Archive for the ‘#medicalcare’ Tag

Universal Medical Care Would Kill More Americans   Leave a comment

Tax reform ended the ACA’s tax penalty to support the individual mandate, thereby freeing many Americans to now negotiate with their insurance companies for more realistic medical insurance premiums. I know lots of people who will insist that means more people will die. I disagree.

More people receiving medical care means fewer preventable deaths. If universal healthcare, such as single-payer, leads to less death, then it is obviously the superior moral choice. Politicians like Bernie Sanders will go a step further and claim that Republican legislation, in fact, kills people by reducing government-sponsored coverage.

I am so far not a supporter of the on-vacation GOP healthcare plan because I don’t think it goes far enough. So when Rick, my cousin who is a world-renown doctor in his field, sent me some ideas for a health care article, I was excited to see that he’s not really for the latest-in-series GOP plan either.

What if there were evidence to suggest that more people would die under a universal medical care scheme than under the current US system? What if, by the left’s standards, the American medical care system is less of a killer than the average European one?

There is no accurate, undebatable estimate for how many people in the US died for lack of medical insurance. Consider the best estimates of how many people die in the US due to a lack of medical care. So, for the sake of argument, we’re going to accept the oft-cited (by the progressives) figure of approximately 45,000 fewer people would die in the US every year if all Americans had decent medical care.

Flip the question.

How many people in other countries die due to deficiencies in the medical care systems? And how many Americans would die if we had treatment outcomes similar to those other countries?

study by the Fraser Institute titled The Effect of Wait Times on Mortality in Canada estimated that “increases in wait times for medically necessary care in Canada between 1993 and 2009 may have resulted in between 25,456 and 63,090 (let’s just say about 44,273) additional deaths among females.” The US has about 9 times as many people, so adjusting for the difference in populations, that middle value inflates to an estimated 400,000 additional deaths among females over a 16-year period. This translates to an estimated 25,000 additional female deaths each year if the American system were to suffer from increased mortality similar to that experienced in Canada due to increases in wait times. Rick did not comment on a system that disproportionately harms women, but I will note that doesn’t sound very progressive.

Image result for image of doctors in hospital corridorLet’s look at interventional outcomes. According to the CDC, stroke is the cause of more than 130,000 deaths annually in the United States. However, the US has significantly lower rates of 30-day stroke-induced mortality than every other OECD country (except Japan and Korea). OECD data suggest that the age- and sex-adjusted mortality rates within Europe would translate to tens of thousands of additional deaths in the US.

Just for example – if America had the 30-day stroke-mortality rate of the UK, we could expect about an additional 38,000 deaths a year. For Canada, that number would be around 43,500. That only accounts for mortality within a month of having a stroke, which in turn accounts for only 10% of stroke-related deaths.

This is further reflected in overall stroke-mortality statistics: for every 1,000 strokes that occur annually in the US, approximately 170 stroke-related deaths occur. The UK has 250 stroke related deaths per 1,000 strokes and Canada has 280 stroke-related deaths per 1,000 strokes. Considering that Americans suffer approximately 795,000 strokes each year, the discrepancy in stroke-related mortality is humongous.

Similarly, cancer-survival rates are considerably higher in the US than in other countries. Check out this data cited by the CDC, which comes from the authoritative CONCORD study on international cancer-survival rates. The US dominates every other country in survival rates for the most deadly forms of cancer.

Recognizing that the US is a much larger country than the UK, if we weight the CDC-quoted survival rates for different forms of cancer in accordance with their contribution to overall cancer mortality, there would be about 72,000 additional deaths annually in the United States if our survival rates were comparable to the UK’s. There would similarly be about 21,000, 23,000, and 31,000 additional deaths per year with Canadian, French, and German survival rates.

Lives are saved by the many types of superior medical outcomes that are often unique to the US. This is not to mention the innumerable lives saved each year around the world due to medical innovations that are made possible through vibrant US markets.

Rick would be the first to admit: our medical system is far from optimal. Among other things, soaring medical care costs need to be controlled, while insuring against medical calamity ought to be much more affordable. Still Sanders and Company’s policy demands display completely ignorant of the massive deficiencies that are characteristic of universal medical care systems. They’ll sing songs all day about the 45,000 lives taken every year by greedy insurance executives and their cronies on Capitol Hill, yet remain completely ignorant of the fact that the European systems they fetishize are less humane by their own standards.

If we’re going to call Paul Ryan a killer for attempting to curtail Medicaid spending, then we logically have to apply that epithet to all politicians who advocate for European systems, because those systems have outcomes that would result in tens of thousands of additional deaths in the US every year.

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Posted December 22, 2017 by aurorawatcherak in Common sense

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What To Expect When You’re Expecting   Leave a comment

Both of my children were born outside of the hospital in a direct-entry midwifery center. Direct-entry midwives, while licensed by the state, are not medical personnel. The midwife center we used has an infant and mother mortality rate of 1 in nearly 30 years of practice/

Alaska’s Medicaid system has covered direct-entry midwife deliveries for nearly 20 years, but that’s a rare thing in the United States, which has the worst rate of maternal deaths in the developed world, according to NPR. You didn’t know that? You would have thought one of the wealthiest and most technologically advanced countries in the world wouldn’t have a high maternal death rate. Yeah, me too.

Not too long ago, someone who wants universal health care insisted it was because of the inadequacy of our medical coverage that these women and their children are dying.

Image result for image of maternity wardNo, not really. Some of the deaths are attributable to poor maternal health – America leads the developed nations in incidents of gestational diabetes. We like to eat and many women view pregnancy as an excuse to chow down. We also smoke and drink while pregnant, despite ad campaigns imploring us not to. But really, the biggest part of the problem is due to high rates of medical invention.

The US medical care system, particularly surrounding pregnancy and delivery, is very interventionist, harming some of our most fundamental rights, including the right to control what happens to our bodies.

A typical American woman (98%) giving birth has a 40% chance of being covered by Medicaid, but the other 60% are usually covered by private insurance. The in-network provider is almost always an obstetrician and the care setting is almost always a hospital.

What happens in that hospital?

  • More than 40% of these mothers will have their labor chemically induced
  • More than 30% of those induced mothers will end up with a cesarean section.
  • Many more will be hooked up to machines and monitored, prevented from moving.
  • Food and water will be withheld during the labor
  • Most, if not all will be subjected to vaginal exams, electronic monitors, and other invasions of their bodies they don’t meaningfully consent to.

Most birthing women have little understanding of the risks and benefits of any of these procedures. They’re told it is for her or her baby’s benefit, but they’re a little busy at the time, so any risks are generally ignored. Yes, all these restrictions and invasions of the mother’s body are done ostensibly for the sake of hers and the baby’s health, but no medical reason exists for this level of intervention for most of these women. The vast majority of childbirths could happen as or even more safely if the mother were able to move around, eat, drink, and avoid invasive interventions.

Why Can’t American Women Use Hospital Alternatives for Childbirth?

Alternatives do exist  that lower intervention rates, lower costs, and provide more satisfactory care. These alternatives include freestanding birth centers (both direct-entry and nurse-midwife) and home births. Many European countries use these options as a foundational part of maternity care with great success. So why don’t we here in America?

Most American women cannot take advantage of these options because:

  • they do not know they exist
  • insurance does not cover them
  • they don’t exist in their area
  • a century of propaganda surrounding birth has effectively convinced women that anything but the hospital will result in death of themselves or their baby

If all this hospitalization and treatment actually helped keep women and babies safe, maybe the economic and human costs would be worth it. But it doesn’t, and they aren’t.

So why do American women give birth like this? What the average new mother does not know is that her choices surrounding how her baby is delivered and how her body is treated during labor and delivery are limited by a tangle of regulations and laws.

Regulations Push Out Entrepreneurial Midwives and Obstetricians

In most states, birth centers must go through a Certificate of Need (CON) process in which they must ask permission from hospitals (their direct competitors) to enter the market. Entrepreneurial midwives and obstetricians must pay tens, sometimes hundreds, of thousands of dollars in application and legal fees to navigate the CON process.

In New York State, entrepreneurs must already have their space rented before they start the CON process, which can itself take a year, thus forcing them to pay rent on an empty facility while they ask permission of their direct competitors to enter the market. That permission is frequently denied. Additonally, most states legally require birth centers to have a written consulting agreement with a physician. Such agreements increase physician malpractice insurance rates, so many are unwilling to sign such agreements.

Birth centers must also enter written agreements with hospitals to transfer their patients in case of an emergency, even though hospitals are already mandated by law to treat anyone who shows up in need. Birth centers cannot operate without these consultation and transfer agreements.

Doctors and hospitals can pull out of an agreement at any time, which means birth centers are at the total mercy of their direct competitors not only to enter the market but to stay in business, even if they are financially successful and providing high quality care.

The regulatory tangle providers find themselves in, means that, while 4 million women give birth in the United States every year, only around 300 birth centers exist to provide out-of-hospital care. Meanwhile, hospitals in many rural areas are closing their maternity wards, leaving women to drive many miles while in labor to find adequate facilities to deliver their babies, which puts themselves and their babies at risk.

How Medicaid Favors Hospital Births

Until recently, Medicaid did not reimburse patients for using birth centers at all, and now that it does, some states’ reimbursement rates are laughable. Many birth centers do not accept Medicaid at all because the reimbursement rates are so low that they threaten the facility’s continued existence. Here in Alaska, which has been covering birth center births for a couple of decades, the reimbursement rate is considerably less than for hospitals, but at least in the range of sustainability, but in states like New Jersey, reimbursement is as low as $250 per birth for care that costs birth centers $2000 or more to provide. For comparison, Medicaid reimburses hospitals for the exact same birth at nearly 30 times that rate (an average of $7,000). Government insurers are therefore paying more for women to receive lower quality care.

Yes, hospitals reimbursement rates reflect complicated births as well as uncomplicated deliveries, but we should acknowledge that such a great difference is indicative of government reimbursement policies that are fundamentally broken. Because Medicaid payment rates do not clearly track or relate to the care being provided or its quality, they create dramatic access barriers to higher quality care.

Barriers to Home Birth

Some women decide that in order to get the birth experience they want, they will opt out of the system altogether, paying for birth out of pocket at home. That seems like a reasonable exertion of free choice. Your body, your baby. Not so much. Government intervention doesn’t stop at the hospital doors. Women in many states who want to give birth at home may find that there are no legal providers to assist them. Until October 2017, home birth with a certified nurse midwife was illegal in Alabama – any midwife who attempted to assist a woman in labor was subject to criminal prosecution. In still other states, birthing mothers who seek an alternative practitioner are limited to certified nurse midwives, who almost always operate in hospitals or in birth centers attached to hospitals that are almost as medical as hospitals themselves.

So What’s Up with Hospital Births?

In many states, women who refuse unnecessary hospital procedures or who attempt home births are subject to state involvement, including threats from Child Protective Services. Things are even worse for women who want a vaginal birth after cesarean (VBAC), which many hospitals prohibit. But most American women, who don’t know that better alternatives exist or who don’t have access to those alternatives, continue to give birth in hospitals where their freedom to control their bodies is extremely limited.

This kind of government activity does not just affect birthing women and it is a primary driver of both cost and poor medical outcomes in other than obstetrics medical fields. Government intervention affects your access to at-home care, urgent care centers, decent and high quality primary care, and a range of other options that can lower costs and increase the quality of care. Until we are fully aware of how our choices are limited – even before we step into the hospital – by CON laws, licensing laws, reimbursement policies, and other regulations, our bodies will continue to be used and abused by the monopolists who control them.

Who are the Monopolists?

Governmemt is a monopoly. It claims powers unto itself and refuses anyone else entry. Medical schools are virtual monopolies or oligarchies. Most hospitals are monopolies or at the best enjoy limited competition and because they have all pursued Certificate of Needs procedures, they really are protected to a large degree from effective competition.

Anytime monopolies exist … even if it is government … red tape, inefficiencies and arbitrary rules will abound … and in the case of the medical profession – one of the most highly regulated sectors of the economy — this leads to lower quality service, higher costs, and a higher mortality rate.

What US Medical Care SHOULD Look Like   Leave a comment

My cousins research group continues and right now we’re reading David T. Beito’s  history From Mutual Aid to the Welfare State: Fraternal Societies and Social Services 1890-1967, published by the University of North Carolina Press in 2000. Having finished reading it before the guys, I wanted to share my unprocessed feelings about it.

Image result for lodge provided medical careReaders who want to know how medical care should operate and what is wrong with today’s system should read Mr. Beito’s book.

The premise of the book is that the US rejected Obamacare in 1918 and it took almost a half century for its supporters to finally win, take over and destroy the US medical care system.

For a quarter century before WWI, many of the nation’s well-to-do young people went to Germany to complete their college education and some of them returned determined to recreate the US in the image of socialist Germany. Richard Ely founded the American Economic Association for that sole purpose. He and economist Irving Fisher would lead the drive for universal, mandatory health care insurance.

In those days, while middle class and wealthier Americans paid for doctors directly, such fees were too high for the working poor, who instead organized into mutual aid societies such as the International Order of Odd Fellows, the Freemasons, the Eagles, the Moose, the Elks, etc. The lodges started offering burial insurance because poor people were terrified of suffering a pauper’s burial. Later, they added healthcare and life insurance, built orphanages and hospitals, and provided banking services and even pensions. Many of these groups had existed for centuries under other names and followed the ancient guild practices of mutual aid to craft members. The Shriners, a branch of the Freemasons, still maintain children’s hospitals. Back in the day, most lodge members couldn’t afford to pay fee-for-service doctors and would otherwise go without medical care, but the lodges provided this care as part of their membership fees.

So what happened?

Socialists were wary of lodges and fraternal societies because they employed security measures to prevent non-members from defrauding them for the benefits of membership. Back in the day before data bases and phone calls — two hundred years ago, say — organizations employed passwords and secret handshakes to prevent such scams.

 

The American Medical Association began attacking the lodges as early as the 1890s because the lodges would contract with doctors for a flat fee per year per member to provide medical care for lodge members. Oddly, this practice of “capitation” is making a comeback with the federal government as a means to restrain the explosive growth in the costs of medical care. Lodges usually contracted with doctors from private medical schools set up by other doctors to fill the deficiency in the supply of new doctors by the state schools.

The AMA claimed that the lodges kept doctor pay too low, causing some to starve. So they launched public relations campaigns to stigmatize the lodge system and the doctors who served the working poor. They bribed politicians to shut down the medical schools they didn’t approve of, insisting that they cared about “public health and safety”, thus creating a shortage of doctors. They bribed hospitals to reject doctors who worked with lodges and convinced medical organizations to ostracize them. AMA doctors refused to work at lodge-owned hospitals and the AMA worked tirelessly to shut those hospitals down. The AMA’s assault on “low pay” for their doctors finally worked,

Lodge practice was also a victim of an overall shrinkage in the supply of physicians due to a relentless campaign of professional “birth control” imposed by the medical societies. In 1910, for example, the United States had 164 doctors per 100,000 people, compared with only 125 in 1930. This shift occurred in great part because of increasingly tight state certification requirements. Fewer doctors not only translated into higher medical fees but also weaker bargaining power for lodges. Meanwhile, the number of medical schools plummeted from a high of 166 in 1904 to 81 in 1922. The hardest hit were the proprietary schools, a prime recruiting avenue for lodges.

When socialists and the AMA proposed mandatory health insurance for every citizen in the early 1900s, the lodges saw it as an attack on their system of self-reliance and mutual aid. Enough Americans shared the same values as the lodges that they defeated the proposals in two referenda. In 1918 the citizens of California voted three to one to reject mandatory health insurance. It failed again in New York in 1919.

Still, times were changing, and Americans were abandoning traditional Christianity rapidly and its values of self-reliance and mutual aid. Churches had always provided charity to the poorest since the early days of Christianity recorded in the Book of Acts in the Bible. Until the 1920s, Americans resisted accepting charity as much as they could out of a sense of honor. The lodges intended to help the working poor, not supplant charitable work. But by the 1920s Americans interpreted self-reliance as selfishness. As Beito wrote,

The traditional fraternal worldview was under attack. Age-old virtues such as mutual aid, character building, self-restraint, thrift, and self-help, once taken for granted, came under fire either as outmoded or as drastically in need of modification.

In 1918 Clarence W. Tabor used his textbook, Business of the Household, to warn that if savings “means stunted lives, that is, physical derelicts or mental incompetents…through enforced self-denial and the absence of bodily comforts, or the starving of mental cravings and the sacrifice of spiritual development – then the price of increased bank deposits is too high.” An earlier generation would have dismissed these statements. Now they were in the mainstream. Bruce Barton, the public relations pioneer and author of the best-selling life of Christ, The Man Nobody Knows, espoused the ideal of self-realization rather than self-reliance, declaring that “life is meant to live and enjoy as you go along…. If self-denial is necessary I’ll practice some of it when I’m old and not try to do all of it now. For who knows? I may never be old.”

JM Keynes echoed Barton in the 1930’s with his famous line, “In the long run we’re all dead,” and with his continual assault on the evils of the Protestant work ethic and savings. The ideal of “service” replaced that of self-reliance. By “service” socialists meant that the wealthy should give to the poor. They helped remove the stigma of charity by convincing the poor that they shouldn’t be ashamed of receiving aid because the wealthy owed it to them.

In addition to the efforts of the AMA to destroy the excellent system of medical care insurance set up by the fraternal societies, the progress of socialism continued to erode the appeal of self-help. The federal government gave favorable tax treatment to corporations who offered group insurance without extending that to individuals while members of fraternal organizations received no tax deductions for their medical care insurance. This meant corporations paid the premiums so workers were fooled into thinking their insurance was “free”.

Good economists understand that corporations, then as now, merely deducted the premiums from future pay raises. The lodges argued that group insurance from the employer would enslave workers to a single company because they would lose their insurance if they lost their job whereas lodge insurance traveled with the individual. You see, that whole “portability” argument had already been addressed and a solution worked out. The lodges were right, but we forgot it over the decades.

The Great Depression weakened lodges as the bulk of the 25% unemployment came from the working poor. More assaults on mutual aid came with the passage of Social Security legislation, company pensions, and worker’s compensation insurance. Again, the government allowed corporations to deduct expenses for those from their taxes without extending the privilege to individuals in fraternal organizations. Then came Medicare and Medicaid in the 1960s.

The book exposes the lie that socialists proposed their welfare measures because they saw a desperate need for them. Churches and charities had provided for the poor who couldn’t work since Biblical times, while the fraternal societies took care of the working poor very well. In 1924, 48% of working-class adult males were lodge members.

Socialists opposed the lodge system, not because it failed, but because they wanted the services provided by the state as they were in Germany. They convinced the American people that socialism would not just help the poor, as the churches and fraternal organizations were, but would eliminate poverty. And as Helmut Schoeck warned us in his Envy: A Theory of Social Behavior, the lust to destroy successful people served as fuel for the fire. Beito’s concluding paragraph is worth reprinting in full:

The shift from mutual aid and self-help to the welfare state has involved more than a simple bookkeeping transfer of service provision from one set of institutions to another. As many of the leaders of fraternal societies had feared, much was lost in an exchange that transcended monetary calculations. The old relationships of voluntary reciprocity and autonomy have slowly given way to paternalistic dependency. Instead of mutual aid, the dominant social welfare arrangements of Americans have increasingly become characterized by impersonal bureaucracies controlled by outsiders.

This Is Why Government Shouldn’t Be Involved in Health Care | Jeffrey A. Tucker   7 comments

Image result for image of ahcaThe Republican-controlled House vote to “repeal Obamacare” – if that is what this was – was a stunning mess.

Did they get it right? The answer is obviously no, and that’s inevitable. Just imagine a bill that sets out to reorganize any industry that is currently mostly market driven, such as shirts, software, groceries, or furniture. Would any bill coming from Congress that pertains to the whole of any of these be wonderful? It’s impossible.

This is because the minds of politicians working together – with all their mixed motives of special-interest acquiescence, electoral fears, and general ignorance – cannot possibly replicate, much less improve upon, the brilliant mind of the market at work.

Sadly, any structural change in the industry is pushed through via legislation.

Fortunately, we don’t have to deal with such bills in most markets. But the health care industry is different. It’s been heavily regulated for more than a century. Obamacare went in the wrong direction, toward more rather than less government control. It actually disabled the mind of the market. The result has been soaring deductibles and premiums, insurers going belly up, and average citizens being forced to pay for insurance they can’t afford to use.Change is necessary. Sadly, any structural change in the industry is pushed through via legislation. That is a tragedy. The challenge is to sort out real vs. fake reform, and do this amidst grandstanding, bombast, posturing, ideological panic, rhetorical bombast, and media mania.

The Miasma of Politics

The House had little more than one day to consider a bill that would affect the lives of every single living American in the most fundamental way. Meanwhile, those of us in the peanut gallery had to try to make sense of whether or not this bill is a promising development, remembering that not backing something necessarily means de facto settling with the legislative status quo.

Even getting the core facts of the legislation was a challenge.

What is the core standard by which any health care bill should be evaluated, given that nothing coming out of Congress that can gain a majority of Republicans will ever be right? The test is this: does this bill take us in the direction of restoring market competition and market signaling, or does it preserve the current managed, artificial, coercive, and unworkable system that relies on government control?

Donald Trump does not understand this at all.

Two main features of Obamacare (explains David Henderson) disable market competition: guaranteed issue and community rating. Guaranteed issue mandates what is covered under all health insurance, thus ruling out flexibility on the part of either buyers or sellers. Community rating forbids insurance pricing from being influenced by risk assessment, which takes the insurance out of insurance. A reform worthy of support must deal directly with these problems.Donald Trump does not understand this at all. He keeps tweeting that he absolutely insists on keeping the mandate that all health insurance must cover pre-existing conditions. The dogmatic demand painted the Republicans in a corner. They couldn’t repeal the very mandates and disabled-pricing schemes that have created such a mess in the industry.

States, You Do It

Yet Obamacare is so bad that some states have toyed with actually nullifying the law. Taking their cue from such movements, the House bill encourages states to take some steps to do just that. Whether they come through or not is another matter.

Still, this amendment brought some skeptics on board. The final bill permited the states to opt out of both the guaranteed issue and the community rating mandates, thus removing Congressional culpability but allowing a decisive number of votes to come out in favor of the bill.

Two bellwethers that I follow in Congress because of their principled stand for market freedom – Justin Amash of Michigan and Thomas Massie of Kentucky – voted differently. Amash was a yes and Massie was a no.

Massie released the following statement:

As recently as a year ago, Republicans argued that mandates were unconstitutional, bailouts were immoral, and subsidies would bankrupt our country. Today, however, the House voted for a healthcare bill that makes these objectionable measures permanent.

The former Democrat Speaker of the House was rightfully derided for imploring Members to vote for a healthcare bill to “find out what was in it.” Yet today, we voted on a healthcare bill for which the text was available only a few hours before the vote. In fact, the Congressional Budget Office had no time to even provide Congress with a preliminary estimate of the full cost of this bill.

By repealing a small number of Obamacare mandates, while leaving others in place, this bill runs the risk of destroying what remains of the individual health insurance market.

The option in this bill that allows States to apply for waivers from some Obamacare mandates is well-intentioned. However, it falls far short of our promise to repeal Obamacare. There also remains the risk that State legislatures, like our federal legislature, are unable to withstand the political pressure from lobbyists who defend Obamacare, and the pressure from those who receive Obamacare’s welfare handouts.

This bill should have included measures that allow Americans to take charge of their own healthcare and get the government out of the way. These measures include allowing the deduction of health insurance costs from income taxes, giving everyone the ability to purchase insurance across state lines, and allowing individuals to band together through any organization to purchase insurance.

In weighing my vote, I heeded the wise advice that “one should not let the perfect be the enemy of the good.” If this bill becomes law, it could result in worse outcomes, fewer options, and higher prices for Kentuckians who seek health care. In summary, I voted against this bill not because it’s imperfect, but because it’s not good.

His argument is strong. If you live in a state that does not opt out of the community rating, you are stuck with the bulk of Obamacare. Massie had an intuition about this: the pressure would be too great to preserve the status quo, thus making the “repeal” wholly illusory. Then the Republicans get stuck with a failure.

Amash has not released a formal statement on his yes vote, but his rationale is easy to anticipate. This bill is nothing like what it should be, but we also know that the right kind of bill could never pass the House. This one does repeal some mandates and taxes. It does permit a path for states to opt out. A no vote effectively means the preservation of the status quo. A yes vote does not make this bill law; it only sends it to the Senate, which will pass something very different (better or worse is yet to be seen).

Democrats Celebrate

Meanwhile, in the aftermath, Democrats imagine that they just won the greatest victory since 2010, even to the point of singing a song on the House floor. The passage of Obamacare was a catastrophe for them. It nearly wrecked a two-term presidency and contributed heavily to the loss of the Senate and the presidency. It has been an albatross around their necks. Now they get to hurl that onto their enemies.

But that alone presents another danger. If this bill is perceived to be authentic “deregulation” and “free market reform,” every failure will come to be blamed not on government but rather insufficient control. “We tried your free markets and they failed!” And there is no question that the partisans of socialized medicine are already positioning themselves in this direction. If you believe the New York Times editorial after the House vote, we’ve already entered into health-care anarchy.

My purpose here is not to settle the question of how one should have voted or what the effects or eventual outcomes will be. There is a bigger and more important lesson here. Any good, service, or industry that is removed from market control and put into the hands of government thereby becomes subjected to the grueling and ghastly machinations of the political process in all its subterfuge, duplicity, and vast waste.

Even if you don’t like every result of market control, it’s hard to imagine that anyone can defend what necessarily replaces it once you surrender any market to control by government.

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Source: This Is Why Government Shouldn’t Be Involved in Health Care | Jeffrey A. Tucker

Posted May 5, 2017 by aurorawatcherak in Common sense, Uncategorized

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It Stinks Less, but It Still Stinks   Leave a comment

Rick, my cousin who is a world-class research doctor who has been helping me to understand medical insurance reform, finally got around to sending me his analysis of the most recent Republican effort to sort of repeal and sort of replace the Affordable Care Act. If I were a Trump voter who voted for Trump and the GOP believing the promise that they would repeal of the Affordable Care Act before it bankrupted me, I’d be a bit annoyed. I am a bit annoyed and I didn’t vote for them expecting them to actually do anything because I knew Trump likes universal medical insurance and socialized medical care. He said things supportive of it back in the run-up to the ACA passing.

Related imageBut, here we are, waiting with baited breath to see if the Republicans actually have a votable bill this time.

The AHCA relies on three stages. The passage of the AHCA is simply Stage 1. As Senator Ted Cruz pointed out when the original iteration of the AHCA was being debated, the basket of goodies in the second and third baskets are what the GOP has been promising voters for over half a decade. The problem is that the first “basket” changes almost nothing and the subsequent baskets rely on easily changed mandates from the Secretary of Health and Human Services, who could be a raving progressive from England after 2020.

If the AHCA can in any way be heralded as a conservative win, it’s the amendments made since the March failure-to-launch that move us toward a medical care system based on free markets that are note-worthy, but the AHCA still isn’t a “free market solution.” To make the bill palatable to the must-have House Freedom Caucus, two amendments were added that allow states to apply for waivers to opt-out of the pre-existing conditions requirement and the provision regarding “essential health benefits”.

However, with one dumb comment from President Trump and a moving story from Jimmy Kimmel — another amendment was added that provides $8 billion over 5 years for the nearly inconsequential issue of “pre-existing conditions.”

People really should know, about pre-existing conditions coverage in America, because mention of the phrase seems to halt all rational discussion, while precious few Republicans are prepared to defend the point eloquently or adequately. It is something vital to understand.

Rushing the medical care vote in March has made Americans, and particularly Republicans, wary. The president and Republican Congress only have themselves to blame because they should have spent months talking about the bill before voting on it. That talking would have educated people on what is actually in the bill. Falling short on today’s vote will leave most Americans who voted for Republicans because they promised to repeal Obamacare and later to replace it with something better, with the clear understanding that Republicans never meant what they said. Bye-bye, GOP!

So we’re stuck with what it is … at least for now.

In broad terms, the bill would likely reduce government spending and decrease insurance premiums for people who are healthy and young and don’t get insurance through their employers. It also likely will increase costs for older, sicker people and take away government-provided coverage from people in the lower middle-class. Those are, despite what the naysayers want you to believe, are good things.

The new American Health Care Act would have far less impact on people who get insurance from their employers, but let’s be clear — the AHCA is a complicated bill that builds off of the ACA, another even more complicated bill, so its potential impact is complicated and, therefore, difficult to predict. But Rick identified some of the major changes to the medical care landscape that could occur if the AHCA passes in its current form.

People with pre-existing conditions will no longer be treated as if they are healthy.

The House Freedom Caucus fought for an amendment to be introduced that loosens regulations that requires insurance companies to sell plans to people who buy insurance independent of their employers or the federal government.  It potentially will impact rules that protect people with pre-existing medical conditions from being discriminated against by medical insurers.

Right now there’s panic among Obamacare supporters that the amendment could make insurance coverage unaffordable for people with existing medical issues. And Republicans and conservatives have proved ill-equipped at defending their position as equally compassionate but packaged in a different vehicle. This allows appeals to emotion, like that of Jimmy Kimmel’s tear-jerker about how his baby wouldn’t be covered because he was born with a heart condition, to shut down all thinking and conversation when the phrase “pre-existing condition” is uttered.

 In truth, the MacArthur amendment keeps the ACA’s guaranteed access clause, which requires insurers to provide policies to those with pre-existing conditions. However, the bill would allow states to apply for waivers that could change the cost and quality of their coverage.

First: prior to the ACA, the vast majority of Americans with medical insurance were already in plans that were required to offer them coverage regardless of pre-existing conditions. Employer-based plans were required to offer coverage to everyone regardless of pre-existing conditions. So were Medicare, Medicaid, and other government programs like the VA. Employer- and government-based plans, prior to Obamacare, represented 90 percent of Americans with medical insurance.

The other 10 percent were people buying coverage on their own, on the individual market. In most — but not all — states prior to Obamacare, people buying coverage on their own could, in theory, be denied coverage for a pre-existing condition.

In reality, in practice, a tiny percentage of Americans were being denied coverage due to a pre-existing condition prior to the ACA. We know this in general because surveys consistently indicated that this was the case, and in detail because of an Obamacare program called the Pre-Existing Condition Insurance Plan, or PCIP.

PCIP was designed to work from the years 2010 to 2014, as a bridge until Obamacare’s insurance regulations took effect. During those years, Americans could sign up for heavily subsidized coverage under PCIP if they had documented proof that they had been denied coverage by an insurance company and had a pre-existing condition.

What happened? Enrollment in PCIP peaked in February 2013 at 114,959.

Under the AHCA with the MacArthur amendment, states could opt out of the law’s essential medical benefits measure, which requires insurers to cover 10 main benefits, including hospitalization, prescription drugs and other services. Insurers in those states would likely offer trimmed-down policies might not cover for all the treatments and medications that those with medical issues need. Carriers would likely offer more comprehensive policies to consumers with costly conditions at higher premiums.

Let’s remember that the #1 driver of the out-of-control premium increases under Obamacare has been people with costly conditions paying the same premiums as healthy individuals who don’t go to the doctor nearly as often.

The amendment addresses this by allowing states to change the ACA’s community rating provision, which bans insurers from charging enrollees higher premiums based on their medical history. Under the revised bill, insurers could charge higher premiums to those with pre-existing conditions who let their coverage lapse. This is very similar to what existed prior to the passage of the ACA. It gave people with pre-existing conditions an incentive to remain covered while holding a lid on premium increases for the rest of us.

States that apply for this waiver would have to set up high-risk pools or other programs aimed at minimizing insurers’ exposure to costly policyholders. This would offset some of the price hikes carriers would levy on those with pre-existing conditions. They’ve only set aside $130 billion to fund these programs through 2026, which some observers feel is woefully inadequate, but the alternative is the bankrupting of the middle-class with the ACA’s out-of-control premium increases, so it’s worth it to return to a system that worked in the past. High risk pools existed before Obamacare, but many were underfunded, charged policyholders premiums in line with the costs of their ongoing care and had waiting lists.

 

Lower-income people could get caught by this amendment if the bill becomes law. A Congressional Budget Office analysis of an earlier version of the bill found 24 million people could become uninsured under the GOP legislation. That number is likely ginned up because it assumed that everyone who went on Medicaid under the ACA would be ineligible under reform, but we showed in our earlier analysis that this is not true. The few lower-income folks who become uninsured due to the rollback of Medicaid expansion may encounter higher premiums when they try to get insurance because insurers would be allowed to set rates based on their health backgrounds.

In other words, people will once more pay premiums based on what their cost of care is likely to be.

 

Medical care is incredibly expensive in the United States, and if you get sick, it’s going to cost a lot. Which is why it’s important for older and less healthy people to purchase medical insurance, but when Obamacare required everybody to buy insurance and insurers to offer coverage to everybody, regardless of their cost of care, it distorted the insurance market and drove up premiums to unaffordable levels for everyone. Before Obamacare, insurance companies were required to sell insurance to people with medical issues provided the person could pay the premiums dictated by their cost of care. That was actually a provision within HIPPA that Obamacare supporters refuse to acknowledge.

Why the ACA is failing is that it regulated how much insurers could charge people with medical issues. This is called “a community rating”. That meant insurers suddenly had to charge everyone the same price for the same coverage. Prices can’t currently be based on factors such as a person’s sex or how sick they are. Under the GOP plan, states could get a waiver that would allow insurers to set prices based on how healthy a person is.

Republicans have argued that they wouldn’t be totally eliminating protections for people with pre-existing conditions because states don’t have to ask for a waiver. Obamacare supporters believe that claim ignores some difficult realities.

Subsidies that help people buy insurance will be reduced under the AHCA. That will likely lead healthier people to leave the insurance market, further increasing premiums for those who remain. Yeah, freedom sometimes allows people to act in their own best interest. States might have to seek the waivers to keep the insurance marketplaces up and running. Yup, that’s the whole supply-and-demand cycle that economists warn us about. All this could add up to insurers’ offering coverage that is unaffordable to people with pre-existing conditions.

The AHCA tries to combat those increased costs through a fund for high-risk pools, insurance programs for people with extremely high health care costs. I am familiar with Alaska’s high-risk pool and it did a good job in covering people with pre-existing conditions … far better than having only one insurance company in all of the state of Alaska to cover everybody in the individual market at very high premium prices.

Monopolies can pretty much charge what they want and Obamacare created a lot of monopoly in the insurance market.

 

Medicaid would go back to being a program for the poor.

Although amendments to the AHCA have gotten the most coverage in recent weeks, changes to Medicaid from the original version of the GOP bill are what cut government spending while rolling back multiple taxes.

Before the ACA, Medicaid was an insurance program for people below the federal poverty line and those who met certain criteria, such as having a disability, being pregnant or being a woman with children. Obamacare changed that by opening up Medicaid to everyone below 138 percent of the federal poverty line in states that chose to expand the program. Thirty-one states and D.C. opted to expand Medicaid, and more than 11 million people joined the Medicaid rolls. Many were already eligible for Medicaid and had chosen not to apply or they only became aware that they were previously eligible when they were forced to apply.  Medicaid expansion included families of four making up to $55,000 here in Alaska. The GOP bill would freeze that part of the program on Jan. 1, 2020.

Some Obamacare supporters claim the AHCA wouldn’t just cut back Medicaid expansion, it would also trim the prior existing program, by capping how much states would be reimbursed for enrollees. The Congressional Budget Office estimates that the net effect of the changes would be 14 million fewer people on Medicaid, which might delay the impending bankruptcy of that program by a decade.

 

Insurance premiums would go down for some, but others would pay more than they currently do.

 

Then there are the insurance subsidies and monthly premiums for people who buy insurance on the private market instead of through an employer. The AHCA would make several big changes that would likely lower premiums somewhat, according to the CBO’s analysis. In addition to potentially changing the costs for people with pre-existing conditions, the bill would allow older people to be charged a lot more than they currently are  …  up five times what younger enrollees pay. Again, older people who are not in good health are a primary driver of the premium increases we’ve seen under Obamacare. Currently, subsidies available to people who buy on the Obamacare marketplaces are calculated so that lower-income people won’t pay more than a set percentage of their income. Subsidies go up if you earn less, live in an area where insurance is more expensive or are older. Under the GOP bill, the system would become simpler: You’d get a subsidy based on your age, which would begin phasing out for people with an income of $75,000 a year.

The McArthur amendment would also allow states to get a waiver on the essential health benefits required by Obamacare. This provision requires plans to cover a range of services, including hospital, maternity and mental health care. So, if you’re a single male, you pay for maternity coverage whether you need it or not. The requirements push up insurance premiums, because insurers must cover more services.

This aspect of the AHCA brings up a larger question facing the bill overall. Passage in the Senate is far from certain, but even before that, the AHCA would have to pass muster with the Senate parliamentarian, the gatekeeper for Senate rule making. See, this GOP replacement bill is not really a full replacement; it’s kind of like an update to the ACA. That’s because the GOP doesn’t have the votes to fully repeal the ACA, which would require 60 senators, so it’s using a process called reconciliation, which allows the Senate to to pass bills that affect the federal budget with a simple majority. Much of the AHCA, such as the cuts to Medicaid and changes to insurance subsidies, falls within that mandate. But other changes, such as waivers to essential health benefits, don’t have a direct budgetary impact, leading some experts to believe the Senate parliamentarian will flag those changes as outside the realm of reconciliation.

 

What We Couldn’t Find in the Bill?

There’s still no interstate purchase of insurance and there isn’t a mechanism for allowing individuals to form groups that are not employer-based, so the two biggest tools for driving down premiums remain unavailable. They may come in one of the two later stages, but as already explained, these are easily swept aside by every new Secretary of Health and Human Services.

While the Republican bill may be a step toward making medical care more affordable to most Americans, it is a far cry from the “repeal” Republicans ran on when the Tea Party began to make inroads and win seats and they realized promising something they couldn’t really deliver was better than being realistic.

The AHCA still stinks like three-day-old fish left out on the counter, but it may not stink quite so much as the ACA. Premiums will go down for healthy individuals in the middle class, but so long as we’re still mostly required to buy insurance or pay a penalty, we aren’t really free to make our own decisions.

 

How the Market Is Already Repealing Obamacare | Stewart Jones   Leave a comment

There’s a common misconception that if you’re opposed to government services, programs and/or departments, then you’re opposed to building roads, education, people getting affordable health care and even people taking care of the sick and elderly. These misconceptions are becoming more apparent as the free market offers solutions and options using innovation and technology, as the government continues to fall in on itself.

doc-patient teamSix months into the pregnancy, we received a letter explaining that due to the changes in the law, our policy would no longer cover maternity services.

I continue to be amazed at the ingenuity of people and individuals working toward solutions in the marketplace, in spite of government. Over time government has assumed more and more control over medical decisions that individuals make everyday.

My Own Experience

I have paid my dentist out of pocket for many years and had private insurance for major medical only. In 2011, my wife and I were expecting our first child and had private health insurance which was slowly being limited more and more by regulations from the Affordable Care Act and Patient Protection Act. It was dreadful!

Six months into the pregnancy, we received a letter explaining that due to the changes in the law, our policy would no longer cover maternity or OB-GYN services. This meant that our insurance would no longer pay for anything related to the birth of our daughter. We searched and shopped for insurance that would help cover the cost of the hospital and birth, but the more government regulations and controls were placed on the market, the more difficult it became to actually get affordable medical insurance and health care.

We spoke with our doctor about it and found that by avoiding insurance altogether and paying the doctor directly, it reduced all costs associated with pregnancy by 60%. We avoided the government-burdened insurance market and paid the doctor directly.

This model of doctors and patients actually working out agreements and paying a flat fee in exchange for medical services is actually very effective. If we could only bypass the government regulations and laws on health care, more people would get better service at a more affordable rate.

Market-Based Medicine

One awesome example of markets finding ways around the government’s stronghold on medical services is the Surgery Center of Oklahoma. In order to run their own practice with the least amount of government interference as possible, two doctors formed this practice 15 years ago. The goal was to eliminate the inefficiencies that accompany hospital networks and Medicare/Medicaid networks in order to run their own practice. The practice has done so well, that it has grown to over 40 doctors now.

According to them:

It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive. As more and more patients find themselves paying more and more out of pocket, it is clear that something must change. We believe that a very different approach is necessary, one involving transparent and direct pricing.”

This has allowed them the ability to perform the best quality surgeries at the lowest and most transparent cost. All of their procedures and costs appear on their website. By bringing this level of transparency to the public, it has forced a price war for surrounding hospitals to post prices for procedures, something that is often hidden. This has brought costs down in surrounding areas.

Exiting the rat race of hospital networks and eliminating acceptance of government payments has allowed them to cut the cost and provide a better service.

In spite of what government does, people around the country are finding ways to lower costs and raise quality in the most competitive and realistic manners.

Flat Fee Memberships

The difficulties with getting health care at affordable rates come not from marketplace inadequacies, but from government regulations.

Another great example, are physician’s offices like Irmo Primary Care, Gold Standard Pediatrics and many others that are starting flat fee pricing for memberships and monthly medical services called Direct Primary Care. These practices are helping to once again bring patients and doctors together without interference from government and bureaucratic middlemen. I love streamlining services!

Dr. Bryan Hill, a South Carolina pediatrician, opened his direct primary care practice in September. “Instead of accepting insurance for routine visits and drugs, these practices charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at much lower prices.”

It’s sad that most of the difficulties with getting good health care at affordable rates come not from inadequacies in the marketplace, but from the many regulations by central planners in government.

History has shown us that free-market forces have the ability to lower costs and increase quality while fostering new growth and innovation. It puts the power in the hands of consumers, where it should be. If government would just get out of the way, then the free-market can fix the problems with healthcare.

Real skills for professional success from successful entrepreneurs. Learn more at FEEcon.org

Source: How the Market Is Already Repealing Obamacare | Stewart Jones

Posted April 25, 2017 by aurorawatcherak in Common sense

Tagged with , ,

Cultural Attitudes That Harm Us   1 comment

American citizens have several cultural attitudes toward health care and savings that has resulted in an economy that spends one-sixth of the GDP on medical care. Other countries don’t pay so much and many of them have universal medical coverage.

So what’s our problem?

Image result for image of cutting-edge medicalA major issue is that Americans have stopped saving anything. Many of us have retirement accounts, which work because it’s not easy to tap into them, but most of us do not have savings accounts. I recently read an article by a financial guru who spent most of the article ripping into Dave Ramsey for suggesting that paying off debt and having 3-6 months of living expenses in savings made no sense to her. You should be investing those funds, not leaving them in the bank account.

So, naturally, since, they don’t believe in savings, the American middle class does not believe in saving up for medical care expenses. The idea that you should have $10,000 to 15,000 in savings for a potential acute medical episode is ridiculous in most people’s minds. This isn’t pre-World War 2 America, nor are we a 3rd world country. That’s “wasted money” just sitting in a bank.

We object to paying one-sixth of our personal income directly on health-and-medical expenses, but we also resent paying one-sixth of the government’s treasury on health-and-medical expenses. We are less willing to spend public funds to pay for health maintenance than we are to pay for medical services, even though study after study shows that we get better results from getting people to change unhealthy lifestyles than from treating the consequences of those lifestyles. You can’t really blame the American middle class from objecting to paying taxes in order to support people who are very poor or very sick when they themselves work hard to have an income and to take care of their health. Americans are not Scandinavians. We believe in personal responsibility, if only for other people.

 

Americans, especially medical care providers, do not want to think of medical care as a commodity that is bought and sold in an open market subject to supply and demand rules. Providers want to be paid (and paid well), but they don’t want to think of themselves as capitalists selling their services, so they prefer payment that comes from third parties where the price is hidden from consumers.

 

Americans are individualists at heart and object to telling other people how to live their lives or being told by others how to live theirs. This means that the right to live an unhealthy lifestyle is considered sacrosanct in the United States. Under the ACA or universal coverage, that means that healthier individuals pay for the poor choices of less healthy individuals.

Americans also tend to live in a state of denial about some health choices, so that about one-quarter of our population engages in unhealthy lifestyles that have long-term medical care expense consequences, the cost of which are born by people who take care of themselves rather than the poor decision makers who require the expensive long-term care.

Americans enjoy being “early adopters” of new treatments, which are often much more expensive in their early, experimental stages than when they have been available for many years. Forty years ago, when medical care was a smaller share of the economy, we could afford that attitude, but new treatment options now require expensive equipment and highly-trained specialists. Although these treatments promise incredible results, they are expensive to the individuals receiving the treatments … or the group that’s paying the bills.

All of these attitudes conspire to make the “Affordable” Care Act, or any replacement other than the free market, incredibly and increasingly expensive for all of us. Universal coverage will only exacerbate the problems that these cultural attitudes engender, leading inevitably in medical care rationing and resultant lack of availability of care, with the end results being similar to England’s 45% higher mortality rate.

Yes, we could choose universal coverage and then attempt to outlaw everything that makes people unhealthy. Good luck with that! It hasn’t worked in France and England, which is one reason England has a 45% higher mortality rate than the US.

Alternatively, we could work with human nature and return our medical care system to the free market it began in. Lift the government-created restrictions against individuals forming groups to drive down medical insurance costs. Lift the government-created restrictions that prevent us from buying insurance across state lines. Life the government-created monopoly against increasing medical schools and opening clinics.  Yes, that would mean that some people wouldn’t make good health choices and wouldn’t have medical care coverage when those choices require them to seek medical care. That would be the consequence of being a poor-decision maker and it might drive some of this group to make better choices. Additionally, medical care would become less expensive because government-created barriers to care and affordable insurance would no longer be a factor in price.

We have a choice to make in this country. Do we want reduced access to expensive care, but everybody having insurance or do we want improved access to affordable care with some people choosing (for themselves) not to have insurance?

I know which one I prefer and which one I believe would result in improved health results.

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