doesn't even hold down rate increases.

Tuesday, May 3, 2011

Another Voice on Obamacare Exchanges

Some opponents of Obamacare have suggested that states should establish Health Benefits Exchanges because they can provide a "firebreak" against federal regulations.  According to Twila Brase of the Citizens' Council for Health Freedom, this is impossible.  Her article makes a compelling read: Here.

Cold & Allergy Meds by Prescription Only? A Recipe for Higher Costs and Violent Crime

Sometimes we face problems to which there are no great - or even good - solutions.  One of those is the abuse of cold and allergy medicines by people who buy them as inputs to methamphetamine.  A few years ago, Oregon attempted an apparently reasonable solution to this problem, buy making pharmacies dispense many of these medicines by prescription only.

Now, California legislators are seeking to replicate this law.  Unfortunately, the harmful consequences to legitimate patients of making these drugs available by prescription only are pretty clear: It adds cost and hassle to acquiring necessary medicines.  The benefits to society - reducing criminal production and abuse of methamphetamine - are far less clear.  The prescription-only rule will likely drive the vile business into the hands of even worse criminals than control it now.

Read the rest of my column in the Sacramento Business Journal (subscription only).

Monday, May 2, 2011

Canada Still Working Towards Universal Health Care

You probably didn’t notice, but Canada is having a federal election today. It’s a big deal up there — and the number one issue is — you’ll never guess — health care! It’s eleven percentage points more critical than jobs and the economy.

Read the entire post at John Goodman's Health Policy Blog.

Tuesday, April 26, 2011

Ryan Republican Medicare Reforms: What They Are, What They're Not, What They Might Become

The Medicare proposal in U.S. Congressman Paul Ryan's budget plan, Path to Prosperity, is superior to the status quo, or anything proposed by President Obama. However, it is somewhat vaguer - and might differ significantly - from the high standard for reform that Ryan set himself last year, in Roadmap for America's Future.

Read this month's Health Policy Prescription here, or as a column at Newt Gingrich's Health Reform Report.

Monday, April 25, 2011

Rhode Island's Medicaid Waiver's Big Influence

The Providence Journal ran a column by me that explained how Rhode Island's Medicaid waiver - which capped federal matching funds in exchange for giving more flexibility to the state, is succeeding and sets an example for the nation.  Read it here.

(It is based on an article that PRI published earlier this month, here.)

Tuesday, April 19, 2011

BayBio2011 Conference!

Every once in a while, they let me out of my policy-wonky cage and let me mix with real entrepreneurs - the ones who make the world work.  Wednesday will be one of those times.

It's been a while since I've focused on medical innovation, so imagine my surprise when I was graciously invited to participate in the BayBio2011 conference.  I'll be there Wednesday and (hopefully) Thursday, too.  I'll be tweeting madly, so please follow #baybio2011.

Monday, April 18, 2011

Overturning the Individual Mandate in Court Does Not End Obamacare

In the Orange County Register, I make the case that an individual mandate and penalty, as instituted by Obamacare, are not really different than the status quo, whereby the government subsidises employer-monopoly health benefits.  Read it here, and please don't be spooked by the math!

Friday, April 15, 2011

Thursday, April 14, 2011

Colorado Republicans for Obamacare?

Colorado’s Health Benefits Exchange legislation, which would implement Obamacare in the state, was “mortally wounded,” but is being brought back to life by none other than the Republican majority leader in the state house of representatives, Amy Stephens, according to the Denver Post’s Tim Hoover.

Exchanges are the vehicles through which the gusher of cash from Obamacare’s tax hikes will be laundered into subsidies to favored health plans, payments to vendors and consultants, and salaried jobs for political appointees.

To be sure, this is not what the conservative Stephens thought she was doing. The bill was rolling happily along a couple of weeks ago, when the state’s liberty groups caught wind of it and convinced Stephens to “test” whether or not this was actually an Obamacare-enabling exchange, by offering an amendment that the exchange could only start up if the state got a waiver from Obamacare. Needless to say, the legislation failed the test, and the bill’s supporters pulled it in order to get to work on Stephens.

Friday, April 8, 2011

Obamacare Exchanges: Flailing & Failing

(This post has been corrected from its initial version, with an apology.  Please see here.)

The most disappointing news on the Obamacare front these days is that at least two Republican governors cannot wait to implement Obamacare in their states. Apparently, one Republican state senator in Oklahoma has finally decided to prevent an Obamacare exchange bill from reaching Gov. Mary Fallin for signature. Fair enough, but how did it get this far in the first place?

In Virginia, Gov. Bob McDonnell has forced amendments to prevent health plans participating in his state’s Obamacare exchange from covering abortions — at least, that’s what he thinks he’s done. In fact, U.S. Secretary of Health & Human Services Kathleen Sebelius will decide whether Virginia’s health plans will cover abortions, because she’s the one who will certify the exchange — or not. Because 100 percent of Obamacare’s subsidies to individuals in the exchanges come from the federal government, Sebelius’s whims will decide the rules governing the cash flows. Virginia will simply be stuck with paying salaries to the bureaucrats and fees to the vendors and consultants who operate the exchange.

Ryan's Medicare Reform Falls Short

A slightly different version of my analysis of the other day, at John Goodman's Health Policy Blog.

ObamaCare Exchange Will Hurt New Hampshire

I'm not sure that I know what the Executive Council of New Hampshire is, but I'm disappointed that they took federal money to start working on an Obamacare Health Benefits Exchange.  One of the Executive Councillors, Christopher T. Sununu, has written a column opposing an ObamaCare exchange.

Read it here. It expresses my views almost exactly.

Obamacare Health Benefit Exchange?



Actually, this is a painting by George Tooker called Government Bureau, from 1956.  But I think we'll have to retitle it unless we defeat Obamacare before the exchanges are up and running in 2014.

Thursday, April 7, 2011

Romneycare's Popularity Plummets

Grace-Marie Turner speaks for many in expressing frustration with Mitt Romney’s inability to let go of his failed Massachusetts health-care “reform.” President Obama himself has frequently asserted that Obamacare is partly based on the so-called conservative ideas encompassed in Romneycare. New polling results from the Bay State might make the president rethink this approach, and give Romney more confidence to admit his error.

A recent poll from Suffolk University and WHDH-TV reports that 49 percent of respondents do not believe Romneycare has helped, while only 38 percent believe that it is working. Fifty-four percent said that Romney’s signing the law likely hurt his presidential chances, while only 22 percent believed that it helped.

Clarifying Ryan's Medicare Reform

As yesterday’s uncritical cheerleading of Paul Ryan’s budget proposal dies down, one of his loudest fans has taken a closer look. Yesterday’s Wall Street Journal editorial asserted (incorrectly) that Ryan’s proposal “means that at age 65 you would be able to keep your same insurer, with the feds paying for that insurance instead of your employer.”

As I’ve already noted, that was a feature of last year’s Roadmap, not this week’s proposed budget. The Wall Street Journal corrected the record in today’s editorial, which clarifies that “the subsidies will flow through Medicare, only to regulated insurers and government-approved plans. It does not go as far as Mr. Ryan’s previous ‘roadmap’ which offered direct cash vouchers for individuals who preferred to buy insurance themselves.”

Wednesday, April 6, 2011

Federal Obamacare Exchanges Are A "Phantom Menace"

Many advocates of individual choice in health care chide me for my unrelenting approach to states legislating Obamacare Health Benefits Exchanges.  "If our state doesn't legislate an exchange, the federal government will impose one on us, and that will be even worse," say these well-meaning folks.

According to Joe Coletti of the John Locke Foundation, "I believed this myself until recently. Now I know this is a phantom menace."

Read Mr. Coletti's article here.

Rhode Island's Medicaid Waiver Survives Scrutiny

Rhode Island, the smallest state, is wielding big influence against federal control of health care. Other states would do well to take notice.

Federal taxpayers pay about 53 percent of Rhode Island’s Medicaid costs. This has created a perverse incentive for state politicians to increase dependency on Medicaid in order to capture more federal funds. A solution is to convert the funding formula, known as FMAP (Federal Medical Assistance Percentages), to a per-head block grant to the states. Unfortunately, under the Obama administration, things have moved in the wrong direction.

The “stimulus” bill of February 2009, increased Rhode Island’s match to about 64 percent. Originally a short-term measure, this excessive leverage was extended through this June. Fortunately, Rhode Island succeeded in crafting a mechanism to restrain out-of-control Medicaid growth. In August 2008, Governor Carcieri tasked his Secretary of Health and Human Services, Gary Alexander, to apply for a “Global Consumer Choice Compact Waiver” from the federal government.

Ryan Flinched on Medicare

Path to Prosperity, Paul Ryan’s budget proposal, beats a significant retreat from last year’s Roadmap for America’s Future. The Roadmap contained a very precise “payment” (in Ryan’s words) of $11,000 — to be adjusted for future inflation by a factor combining changes in the Consumer Price Index and changes in medical prices — for future Medicare beneficiaries who are now under 55 years of age. Furthermore, you could have taken the “payment” and used it to “to pay for one of the Medicare certified plans, or any other plan, such as those offered by former employers or available from the private market” (p. 51).

ObamaCare - Live Your Carefree Lifestyle!



Just had to share this very funny spoof from Mark Skousen.

Monday, April 4, 2011

No Obamacare Health Benefit Exchange for Pennsylvania

My  column in the Bloomsburg Press-Enterprise enjoining the Keystone State to shun an Obamacare Health Benefits Exchange.

I am beating the drum insistently on this because Governor Corbett's Administration might fall off the fence the right way on this issue, according to local sources.

Thursday, March 31, 2011

Repeal Obamacare's 1099 Reporting Provision? No Way!

I probably should have weighed in on this issue a few weeks back, but the looming bipartisan repeal of Obamacare’s 1099 reporting requirement is nothing for Obamacare’s opponents to cheer.

The 1099 provision refers to the justly reviled clause in Obamacare (section 9006) that compels any business spending at least $600 on a supplier to issue a 1099 to that supplier. So, if my consulting business buys $600 worth of office supplies from Staples, I’m supposed to issue Staples a 1099!

Rick Perry: No Obamacare Exchange for Texas

Governor Rick Perry has reportedly prevented State Representative John Zerwas and other legislators from making a potentially fatal blunder in the fight against Obamacare. According to local media, the governor’s office has discouraged Rep. Zerwas from championing legislation establishing a state-based Obamacare Health Benefits Exchange in Texas.

Wednesday, March 30, 2011

How Many Melanoma Patients Did the FDA Kill?

By my estimate, more than 1,000 people have died prematurely because of foot-dragging by the FDA. Here’s why:

After an “expedited” analysis that lasted a year and a half, the FDA has finally approved Bristol-Myers Squibbs’ Yervoy (ipilimunab) for metastatic melanoma. The deadliest type of skin cancer, melanoma killed 8,700 Americans last year, according to the National Cancer Institute. BMS submitted its application to the FDA on August 18, 2010, with a target date for approval of December 25. On November 2, the FDA pushed out the target date. On March 25, the FDA approved the lifesaving medicine.

So, the question is: How many patients did the FDA kill by delaying the medicine?

Tuesday, March 29, 2011

A Mandate is Not a Solution to Medical-Malpractice Crisis

Today’s New York Times has a compelling op-ed by Ronen Avraham, a law professor at the University of Texas. It proposes a way to fix the out-of-control medical-malpractice laws that hold sway over much of the country. Pointing out that both Republicans and Democrats in D.C. regret that Obamacare didn’t do enough on med-mal, Professor Avraham proposes a reform based on the sound principle that physicians who follow accepted medical guidelines should suffer reduced liability. I can’t imagine that any reasonable person would disagree with this principle. However, there are two problems with his proposal.

Monday, March 28, 2011

What Explains Sebelius' Ignorance of Health Law?

I've often wondered at how little Kathleen Sebelius, U.S. Secretary of Health & Human Services, knows about state and federal health legislation pre-Obamacare.  Career politicians do not get rewarded for telling the truth, but her ignorance is shocking.

Thursday, March 24, 2011

Yesterday's Two Radio Interviews Podcast

KQED, Northern California's largest NPR affiliate, has posted my interview with Michael Krasny on the one-year anniversary of Obamacare here.

KCRW, Southern California's largest NPR affiliate, has posted my interview with Warren Olney here.

CALIFORNIA DREAMIN! Come to the San Francisco Tea Party, April 15th, 2011




I understand that my colleague Jason Clemens of the Pacific Research Institute, will be speaking at the Tax Day rally in San Francisco.  I've spoken against Obamacare at previous rallies and I might step up to the podium on April 15, but might leave it to the tax expert.  Clemens has written or co-authored a few studies on California's fiscal mess, including this one.

I hope that we'll see you there!  (I should note of course, that my or my colleague's participation does not imply that we or our employer endorse everything that anyone might say at the rally.)

Wednesday, March 23, 2011

Who Got Obamacare Waivers?

From the department of "I was going to do this myself but these folks did it better," I'd like to share an analysis of who received Obamacare waivers, published by the Sunlight Foundation Reporting Group.  It looks like a pretty mixed bag of outfits.  I can't really see much rhyme nor reason to who gets one and who doesn't.

Some are just strange: Aetna received an exemption for plans that it offers to firms with more than 209,000 enrollees. So, what happens when a firm with 210,000 enrollees closes a plant and the headcount drops to 200,000? It loses its waiver, too?

Also, note that these waivers are for one year, i.e., most will be expiring in the first quarter of 2012, and the scrambling to defer the pain of Obamacare will begin again - just in time for election season.

(Crossposted at National Review Online.)

Tuesday, March 22, 2011

Jindal: No Obamacare Exchange for Louisiana

Louisiana governor Jindal has told POLITICO Pulse that he will not establish an Obamacare Health Benefits Exchange in his state. According to POLITICO, this is the governor's first definitive statement on the question.

As I discussed a few days ago, Georgia governor Deal also took some time to make a final decision on a Health Benefits Exchange. But he eventually made the right decision: No exchange.

A shrinking number of Obamacare's opponents continue to insist that states can establish narrow exchanges, like Utah's apparently ineffective one, that will serve as a "firewall" against Obamacare. Governors like Deal and Jindal know that any exchange can only serve as fertilizer that will allow Obamacare's roots to grow deeper into the soil - and making repeal more difficult.

(Plus, I suppose that Deal and Jindal would like to avoid President Obama campaigning in Georgia, Louisiana, and nationwide in 2012 saying "Health reform is very flexible and responsive. Look: I made a deal with these Republican governors!".)

Replacing Employer-Monopoly Benefits: Tax Credit or Deduction?

My column at Health Reform Report (http://t.co/m3LKoxS.)

New Mexico, Pennsylvania, Idaho: Say No To Obamacare Exchanges!

I continue my campaign of encouraging states not to collaborate in establishing Obamacare Health Benefits Exchanges.  I had an op-ed published in Pennsylvania encouraging the Keystone State to avoid an exchange.  Paul Gessing of the Rio Grande Institute and I collaborated on an op-ed in New Mexico with the same message.  And Wayne Hoffman of the Idaho Freedom Foundation kindly cited my work in an op-ed encouraging his state to resist Obamacare by not legislating an exchange.

Thursday, March 17, 2011

Ohio Can Defeat Obamacare

I have a column in the MedCity News in Cleveland (OH), which encourages the legislators and governor of Ohio to resist the lure of an Obamacare Health Benefits Exchange.  Hopefully, the folks at the Cleveland Clinic will read it!

Nathan Deal Makes the Right Deal for Georgia

Very good news from Atlanta, where governor Nathan Deal has reconsidered his previous decision to collaborate with Obamacare by establishing a Health Benefits Exchange in Georgia. Although a bill was moving through the legislature, governor Deal reconsidered and decided to stall an exchange, according to the Atlanta Journal-Constitution. This follows my column opposing exchanges in that same newspaper a few days ago.

Speech to Silicon Valley Assocation of Republican Women

Yesterday, I gave a speech to the Silicon Valley Assocation of Republican Women on Obamacare and its alternatives.  If you have 40 minutes, I hope you'll find it useful.  (If you don't I plan to do shorter podcasts in the near future, but have not settled on the technology to use.)

Tuesday, March 15, 2011

Individual Tax Credit or Deduction for Health Benefits?

Conservatives have always advocated reforming employer-monopoly health benefits by giving the tax break to individuals instead.  But should it be a tax credit or a tax deduction?  This month's Health Policy Prescription discusses the benefits and drawbacks of each.

Monday, March 14, 2011

Mitch Daniels' Medicaid Reforms: The Perfect Vs. The Good

Michael Cannon and Grace-Marie Turner (aided and abetted by Robert Goldberg) have started a real dispute on the effectiveness of Indiana governor Mitch Daniels’s Medicaid reform.

I think that this is really a proxy war over Obamacare. Like me, Cannon encourages absolute non-collaboration with Obamacare, so that its roots cannot grow into the soil before it can credibly be overturned. Because Governor Daniels has been shaky on this front (as I’ve already described), Cannon’s arguments against the Healthy Indiana Plan (HIP) and against Governor Daniels’s accepting federal Obamacare grants have blurred together into an almost ad hominem criticism of Daniels. Turner, on the other hand, not only supports HIP but has made the unfortunate decision to advise governors to establish bare-bones Health Benefits Exchanges, an approach that I have long believed jeopardizes the defeat of Obamacare.

Friday, March 11, 2011

How Massachusetts' Commonwealth Connector is Better Than Utah's Health Exchange

The range of current libertarian-conservative expert opinion on ObamaCare’s Health Benefits Exchanges has well-defined boundaries. On the one hand, there are those who believe that states are obliged to establish some sort of barebones exchange along the lines of the Utah Health Exchange in order to prevent the federal government from coming into a state and imposing a bloated contraption like Massachusetts’ Commonwealth Connector. (For an example of this approach, see here.) Others (especially myself) believe that the Utah Health Exchange is unimpressive, that no “exchange” can overcome certain bureaucratic necessities, and that states should therefore refuse to collaborate with ObamaCare, while waiting for it to be overturned by the Supreme Court or a future Congress and President. (The Cato Institute’s Michael Cannon has also arrived at this conclusion.)

None of us has anything positive to say about Massachusetts’ Commonwealth Connector — until now! In one respect, the Commonwealth Connector is an extremely well-run government program, while the Utah Health Exchange is not. The issue is transparency.

Thursday, March 10, 2011

Fight Against Obamacare = Fight Against Government-Run Health Care?

The previous congressional majority managed to jam Obamacare down the throats of an increasingly resistant nation. Now the fight against Obamacare may have delivered a shock to the system that goes beyond the battle cry of “repeal and replace.” Serious health care reformers, however, still face some unpleasant realities.

Monday, March 7, 2011

Should the Government Control Big Pharma's Social-Media Marketing?

Ralph Nader’s disciples are upset that pharmaceutical companies are using new media to reach out to potentional consumers of their medicines. In a recent submission to the Federal Trade Commission (FTC), the Naderites encourage the FTC to add its weight to the Food and Drug Administration’s intrusive control over drugmakers’ free-speech rights. Note that the Naderites focus only on drugmakers: They express no concern whatsoever about anti-pharmaceutical zealots who go online to critize modern therapies, or adventurous trial lawyers who troll the Internet to recruit patients to join class action lawsuits against drugmakers.  Why should drugmakers’ free-speech rights be uniquely hobbled by government control?

Thursday, March 3, 2011

Debating the Wisdom of Health Benefit Exchanges

My column at the Center for Health Transformations' Health Reform Report explaining reasons for states to decline to invest in establishing Obamacare Health Benefits Exchanges is here.

Tuesday, March 1, 2011

Georgia Should Shun an Obamacare Health Benefit Exchange

Unfortunately, Georgia Governor Nathan Deal continues to collaborate with the Obamacrats on establishing an Obamacare "exchange".  Today's Atlanta Journal-Constitution ran "pro" versus "con" columns by myself and Kathleen Sebelius, U.S. Secretary of Health & Human Services.  Read them both here.

Thursday, February 24, 2011

The Individual Mandate Vs. Employer-Based Benefits (Encore!)

A few days ago, I posted a Daily Caller column in which I point out that there is no real, economic, difference between the so-called "individual mandate" to buy health insurance and the status quo.

An Adobe Acrobat version, published as a Health Policy Prescription by the Pacific Research Institute, is here.

Friday, February 18, 2011

Has Opposition to Obamacare Opened a New Front on Entitlements?

Okay, maybe the Republicans are serious about reforming entitlements — especially Medicare, the Big Kahuna. Usually, politicians’ claims to be almost willing to make preparations to eventually propose having an “adult conversation” about entitlements are not worth wasting time on. But this time may be different — and I credit the fight against Obamacare with moving the goalposts.

Read the entire column at National Review Online (more activist version) or John Goodman's Health Policy Blog (more wonky version).

Thursday, February 17, 2011

The Fight For Health Freedom Loses a Champion: Jack Calfee, RIP

I woke this morning to learn the terrible news that Jack Calfee of the American Enterprise Institute had unexpectedly passed away yesterday.  AEI made the announcement this morning here, and linked to his substantial and influential body of work.

When I got into health policy in 2000, my first projects focused on government intervention in prescription drugs: Patent law, the regulatory bureaucracy, restrictions on free speech (Direct-to-Consumer advertising, detailing physicians, et cetera).  Jack Calfee was the giant in this field: His thorough, accurate, and diligent research demolished any legitimate claim that the federal government should exercise undue interference over the actions of patients, doctors, or pharmaceutical innovators.

We need him today more than ever.  Jack Calfee, RIP.

Wednesday, February 16, 2011

The Individual Mandate vs. Employer-Monopoly Benefits

It pains me to have written this article.  I cheer judge Hudson's and judge Vinson's findings that Obamacare is unconstitutional.  However, as an economist, I recognize that there is no real difference between an individual mandate (that penalizes a resident for not buying health insurance) and non-taxable health benefits.

It pains me even more to report that the original Health Policy Prescription had a typo in Table 2, so I have pulled it off the blog until we correct it.

Fortunately, the Daily Caller has run the correct column, here.

Obamacare Will Destroy Utah's Health Exchange

Back in a November 2009, Utah governor Gary Herbert complained in remarks at the Heritage Foundation that the federal government was “freezing out the states” on health-care reform.

How have things gone since then? According to the governor’s remarks (as reported by Jane Norman of CQ HealthBeat) when he returned to the Heritage Foundation last week, “Utah officials waited for eight months to find out if the state would be allowed to use e-mail rather than paper to communicate with Medicaid recipients and save $6 million a year.” Herbert concluded — with bemusement – that “they sent us a denial by e-mail.”

Monday, February 14, 2011

Virginia Does Not Need a Health Benefit Exchange

To preserve Virginians' access to health care, Gov. McDonnell needs to stop listening to academics and bureaucrats — and start listening to individuals and businesses already suffering from Obamacare. His administration needs to cease collaboration with the federal government on establishing a health benefits exchange.

Read my entire column at the Richmond Times-Dispatch.

Thursday, February 10, 2011

Don Berwick Finally Vetted

People who follow the health bureaucracy were appalled when President Obama appointed Dr. Don Berwick to be Administrator of the Centers for Medicare & Medicaid Services - the Health Czar for people over 65 or low-income Americans - without Senate confirmation.

President Obamacare skirted this Constitutional requirement because Dr. Berwick is an unapologetic fan of government-monopoly control of citizens' health benefits.  Until now, the Administration has never been held accountable for this reckless appointment.

Now, the new majority in the House of Representatives is finally asking him the tough questions about he plans to limit health benefits to people under his control - America's Medicare and Medicaid beneficiaries.

A new website, Don Berwick Online, does the public service of bringing these hearings, and Dr. Berwick's record, to the people's attention.

Wednesday, February 9, 2011

Defeating Obamacare: Governors Respond to Judge Vinson's Decision

This month's Capital Ideas column, which focuses especially on the responses from Florida governor Scott and Georgia governor Deal.

Read the article here.

Tuesday, February 8, 2011

Responsible Resistance to Obamacare: Has Mitch Daniels Shown the Way?

In an op-ed in the Wall Street Journal, Indiana governor Mitch Daniels offers up a dilemma to U.S. Secretary of Health & Human Services Kathleen Sebelius: If she wants his co-operation (and that of 20 other governors), she’ll need to twist and turn Obamacare inside out to get it.

Friday, February 4, 2011

Subsidizing Health Insurance: Tax Exclusion, Tax Deduction, Tax Credit, or Individual Mandate?

According to Judge Roger Vinson’s decision on January 31, Congress has no power to legislate an “individual mandate,” whereby the federal government charges the citizen a “penalty” if he does not buy a private health-insurance policy. As an opponent of Obamacare and a supporter of the Constitution, it’s a decision that I cheer. But as an economist, I find it absurd. If last year’s majority had designed the legislation slightly differently, it would not have prompted the smallest whisper of constitutional challenge.

To understand this, let’s look at a very simple society comprising two equally productive households: Smith and Jones, under four different scenarios:

Read the rest of this article at John Goodman's Health Policy Blog.

Thursday, February 3, 2011

States React to Judge Vinson's Ruling

Florida has led 25 other states to an overwhelming judicial victory against Obamacare in federal court, but, unsurprisingly, some states are ignoring Judge Roger Vinson’s decision that Obamacare — in its entirety — violates the U.S. Constitution.

States Demand Medicaid Reform

Katrina Trinko has written an article at National Review Online, in which she discusses the crushing fiscal burden of Medicaid on states, and how Obamacare makes it worse.

Friday, January 28, 2011

Crowdsourcing, Price Formation, & Health IT

From the perspective of the average patient, going about his life unconcerned about health policy or economics, what is the most frustrating characteristic of U.S. health insurance? Surely, it is the madness of the billing cycle: Never knowing how much a medical service costs until long after you’ve received it, and sometimes only after a flurry of phone calls and paperwork that can take months to clear up.

Monday, January 24, 2011

My Participation in the Daily Blogs

Who will suffer most from Obamacare? Those most in need of medical care, as I and others discuss at John Goodman's Health Policy Blog.

Who's to blame for the forthcoming "doctor shortage"? Physician heal thyself, says I, also at John Goodman's Health Policy Blog.

There's an interesting discussion of the absurdity of medical billing over at The Health Care Blog, in which I point out that any claims adjudication will be burdened by bureaucratic frustration - which is why insurance should be used rarely, and only for unforeseen, catastrophically expensive illnesses or accidents.  Obamacare takes us in the wrong direction.

Sunday, January 23, 2011

Federal Exchange Grants Fertilize Obamacare

Over at The Health Care Blog, Merrill Goozner cheers Republican governors who are taking federal money to develop Obamacare exchanges.

Mr. Goozner asserts that the shower of federal Obamacare grants enables states to act as "laboratories of democracy.  If only! Accepting federal grants to implement Obamacare is far from the idea of states being "laboratories of democracy". It's the kind of thinking that led George W. Bush to impose No Child Left Behind on states' schools.

Saturday, January 22, 2011

Greg Scandlen Takes on the Bush Republicans

I immigrated to this country in 2005 to research and promote consumer-driven health care.  I had unrealistically high hopes for what the Republicans led by George W. Bush could achieve.

Friday, January 21, 2011

Obamacare Exchanges a Bad Bet for Wisconsin

Wisconsin has a Republican "trifecta": majorities in both legislative chambers and the governor.  There's no reason for them to throw away their advantage by collaborating on setting up an Obamacare health-insurance exchange.

Read my column in the Milwaukee Journal Sentinel.

Thursday, January 20, 2011

Two Ways to Improve the Repeal Bill

Not that I’m trying to be a party-pooper, but there are two things that would have improved yesterday’s repeal bill (and, by implication, will improve it if and when the Senate deals with it), neither of which adds complexity to the elegant and brief bill passed by the people’s chamber.

Read the rest of the post at National Review Online.

Wednesday, January 19, 2011

Rhode Island's Medicaid Waiver Shows How States Can Save Their Budgets From Obamacare's Assault

Key points from this month's Health Policy Prescription:

• On the last day of the Bush Administration, Rhode Island won a federal waiver to reduce federal control and increase patient choice in the state’s Medicaid program.

• In 18 months following the waiver, Rhode Island’s Medicaid spending was almost one-third less than budgeted: $2.7 billion versus $3.8 billion.

• Rhode Island’s successful reforms include the ability to incentivize higher quality care, rebalancing long-term care, and giving beneficiaries more direct control of their health spending.

• Because Obamacare will impose a catastrophically expensive expansion of Medicaid dependency on states, governors and state legislators should invest significant effort in crafting and lobbying for waivers similar to Rhode Island’s.

Read the entire article here.

Tuesday, January 18, 2011

Repealing Obamacare Is Not "Symbolic", It's a Constitutional Duty

Even conservative talk-radio hosts and, this morning, the Wall Street Journal seem to have fallen for the line that the vote to repeal Obamacare, expected tomorrow in the House of Representatives, is “symbolic.” Apparently, because Sen. Harry Reid is unlikely to allow a vote in the Senate, and the president would veto repeal if it managed to beat the odds and get to his desk, the whole exercise is a waste of time.

How the tables have turned! Back when Nancy Pelosi was speaker, the legacy media bemoaned the fact (as of last October) that the House had passed 420 bills that the Senate had not taken up. Journalists would never have dared label these bills “symbolic.” Rather, the problem was a “gap in productivity” between an energetic and progressive people’s chamber and the Jurassic Senate, where archaic rules empowered a rump to block critical agenda items.

Read the entire entry at National Review Online.

200 Economists' Letter Encouraging Repeal of Obamacare

About 200 hundred economists (including me and about 199 who are smarter than me) signed a letter to Congressional leaders strongly endorsing the repeal of Obamacare.  It was organized by Douglas Holtz-Eakin of the American Action Forum.  The text is here.

Thursday, January 13, 2011

On Medicare Paying Doctors for End-of-Life Counseling

The Wall Street Journal published my letter this morning on the Administration's (since rescinded) decision to pay doctors an extra fee for providing end-of-life counselling to Medicare beneficiaries.  I wrote it in response to a letter by a physician who advocated such reimbursements.  My letter disagreed:

Wednesday, January 12, 2011

Insurance Brokers Should Reverse Their Position on Obamacare

A recent story in Politico confirmed what was already known in health-policy circles: In order to meet Obamacare’s arbitrary Medical Loss Ratios (MLRs), health insurers are cutting commissions to brokers. (The MLR is the ratio of premiums to claims paid out to health providers.)

Fair enough, many might say: The point of establishing this arbitrary accounting target was to ensure more cash flow to providers than to middlemen. This outcome leads to an unhealthy schadenfreude for me, because I’ve always thought brokers should have advocated strongly for individually owned health insurance, instead of the current employer-based monopoly, but unfortunately, because most health insurers pay commissions as a percentage of premiums, brokers’ interests were not aligned with society’s interest in reforming the bloated and expensive employer-monopoly system.

Read the entire entry at National Review Online.

Monday, January 10, 2011

The End of the Individual Mandate is Not the End of Obamacare

Last month Virginia attorney general Ken Cuccinelli successfully argued that the so-called “individual mandate” in Obamacare was outside congressional competence. Advocates of individual choice in health care cheered a significant victory, but this is not the final judicial word on Obamacare.

Thursday, January 6, 2011

Off the blog until next week

To Orlando for Cato Institute conference on state health reform - which I'll be tweeting, so be sure to follow johnrgraham on Twitter.

Tuesday, January 4, 2011

Health-Insurance Exchanges Bad for Michigan

My op-ed in the Detroit Free Press: States with freshly baked, single-party, Republican rule, need to be especially wary of being duped into enabling Obamacare.

Monday, January 3, 2011

Pawlentycare vs Obamacare: A Brief Examination

Over at The Atlantic, Nicole Russell has given us “A First Look at Pawlentycare.” There’s little doubt that Tim Pawlenty, former governor of Minnesota, is eager to trumpet his state’s achievements on health-care reform, and he definitely talks the talk of consumer-driven health care. I was very impressed by an op-ed he wrote in the San Diego Union-Tribune last November, wherein he called for “repealing Obamacare state by state”.

Read the entire article at National Review Online.