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Monday
Aug242015

Are Amputees Medicare's Next Victims?

Let me start this blog post with a thank you to Brad Knollenberg and AccessRX America for doing an interview with me about my book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physician.  The interview focuses a lot on the Part D portion of Medicare and how it impacts community pharmacists.  The issues surrounding community pharmacists were not my area of expertise, so thanks to Brad for providing me with a lot of information.  Interview is here.

On other matters, the Centers for Medicare & Medicaid Services (CMS) has proposed new regulations for Medicare’s treatment of amputees.  Although the issues are complicated, in short the new regulations will likely make it harder for amputees to qualify for prosthetic limbs.

From the theory advanced in my book, this is fascinating—although from the perspective of amputees, it must be unnerving, to say the least.  As I argue in Medicare’s Victims, the sickest are often likely to be victims of Medicare because they lack political power—that is, the lack the ability to influence Congress on Medicare policy. First, not that many people get seriously ill in a given year, seldom enough to amount to much at the ballot box. Second, they are seldom in any condition to be organizing, protesting, donating to Congressional campaigns, etc. that are the sorts of things that can persuade Congress to make changes in Medicare policy. 

There are only about 2 million amputees in the U.S., and not all of them are on Medicare.  That’s probably not enough to have much impact at the ballot box.  On the other hand, most amputees don’t have a debilitating illness.  They can engage in protesting, getting media attention and other activities that can influence Congress.  And they are not alone in this fight, as prosthetic manufacturers aren’t crazy about the proposed rules either.

Right now, the Amputee Coalition and the American Orthotic and Prosthetic Association are fighting CMS.  It will be interesting to see who prevails.

Thursday
Aug202015

Rubio's Health Care Plan: Economics vs. Politics

It is often the case that good economics makes bad politics, and vice-versa.  That is evident in the part of Senator Marco Rubio’s health care plan that deals with the employer-based tax exclusion for health insurance.

Rubio’s plan proposes a refundable tax credit for purchase of insurance on the individual market.  It also proposes reducing the employer-based tax exclusion gradually over a period of 10 years until its value is equal to that of the tax credit.

John C. Goodman shows why this is a good idea by explaining what is wrong with the current employer-based system:

Under the current system employers can spend an unlimited amount on health insurance with pretax dollars. Wages are taxed. Health insurance is not taxed. So the 150 million people who get their health insurance at work can all lower their taxes by receiving more of their compensation in the form of health insurance instead of wages. For someone in the 40% tax bracket, the ability to buy insurance with pre-tax amounts to a 40% federal tax subsidy. Insurance can be worth no more than 61 cents on the dollar and still look attractive to this employee.

No wonder our system is so wasteful.

With a fixed sum tax credit, we subsidize the core insurance that we want everyone to have and leave employees and their employers free to purchase additional insurance with after-tax dollars. When that occurs, they are unlikely to spend an additional dollar on health insurance unless they get a full dollar’s worth of value.

Goodman likes Rubio’s plan so much he concludes, “My only quibble with Sen. Rubio is that he wants to take 10 years to level the playing field between employer and individual purchase. Ten Years? Let’s do it tomorrow.”

Over at National Review Online, James Capretta is less enthused.  While he acknowledges that Rubio’s plan is “fair” in that people with employer-based insurance and individual insurance would get the same tax break, he warns that, “it is more vulnerable to political attack than the Walker approach because it would create some uncertainty about the continued viability of existing employer plans. For that reason, it seems likely that the Walker approach to tax credits would hold up better over time, especially when the inevitable attacks come from Obamacare’s defenders.”

Economically, Goodman is right.  Getting rid of the employer-based tax exclusion would eliminate a huge inefficiency in our health care system, and the sooner we do it, the better our health care system will be.

Yet making the switch quickly would almost certainly create a substantial backlash.  About 169 million people receive their insurance via their employers, and changing the tax system quickly would likely cause many of them to lose their current insurance.  Doing that would make the consumers who lost their insurance in late 2013 look like a day in the park.

I suspect that’s why Rubio chose to do it gradually over ten years.  Yet that still might not be enough to avoid political problems.  As Capretta notes, there would still be a great deal of uncertainty as to whether people could keep their employer-based health insurance.

Nevertheless, it’s good that Rubio is tackling this issue.

FYI: NCPPR has a spreadsheet listing Rubio’s, Scott Walker’s and a host of other conservative/libertarian plans that lays out how each plan tackles important issues such as tax-treatment of health insurance, pre-existing conditions, and Medicaid.  A glossary is provided here for those not familiar with various health-care policy terms.  

Monday
Aug172015

In Memoriam: Whitney Ball

WhitneyBallCroppedWWe at the National Center for Public Policy Research were saddened to learn today of the death of Whitney Ball, the founder and CEO of DonorsTrust and an indefatigable fighter for liberty and limited government.

Unlike many, we cannot claim the honor of having been close friends of Whitney’s, but we did work with her many times over the years and can testify firsthand that her work was extremely valuable to many, many important efforts and organizations.

It is often said that many of the most significant contributors to any movement are the people whose names you rarely hear. So it was in the case of Whitney Ball.

Whitney left us too young, at 52, after keeping breast cancer from its victory over her life here on Earth for many years. Her friends say she fought breast cancer with cheerfulness and optimism, and thus she is an inspiration to us not only for her many public contributions, but in the way she conducted her private life as well.

The group she founded, DonorsTrust, has issued a statement and a collection of statements from others who knew her better than we did. Whitney did a great deal in this life to serve our movement, our families, our liberties and our nation. Please take a moment now to visit their “Remembering Whitney Ball” page in her honor.

Wednesday
Aug122015

That's Okay. New Mexico's ObamaCare Exchange Will Be Just Fine with Fewer Insurers

In early June, Mother Jones writer Kevin Drum stated, “don’t pay too much attention to scare stories about gigantic increases in Obamacare premiums next year.”  One reason, he said was that a “few months from now, the real rate increases—the ones approved by state and federal authorities—will begin to trickle out.”

Indeed, that has now happened in New Mexico.  Blue Cross and Blue Shield New Mexico (BCBSNM) had requested an average rate increase of over 50 percent for its exchange policies.  But early last week, the “Office of the Superintendent of Insurance denied the company’s 51.6 percent rate increase request.” 

I suggested, back in June, that such denials were not going to be a common occurrence, and they may still not be.  But, for the sake of argument, let’s say Drum-1, Me-0.

Yet it will likely prove a pyrrhic victory for the left.  As I also noted at the time, 

let’s suppose that state and federal regulators take their machetes to the proposed rate hikes. That won’t be good for the exchanges either. If an insurer needs a 35 percent increase in a policy’s premium to cover costs, and regulators won’t allow the premium to rise more than 20 percent, chances are the insurer will take big losses on that policy again in 2016. If that happens too many times, the insurer will cut its losses and leave the exchange. Fewer insurers means less competition, which will cause premiums to rise even more in the long run.

Here is BCBSNM’s response to the denial of their requested rate increase: “Blue Cross Blue Shield told the Albuquerque Business First they might leave the New Mexico Health Exchange. The insurance company says it isn’t able to offer sustainable rates without increasing premiums.” 

But that’s no problem said Martin Hickey, CEO of the New Mexico Health Connections, another insurer on the New Mexico exchange.  If BCBSNW leaves, “We’ll certainly be ramping up and we’re confident that we’ll be able to take lots of new members,” said Hickey.

Of course, New Mexico Health Connections will eventually have to ask for hefty premium hikes if it receives many of BCBSNM’s sicker customers.  But Hickey probably realizes that won’t be much of a problem, since if BCBSNM leaves, there will only be four insurers on the New Mexico exchange.  Regulators will be loath to risk  reducing that number to three by rejecting a large rate increase request Health Connections.

Tuesday
Aug112015

Danhof's Criticism of Apple's Tim Cook Highlighted by Rush Limbaugh and Fox Business Network

Is Tim Cook failing as the leader of Apple? He certainly seems hypocritical about gay rights when he calls Indiana discriminatory while doing business with Iran. Justin Danhof, director of the Free Enterprise Project, told host Neil Cavuto on the August 5 episode of Fox Business Network’s “Cavuto Coast to Coast” that Tim Cook also does not have the trust factor that Steve Jobs had, and the company’s lack of transparency about projects in development is hurting the business.


Danhof’s exchange with Cavuto was picked up just a few hours later by Rush Limbaugh, who aired a portion of the segment on his show and featured it on his website.


Friday
Aug072015

A Word About the Economy: “Stagnant”

Another month has come and gone with not a lot of good economic news for Americans.

Obama and his supporters might cheer at official unemployment figures that are slowly edging toward five percent like they do for other alleged economic progress, but they fail to note things such as low workforce participation and extremely high unemployment among black teens who are being denied valuable training opportunities.

And how about all those people dependent on government assistance?

How can these not indicate an economic crisis?

Project 21 member Derryck Green, who regularly covers the economic stewardship (or lack thereof) on the part of the Obama Administration, uses the word “stagnant.”

To follow is Derryck’s “About Those Job Numbers” report for July:

As has been the case throughout the Obama presidency, the economy hasn’t gotten the attention it deserves. The dangerous mixture of his obvious incompetence and adherence to a strict leftist ideology has made President Obama a destructive national embarrassment on too many issues to keep count.

When the economy does get mentioned, the news is spun tight and fast so the American people won’t get catch on about Obama’s poor economic leadership. 

Don’t expect this month to be any different.

To begin with, the U.S. Department of Commerce released its revised gross domestic product (GDP) numbers for the first quarter of this year as well as its initial GDP estimates for the second quarter.  Initially, the GDP reportedly contracted in the first quarter.  But now, as a result of some probably creative calculations, Commerce officials now claim the economy actually grew at a 0.6 percent rate in the first quarter.

As for the second quarter approximations, Commerce expects the economy grew at a 2.3 percent rate — below the 2.6 percent expectation.

If that weren’t bad enough, Commerce Department officials also said that economic growth between 2012 and 2014 was revised downward 0.3 percent — to two percent growth annually.  That means that, for the past six years, the economy has only grown at a rate of 2.2 percent annually.  That’s the worst six-year economic growth in the past 70 years.

Initial reports on private job creation was underwhelming according to the independent payroll processor ADP, which estimated July’s job creation at an underwhelming 185,000 jobs — far below the 215,000 that were initially predicted.  Adding to that, June’s job creation numbers were revised downward to 229,000 from an original estimate of 237,000.

At the federal Bureau of Labor Statistics (BLS), it was reported that July’s non-farm job creation at 215,000 — right around what analysts expected.

The BLS also said that the unemployment rate held at 5.3 percent, with more than 93 million people not in the workforce.

The alternative U-6 unemployment rate — a more accurate indicator of the nation’s jobless rate because it factors in the underemployed and those discouraged enough that they’ve stopped job-hunting — was 10.4 percent.

The unemployment rate for blacks, which has generally been twice the rate of the national rate, was 9.1 percent.  Black teen unemployment thankfully dropped below 30 again for one of the few times in the Obama presidency to 28.7 percent.

The unemployment rate for women, who’ve also faired poorly in the Obama economy, was 5.3 percent — with 124,000 more women having left the workforce since last month.  Now, more than 56,000,000 women are no longer in the workforce.

The Latino jobless rate was 6.8 percent.

And, last but not least, the labor force participation rate for July is 62.6 percent — once again reaching a 38-year low.

Overall, the poor economic stewardship of Barack Obama and his administration is seen in a flurry of bad financial news:


  • According to the Census Bureau, the second quarter of 2015 saw homeownership rates drop to 63.4 percent — the lowest since 1967.
  • The number of Americans on food stamps is at record levels.  More than 45 million people have been on the Supplemental Nutrition Assistance Program (SNAP) for 48 straight months.  This includes more than 22 million households.
  • According to a report released by the Annie E. Casey Foundation, Barack Obama’s alleged economic “recovery” has now put more children in poverty than the actual recession.  During the recession, roughly 18 percent of American children lived in poverty.  In 2013, that number had risen to 22 percent.  Sadly, black children suffered disproportionately with 39 percent of black kids living in poverty.
  • According to Pew Research data, the lack of full-time jobs is forcing more than 20 million Millenials — adults between the ages of 18-34 — to live with relatives rather than living on their own.
  • Hourly wage growth was essentially stagnant in the second quarter.  It increased only 0.2 percent — an all-time low.

None of this news is good, no matter how the Obama Administration may try to spin it.  Too many people remain unemployed, as evidenced by the BLS’s own numbers — including the Jimmy Carter-era labor force participation rate.

And Obama’s answer to the poor economic situation he created?  Aside from ignoring it?

Obama announced this week he wants to increase economy-killing regulations with the help of the EPA under the guise of cleaning our air.  It’s expected such regulation will significantly increase the costs of household energy bills to the tune of $1 trillion, costing the economy over $2.3 trillion in economic growth.

Obama promised a fundamental transformation of America — and this is exactly what it looks like.  Just not in a good way.

Thursday
Aug062015

ObamaCare Is a Very Inefficient Way to Deliver Health Care

In late July, the political left celebrated a new study from the Journal of the American Medical Association that purported to show that people are getting better care under ObamaCare.  Johnathan Cohn claimed that the study is “one more reason to think Obamacare is not the fiasco that critics claim it to be.”

Actually, the study gives us quite a few more reasons to think that ObamaCare is very inefficient.

The study, “Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act,” used data from a Gallup survey to examine how the ObamaCare exchanges and the Medicaid expansion effected the number of insured, access to a physician, access to medication, ability to afford care, how many people were in fair or poor health, and the percentage of days in the last month a respondent’s activities were limited by poor health.  The study found improvements in all of those categories.  For example, since January 2014, when both exchange policies and the Medicaid expansion went into effect, the number of uninsured has dropped by 7.9 percentage points and those who had no personal physician dropped by 3.5 percentage points.

Success?  Well, depends on how you look at it. John Graham at the Independent Institute had a diferent take. He stated that the study means “56 percent of those who got insurance under Obamacare still lack access to a personal physician.”  (Here’s the math: 1-(3.5/7.9)= .557.)

Here is how ObamaCare fares on all of the measures:

In addition to 56 percent of those who have gained insurance having no personal physician, about 70 percent don’t have easy access to medicine, well over half are still in fair or poor health, and just shy of four in five have not seen a decline in the number of days that poor health have limited their health.  The only measure which ObamaCare apologists might crow about is the “cannot afford care” measure, but that is still over 30 percent. That’s really something, given that over the time period the JAMA study examined the federal government spent about $60 billion on premium subsidies and the Medicaid expansion.

The study also provides further evidence (as if we needed any) that private insurance works better than Medicaid:

There was plenty of evidence prior to ObamaCare that expanding Medicaid might not be such a good idea, but what does evidence matter when there is a society that needs fundamental change?

Indeed, given the way the political left has spun this study, it seems that evidence matters very little at all.

Monday
Aug032015

Book: Medicare Harms Patients And Impairs Doctors

Some housekeeping chores I didn’t get to last week.  First, thanks to Richard Eisenberg, who did an interview with me about Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians, that appeared at both Forbes and PBS’s Next Avenue.  Here’s a bit from the interview:

And you also say a lack of coordination of care leads to undertreatment for Medicare patients, especially regarding pharmaceutical use and cancer. Tell me about this.

It can get very confusing with medications, doctors appointments and treatments. It helps to have a coordinator. Medicare doesn’t pay for care coordination, so there’s no incentive to coordinate care, except with the Medicare Advantage program. Without coordination of care, there’s a higher rate of hospital readmission.

When Medicare was established, if you were 65 or older, there wasn’t much you could do for some of these medical conditions. No one anticipated you could keep people alive for decades. Medicine has evolved, but Medicare hasn’t adapted.

Next, thanks to Allan Wallace and the Pittsburgh Tribune.  Wallace gave Medicare’s Victims a nice little review on the Tribune’s Review page.  A few days later the Tribune ran an editorial entitled “Medicare @ 50: Sick, getting sicker,”  that included these paragraphs:

David Hogberg, an analyst for the National Center for Public Policy Research, has documented how Medicare rules and regulations harm patients and doctors in his new book, “Medicare’s Victims.” That betrays the original Medicare legislation’s prohibition against federal interference in doctor-patient relationships, he reminds.

Mr. Hogberg calls Medicare “a sick program … that needs to be seriously revamped.” And the longer that unjustified optimism about this big-government mess delays reform, the longer that taxpayers, hospitals, doctors and patients will suffer.

Cool!  And thanks!

Friday
Jul312015

Why ‘Medicare-for-All’ Is A Terrible Idea

Yesterday I had another article at The Federalist examining Robert Reich’s push for single-payer health care, a.k.a. “Medicare-for-All.”  This was one of the more enjoyable pieces I’ve written in a while, so here is an excerpt:

 

And what is Reich’s solution to [rising costs]? As he states at the beginning of the article, “Medicare offers a way to reduce these underlying costs—if Washington would let it.”

I can see it now: You are slapping your forehead, exclaiming, “If Washington would let it! Why didn’t I think of that?!”

Well, Washington won’t let Medicare make such changes because it is filled with groups such as hospital and physician associations that have a vested interest in keeping a cash cow like Medicare largely the way it is. Those vested interests don’t care for the competition that would arise if Medicare started changing what it paid for.

Plus, why Medicare’s lower administrative costs is a silly argument, erroneous health care comparisons, why the sickest people will suffer under such a scheme, and more.

Thursday
Jul302015

Medicare's Unhappy 50th Anniversary

Today is the 50th Anniversary of President Lyndon Johnson signing Medicare into law.  The Daily Caller published my article today explaining why that is nothing to celebrate.  Here is an excerpt:

Medicare has a dark underbelly that is seldom given much attention in the media. Certain patients, often the sickest, are harmed by Medicare’s policies. Grandiose promises were made when Medicare was signed into law. Yet, as the example of patients like Dolores makes clear, the program has failed to live up to its promises.

When President Johnson signed Medicare, he said, “No longer will older Americans be denied the healing miracle of modern medicine.”  Yet Medicare denies treatment routinely, even when a physician recommends that treatment.

That is another thing Medicare was not supposed to do.  The first part of the legislation, entitled “Prohibition Against Any Federal Interference,” makes a fairly explicit promise that Medicare would not interfere with the doctor-patient relationship. It states, “Nothing in this title shall be construed to authorize any federal office or employee to exercise any supervision or control over the practice of medicine.”

Physicians are ready sources of complaint about how Medicare interferes with their practice.

The article focuses on Dolores Reiss and Clay Bell, two Medicare patients who were denied much needed speech and physical therapy due to Medicare’s rules.  The article traces their struggles.  But you can read their full stories in my book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians.  

Wednesday
Jul292015

The Silliest Argument in Favor of Medicare-For-All

Easily the most absurd claim advanced by the Medicare-for-All (i.e. single-payer) crowd is that Medicare is more efficient than private sector health insurance because it has lower administrative costs.

 

There are numerous problems with that argument, not the least of which is that comparing government administrative costs with private sector ones is usually an apples-to-oranges comparison.  Michael Cannon of the Cato Institute has a great criticism of the argument here.

 

But that doesn’t stop someone like Robert Reich, who should know better, from using it:

 

Medicare’s administrative costs are in the range of 3 percent.

That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums).

To make this simple, let’s apply that logic to other areas of the government.  It’s quite possible that AmTrak has lower administrative costs than Georgia Southwestern, and the Post Office’s Priority Mail Service has lower administrative costs than Federal Express.  I’ll wait for Reich to argue that freight rail and overnight delivery would be more efficient if run by the government, but I won’t hold my breath waiting.
 

Tuesday
Jul282015

Medicare's Victims: What Readers Are Saying

My new book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians, received its first review on Amazon:

I am a patient of Dr. Juliette Madrigal-Dersch, and I thoroughly enjoyed the section about her and her practice. She is a wonderful doctor who has taken good care of me since 2003. I would never consider seeing another doctor. Just spending thirty minutes with her makes me feel better emotionally and I always know her care plan for me is accurate and in my best interest. Thank you for your excellent book. My mother has recently fallen into the doughnut hole again and your book helped me understand that pitfall. 

Now that is the type of review that really warms the heart.

It also received praise from Todd Keefer, who goes by the Twitter handle @FreeMktMoney. He had this to say:

  

Thanks, Todd!

He also added this:

 

 

Couldn’t have tweeted it better myself.

Thursday
Jul232015

ObamaCare + Illegal Immigration + California = Insanity

I’m not really sure where to start with this, so let’s just start with the basics.  From the San Jose Mercury News:

A first-in-the-nation bill aimed at expanding health care for illegal immigrants sailed through the Senate on Tuesday even as some lawmakers acknowledged that thousands of legal residents are having to struggle to access health care through the state’s Medi-Cal program.

In a 28-11 vote, a newly pared-down version of Senate Bill 4 by Sen. Ricardo Lara, D-Bell Gardens, would let undocumented Californians buy health insurance with their own money through the state’s Covered California exchange if the state is given a waiver by the federal government. It would also allow anyone age 18 and under to enroll in Medi-Cal regardless of immigration status — and let undocumented immigrants age 19 and up enroll in Medi-Cal if there’s money provided in the state budget.

Since the Obama Administration has no problem taking unilateral action on illegal immigration, I don’t see why Obama would have a problem granting a waiver.  You mean it’s probably illegal to do that?  Yeah, like that would stop him.

I think the only question is whether the Obama Administration would make illegal immigrants eligible for premium subsidies.  That might be problematic, since that would require illegals to file tax returns with the Internal Revenue Service.  Then again, the IRS might not even notice since it seems preoccupied with other things these days.

The most troubling aspect of the bill is the provision that lets the kids of illegal immigrants on to Medicaid (Medi-Cal in the Golden State).  Wonder what message that sends south of the border?  Something like, “Cross the border into California and get free health care for your kids”?

Finally, you know it is crazy time in California when Governor Jerry Brown looks like the reasonable one: If the bill “clears the Legislature, the measure goes to Brown, who could veto it.”

Wednesday
Jul222015

Justin Danhof Criticizes Apple CEO Tim Cook on Fox Business Network

On yesterday’s episode of the Fox Business Network’s “Cavuto: Coast-to-Coast,” Justin Danhof of the National Center for Public Policy Research criticized Tim Cook’s handling of Apple. Danhof, the Director of the Center’s Free Enterprise Project, was especially critical of Cook’s diversion of resources away from core business to products that aren’t popular and to political issues like the environment.


More information about the Free Enterprise Project and the history behind Justin Danhof and Tim Cook, including the “Tim Cook moment”, can be found here: http://www.nationalcenter.org/fep.html

Wednesday
Jul222015

Horace Cooper Discusses the Bill Cosby Rape Allegations with Dr. Drew

Did U.S. District Judge Eduardo C. Robreno have the right to release sealed documents regarding past allegations about Bill Cosby? Is a suspect’s right to privacy dependent upon how many accusers he has, or upon how famous he is?

On last night’s episode of HLN’s “Dr. Drew” show, Horace Cooper of Project 21 and the National Center for Public Policy Research addressed these issues and more.

Additional comments from Horace about this issue can be found in this press release: http://www.nationalcenter.org/P21PR-B…

Monday
Jul202015

Medicare Pits Doctors against Patients

A quick note:  Tomorrow I’ll be presenting my book, Medicare’s Victims, at the Heritage Foundation at Noon.  Details here.

Today the Washington Examiner has run my article, “Medicare’s midlife crisis: Catastrophic finances pit doctors against patients.”  In it I examine Medicare’s financial difficulties and how that leads to government interfering in the doctor-patient relationship.  Here is a snippet:

When Medicare became law in 1965, the first part of the legislation was titled, “Prohibition Against Any Federal Interference.” It states, “Nothing in this title shall be construed to authorize any Federal office or employee to exercise any supervision or control over the practice of medicine,” a rather explicit promise that Medicare would not interfere with the doctor-patient relationship.

If this was an attempt to assuage the public, it was dishonest. A later section of the law stated that “no payment may be made under part A or part B [of Medicare] for any expenses incurred for items or services … which … are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” That put Medicare on a collision course with the doctor-patient relationship. Inevitably some physician would deem a treatment “reasonable and necessary” that Medicare did not.

 

Here is a prediction on Medicare’s future:

 

This is where a government healthcare program like Medicare inevitably leads. As the program’s costs exceed the means to pay for it, expenses must be reduced. Members of Congress will, of course, reduce Medicare’s costs in ways that cause them the least amount of political trouble.

 

That means the sickest Medicare patients will suffer the most because they are the most politically powerless. First, relatively few people get seriously ill each year, too few to have much impact on congressional elections. Second, because they are ill, they are in no condition to be organizing, protesting, getting media attention and the other things that can compel Congress to change Medicare policy. Finally, some of them are so ill that they won’t be around much longer to cause Congress any headaches.


Read it all.
Monday
Jul132015

Dissecting Medicare

Thanks to PJTV, which has aired the first television interview about my new book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians.

It’s part of a series called “Keeping Your Gold In Your Golden Years.”  The host, John Phillips, and I discussed issues such as whether Medicare is a good program as long as you don’t get sick, what is Medicare’s one fundamental flaw, how safe is his grandmother on Medicare, and whether Medicare-for-All is a good idea. 

You can view the PJTV interview here.

You can also watch it below.

Oh!  And Medicare’s Victims is available at AmazonBarnes & Noble, and Lulu. Just in case you were wondering.


Friday
Jul102015

Think Progress Discovers Gentlemen Prefer Blondes and Other Lite Fare

It’s Friday, so I’ll leave my book alone for now and focus on some less serious matters.

1. From Think Progress:  “Serena Williams Beat Maria Sharapova For The 17th Straight Time. But Serena Still Makes Less Money.”  This is one of those great stories where the laughter starts with the headline.  While Williams has dominated Sharapova in recent years, “it is Sharapova, not Williams, who makes the most money,” according to TP. “In 2014, she was listed as Forbes highest paid athlete, earning $24.4 million. Serena earned $22 million.”

Oh my Gawd, I think I’m having a fainting spell!  You can guess what TP claims the cause of this gross injustice is.  (“Isn’t it nice that TP is concerned about injustice among the 1%?” — the Wife.)

2. The Annivesary of the End One of the Worst Marketing Decisions of All Time.  Tomorrow is the 30th anniversary of the introduction of Coca-Cola Classic.  If you’re not aware of what that means, you were probably born sometime after about 1975.  For more, go to 4:43 here:

 

3. Moore vs. Krugman Death Match!  On Wednesday at Freedom Fest, Stephen Moore and Paul Krugman had a very informative and, at times, spirited debate over the topic of “How can we best restore the American Dream?”  While the debate is not yet online, my friend Elizabeth Sheld has a very good report about it at PJ Media.

4. And, Oh, By The Way.  Did you know there is a new book out about Medicare?  Available at Amazon, Barnes & Noble, and Lulu.  My friend David Catron highly recommends it.

Friday
Jul102015

Pointing Out Harm Reduction Gains

Tobaccocigarettee cigDPCW

Tobacco harm reduction is one of the most important issues to the Risk Analysis Division. We believe that proper (limited) regulation of reduced risk products such as e-cigarettes and snus, a type of smokeless tobacco, can save more lives than any new tax, warning label, or ineffective “public service” campaign.

I often have to remind my colleagues that changing minds, especially on a topic as emotionally charged as this one, takes time. Gains will come, but only incrementally. Yesterday, after writing a letter about the issue to a group of Massachusetts legislators, I got to remind myself how those gains can go unnoticed. 

First, here’s the letter:

Dear Members of the Joint Committee on Public Health (JPH) and Rep. Finn,

I’m writing in reference to HB1943 - An Act to study the use of harm reduction, sponsored by Rep. Finn, to be considered at your upcoming meeting. 

As a policy analyst on science-based policies to reduce the deadly toll of smoking tobacco, I am pleased that your committee will deliberate this issue. I have long advocated that regulators consider the use of harm reduction as a strategy for reducing cigarette smoking in the Commonwealth, thereby reducing death, disease and health care costs associated with the use of cigarettes.

I am also pleased that Congress has incorporated the concept of harm reduction in the Family Smoking Prevention and Tobacco Control Act, which gives the Federal Food and Drug Administration authority to regulate tobacco products.

In fact, the FDA has already begun evaluating harm reduction, especially with regard to e-cigarettes, in its regulatory approach. The agency will soon finalize the proposed ‘deeming regulations’ which will set a framework for regulating e-cigarettes.” 

In addition, together with the National Institutes of Health, the FDA is in the midst of a national longitudinal study called Population Assessment of Tobacco and Health (PATH), which includes multiple evaluations of how people are using e-cigarettes, to help better develop e-cigarette regulations based on real-world usage.

Given the major financial resources and scientific expertise being deployed by the FDA, I would respectfully suggest that the commonwealth rely on the federally funded science, rather than requiring the Massachusetts DPH to do its own, more limited study.

That said, it is worth keeping in mind comments from the FDA’s chief tobacco regulator, Mitch Zeller, who toldthe Robert Wood Johnson Foundation’s NewPublicHealth that, 

“…if at the end of the day people are smoking for the nicotine, but dying from the tar, then there’s an opportunity for FDA to come up with what I’ve been calling a comprehensive nicotine regulatory policy that is agency-wide and that is keyed to something that we call the continuum of risk: that there are different nicotine containing and nicotine delivering products that pose different levels of risk to the individual.
Right now the overwhelming majority of people seeking nicotine are getting it from the deadliest and most toxic delivery system, and that’s the conventional cigarette. But if there is a continuum of risk and there are less harmful ways to get nicotine, and FDA is in the business of regulating virtually all of those products, then I think there’s an extraordinary public health opportunity for the agency to embrace some of these principles and to figure out how to incorporate it into regulatory policies.   

This principle, together with the FDA’s scientific and population based evaluations of e-cigarettes, will be valuable tools for the Commonwealth as it considers appropriate regulations to incorporate the use of harm reduction as a strategy for reducing cigarette smoking.

 

Sincerely,

Jeff Stier

Senior Fellow, National Center for Public Policy Research

Director, Risk Analysis Division

Now, the reflection. A liberal Massachusetts legislator authored a piece of legislation encouraging the state’s health department to study how tobacco harm reduction could save lives. I supported a 2012 Indiana law that required the state to take into account the benefits of “tobacco harm reduction” when making policy. Who would have thought, that in 2015, now even democrats in Massachusetts are considering endorsing the idea as well.  While I don’t think the Massachusetts legislation is a good use of resources at this point in time, nonetheless, it is worth noting as a marker of our incremental progress.

Thursday
Jul092015

Does Medicare Impoverish the Disabled?

In my new book, Medicare Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians, I examine how the disabled fare with Medicare’s cost sharing.

One disabled woman that I interviewed for the book was Francine English, who is now, sadly, deceased. For her, the problem was Medicare’s cost sharing.  For example, Medicare Part B requires beneficiaries to pay 20 percent of any treatment; Medicare pays the other 80 percent.  Most seniors on Medicare have some type of supplemental insurance, often called Medigap, that covers the cost sharing.  But it’s expensive, and if you’re like Francine who was getting about $10,000 annually from Social Security Disability Insurance, you’re not able to afford the premiums.  At the time I interviewed her, Medicare’s cost sharing had caused her to run up about $2,000 in medical debt.

One of the things I found most interesting while researching this book is that there doesn’t appear to be any research on the amount of medical debt incurred by the disabled who are on Medicare.  It would seem to be a prime area for research.  You have patients who are often quite ill, need a lot of health care, and often don’t have the means to pay for Medicare’s cost sharing.   But no one, apparently, had looked at this phenomenon. Thus, I had no way of discussing the extent of the problem.

The best I could do was to examine whether there were a lot of disabled people on Medicare who had trouble accessing care because of the cost sharing.  As a I noted in Tuesday’s blog post, there is a lot of evidence that disabled people on Medicare do have trouble accessing care because of cost.  Thus, if there are a lot of disabled patients who don’t access care because of cost, it would likely follow that there disabled patients who run up a lot of debt because they do seek care.  

Unfortunately, I don’t have a good explanation for what is arguably the biggest problem most overlooked by health care researchers at least in regards to Medicare.  Perhaps it has something to do with the fact that the vast majority of health care researchers are liberals and, as such, probably have little interest in digging into the shortcomings of government programs.  But that’s just a theory.

Nevertheless, it is an area that should be thoroughly researched because it’s quite possible that Medicare may impoverish some of our most vulnerable citizens by saddling them with medical debt.

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Medicare’s Victims is available at Amazon, Barnes & Noble, Lulu, and iBookstore