Archive for the ‘Health Care’ Category

Many doctors are getting around Obamacare by helping patients directly

Tuesday, January 26th, 2016

Originally published at Rare

The alleged goal of Obamacare was to increase the amount of people who have health insurance. It instead created a problem: While more people are covered (millions after the plans they had were banned), insurance is more expensive overall, and has not correlated with increased access to care.

High deductibles (the amount of money a patient has to provide out of pocket before insurance starts paying) have rendered many insurance plans essentially unusable for working and middle class Americans.

While this is a negative development – and speaks to the cronyism inherent in government and insurance companies colluding with each other – a silver lining has appeared as a market response to this chaos.

Many doctors are starting to open cash-only practices where insurance isn’t accepted. This can provide patients with a high-quality, affordable alternative for access to basic care.

As Kathleen McGrory reported for the Tampa Bay Times, many doctors are moving toward a direct primary care model, with 400 now providing basic services for cash payments since Obamacare was enacted. This allows doctors and patients to work with each other absent the nefarious government-insurance complex middleman.

McGrory highlighted the story of a doctor named Trinette Moss, whose cash-only practice in Clearwater, Florida is thriving. Wrote McGrory, “Billing at [Moss’] office works like this: Patients between 18 and 49 years old pay $60 a month. The fee covers unlimited office visits, urgent care services and an annual physical. It costs $15 a month to add a child.”

“Moss says the model, known as direct primary care, makes financial sense. She doesn’t have to hire anyone to file and track insurance claims. And she collects enough in monthly fees to keep her practice small.” Eliminating the bureaucratic barrier that so often divides doctors and patients? That sure sounds good to a lot of consumers, especially in the age of high deductibles and co-pays.

In Florida, legislators have taken notice of Moss and doctors like her, and want to accommodate this direct primary care model. As McGrory explained, “Lawmakers are considering a proposal (HB 37/SB 132) that would ensure direct primary-care providers don’t run afoul of state insurance laws, paving the way for more doctors to contract directly with patients.”

The fact that laws making it difficult for doctors and patients to contract directly exist in first place is a telling problem. Advocates of freeing the healthcare market have long noted that the regulatory maze around insurance and access to care has put consumers at a disadvantage. How can a person shop for the most cost effective services – and how can competition drive those costs down – when the government has essentially banned a market all together?

While the direct primary care model is far from a solution to the overall corporatist mess of Obamacare, it’s an instructive innovation; a response to the fact that the government has so distorted the market that it’s time to get back to basics. When paired with a catastrophic insurance plan, direct care can make sense.

The trouble however, is that it doesn’t on its own, satisfy the requirements of Obamacare’s individual mandate, which can fine you thousands of dollars, depending on your income, if you don’t have health insurance.

Overall, direct access to a doctor without the drama of government bureaucracy and insurance is a good thing. As Dr. Moss said, “It just seems like this is the right thing to do. You can help everyone from waitresses making minimum wage to executives, and be more accessible to them all.”

If only the government would allow more direct competition rather than the crony prototype it’s relied on through Obamacare, there could be more of a market in healthcare overall. But small pockets of innovation are always welcome amid the central planning.

Hopefully, more state governments will follow Florida and work to accommodate this model.

Bernie Sanders’ socialized healthcare plan is a utopian joke

Tuesday, January 19th, 2016

Originally published at Rare

Bernie Sanders believes that access to healthcare is a right – and he’s willing to blow up any semblance of individual choice you enjoy in this arena (along with the economy) – to pursue this ideological fantasy.

You have to give the man credit for one thing – he’s honest about his extreme, radical, and frankly dangerous intentions: He’s calling for a $28 trillion federal takeover of your healthcare.

Unlike President Obama, who famously said, “if you like your plan you can keep it” under Obamacare (the joke was on us) Sanders is explicit: He will ban private insurance. You will not be able to pay a doctor directly for his or her services.

This is the intellectual equivalent of the government declaring that food is a right and nationalizing grocery stores. Your taste preferences? Desire to shop at Wal-Mart versus Whole Foods?

They’re subordinate to the Greater Good, comrade!

Health care policy analyst Avik Roy recently laid out the trouble with Bernie’s inaccurately named “Medicare For All” plan, not least of which is that it’s likely to increase the deficit by an eye-popping $19 trillion.

As Roy explains:

“The plan would effectively abolish the private health insurance industry, including companies like UnitedHealth Group, Aetna, and Anthem. It would charge the government with designing and administering a universal, comprehensive insurance product that would cover ‘the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments.’”

There’s no pretense here about you being able to keep your plan or your doctor: You will quite literally be forced into whatever scheme government bureaucrats see fit – including the possibility of being forced to forego treatment because some government official deemed your preferred method of care “medically unnecessary.”

And naturally, this attack on your liberty comes with a hefty price tag, paid primarily by, you guessed it, the middle class! So much for Bernie’s fist shaking rants about millionaires and billionaires: You could tax them at 100 percent and it would fund the government for less than half a year (ignoring the economic fallout and resulting loss of additional tax revenue, of course).

Bernie wants us to pay an astounding amount of new taxes. In fact, for many earners, including the not-so-super-rich, they could see what they owe to the federal government nearly double.

Keep in mind that this doesn’t count existing state and local tax burdens. This, ladies and gentlemen, is the price of “free” health care, college, [insert utopian fantasy of your choice here]. You give, in some cases the majority of your earnings to the government, all for them to restrict your access to a market otherwise filled with endless options.

As Dr. Michael Hurd explained:

“Ideologically, Sanders is completely wrong. People do not have a morally justifiable reason for using government to force others to pay for their health care. And if they already pay for their medical care through taxes, they have a right to opt for purchasing medical care on a free market instead. Doctors likewise have a moral right to sell their very important services on a free market. Their skills, minds, bodies, and years of specialized training do not belong to the government; they belong to doctors themselves. Patients should want it this way, because doctors sovereign over their own destinies are also the most self-responsible and capable.”

Sanders’ health care plan is a disaster, morally and economically. The good news is, as even Hillary Clinton has pointed out, that the American people don’t support this nonsense.

Outlawing private insurance is about as feasible as outlawing private schools. The task before us now, as Avik Roy pointed out, is to fight for free market reforms that make healthcare more affordable and put individuals in control of our own medical choices.

ObamaCare is imploding and no one seems to have noticed

Wednesday, October 21st, 2015

Originally published at Rare

Remember when grassroots conservatives were fired up about fighting ObamaCare?

Despite some repeal battles still being bandied about in Congress, ObamaCare does not seem to be defining the Republican primary in the way that it dominated the discourse during the 2010 tea party sweep of the House and the 2014 GOP takeover of the Senate.

Perhaps it’s about timing. After all, conservatives haven’t been able to defund the law despite an insistence from some corners of the movementthat such a feat was possible with a sitting Democratic president.

And the two cases challenging ObamaCare that made it to the Supreme Court ultimately favored the White House. Meanwhile, despite the fact that various strong policy alternatives to ObamaCare exist, the Republican Party at-large hasn’t coalesced around a specific replacement for the law.

Yet as furor over ObamaCare has been pushed to the political back-burner, many key predictions made by the law’s critics about its impending failures are coming true.

Brian Blase, a contributor to Forbes’ health care reform series The Apothecary, explained in an article published this week, just 10 million people are now expected to enroll in ObamaCare next year; only half the number the Congressional Budget Office projected a mere four months ago.

Blase said, “While there are several factors that explain how the expert community likely erred so significantly (in its enrollment predictions), the most plausible explanation is that exchange plans are much less attractive than experts had projected.”

This is particularly concerning, seeing as the unwieldy law did far more than simply create a now-failing federally subsidized exchange to complement a thriving private market. One of the reasons ObamaCare has been unpopular is precisely because the president’s original promise that everyone could keep their existing health care plans turned out to be false.

In fact, several million people have lost their plans as a direct result of the anti-market provisions that ban insurance policies the government deemed insufficient. All the while, undesirable plans are subsidized by taxpayers who don’t want them, and uninsured individuals are fined for refusing to purchase sub-par, highly regulated insurance.

Additionally, due largely to ObamaCare, federal regulations and their cost to the economy have skyrocketed. In 2013, now Senate Majority Leader Mitch McConnell printed out the 20,000 pages of regulations associated with ObamaCare, noting that there would be more to come; a promise that has, as a matter of course, been fulfilled.

And like all regulations, these come with a cost to the economy.

Regulation Rodeo, a recently launched project of the American Action Forum that tracks the costs associated with ever-increasing regulatory burdens, provides the public with data that shows just how bogged down the economy has become in the years since ObamaCare has passed.

For example, in the four years prior to ObamaCare’s passage, 2006-2009, the cost per year of federal regulations surrounding health care amounted to an average of $3.1 billion. Paperwork hours per year were at 5.9 million, and the cost per regulation was $80.9 million.

These numbers seem high enough. Yet consider what has happened since ObamaCare’s implementation.

Regulation Rodeo shows the cost per year of federal health regulations between 2010 and 2015 now averages $10.3 billion. Paperwork hours have increased to 17.8 million per year, and the cost per regulation is an eye-popping $313.1 million. And we haven’t even made it to the end of 2015 yet.

While these numbers may seem arbitrary on their face, they represent the growth of bureaucracy at the expense of average Americans. Middle class consumers, particularly those in the individual market, are in most cases paying hundreds if not thousands of dollars more for lesser health care—all as a direct result of ObamaCare’s regulatory maze.

As Blase wrote at Forbes, “The fact that people find exchange plans so much less attractive than experts assumed when the law was passed will hopefully convince some supporters of (ObamaCare) that the law needs to be revisited, and likely fundamentally changed.”

Hopefully. But with a Democrat in the White House, don’t hold your breath.

Government protectionism, not the free market, caused an insane increase in the price of this HIV drug

Wednesday, September 23rd, 2015

Originally published at Rare

Any time news breaks of a company dramatically increasing its prices, particularly when it appears to have complete ownership of a crucial product such as medicine, predictable cries of “the free market failed” echo throughout the pundit class and spread like wildfire via social media. The trouble with this knee-jerk reaction however, is that a rudimentary amount of digging reveals the source of the problem: government-granted monopolies that ban legitimate market competition.

As James Peron, President of the Moorefield Storey Institute wrote at Huffington Post:

“One story that has everyone outraged is that of Turing Pharmaceuticals, run by a scoundrel — by all accounts — named Martin Shkreli. He took the price of the 62-year-old drug Daraprim, used to treat toxoplasmosis in HIV patients, and raised it to $750 a tablet.”

Peron is right to cite the outrage. It’s all over Facebook and Twitter, coming from individuals who, not wrongfully given the hype, attribute the situation to a greed that can allegedly, only be fueled by a market economy. We’re at the point with this particular instance where Hillary Clinton, who supports the kind of big government corporatism that grants the monopolies in question, has jumped on the outrage train.



Clinton, like most politicians, wants to “solve” a problem that stems from an unjust granting of government monopolies with, you guessed it, an even bigger government monopoly. Peron continued:

“The patent on Daraprim expired long ago. So what prevents others from selling this drug? The free market? Surely, other companies are also greedy and would be willing to sell the drug at half the price as Shkreli. Others would find they could make a hefty profit at 10 percent. The price of Daraprim would soon decline to what it is in the rest of the world. Outlets in Canada, the U.K. and South Africa sell it for between ¢50 and $1.50 per tablet, not $750.00.”

Interesting. So what’s going on in the United States? Peron notes:

“It appears that Mr. Shkreli is one of those regulatory ‘entrepreneurs’ using the power of the state to manipulate things in his favor. It has been alleged his investment fund shorted various pharmaceutical stocks and then filed complaints against the companies with the Federal Drug Administration, thus causing an investigation. The investigation would then negatively impact the price of the stock, and Shkreli would profit.”

Why is this possible? The labyrinth of corporatist regulations and market restrictions, enacted by the very politicians allegedly outraged by the results of the system they’ve implemented, favors people like Shkreli. All the while, legitimate entrepreneurs can’t compete, thanks to laws built to favor certain politically connected corporations over others.

Derek Lowe, writing at Science Translational Medicine, aptly explains what’s going on:

Companies do (and should) have the right to charge what they think their market will bear. But ordinarily, you’d think that most markets wouldn’t have enough slack in them for a price increase like that one. What we’re seeing is a peculiar part of a generally peculiar market, though. Drug companies are granted a temporary monopoly by the patent system …. One feature of the existing order is that patents expire (and you’d be surprised how many loud anti-pharma activists don’t seem to realize that). And once they expire, the price comes down as the generic manufacturers get into the market ….

…. That’s how it’s supposed to work, anyway. But in recent years, another strategy has emerged …. Entire companies have sprung up to take advantage of this sort of leverage – not by discovering their own drugs …. but by buying up existing ones. And the most egregious examples have come in the generic sector. By various means, old generic compounds have ended up as protected species, and several companies have made it their business to take advantage of these situations to the maximum extent possible….

…. The FDA grants market exclusivity to companies that are willing to take ‘grandfathered’ compounds into compliance with their current regulatory framework, and that’s led to some ridiculous situations … (Perhaps the worst example is a company that’s using this technique to get ahold of a drug that’s currently being provided at no charge whatsoever). There are also loopholes that companies are trying to exploit when competitors try to prove generic equivalence: whatever it takes to keep competition away and get unlimited pricing power.

This system is quite literally, the opposite of a free market. A government agency is granting exclusivity to politically favored companies, and through this monopoly enacted by force of law, banning the type of market that would yield lower-priced alternatives.

So the next time you hear capitalism being blamed for this type of scenario, make sure to politely remind the offender that corporations are empowered to behave this way precisely because the government bans their would-be competitors from entering the market in the first place.

The legal challenges to Obamacare aren’t over

Saturday, September 12th, 2015

Originally published at Rare

When the Supreme Court ruled that Obamacare subsidies could continue to be doled out this summer, President Obama was quick to declare victory. “After multiple challenges to this law before the Supreme Court – the Affordable Care Act is here to stay,” he said.

The trouble for the president, however, is that the legal challenges to his signature health care law aren’t over.

This week, a federal district judge ruled that a case against the law brought by House Republicans has legitimacy. As Judge Rosemary Collyer explained in her ruling:

Through this lawsuit, the House of Representatives complains that Sylvia Burwell, the Secretary of Health and Human Services, Jacob Lew, the Secretary of the Treasury, and their respective departments have spent billions of unappropriated dollars to support the Patient Protection and Affordable Care Act.

She also noted: “The House further alleges that Secretary Lew and Treasury have, under the guise of implementing regulations, effectively amended the Affordable Care Act’s employer mandate by delaying its effect and narrowing its scope.”

Constitutionally speaking, all legislation that spends taxpayer money must originate in the House of Representatives. It is also not constitutionally appropriate for the executive branch to rewrite law, but where the line between implementation and rewriting is drawn has long been a source of contention. (The recent King v. Burwell case also alleged an Obamacare rewrite, but the Supreme Court ultimately rejected that argument.)

As Judge Collyer further explained:

The Secretaries move to dismiss, arguing that the House lacks standing to sue. They argue that only the Executive has authority to implement the laws, and urge this Court to stay out of a quintessentially political fight in which the House is already well armed.

In response to Collyer’s ruling, Speaker Boehner said:

The president’s unilateral change to ObamaCare was unprecedented and outside the powers granted to his office under our Constitution. I am grateful to the Court for ruling that this historic overreach can be challenged by the coequal branch of government with the sole power to create or change the law. The House will continue our effort to ensure the separation of powers in our democratic system remains clear, as the Framers intended.

The next step for this case—which is rare because it’s a battle between two co-equal branches of government—will be a hearing in the U.S. Court of Appeals for the D.C. Circuit. It’s possible that the case will ultimately end up at the Supreme Court, though it’s not yet clear if that will occur.

As for Obamacare itself, the law is facing other challenges as well. As Investors Business Daily reported:

ObamaCare enrollment has fallen sharply since March, and that’s before consumers confront huge rate hikes for 2016. These are not the signs of a successful program.

In its latest enrollment report, the Centers for Medicare and Medicaid Services says 9.9 million were still enrolled in ObamaCare exchange plans.

That’s almost 2 million fewer than the administration claimed in the spring, when it bragged that 11.7 million had signed up, and way below the Congressional Budget Office’s earlier forecast of 13 million. And if this year is anything like last year, that 9.9 million will dwindle further as the year goes on.”

Whether the president’s beleaguered law can survive this latest round of adversity remains to be seen.