From The Archives: Medicare Means Testing - Test the Deductible, Not the Premiums

Many conservatives believe that increasing means testing for Medicare would be a good solution. Some would even go so far as to eliminate Medicare benefits for very rich people (like Warren Buffett).

But this is not consistent with principles of limited government. I have recently dug up an article I wrote on the issue from 2008. While the figures are out of date, the argument remains the same.

Read it here.

Research Archive Update

As previously noted, it is very difficult to find my archived articles at the PRI website. I have updated the links to some of the articles at my LinkedIn profile.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

Health Spending & The "Supercommittee" Redux

I wrote a shorter version of last month's Health Policy Prescription for John Goodman's Health Policy Blog.  Read it here.

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.

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.

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".

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.

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.

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.