Update on Research Archive

I have learned that the Pacific Research Institute, which was my previous employer, has changed its website. The new one is at this link here. As a result, many of the links to which I have pointed readers (especially Health Policy Prescriptions) are obsolete. Well, nothing lasts forever!

If you want to find those articles, I recommend going to either the search function of at the top right of the new website and typing "Health Policy Prescriptions" in the search bar, or going to the horizontal tab named "Health Care" and browse "John R. Graham" using the drop-down list of authors (also on the right side).

Last Day at Pacific Research Institute

Colleagues and supporters:

Thank you all for your interest in my publications and proposals to reform American health care. Today is my last day as Director of Health Care Studies at Pacific Research Institute and Executive Director of the Benjamin Rush Society. I am very grateful to have had the opportunity to contribute to PRI's efforts to reform American health care in the direction of more individual choice and less government control.

I will be leaving San Francisco (by car) tomorrow to drive across the country to Washington, DC, where I will be joining the Advanced Medical Technology Association (AdvaMed), the trade association for innovative medical-device makers on August 20.

As of today, this blog will be updated very seldom (if ever). It becomes an archive, I suppose, so plunder it as you see fit!

Best wishes,

John R. Graham

Orphan Drugs & Humanitarian Devices: Current Policies Don't Meet the Challenge

An orphan drug is a drug that treats a rare disease. In the U.S., a disease from which fewer than 200,000 is defined as rare. A Humanitarian Use Device is one from which no more than 4,000 patients will benefit.

It is very difficult to attract investment in innovation in these areas, because it is very difficult for entrepreneurs to earn a profit. Starting in 1983, U.S. law has provided incentives to promote more investment. The recently signed Food and Drug Administration Safety and Innovation Act contained a number of improvements to these policies.

Unfortunately, these reforms are unlikely to achieve the goals desired by their enthusiastic supporters - the topic of this month's Health Policy Prescription, which you can read here.

A State Needs A Health Benefits Exchange Like A Fish Needs A Bicycle

Recently, former U.S. Senator Bill Frist, MD, wrote an op-ed in which he advocated collaboration with Obamacare through establishing Health Benefits Exchanges, run by politically appointed boards which will choose health plans for individuals if Obamacare survives.

Dr. Frist's recommendations would be dangerous for any state to implement, as long as Obamacare survives.

Next week, I'll be speaking at the World Congress 3rd Annual Leadership Summit on Health Insurance Exchanges. I've uploaded notes for my presentation, "A State Needs A Health Benefits Exchange Like A Fish Needs A Bicycle," here.

User Fees For Medical Devices

My latest column for Forbes.com: The Apothecary, explaining why throwing more money at the Food and Drug Administration will not improve the productivity of regulation of medical devices. Read it here.

The FDA Caused Drug Shortages; It Won't Solve Them

My latest column for the Detroit Free-Press addresses the causes and possible solutions to shortages of generic injectable sterile drugs. Read it here.

User Fees for Medical Devices: Third Time Lucky?

Congress recently re-authorized user fees for medical devices. These user fees are paid by the manufacturers to the Food and Drug Administration to finance the regulatory process of licensing new medical devices.

However, user fees have been in effect since 2003, and the FDA has taken in the cash without improving output. Indeed, productivity has declined significantly since user fees took effect.

Read this month's Health Policy Prescription here.

Republican Politicians' Weakness on Health Reform

The other day, the Wall Street Journal editorialized on the failure of Republicans in Congress to propose a coherent reform to private health insurance, in the wake of Obamacare's failure.

Today, they published my letter in response. Read the letter here (no subscription required).

The Supreme Court Obamacare Decision: An Interview

Here is a link to my radio interview last Sunday, which discusses scenarios in the wake of the Supreme Court's forthcoming decision on the constitutionality of Obamacare.

Shortages of Generic Sterile Injectable Drugs: Diagnosis and Solutions

According to the U.S. Food and Drug Administration, the number of times that sterile injectable drugs were in short supply almost tripled from 61 in 2005 to 178 in 2010. The figure reached more than 250 in 2011.

Although the problem is complex, the possible causes can be categorized as supply-side or demand-side. But which dominates?

Repealing Medical-Device Tax is Lifesaving Legislation

Last week, the U.S. House of Representatives voted to repeal Obamacare's medical-device tax. Conventional wisdom concludes it will go no farther. It can, and it should. Read the entire column at Forbes.com: The Apothecary.

Obamacare's Medical-Device Tax Kills Jobs, As Well As Patients

How has the medical-device industry been so successful at moving repeal of its Obamacare excise tax to the front of the queue of the agenda to repeal Obamacare?

My latest column at Forbes.com tries to figure it out. Read it here.

Obamacare's Medical-Device Tax to Cost $2 Billion R&D, 1 Million Life-Years, Annually

Obamacare levies an excise tax on medical devices that will reduce research & development investment by over $2 billion every year, beginning in 2013. This will have an impact on patients' health. An initial estimate figures that this will cause a loss of one million life-years annually.

Read this month's Health Policy Prescription, by Benjamin Zycher, at this link.

Interstate Purchase of Health Insurance? No Magic Bullet

Many conservatives promote the idea of interstate purchase of health insurance as a solution to the health-insurance crisis. What exactly does this mean?

In fact, health insurers "sell across state lines" already. Generally speaking, large insurers either have separate subsidiaries in different states (e.g. WellPoint) or write policies from a balance sheet in the state in which they are domiciled (e.g CIGNA).

But interstate purchase as described by conservative activists is somewhat different. In a podcast produced by the Heartland Institute, I explain why it is an impractical solution.

Listen to it here.

A Debate on Obamacare at UC San Diego

The Benjamin Rush Society Presents The Arthur N. Rupe Debate Series:

Be It Resolved That:

"Obamacare (PPACA) Is Harmful to Physicians & Patients"

University of California, San Diego, School of Medicine
Medical Education - Telemedicine (MET) Building, Auditorium 9500 Gilman Avenue, La Jolla, CA 92093-0618

Thursday, May 17, 2012

Pre-debate reception at 5:00 p.m. Debate at 6:00 p.m.

In Favor: Robert Hertzka, MD (San Diego, CA) Anesthesia Service Medical Group, Inc. Past President, California Medical Assoc. & San Diego County Medical Society Robert Moffit, PhD (Washington, DC) Senior Fellow, Center for Policy Innovation, The Heritage Foundation

In Opposition: James Cruz MD (San Diego, CA) Medical Director for Medicare, Molina Healthcare Micah Weinberg, PhD (San Francisco, CA) Senior Policy Advisor, Bay Area Council Senior Research Fellow, Bay Area Council Economic Institute

Moderator:
Tom Fudge (San Diego, CA)
Morning Edition Anchor, KPBS Public Broadcasting

This event is free but seating is limited. Please reserve your seat by registering at this link.

(A map showing the nearest parking is at this link.)

(A printable version of this invitation is at this link.)

For more information , or to volunteer, contact Dustin Wailes, chapter president, at brs.ucsd@gmail.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it

After Obamacare: More for the Supreme Court to Strike Down

As we wait in cautious optimism for the Supreme Court to free us from the burden of Obamacare, let's think of some other harmful federal intrusion that would be good to get rid of. How about the curious notion that Congress should regulate health insurance at all?
Read the entire column at Forbes.com: The Apothecary.

Americans Control Fewer of Our Own Health Dollars Than Swiss, Swedes, or Canadians!

What is unique about U.S. health care? Well, not only do we control fewer of our own health care dollars directly than our friends in other developed countries do, but we've also been going in the wrong direction for over two decades.

After defeating Obamacare, breaking this long-term trend will be a critical objective of the real health reform that replaces it.

Read the entire article here.

ALEC Is Critical To Defeating Obamacare

You may have never heard of ALEC before the last few days, when both the New York Times and the Wall Street Journal editorialized on a campaign waged by shadowy lobbying groups to influence corporations to withdraw their support from this non-profit collaboration of state legislators.

The American Legislative Exchange Council, which was founded in 1973, is the only venue where state legislators committed to the Jeffersonian principles of limited government meet together to collaborate on model legislation that they are free to introduce in their state legislatures. As well as legislative members, ALEC includes private-sector members. I represent my employer in a small sub-set of the private-sector group, the non-profit private-sector members (a.k.a. the think tanks).

Anyone interested in defeating Obamacare and replacing it with a reform that puts patients – not the government – in charge of our own health-care dollars needs to support ALEC’s continued independence and success.

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

Is Government Harmful to Medical Innovation? A Debate at Harvard University, May 3

The Benjamin Rush Society Presents The Arthur N. Rupe Debate Series:

Be It Resolved That:

"Government Is Harmful to Medical Innovation"

Harvard Medical School
Tosteson Medical Education Center (TMEC), Floor 2, Room 227260 Longwood Avenue, Boston, MA 02115

Thursday, May 3, 2012

Pre-debate reception at 5:45 p.m. Debate at 6:30 p.m.

In Favor: Neil Minkoff, MD (Sudbury, MA) Founder, FountainHead HealthCare & Commissioner, Massachusetts Group Health Insurance Commission Avik Roy (New York, NY) Senior Fellow, Manhattan Institute for Public Policy & Editor, The Apothecary blog at Forbes.com

In Opposition: Jerry Avorn, MD (Boston, MA) Professor of Medicine, Harvard Medical School & Chief, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital John Abramson, MD (Boston, MA) Lecturer on Health Care Policy, Harvard Medical School & Author, Overdosed America: The Broken Promise of American Medicine

Moderator:
Jeffrey S. Flier, MD (Boston, MA)
Dean, Faculty of Medicine, Harvard University

This event is free but seating is limited. Please reserve your seat by registering at this link.

(The nearest MBTA station is Longwood Medical. A map showing the nearest parking is at this link.)

(A printable version of this invitation is at http://tinyurl.com/boj9to6.)

For more information , or to volunteer, contact Ilana Yurkiewicz, chapter co-president, at ilana.yurkiewicz@gmail.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Why Didn't The Supreme Court's Obamacare Hearings Cream Health Insurance Stocks?

There is a split between what free-market policy analysts believe Obamacare will do to health insurers and what investors believe. Wonks tend to think that the regulatory burden imposed by Obamacare – especially increasing politicians’ power over health plans’ ability to set premiums – will demolish private health insurance.

But Wall Street sees it differently: The “individual mandate” that every American acquire health insurance has been understood as an overwhelming gift to the health insurers. Their premiums, although highly regulated, are about to become fairly risk-free. Perhaps they should be analyzed as utilities?

Read the entire column at Forbes.com.

What If We Regulated Legal Services Like Health Care?

Well, the future of American health care is now controlled by lawyers. That may not be news – doctors, drug makers, and medical-device makers have long complained about the cost of lawsuits. But this different: The future of PPACA is in the hands of the Supreme Court.

Hundreds of lawyers billed thousands of hours analyzing and preparing briefs for the case. And that’s after countless hours spent by Congressional staff lawyers putting the bill together in 2009 and 2010.

The result? A “law” so confusing that even the legislators – themselves mostly lawyers – could not bother to even try to read it. It makes one think: If the lawyers are designing the health-care system, shouldn’t they be forced to operate under regulations similar to those they’re imposing?
Read the entire article at John Goodman's Health Policy Blog.

If the Supreme Court Kills Obamacare, Should We Thank Mitt Romney?

There is no doubt that the campaign to “repeal and replace” ObamaCare will have its weakest standard bearer if Mitt Romney becomes the Republican candidate for President. His embrace of an “individual mandate” to buy health insurance or pay a penalty, as legislated in his 2006 Massachusetts health reform, is anathema to those faithful to the ideal of limited government.

But maybe we should look at it another way: If Mitt Romney had never signed his 2006 law, those of us committed to defeating ObamaCare would never be in the fortunate position we are today – the whole, ungodly mess hanging by a thin thread after a brutal hazing in the Supreme Court.

Read the entire article here.

Skin in the Game: Governor Brown is Right and Secretary Sebelius Is Wrong About Medicaid Co-Pays

It's not often you see budgetary sense coming out of the California state Capitol. So, we should cheer the legislators and governor who have proposed a modest reform to Medi-Cal, California's Medicaid program for low-income residents, that would have improved incentives for patients and reduced the budgetary bleeding by about half a billion dollars - if it had take place last year.

California governor Brown believes - correctly - that if Medi-Cal beneficiaries have "skin in the game," that they will make better use of the medical services that the taxpayers subsidize. Unfortunately, U.S. Secretary of Health & Human Services Sebelius has quashed this reform, on questionable legal grounds.

Read the entire Health Policy Prescription here.

"Health Care Should Not Be The Responsibility of the Federal Government" - A Debate at Robert Wood Johnson Medical School (Piscataway, NJ) on April 17

I will have the honor of moderating a debate hosted by the Benjanin Rush Society of Robert Wood Johnson Medical School on the resolution that: "Health care should not be the responsibility of the federal government."

The debate will take place at the Piscataway, NJ campus, within striking distance of New York and Philadelphia, on Tuesday, April 17. There will be a wine and cheese reception at 5 p.m. and the debate will start at 6 p.m.

Each team debating the resolution is comprised of one physician and one lawyer - all four deeply involved in struggle over PPACA - and a timely combination given the Supreme Court's current litigation over Obamacare.

This debate is free, but seating is limited. Please go to this link for more information and to register to attend.

Please distribute this invitation widely, broadly and deeply.
 

Panel Discussion in Bellevue, WA on April 19: Obamacare - An Unhealthy Choice for America

I will be speaking at an event hosted by The Freedom Foundation in Bellevue, WA, on April 19. The topic is Obamacare - An Unhealthy Choice for America.
All are welcome! Please come and bring your family, friends, and colleages. If you're not available, but know folks in the Seattle area who would be interested, please let them now.

More information and registration at this link.

Health Premiums Rising Fast, Even Though Medical Spending Constrained

Obamacare is primarily responsible for the fact that health-insurance premiums are outpacing the growth in underlying medical claims. See my op-ed in the Washington Times here.

Feed the Beast: Renewing the Prescription Drug User Fee Act (PDUFA) in 2012

Believe me, I'd like to see real reform of the obsolete pharmaceutical regulatory apparatus in the U.S. But it ain't gonna happen this year. The current law that funds the Food and Drug Administration (FDA), the Prescription Drug User Fee Act (PDUFA) sunsets in September 2012.

In the absences of real reform, it should be renewed. Read more in this month's Health Policy Prescription.

What I learned at Haas Business School's Health Care Conference

My latest column at Forbes: Apothecary is here.

Real Insurance Could Never Operate With An 85% Loss Ratio

Obamacare demands that most health plans operate with a medical loss ratio (MLR) of 85 percent (or 80 percent for the individual market).

Politicians, bureaucrats, and people in general are very fixated on how much of our premiums go to administrative costs, including executive salaries and profits, of health plans. It’s easy to understand a politician winning applause for promising that she’ll ensure health plans spend more of their revenue on patient care.

But there is an even more fundamental question: Why are politicians not attacking other (non-health) insurers who spend only 70, 60, or even 50 cents on the dollar in claims? Surely these insurers are even “greedier” than health insurers.

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

Health Spending Grows, While Premium Growth Accelerates

As I wrote in my last Health Policy Prescription, Obamacare has resulted in increasing administrative costs and margins of insurers.  Here is a shorter, bloggy, version of the article.

Health Reform in Idaho: Say No to Obamacare Exchange Handout

Yesterday, I had the privilege of being a guest of the Idaho Freedom Foundation, which invited me to speak to legislators and civic leaders on the question of how Idaho should respond to Obamacare.

Unfortunately, governor Otter has accepted $20.4 million from the federal government to impose Obamacare in Idaho.

Here is a short video and partial transcript of my remarks.

California Hospitals' Unhealthy Dependence on Government

While many Americans are eager for the U.S. Supreme Court this year to decide the constitutionality of President Barack Obama's health care overhaul, a federal judge in Los Angeles has just made a misguided decision that cuts right to the root of the government's role in controlling people's access to medical care, whether state legislators or federal judges have the power to decide how much to spend from the state treasury and health care providers' unhealthy and unsustainable dependency on government.

Read my entire op-ed on the case, at the Orange County Register.

Benjamin Rush Society Hosts Leadership Development Reception in New York City

As I announced a few month's ago, I have taken on additional responsibilities as the Executive Director of the Benjamin Rush Society, a national society of medical students that has chapters across the country.  The Society's mission statement is posted here.

Due to the initiative of Deroy Murdock, syndicated columnist and member of the Society's Board of Advisors, we hosted a Leadership Development Reception in New York City on January 19.

A report on the event (including a very amateur video) is posted at the Society's website.

I generally do not write about the Society's activities on this blog, or on my own Facebook or Twitter feed, which are dedicated to my policy research.  Nevertheless, I'd like my readers to know that the Society is growing (and taking up more of my time).

The Society has its own Facebook page (here) and it's own Twitter feed (here). If you'd like to keep abreast of the Society's activities, please consider using those media.  In a few days, I will also be setting up an e-newsletter that I anticipate will be published quarterly.  Once that's up and running, I will let you know so that you can sign up for that if you prefer.

What Are the Costs and Benefits of Patents on Prescription Drugs?

On January 23, the Wall Street Journal hosted an interesting debate between Josh Bloom, Phd, of the American Council on Science and Health, and Dr. Else Torreele of the Open Society Foundation. (The link is here, and was free when I last checked. If it disappears behind a wall, the citation is: Josh Bloom & Els Torreele, “Should patents on innovation be extended to encourage innovation?” Wall Street Journal, 1/23/2012.)

Dr. Bloom makes a classical case for patent protection as an effective legal mechanism to incentivize pharmaceutical R&D. And he goes a step further, proposing that more innovative medicines be awarded longer patent protection and less innovative ones shorter patent protection. (It’s an idea with which I’ve noodled, but never figured out how to define the dividing line.)

Dr. Torreele asserts that patents do not prompt innovation, and that the profit motive leads to misdirection of research in favor of profitable markets, thereby neglecting diseases of the developing world.

I vote for Dr. Bloom’s analysis. Read my entire column at Forbes.com: the Apothecary.

If Health Spending is Increasing Slower, Why Are Premiums Increasing Faster?

The short answer: Blame Obamacare.  For the detailed answer, please read this month's Health Policy Prescription here.

Competition in Health Insurance: What Should Government Do?

A condensed version of my latest Health Policy Prescription, at John Goodman's Health Policy Blog.

Will Idaho Lose Medicaid Cash Unless It Sets Up A Health Benefit Exchange?

That's the strange claim of Governor Butch Otter, facing massive resistance to his plan to impose an Obamacare Health Benefit Exchange in Idaho. An Idaho reporter called me for comment on the governor's curious claim that declining to establish an Exchange could result in Idaho losing 20 percentage points of its federal matching funds, which would be $300 million! The resulting article is posted here.

As a result of the reporter's persistent questioning, the governor's office downgraded the claim to a threat suggested during conference calls with federal bureaucrats.

Look folks, the whole notion is bunk.  There is no connection whatsoever between a state's federal matching funds and whether it establishes a Health Benefits Exchange.  No state should establish a Health Benefits Exchange - period, full stop. I have written a series of articles about exchanges, all available at this link.

I am blogging from a conference in Albuqerque that is sponsored by the Cato Institute.  Tomorrow, I will be giving a presentation to state policy leaders explaining why they need to avoid, obstruct, and resist establishing Health Benefit Exchanges in their states.  Fortunately, other experts, including Michael F. Cannon of the Cato Institute are here; and we all agree that the governor has no legitimate basis for his extreme claim.

Idahoans resisting Governor Otter's irrational urge to establish a Health Benefit Exchange are on the right track.