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 (

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.