Black Ribbon Project

Morality — Not Costs — As the Proper Basis for Health Care Reform

2012-01-05T10:48:00.000-08:00

John David Lewis died January 3rd after a heroic battle against cancer. He was a relentless advocate of healthcare freedom and the morality of the free market.

(HT Freedom and Individual rights in Medicine)

The ACA vs. Insurance Brokers

2011-11-20T09:26:00.000-08:00

The arbitrary restrictions on Medical Loss Ratios (MLR) established by the ACA are having a number of detrimental effects, including destruction of the business of insurance brokers. By serving as experienced and educated advisers, these small businessmen provide a valuable personalized service to purchasers of insurance. Claims that such "administrative activities" of insurance companies are wasteful are quickly debunked when you compare the amount of fraud and waste within Medicare and Medicaid to the the fraud and waste in the private insurance industry.

Analyzing, aggregating and disseminating both information and products are activities which add value and contribute to overall economic efficiency. Putting arbitrary caps on how much a business can spend to make their business function efficiently is just one of many ways that central planners demonstrate their ignorance of basic economics.

The new limits on MLRs are forcing insurance companies to cut expenditures in ways which will reduce consumer choice and in the long run lead to greater waste and expense.

The National Association of Insurance Commissioners has submitted a resolution to HHS explaining this detrimental effect and requested the following corrective actions:

The Department of Health and Human Services should take whatever immediate actions are available to the Department to mitigate the adverse effects the MLR rule is having on the ability of insurance producers to serve the demands and needs of consumers and to more appropriately classify independent producer compensation in the final PPACA MLR rule. The potential options available to HHS include: (1) approving state MLR adjustment requests; (2) placing an immediate hold on implementation and enforcement of the MLR requirements relative to independent agent and broker compensation; and (3) considering the NAIC’s finding that a significant portion of insurance producer activities are dedicated to consumer advocacy and service and therefore classifying an appropriate portion of producer compensation as a health care quality expense for purposes of Section 2718 of the PPACA.

It is an outrage that companies have to beg government officials for the freedom to operate their businesses as they see fit. Americans must not be blinded to how the ACA ramps up this inappropriate use of government power.

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Calling All Doctors

2011-10-03T08:13:00.000-07:00

Docs-4-Patient-Care

National Annual Meeting

Washington DC

November 2-4 2011

Dr. Lee Hieb explains how regulation hurts patients

2011-09-24T09:47:00.000-07:00

When is rationing not rationing?

2011-09-06T19:41:00.000-07:00

When is rationing not rationing, a mandate not a mandate and price-fixing not price fixing?

When the government says so.

Supporters of the PPACA react to opponent’s charges of rationing by claiming that the Independent Payment Advisory Board (IPAB) can't ration because the law says it can't.

"The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria. [Emphasis added] Pub. L. 111-148, § 3403"

But when the government takes your money to fund a program (e.g. Social Security and Medicare) and then in any way limits your access to the benefits of that program, that's rationing. Since the law prohibits restricting benefit restriction and increased cost sharing by patients, the only effective way left for the IPAB to achieve mandated spending decreases is to lower payments to doctors and hospitals. But if you end up with less access to doctors and medical care because the government pays them less, that’s rationing. No matter how much you try to deny it, or what you call it instead of rationing: a rose is a rose...and government controlled health care is rationing.

The same people who say the IPAB cannot and will not ration will tell you that markets ration through prices. This is a complete misrepresentation of the role of prices in a free market. Free market prices are a signal. They provide information. Prices do not ration any more than a bathroom scale makes you fat or thin. Free market prices give you information about the relative scarcity of resources and then allowyouto decide how to allocate your own private resources. Free market prices are a reflection of what individuals voluntarily pay. Government rationing is an act of force. It's a fundamentally different kind of interaction when the government determines for you how your resources are to be allocated--whether the government expropriates them first, as in the case of Medicare, or simply mandates how you must spend them, as in the case of the individual mandate to purchase health insurance.

While we are talking about mandates—in the legal challenges to the PPACA, the government is currently arguing before the courts that the “requirement to maintain minimal essential coverage” is not a mandate to buy coverage. The government’s top lawyer, Solicitor General Neal Katyal, argued in court:

Congress is not regulating the failure to buy something, but the failure to secure financing.

The New York Times reports:

Mr. Katyal…argued that the law’s insurance mandate, which takes effect in 2014, does not so much require individuals to buy coverage as it does regulate the way they pay for health care they will inevitably consume.

This is a distinction without a difference. Lawyers are good at word games, but if you look at the actual real life effect of the law, it is a mandate which offers you no real choice: you can either obtain a government-defined product or you can break the law and pay a penalty.

In language similar to the restrictions placed on the IPAB, the new heath care control law also forbids the use of quality-adjusted-life-years (QALYs) “as a threshold to establish what type of health care is cost-effective or recommended.” But thousands of cost-utility studies use QALYs to determine cost-effectiveness. Realistically, QALYs are the yardstick currently used to measure and compare outcomes to various medical treatments. It is hard to imagine how this ban could be any more meaningful than the ban on rationing discussed above.

Just over a year ago, The Christian Science Monitor reported:

[T]he Antitrust Division, [of the Dept. of Justice] joined by Idaho Attorney General Lawrence Wasden, forced a group of Boise orthopedists to accept price controls for worker’s compensation and HMO contracts as part of a settlement accusing the doctors of “price fixing”… [T]he Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal “price fixing”… The FTC has hinted at this when it’s said physicians must accept Medicare-based reimbursement schedules from insurance companies. But the DOJ has gone the final step and said, “Government prices are market prices.”

Through a simple decree, the government thinks it can turn prices set by voluntary exchange into price-fixing, and government-determined prices into market prices. Who are they trying to convince? Must be themselves because any one with a bit of common sense can see that changing the terminology can not change the reality.

Other equivocations by government officials and their defenders include denying that clinical guidelines accompanied by sanctions and rewards do not amount to promoting “cookbook medicine.” And that as long as you call it “evidence-based care,” you can ignore the fact that much of the “evidence” is controversial and that many of the guidelines are written or funded by those with vested interests in a particular outcome.

Lest you think that this verbal trickery is restricted to health care, you can find much of the same in the politicization of energy policy. Regarding the elimination of the incandescent light bulb, Penelope Green writes in the New York Times:

The [Energy Independence and Security Act of 2007] does not ban the use or manufacture of all incandescent bulbs, nor does it mandate the use of compact fluorescent ones. It simply requires that companies make some of their incandescent bulbs work a bit better, meeting a series of rolling deadlines between 2012 and 2014.

Yet, a short week later, again in the NYT, Andrew Rice informs us:

[O]ne day very soon, traditional incandescent bulbs won’t be available in stores anymore. They’re about to be effectively outlawed…Conservatives like Rush Limbaugh have denounced the “light-bulb ban” — actually, [it’s] a new set of federal efficiency regulations that the traditional incandescent can’t meet.

You see, a ban on light bulbs isn’t really a ban on light bulbs, because the law doesn’t call it a ban.

As Richard Ralston so aptly warns:

“When the clear meaning of words is replaced with government fiat in this way, all limits on arbitrary government power and its use of force are destroyed.”

Rationing, mandates, price-fixing, and bans are al terms with precise meanings in plain English. Shame on us if we are fooled by the deliberate distortion of these simple definitions. Stick and stones can break our bones, and words can actually hurt us --when they are used to obscure instead of clarify our understanding of reality.

(This post was published in Townhall.com in a shorter version here.)

What can medicine learn from McDonald's?

2011-08-22T09:25:00.000-07:00

Apparently a lot.

(For some reason I can't resize this to make it fit. You can also view this clip here.)

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Amicus Brief filed to FL v HHS

2011-08-07T08:47:00.000-07:00

Docs 4 Patient Care, Benjamin Rush Society, and Pacific Research Institute,

File Amicus Brief Against Obama Care

May 12, 2011 – Docs 4 PatientCare, the Benjamin Rush Society, and the Pacific Research Institute issued the following statements after filing an amicus brief in the U.S. Court of Appeals for the 11^thCircuit supporting the district court’s decision that Obama Care is unconstitutional.

Hal Sherz, MD, FACS, FAAP, President and Founder of Docs 4 Patient Care said: “We believe that it is vitally important for a physician group to stand up and speak out on behalf of all of the doctors in this country who oppose this law, but feel disenfranchised and disheartened. As opposed to other medical organizations that have failed to stand up for its constituents and have instead urged them to accept the onerous changes being forced upon them by a statist administration, we are conveying hope by challenging the legality of this law and the brazen attempt of the government to control healthcare.”

Sally C. Pipes, founder of the Benjamin Rush Society and President and CEO of the Pacific Research Institute said: “We believe that the district court was correct that the mandates imposed by the federal government in the PPACA are not a constitutional exercise of governmental power. Forcing Americans to purchase expensive health insurance or face a penalty is not the responsibility of government. Doctors and patients – not the government -- should be in charge. Only then will America achieve affordable, accessible, quality care for all.”

Google docs web link of amicus brief

(Addendum: better link) Amicus Brief

That's the official press release.

In my new role as Senior Health Policy Analyst for Docs 4 Patient Care, I was able to contribute behind the scenes by providing a comprehensive bibliography of peer-reviewed articles on cost-shifting in health care, as well as participate in strategy discussions while the brief was being written. Very exciting--and educational--process.

Although the D4PC leadership initially wanted to argue from fundamental principles, we were advised that such arguments, especially at the appellate level, would be dismissed almost out-of-hand because of the past 70 years of Supreme Court rulings on Commerce Clause interpretation. The more effective place for those more fundamental arguments is in the media and the political arena--places we are doing our best to speak out frequently and consistently.

If we are to rid ourselves of the PPACA and its disastrous effects on personal health care freedom, popular discontent must be loud and clear. Chances for complete repeal )after a successful 2012 election), as well as Supreme Court comfort with over-turning legislative action, both depend on public opinion of the law.

I am convinced that the more people know about the details, the more they will oppose the law.

Continue to write letters to the editor.

Speak up and speak out.

Invite conversations by wearing the Black Ribbon.

The battle for the sanctity of the private doctor-patient relationship is still going strong.

There is no moral case for Obamacare

2011-07-23T11:47:00.000-07:00

Economist John Goodman asks "Is there a moral case for Obamacare?"

The short answer is "no."

Goodman's longer answer:

What cries out for moral justification are the mandates and regulations being forced on the other 300 million people. Why are they being forced to pay more, or allowed to pay less, than the true cost of their insurance? What moral principle can justify that?

Search the world’s ethical codes and you will have a hard time finding any that are consistent with a health reform that:

Gives people in health insurance exchanges up to 10 times as much federal subsidy as people at the same income level getting insurance at work.
Forces young people to pay two or three times the real cost of their insurance in order to subsidize older people who have more income and more assets.
Takes from low-income seniors in order to provide subsidized health insurance for non-seniors who have higher incomes.
Takes from people who use tanning salons and people who need crutches and wheelchairs and pacemakers and gives to … well …. who knows?

Read the rest here.

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The Benevolence of Inequality

2011-07-07T21:48:00.000-07:00

If we accepted inequality in health care, instead of insisting on instant equal access for everyone to the newest, best and most expensive treatments, where would health care be today? It's impossible to even imagine what treatments and cures would be available and affordable.

A multi-tiered healthcare system which respects individual property rights (instead of violating them through coercive wealth redistribution ) is not only the right thing to do, but we would all be better off in the long run.

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The Fight Against Tyranny Never Ends

2011-07-04T08:32:00.000-07:00

On the 4th of July, we must remember why we celebrate. Today I will rejoice in the freedom we have in this country--but not for a second will I forget the fact that there are many who do not understand what a precious and fragile gift we have inherited.

The eight pillars of the federal government healthcare takeover:

1. Federal mandates on individuals
2. Federal mandates on employers
3. Expanding federal entitlements
4. Squeezing funds out of Medicare and choking off private plan choices'5. New federal taxes
5. New federal taxes
6. [federally controlled] Health insurance exchanges
7. Federal government-sponsored health plans [public options]
8. Federal control over private health insurance

from Why ObamaCare is Wrong for America

The new government mandated cigarette labels:

“If they’re going to take truthful, non-deceptive advertising and put extraordinarily evocative and gruesome pictures on them and force the companies to use their money to present the government’s message, that’s a big step in a free society,” says Dan Jaffe, executive vice president of government relations with the advertisers’ association.--Shawn Zeller, CQ.com

ObamaCare also requires insurance companies participating in exchanges to have their marketing approved by the government.

What we can expect if the individual mandate to purchase health insurance is upheld:

“Mandatory Life Insurance,” Cries California Congress Person
BROADMOOR, CA. June 29, 2011: “Tomorrow I plan to introduce the Affordable Life Insurance Empowerment Act in Congress,” said Arly Esperson, Congressperson from California’s 54^th Congressional District. “Now that the Sixth Circuit Court of Appeals has ruled the health insurance mandate is constitutional, I think it’s time we take the next step.”--[Not a real bill, but it could be.]-- DaveRacer, posted at The COHR Man

Supporters of ObamaCare may find that title offensive, but it is a more accurate and neutral moniker than a title which claims the law is affordable or that it protects patients.

ObamaCare is more than an attack on our healthcare freedom. If allowed to stand, it will push us further toward the collectivist end of statism. Either a man owns his own life, or he does not. Our country was rightly founded on the belief that he does. ObamaCare is premised on the collectivist premise than a man's life is held hostage to the will of the majority and needs of "society." Compassion for the sick, poor and disadvantaged are essential parts of being human but can never justify initiating force. To maintain a peaceful, prosperous and civil nation, we must devise solutions to our problems while ruthlessly respecting every individual's right to life, liberty and the pursuit of happiness.

Have a glorious 4th of July.

Book Review: The Truth About ObamaCare

2011-06-30T10:30:00.000-07:00

The Truth About ObamqCare by Sally Pipes Regnery Pub. Inc., 2010

This book provides an easy to read synopsis of the recent health care reform. Pipes does a good job of bringing up the counter arguments to those who defend ObamaCare as a necessary step in the right direction.

1. She provides a brief summary of the history of health care in the US which brought us to our current situation.
2. She presents the data to show the problem of the uninsured is not 15% of our population but closer to 3%.
3. She explains how the PPACA (aka ObamaCare) will exacerbate rising health care costs because it misidentifies the causes of rising costs.
4. She provides a succinct explanation of how laws, government policies and regulations make medical care unaffordable for a significant segment of our population.
4. She explains how ObamaCare will increase the problems of inaccessibility to medical care, restrict our choices and eventually lead to rationing.

But no need to despair. In her last chapter, Pipes offers some alternative solutions which will increase choice, increase affordability and set us back on the path of ever-improving medical care.

For anyone who has been closely following the health care debate and the development of PPACA, this book adds nothing new. It does put into one easy-to-read place a brief outline and introduction to the major issues involved.

For those just getting interested in the topic, it's a great place to start.

220 pages. Large type. Well referenced.

Black Ribbon Project: New Poster

2011-06-29T13:47:00.000-07:00

The Black Ribbon Project is working along side several other great health care freedom organizations. Be sure to check them out.

Docs 4 Patient Care
AAPS
The Galen Institute
The Benjamin Rush Society
Freedom and Individual Rights in Medicine
The Lucidicus Project
PatientPowerNow.org
Citizens' Council for Health Freedom
MediBid

Not pictured:
National Center for Policy Analysis

"Nutrition Reform Act" And Accountable Grocers

2011-06-23T22:28:00.000-07:00

Accountable Grocers: A Culture and Payment Change

In today's environment, Grocers are generally paid a fee for each food item purchased. Therefore, Grocers increase revenues by increasing the number and variety of foods sold, and by keeping their stores open for longer hours. But too many Americans are obese from overeating high calorie food with low nutritive value. The new Centers for Food and Nutrition ("CFN") policy and program initiatives are going to drive a new model, Accountable Nutrition. Accountable Nutrition takes the old fee for service model and turns it upside down.

Under an Accountable Nutrition program, Grocers are paid based on their quality outcomes. The Citizen Protection and Affordable Nutrition Act ("Nutrition Reform Act") created the Shared Calories and Savings Program which promotes Accountable Nutrition Organizations ("ANO"). The ANO model is intended to require Grocers to create a new legal organization that is financially and nutritionally integrated.
This financial and nutritional integration is intended to coordinate sales among restaurants, Grocers and other food suppliers as well as integrate reporting on financial and nutritional metrics. The ANO would be paid for the services rendered, but instead of increasing revenues with increased sales, if the ACO can minimize the costs associated with feeding 5000 beneficiaries then the ANO gets a share of the monetary savings. Thus, Grocers will be motivated to reduce food sales and instead focus upon the customers achieving quality outcomes. However, if the Grocers fail to achieve quality outcomes, the Grocers will not be eligible to share in the savings. Specifically, the proposed ANO require Grocers to report on sixty-five (65) measures that focus upon the following policy priorities: (1) shopper experience; (2) maintenance of balanced diets; (3) shoppers attaining ideal body mass and (4) managing at risk shopper populations--such as those who purchase tobacco and alcohol. The Grocers will be scored on each measure within each policy priority. If the quality benchmark is achieved, the ANO Grocer is eligible to share in the monetary savings.

This initiative of scoring a Grocer's service will likely change the culture and behavior of Grocer practices. Because the Grocer will be scored based upon the shoppers' perceived experiences, Grocers must focus upon the factors that impact shopper satisfaction scores, i.e. length of check out lines, friendly staff, ease of parking. Grocers must also consider what information technology systems will be used to coordinate nutrition monitoring with other food dispensers and what support tools can be used to prevent junk food binges and promote shopper weight loss. Likewise, engaging the shoppers to modify their behavior will be a critical component of improving quality outcome scores and protecting the Grocer’s ability to receive payment. This concept of reporting on quality measures and tying payment to the quality outcomes will change not only a Grocer’s business plan for profitability/sustainability, but should change the sales patterns of Grocers.

In addition to the ANO concept, CFN has established other programs that require quality reporting to obtain reimbursement. For example, Grocers can receive an increase in their reimbursement from CFN if they participate in the E-coupon program. Likewise, Grocers that report on quality benchmarks in the Grocer Quality Reporting Initiative (“GQRI”) are also eligible for financial incentives. Further, the Centers for Food and Nutrition Innovation (“CFNI”) demonstration projects also focus upon improving quality outcomes and reducing costs. Therefore, the focus on quality nutritional outcomes will likely continue to drive change in behavior while facilitating payment reform.

Don;t know why someone didn't think of this before.

(Original article:

Accountable Care: A Culture and Payment Change

The Changing Character of Medicine: Are We Headed in the Right Direction?

2011-06-09T08:40:00.000-07:00

As our country moves from being a nation of small business owners to a nation of employees, we are losing an important avenue for understanding the benefits and benevolence of capitalism. This trend makes it all the more important to speak up on the morality of profits, private property and voluntary exchange to counter the loss of the direct, concrete experience gained by self-employment.

Physicians are no different. As the quality and integrity of our medical care depends upon free and independent thinking, in medicine, it's even more directly a matter of life or death.

Read more:

The Changing Character of Medicine: Are We Headed in the Right Direction?

PJ Media June9, 2011

Why You CAN'T Keep Your Current Coverage

2011-06-08T07:47:00.000-07:00

No time to write a post myself on this important topic--especially as Chris Jacobs has already written on it so well.

From today's email:

The Wall Street Journal has coverage today of Monday’s McKinsey study suggesting that more than half of all employers could decide to drop coverage by 2014 – both a news article and an op-ed by Grace-Marie Turner (copied below). The op-ed notes that if half of all employers dump their employees in Exchanges, that will meanabout 78 million Americans would lose their current plan. As the news article notes, this potential change by employers is entirely rational: While the health care law does include a modest $2,000 penalty for employers who do not offer “affordable” coverage, as the article notes, “Health-policy experts have questioned whether that is high enough to discourage companies from health coverage.” Indeed, Credit Suisse in a Monday note to clients reiterated that employers dropping coverage is “exactly what was intended” by the law in the first place.

The White House was quoted in the news article as saying the McKinsey study was “an outlier amid other research suggesting that employers overwhelmingly would keep coverage.” But in reality, the studies saying that employers will drop coverage continue to mount:

· A PWC survey of employers released just two weeks ago found that nearly half of all employers “indicated they were likely to change subsidies for employee medical coverage” thanks to the law.

· Former Congressional Budget Office Director Doug Holtz-Eakin’s analysis confirmed that many more firms than originally projected will have a rational economic basis for dropping their plans come 2014 – resulting in up to $1 trillion more in new federal spending on insurance subsidies than official estimates.

· An Associated Press story from last fall, titled “Employers Looking at Health Insurance Options,” included quotes from a Deloitte consultant saying that “I don’t know if the intent was to find an exit strategy for providing benefits, but the bill as written provides the mechanism” and from the head of the American Benefits Council claiming that the law “could begin to dismantle the employer-based system.”

· Former Tennessee Governor Phil Bredesen – a Democrat – wrote an op-ed explaining very succinctly why employers will drop their existing coverage options. Gov. Bredesen noted that Tennessee could drop coverage for its state employees, pay the $2,000 per employee penalty to the federal government, give their workers cash raises to compensate for the loss in health benefits, and STILL come out at least $146 million per year ahead.

Even worse than the prospect of 78 million Americans losing their current health coverage would be the trillions of dollars in new federal spending on the taxpayer-funded insurance subsidies many of these individuals would receive. At a time when America faces a looming entitlement crisis regarding Medicare and Medicaid, these recent developments illustrate just how significantly worse Obamacare will make our fiscal predicament.

Chris Jacobs

Health Policy Analyst

Republican Policy Committee

(202) 224-2946

Book Review: In Defiance of Death

2011-06-07T12:24:00.000-07:00

In Defiance of Death: Exposing the Real costs of End-of-Life Care
by Kenneth Fisher, MD with Lindsey Rockwell, DO and Missy Scott

End-of-life care has tragically been lumped together with the bruha over "death panels." Given the dire need to reign in the rising costs Medicare, and the looming threats of rationing under the auspices of "comparative effectiveness" and cost-control via the Independent Payment Advisory Board, these concerns are understandable but misplaced. But, assuring that people have humane and appropriate end-of-life care in line with their own wishes should have nothing to do with government rationing and everything to do with good medicine.

Drs. Fisher and Rockwell along with free-lance writer Scott have written a compassionate, extensively researched appeal for rational end-of-life care. Their long over due discussion has the potential to improve the quality of medical care, while at the same time help eliminate wasting our wealth on futile treatments.

We spend a very large proportion of our health care dollars at the end of our lives. The reasons for this are multiple, but include an inadequate legal definition of death, the shifting of decision-making away from medicine and into the legal realm, lack of adequate communication between patient and medical care-takers about end-of-life wishes and realities (aggravated in part by the Patient Self-Determination Act), unrealistic expectations of what medical science can accomplish, and the divorcing of medical decisions from economic considerations.

Dr. Fisher offers some very intriguing solutions which are worth further discussion.

Death should be defined not as "absence of all brain activity" but the absence of cerebral cortex functioning. This would clarify the futility of continuing to keep bodies alive when the person who once inhabited them no longer exists.

Hospitals could form Appropriate Care Committees to assist families and physicians provide the best possible care for individual patients. We must actually apply what we already know about which interventions are futile in which contexts, and when further treatment is merely prolonging suffering and death. Where I part ways with Dr. Fisher is his recommendation that these committees extend into a government-managed hierarchy. I can see them as a selling point for hospitals ("We provide only the best, appropriate care.") but it frightens me to think of the government making those determinations.

Another idea of Dr. Fisher's is to eliminate CPR as the default action for cardiopulmonary arrest. Upon hospital admission, each patient fills out a fresh advance directive form (a good idea), and if CPR is desired, an order for its use would have to be expressly written. The danger, of course, is that the order for CPR could be absent due to oversight rather than as a true reflection of the patient's wishes--and potentially lead to an irreversible error. Dr. Fisher points out that CPR-as-default was instituted when most hospital patients had acute, reversible problems. That is no longer the case. A growing proportion of hospitalized patients are admitted with debilitating chronic illnesses and aggressive treatment is frequently not beneficial. I am still not sure what to think on this issue--but it is a discussion which needs to occur.

A useful clarification in the book is the differentiation between the absolute right of individuals to refuse any and all treatment and the non-existence of a right to demand treatment that is not medically indicated. The tricky part is who gets to define what is "medically indicated." Dr. Fisher recommends only limiting treatments which are not controversial (such as attmepting to keep an anencephalic infant alive via mechanical ventilation.) These non-controversially futile actions are where there is no right to demand treatment.

Dr. Fisher also calls for more training of medical personal in end-of-life matters and palliative care. The goal is to do our best to assure patients do not pointlessly suffer by receiving futile treatments, and families do not deplete life savings for inappropriate care. I heartily agree that a deeper understanding of this aspect of medicine is sorely needed.

In summary, I support the following improvements recommended by the author:

1. Implement a mechanism to keep advance directives fresh and timely.
2. Develop Appropriate Care Committees for hospitals and long-term care facilities.
3. Alter medical education to emphasize continuity of care.
4. Increase training in palliative care/end-of-life
5. Redefine death to loss of cerebral cortex functioning.
6. Consider changing CPR away from being the default action.
7. Address the issue of a shortage in nurses through expansion of 2-year hospital-based nurse training programs.

Some of the recommendations with which I differ:

1. Making the Appropriate Care Committees a government function.
2. Create a central agency to mandate uniform insurance billing (with the rationale that it will decrease administrative costs.) This is properly a market function.
3. Government support of primary care over specialists, or vice versa. Again, the balance of primary care to specialists needs to be a market discovery by free individuals choosing what is of value for themselves.
4. Legally restricting or eliminating the direct advertising of drugs and medical devices. Yet again, this is an appropriate free market activity.

These areas of disagreement in no way detract from the over all value of the book. Dr. Fisher presents much valuable information accompanied by a number of concrete practical actions we could take to address a very real and serious problem within our current health care system. This book is an excellent place to start several long over-due conversations.

In the end, the way for us to assure the most cost-effective use of resources is by doing what is best for the patient in his or her entire context: medically, psychologically and economically. This can not be achieved in the collectivized, centrally controlled system of a medical commons where treatment decisions are divorced from economic consequences. As physicians, we can do a better job by understanding and then communicating the limits of beneficial treatment. As a society, we need to return personal responsibly and a respect for property rights, which means accepting the consequences of living in a world of limited resources and limited life.

There is a time to defy death, but in the end, no one gets out of here alive. And nothing in life, not even death, is free.

Medicare Reform: Paying for the Cake You Want to Eat

2011-06-02T07:20:00.000-07:00

Today's post is up on PJ Media.

Since Medicare and Medicaid became law in 1965, people have been told: “You can have your cake and eat it too.” You can have the medical care you need and not have to pay for it. (You may think you are paying for Medicare with your payroll taxes, but in fact those taxes cover less than 1/3 of your projected health care costs.)

For decades, Medicare and Medicaid have been paying for health care with no one facing the difficult question: “Is what we are purchasing worth the cost?” Not the doctors, nor the “beneficiaries” — and especially not the politicians. Doctors get income; patients get health care; politicians get votes — all with the carefree ease of paying for it with other people’s money.

Check it out--and leave lots of comments!!

Doctors Speak to Congress on behalf of Patient Care

2011-05-28T11:57:00.000-07:00

Dr. Jane Orient, executive director of AAPS, congressmen Dr. Burgess (TX-R) and Dr. Amerling testified last week before the House in support of freedom of choice for doctors and patients.

This clip is just shy of an hour long but is well worth the time to watch. The PPACA is tragically misnamed: it neither protects patients, nor will it bring down costs. Entitlements are driving federal and state budgets over the cliff, and the PPACA adds significantly to the momentum.These three doctors provide explanations for why this is true.

The new law is specifically designed to disrupt the direct doctor-patient relationship which is the foundation of private practice medicine. This fact is illustrated by what Dr. Berwick, the current head of Medicare, wrote in his book New Rules:

Today, this isolated [doctor-patient] relationship is no longer tenable or possible. Health care has become an industry, with numerous loci of authority well beyond the doctor’s office. In many ways, the relationship of the patient to the doctor is less important. Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care.

In place of a direct doctor-patient relationship, Berwick advocates (and the PPACA strengthens) our current dysfunctional third party payment system which places a bureaucrat into the middle of our medical decisions. More and more, doctors are being required to make treatment decisions based on population-based clinical guidelines rather than the customized needs of individual patients.

Regulatory requirements are making it more difficult for physicians to survive as small businesses, driving physicians to either retire early or work as employees. It is possible that the physician-as-employee model is less expensive (which is not the same as more efficient or cost-effective,) but shifting to that model should occur voluntarily through a free market, not by the government stacking the deck against the option of private medicine.

For more details on how the new health care control law will take away freedom of choice without solving problem of rising costs, watch the video clip below.
If you prefer to read their statements instead of watch, you can find them here: Dr. Orient's, Dr. Amerling's. I don't have a link to Br. Burgess' statement, but he comes first in the video after a brief introduction by Dr. Orient.

Advancing Liberty, Creating Change, Part 2

2011-05-22T08:29:00.000-07:00

See here for Part 1

Randy Barnett was the speaker I came to hear at the recent symposium, Advancing Liberty, Creating Change, --and he did not disappoint.

Mr. Barnett is a constitutional law professor, author of Restoring the Lost Constitution, argued before the Supreme Court in Gonzalez v. Raich (a key case in Commerce Clause precedent), written multiple amicus briefs in support of the unconstitutionality of the individual mandate, and is now the legal representative for the NFIB in the appeals case of Florida v. HHS (the same case in which Docs4PatientCare has filed an amicus brief).

Barnett briefly summarized how the case against the mandate developed, illustrating how a small number of people can make a big difference. A conversation between Barnett and someone from the Heritage Foundation led to a paper on the unconstitutionality of the individual mandate. The paper was published just before the bill was passed Dec. 23, 2009, setting out the terms of the debate, and providing Senate Republicans with a basis to place on record a constitutional objection to the mandate.

Currently, there are five individual mandate legal challenges on expedited repeal. The government has ramped up the seriousness with which it is defending the mandate by having the Solicitor General argue the case at the appeals level. This is a very unusual move as the government's top lawyer usually only becomes involved, if at all, when a case is before the Supreme Court.

Barnett expects the cases on appeal will wrap up around August or September allowing for a petition to the Supreme Court in the fall. Oral argument would then be heard by SCOTUS in January of 2012 with a decision by the end of its term in June. You can read Barnett's estimate of how the judges may rule in his article Commandeering the People.

Barnett emphasized the importance of having a viable alternative to the PPACA pass in the House. It doesn't have to become law, but something must exist as an expression of Congress' will and a potential means to prevent the total dislocation of health care reform. He also maintains that if we win, the gains are important but not that large. If we loose this battle, however, we lose the nature of this country as one of limited government (and I would argue, because of the gigantic regulatory power delegated by the PPACA, Rule by Law takes a crippling blow.)

At the reception after the talks ended, I spoke briefly with Mr. Barnett, thanking him for all of his work defending health care freedom. He recommended the ACA Litigation Blog as a good source of information for those interested in following this case closely. The site also has links to the official documents of the 5 legal challenges making their way to the Supreme Court.

If you are interested in delving further into the constitutional issues, I would recommend starting with three documents: Judge Vinson's ruling of FL v. HHS (which provides a concise and cogent summary of the history of Commerce Clause cases), Barnett's brief to the 9th Circuit Court of Appeals (which presents the key arguments of the unconstitutionality of the mandate consistent with current legal precedent), and his article "Commandeering the People" which takes a closer look at the role of the Necessary and Proper Clause in light of the current constitutional debates.

To rid ourselves of this onerous law, popular discontent must be the dominant mood of the country. To maintain discontent, we must avoid resignation by keeping the hope of affecting a change alive. One way to do this is to announce to each other support for repeal by wearing or displaying the Black Ribbons. The more Black Ribbons that are out there, the more people can see they are not alone, that there is hope of change.

Let's make a difference, now.

Advancing Liberty, Creating Change

2011-05-15T12:14:00.001-07:00

Two days ago I had the wonderful opportunity to attend a symposium co-hosted by the Institute for Humane Studies and the Mercatus Center. Held on the 25th floor of the Hotel Nikko, the views were as stunning as the speakers were inspiring.

The formal part of the symposium was opened by economist Dr. David Henderson who described the almost miraculous success of the Liberal Party in Canada which, through real and significant cuts in government spending, brought Canada back from the precipice of economic disaster. In 1995, the WSJ called the Canadian dollar the "peso of the north" and Moody's put Canadian credit on watch. At that time, Canada had a debt-to-GDP ratio of 70%. Following these cuts and important changes in unemployment benefits, Canada then ran budget surpluses from 1997 until the international recession of 2008. The big lessons from this Canadian experience for U.S. politicians are the following:

You can cut spending and still get reelected.

You can cut spending and the world does not fall apart.

You can cut spending and grow the economy.

As our Congress continues the Budget Debates, let's work to remind them that these truths will also hold for health care spending.

Next, Adam Thierer spoke on the very important battle to preserve internet freedom. Although his talk was equally fascinating as the others, it wasn't as directly relevant to health care so I refer you to his written body of work for the details of his ideas.

Adam was followed by Matt Mitchell, speaking on the growing problem of unsustainable trends in state government spending and debt. The two largest contributors to this problem are Medicaid and the effects of public employee retirement benefits. From his talk, I took away two key points.

Unions in the private sector increase the wages of some workers at the expense of other workers, but are limited in what they can demand from their employers because of business' need to make a profit. (What came to my medical mind was the fact that a successful parasite doesn't kill off its host.) If profits decrease too much, the business (and the jobs) will disappear. Unions in the public sector don't have customers paying for goods and services--they have taxpayers, who can't choose to go away. Also, in the public sector, unions get to vote for and select the people with whom they negotiate for their benefits. In the private sector, unions don't get to vote for their employers (other than with their feet.) The fundamental incentives for public unions have no brakes. To improve the situation, we need to change the rules and alter the incentives. Tweaking the numbers will never be enough.

With regard to Medicaid, Matt showed that the problem goes beyond the incentives for expansion that the current system holds. (Because of Federal matching funds which shift state costs to the country as a whole, States have the incentive to continually expand Medicaid programs.) He also pointed out that whenever government funds a program, it creates a powerful vested constituency which pushes for continued spending and expansion. Data shows that when the Federal government reduces payments for state programs--the programs don't shrink or go away. The states just continue to fund them through state debt or raising taxes. A looming danger of the PPACA is the enormous new entitlement constituency it creates, not only through the expansion of Medicaid, but also through insurance premium subsidies.

The formal talks were punctuated with opportunities to talk personally with the speakers and fellow attendees. It was an exciting chance to meet face-to-face several people whose works I have admired from afar, or have met only in the cyber-world of Yahoo groups. In spite of the very real and significant challenge to individual rights which our country currently is facing, the general mood of the speakers and the audience was decidedly optimistic. I left encouraged and inspired, knowing that people of such intellectual caliber and integrity are fighting for the cause of freedom.

(Report on the symposium will be continued next post.)

Update: New paper out from the Mercatus Center-"Public Sector Unionism: a Reivew"
Update: Paper on-line by David Henderson CANADA’S REVERSED FISCAL CRISIS

Cookie Cutter Medicine

2011-05-11T21:15:00.000-07:00

Patient Diana Hsieh relates her personal experience with a health problem to illustrate why "cookie cutter" medicine and government "quality control" through adherence to clinical guidelines is bad for your health.

For a more technical discussion, don't miss the following posts by two practicing physicians who regularly blog on health care policy.

"Dangers of strict adherence to clinical guidelines" by Doug Perendia

and

"Who Writes these guidelines anyway?" by Dr. Rich Fogoros

.

Medicare "As Is" is Not an Option

2011-04-28T12:47:00.000-07:00

The Budget War has reignited the Medicare War with both Republicans and Democrats fearful of angering Seniors (and potential Seniors) about diminished access to blank-check health care.

Polls show people want Medicare to continue "as is" --but this is not a fiscal possibility.

Medicare must be changed, and both Pres. Obama and Rep. Ryan offer ways to change it.

The President calls for top-down restriction of care by a government-appointed panel of experts. Ryan's plan calls for restriction of government payment to individuals and more individual choice.

Neither plan ends Medicare --just Medicare as it currently exists.

Neither plan supports Seniors' ability to pay for care when Medicare won't.

The debate must continue.

More information here, here and here.

Just ask

2011-04-28T10:56:00.001-07:00

5 Questions from WTRC Films on Vimeo.

Black Ribbon Project Goes to Washington

2011-04-23T10:12:00.000-07:00

D4PC "Crash Card" report:

(Although not visible in this photo--every doctor proudly wears a Black Ribbon.)

Charging the Hill

Dr. Hal Scherz's Field Report from the Capitol

Speaker of the House John Boehner prioritized a meeting with the leadership of Docs4PatientCare just before meeting with President Obama in the midst of the political fight over the Government shut down.

On April 6 & 7, a group of leaders from Docs 4 Patient Care went to Washington for meetings on Capitol Hill with Senators, Congressmen and their staff, for policy meetings and to participate in a healthcare symposium with the Galen Institute.

Docs4PatientCare staging outside the
Capitol to "Charge the Hill" on behalf
of the Doctor-Patient Relationship.

On this trip to DC, as compared to previous ones, we had no trouble arranging meetings with Senators and Congressmen. That is because after 2 years of work, they recognize that we are a bona fide organization and worthy of their time.

We would have had meetings with many more Senators and Congressmen then we did, had it not been for an imminent government shutdown, which occupied most of their time and attention.

Nonetheless, the highlight of our trip in many respects was our 30 minute meeting with Speaker of the House, John Boehner, which immediately preceded his first meeting with President Obama over the budget impasse.

Most of the time, groups come to DC with their hand out, trying to get a bigger slice of the federal pie. They gain entry into these offices because they have spent an enormous amount of money through lobbyists, who are hired guns, but have no real skin in the game.

We were received differently, because we are different.

New Congressman and
Docs4PatientCare member,
Dr. Dan Benishek came to
Washington to prevent the
trampling of the Doctor-
Patient Relationship.

We did not come asking for anything except for the opportunity to help them fix healthcare. We told them who we were (although many already knew), and what we had done. We shared with them our successes in the 2010 elections- helping Congressmen Dan Benishek MD, get elected in Michigan, and Joe Walsh in Illinois.

We shared with them our Prescription for Healthcare Reform and that we believed that with our expertise, we could help them with the healthcare message far better than policy experts or media professionals. We explained how our organization worked- which is not to have lobbyists, but instead to develop personal relationships between doctors and their elected officials in Congress.

We offered to help with Congressional testimony and to give assistance in healthcare matters that affect our patients and us every day, because as opposed to the faux doctors who gave up taking care of patients in favor of becoming bureaucrats, we are on the front lines daily. Finally, we shared a vision of what we can do in 2012 to help put people into Congress and the White House who will be serious about fixing healthcare in America. This can be done through the media but is better accomplished through the influence that we have on the 2000-10,000 patients that each of us sees in our offices and clinics.

We informed them about our new web site and how we had transformed it into the trusted source for healthcare information by keeping it current with updated daily content. Many of them already knew about this and had been following us.

This was a powerful message.

Speaker Boehner and everyone else that we met with acknowledged just how powerful it was. They all appreciated that we were there and had given up time at our practices and with our families and traveled to DC at our own expense. They all told us essentially the same thing:

We need a continued presence in Washington and we need to bring doctors from as many Congressional districts as possible.

We need to build our membership. There is a palpable need for a group like Docs 4 Patient Care, but the best way for people to notice us is to have as many members as possible.

We need to work to change control of Congress and the White House in 2012, otherwise, the prospects for healthcare will be bleak.

D4PC's rising influence after
the mid-term elections.

In addition to the meeting with Speaker Boehner, we met with the GOP healthcare leadership team in the House (Boehner, Cantor, McCarthy) and the Senate (McConnell). We met with Senator John Barrasso MD from Wyoming and his team, the team of Sen. Tom Coburn MD and Sen. Rand Paul MD. Also with 3 of the 5 freshmen GOP physician Congressmen- Scott DesJarlais (TN), Andy Harris (MD), and Dan Benishek (MI). We chatted with John Fleming MD (LA), Joe Wilson (SC) and John Culberson (TX). We also met with the healthcare specialists for Reps. Mike Burgess and Michelle Bachman.

We had an excellent healthcare symposium with the Galen Institute and Congressman Tom Price MD, helped out by delivering an impassioned speech about why this healthcare law is a disaster for America and what we must do to get rid of it.

The Heritage Foundation is one of our most important strategic partners and we were hosted to an afternoon session by Bridgett Wagner, the Director of Coalition Relations and attended by Galen Institute President Grace-Marie Turner to discuss Docs 4 Patient Care, healthcare policy issues and strategy, and Grace-Marie's new and excellent book- Why Obamacare is Wrong For America; an essential must read book for anyone who hopes to understand this difficult and convoluted subject.

Just a couple of other items to share-

Congressman Tom Price presents
the case to repeal ObamaCare.

We have filed an amicus brief in Virginia in support of the Virginia case against the Federal Government which challenges the mandate that people must purchase healthcare insurance in the Affordable Care Act. We are looking to get involved with other court actions in the near future.

We are in the process of forming Docs 4 Patient Care state chapters. We have chapters in Arizona, Colorado, and Illinois. We formally launched the Georgia Chapter this week. We are looking to have 20 state chapters by the end of 2011.

So there you have it.

Docs 4 Patient Care is very much real and vibrant.

We need those of you that have never joined as a member to do so- what more do we have to do to prove ourselves to you? Just go to our web site- docs4patientcare.org now and click on Become a Member.Those of you who have not sent in dues for this year- you are not a member, so please renew by clicking on the same link. (unless you signed up as a Gold Member since September).

We cannot succeed without every one of you. We will do the heavy lifting if you do not want to - just help us do it by supporting us. No one else will help you (or your patients) if you don't start now, by becoming a member.

Those who want to get into the fight- just let us know and we will give you something to do.

Thank you.

DEFUND, REPEAL, & REPLACE

The full framework of our plan for America can be viewed here. We invite all Americans to join us in the true effort to reform healthcare.

"Quality Bonuses"--Grease for the Squeaky Wheels

2011-04-20T07:32:00.000-07:00

One hand giveth while the other taketh away--and both hands live in the White House.

— Millions of seniors in popular private insurance plans offered through Medicare will get a reprieve from some of the most controversial cuts in President Obama's healthcare law.

--LA Times 4-20-11

The ability to arbitrarily punish and reward groups and individuals is one of the key problems with politicizing an economic activity. Rule by Men instead of Rule of Law.

Once power is concentrated in the hands of the few, the threat to liberty accelerates--Newton's laws of motion applied to political power instead of mass.

While I was in Washington DC last week, several different people remarked that a key strategy for supporters of the health care control law will be to keep potential complainers happy---and quiet. The waivers, and now out-right hush money like Medicare Advantage "quality bonuses" are just two ways this will be accomplished.

There are only two ways to rid ourselves completely of this terrible law--either the Supreme Court rules it unconstitutional, or opponents take control of the government in 2012. Both of these pathways require continued popular discontent.

We must do everything we can to keep this issue fresh in the minds of voters. It truly has life and death consequences--for both our liberty and our access to affordable, trust-worthy medical care.

Why the ACA is wrong and must be repealed.

2011-03-18T16:12:00.001-07:00

The Black Ribbon Project is participating in the Independent Women's Voice ObamaCare Video Contest. The deadline of midnight March 19th is approaching fast, but it's not too late to add your own original contribution. First prize is $5000---but the competition is pretty stiff. All entries will be posted on their website, however, so it's a great way to spread your personal message.

The Black Ribbon Project supports repeal of the ACA because of the way it tramples on the doctor-patient relationship--but more than that, it endangers the roots of civil society.

What a great challenge to get to meat of the matter in under one minute!

Be sure to check out the website and vote for your favorite. Some are really quite good!

IWV You Tube Channel

Shameless request: Vote for my video. From what I can tell, the winner is whoever gets the most viewer votes. Any winnings I receive will go to The Black Ribbon Project.

How to Defend Health Care Freedom

2011-03-10T22:12:00.000-08:00

Last fall, I was invited to speak about the Black Ribbon Project at the annual meeting of the American Association of Physicians and Surgeons. I took the opportunity to share a few of my thoughts on the principles we need to promote to effectively defend health care freedom and the doctor-patient relationship. I am pleased with how much I was able to cover in just 25 minutes. Let me know what you think!

Testimony on Fiscal Consequences of PPACA

2011-01-31T09:03:00.000-08:00

Richard Foster, Chief Actuary, Center for Medicare and Medicaid.
1/26/11 Testimony before the House Committee on the Budget

McCLINTOCK: “True or false: The two principle promises that were made in support of Obamacare were one, that it would hold costs down. True or false?”

FOSTER: “I would say false, more so than true.”

McCLINTOCK: “The other promise… was the promise that if you like your plan, you can keep it. True or false?”

FOSTER: “Not true in all cases.”

A Tale of Two Emails on repeal of the PPACA

2011-01-18T14:12:00.000-08:00

I recently received two emails. One is from the White House with the Orwellian title, "Protecting Your New Freedoms Under the Affordable Care Act." The other, "What Repeal Really Means" was from Chris Jacobs of the Republican Policy Committee.

Read both releases carefully.

Our President claims he can offer people the chance to be free from the demands of reality by making others pick up the tab.

But no one can be free from the requirements of reality---the necessity of creating the values you need to sustain your life. Freedom is not a metaphysical concept but a political one, one whose true meaning is to be free from the coercive acts of others.

If allowed to stand, the PPACA will extend the power of government, further depriving us of the freedom we need to sustain our lives: the freedom to use our own minds, set our our values and priorities, and to act on our own choices. The PPACA will extend the current erroneous legal precedent that government can rightfully dictate the contents of private contracts and exchanges, along with regulating items we produce for our own private use as "interstate commerce" (see Wickard v. Filburn.) In addition, the government will be allowed to dictate what we must and must not purchase, and with whom, and for what price.

The PPACA is one of the biggest intrusions into our economic freedom in recent years. No individual or business will be left unaffected--and few, if any, restrainsts will be left on the power of government over our economic lives. And since freedom is of a piece, loss of economic freedoms will eventually require the erosion of freedom in all other realms.

What does repeal of ObamaCare really mean? It means resurrecting the Rule of Law and reasserting the Constitution as a limit on government power, and the purpose of government as the protector of individual rights.

The main issue is not whether or not repeal will add to the deficit, or if repeal will save jobs.

The main issue is that repeal will restore essential freedoms and take a step in the right direction of limiting the intrusion of government into our private lives.

ObamaCare must go so we can live our lives in freedom.

A solution which destroys freedom, is no true solution at all.

Federal Judge Rules Individual Mandate Unconstitutional

2010-12-13T23:11:00.000-08:00

U.S. District Judge Henry E. Hudson ruled today that the individual mandate of the ACA (a.k.a. ObamaCare) is unconstitutional.

“Neither the Supreme Court nor any federal circuit court of appeals has extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market. In doing so, enactment of the (individual mandate) exceeds the Commerce Clause powers vested in Congress.” from newsok.com

I have previously read that due to the lack of a severablity clause, if any part of the law is ruled unconstitutional, the whole bill will have to be thrown out. Unfortunately, it turns out to be more complicated than that.

Here is the best explanation I have yet come across:

A Guide to Severability and ObamaCare

[T]he lack of a severability clause wouldn’t necessarily result in the overrule the rest of the legislation, which mostly have to do with spending and rationing — the expansion of Medicaid, Medicare cuts, and sweeping regulatory authority — and isn’t wrapped up in the mandate. This has been the Court’s approach to other issues, such as the recent Sarbanes-Oxley ruling, another law which lacked a severability clause, where they invalidated a portion of the law and allowed the rest to stand.

Some proponents of the ACA believe that the health of the individual mandate would move us closer to implementing a single payer system. (See Ezra Klein's article in today's Washington Post.) The danger of this is only too real.

The best way to prevent that from happening is to continue to speak out against ObamaCare as a whole.

Even a Supreme Court ruling that the individual mandate is unconstitutional will not save us from the multitude of other violations of life, liberty and property intimately woven throughout the ACA.

Preservation health care freedom and the sanctity of the doctor-patient relationship requires the complete REPEAL of the ACA, and the extraction of government from the business and practice of medicine.

For more analysis on today's reading see:

Individual Mandate in Heath Reform Law Ruled Unconstitutional by Federal Judge on Medscape.com

ObamaCare Is Unconstitutional by Grace-Marie Turner

Full Text of the Opinion

Health Reform Will Survive it Legal Fight by Eric H0lder and Kathleen Sebelius

Debt Reduction and Health Care Freedom

2010-11-19T11:08:00.000-08:00

Two for the price of one.

With the national debt rising to dangerous levels, serious cuts to government spending are paramount. President Obama’s debt commission has made some interesting recommendations–but even better are the following proposals…

Regulations and Arbitrary Rule

2010-11-12T08:22:00.000-08:00

Last month, federal officials granted dozens of one-year waivers that were aimed at sparing certain employers, including McDonald’s, insurers and unions who offer plans that sharply limit the coverage they provide...

Concerned about the potential disruption that would be created by enforcing the new rules, the administration has granted dozens of additional waivers and also made clear that it would modify other rules affecting these policies. Last week, the Department of Health and Human Services issued more guidance, saying it would use a different method of calculating spending for these plans so they would be able to meet new regulations dictating how insurers should use the premium dollars they collect. NYT 11/9/10

This is what was meant when Speaker Pelosi infamously informed us "We have to pass the bill so we can see what is in it." So many details have been left up to regulatory rule making, even if Congressmen had read the bill, there would be no way to know its actual meaning. Far too much was left up to the discretion of yet-to-be-created agencies, and the Secretary of HHS.

And that is the way it has to be. It is the nature of central planning.

Command and control economic planning can not function through legislating. Legislative reaction time is too slow and the decision making process to cumbersome and contentious. The only way to allow for the necessary responsiveness and flexibilit is to delegate a significant portion of the decision making power to regulatory agencies. The broader the regulatory mandate, the more the decisions become sway to special interests and the arbitrary whims of the regulators and rule-makers.

One of the first casualties of regulation is Rule by Law--which is replaced with Rule by Men. The second casualty is usually Equality Before the Law--which is replaced with Rule by Special Favor. This is the nature of central planning, and of the regulatory behemoth which it spawns. Everybody has to follow the rules...except those who Sebelius decides to let off the hook.

Special waivers are now up to 111.

UpDate: Here is the current waiver list.

White House Healthcare Stories Ignore Hazlitt's Lesson

2010-11-04T13:08:00.000-07:00

The ink is barely dry. The electrons have barely been tallied. The lessons of the election have yet to be learned.

Yet, the White House continues blindly down the path of promoting its unwanted, hopelessly flawed health care law by committing the economic fallacy of ignoring what is unseen. (But I guess that goes hand-in-hand with being blind.)

Today I received the following in an email from Nancy-Ann DeParle, director of the Office of Health Reform:

Health Care Updates
Health care is an issue that’s important to all of us and the new health care law is already helping Americans across the country. Visit the 50 States/50 Stories map to find stories of how the new law is affecting people in your area -- people like Jim Houser, who will be receiving a small business tax credit that will enable him to continue providing health insurance to his employees or Adrienne Lowe who can now stay on her parents’ plan after graduating from college. You can also watch as the President makes a surprise phone call to Gail O’Brien who was without insurance when she was diagnosed with lymphoma and has been able to get coverage through the newly established Pre-Existing Condition Insurance Plan.
These are just a few of the examples of Americans who are benefitting from the Affordable Care Act. Across the nation, the new law is making health care better for millions of Americans.

The Fifty Stories are only the tip of the ice berg--and unless Obama et al start paying attention to what lies below the surface, our country's finances and health care are headed for the same fate as the Titanic.

What is NOT mentioned, of course, are all the jobs which will NOT be created because labor costs will be too high due to the tax and regulatory burdens the law places on employers and businesses.

Or the medical devices, medicines and cures that will NOT be invented.

Or the aspiring young adults who will NOT choose medicine as a career because of decreasing incomes and job satisfaction---caused by government price fixing, paperwork and billing hassles, --to say nothing of the repeated vilification of physicians as greedy and incompetent (in need of ever more practice guidelines and government oversight.)

Or employers who respond to the law's strong financial incentives to drop health insurance coverage for their employees.

Also not mentioned are the number of insurance companies which must either discontinue significant benefits, (unless they get a waiver) raise premiums or go out of business due to the PPACA.

So don't be fooled when the White House tells stories.

Be sure you understand the lesson that Obama, DeParles and the rest of the White House gang either refuse to understand, or worse, understand but choose to ignore:

This is the persistent tendency of men to see only the immediate effects of a given policy, or its effects only on a special group, and to neglect to inquire what the long-run effects of that policy will be not only on that special group but on all groups. It is the fallacy of overlooking the secondary consequences.

In this lies the whole difference between good economics [or politics] and bad. The bad economist [or politician] sees only what immediately strikes the eye; the good economist looks beyond. the bad economist sees only the direct consequences of a proposed course; the good economist looks also at the longer and indirect consequences. The bad economist sees only what the effect of a given policy has been or will be on one particular group; the good economist inquires also what the effect of the policy will be on all groups.

The distinction may seem obvious...Yet when we enter the filed of public economics, these elementary truths are ignored."

--Henry Hazlitt, Economics in One Lesson

.

Health Care Rights and Wrongs

2010-11-03T18:00:00.000-07:00

For Patient Autonomy: Repeal ObamaCare

2010-10-29T16:36:00.000-07:00

Dr. Alieta Eck of AAPS, and Drs. Pegg, Hansen and Lovett of Docs4PstientCare assisted the Independant Womens Forum in making this commercial prompting voters to ask their candidates to pledge to repeal ObamaCare if elected.

Listen carefully to their message, because it gets right to the heart of the matter: ObamaCare takes control away from patients and doctors and gives it to government bureaucrats. The PPACA may be primarily insurance reform, but whoever controls insurance, controls the payment for medical care and will eventually have to control what gets paid for. That means deciding what your treatment options will be.

The solution?

Repeal ObamaCare.

Restore choice and accountability--for patients, doctors, hospitals and insurance companies.

In a free country, we all have our part to play.

Then, to make sure we don't simply go back to the problems which prompted health care reform, the next steps include:

1. End government policies which give preferential tax treatment to employer-based insurance with first-dollar coverage. Instead, all medical expenditures must have the same tax advantage or disadvantage. This will increase the availability of insurance for individuals, and insurance portability for everyone.

2. Allow insurance companies to complete across state lines. Insurance companies from states with the least intrusive regulations are already less expensive than those in heavily regulated states, so prices for insurance will rapidly drop. (For an Oct. 2010 report on health insurance mandates by state, see here.)

3. Remove legal limits and hindrances to purchasing catastrophic health care combined with a Heathcare Savings Accounts so people can more easily take advantage of this form of insurance which has repeatedly demonstrated its superiority in lowering health care spending and maintaining patient satisfaction. A significant part of the cost problem in health care relates to the perverse incentives which occur in a third-party payer system.

4. Allow balance billing for Medicare to end the massive amount of cost-shifting doctors and hospitals have to do in order to make up for the inadequate payments they receive from the government. When doctors are able see Medicare patients without losing money, the doctor shortage for Medicare patients will disappear.

5. Encourage states to enact real tort reform. Defensive medicine increases testing and procedures and drives up costs.

But first, we have to repeal ObamaCare.

Take the Pledge.

ACOs Threaten Quality Medical Care

2010-10-18T19:29:00.001-07:00

The PPACA is "nudging" doctors out of independent practice and into working as employees of large practice groups or hospitals. This move is occurring because of the bundled payment structure of Accountable Care Organizations (ACOs) which favors "vertical integration" of doctors, hospitals and health plans.

The only problem is that bundled payments are simply capitation rewritten, and employee physicians face divided loyalties between the needs of their employers and the desires/needs of their patients.

This arrangement is especially insidious when coupled with the ethics of "social justice" which gives a physician the moral OK to sacrifice his patients to the "greater good" of society. What is good medicine for the masses is often at direct odds with what is good for the individual patient--and thus, quality medical care suffers.

Resources:

For more on the PPACA effects on private practices see "Killing Marcus Welby: How ObamaCare stifles private practices" by Scott Gottlieb, MD, NY Post 10/18/100

For more on problems with the underlying assumptions for ACO's see "On Being Politically Incorrect and Realistically Correct about ACOs" by Richard Reece, MD at Medinnovation, 10/7/10

For more on the destructive effects of the concept of "Social Justice" on the availability of quality medical care, see Dr. Rich Fogoros at The Covert Rationing Blog.(multiple posts)

See also:'"Deconstructing ACOs" by John Goodman at John Goodman's Health Policy Blog, 8/18/10

September BRP Update

2010-09-29T21:37:00.000-07:00

A lot has been happening with the Black Ribbon Project and an update of developments is long over due.

Over 1000 ribbons have been distributed, with orders pending for several hundred more.

Bumper stickers with 3 different slogans are now available to donors upon request.

One BRP supporter was using a Post-It note to send a short message to her doctors. Included with every bill she paid was a note saying “Thank you. Health care is not a right.” To make the task easier, and to spread the word about the BRP, we designed the pre-printed pads shown below. The pads have 50 pages each and are also available to donors upon request.

A new tri-fold pamphlet is almost complete. The pamphlet introduces the Project and offers suggestions on how the Black Ribbons can be used to focus attention on the fact that quality medical care requires freedom of choice. If you are interested in receiving pamphlets to hand out, email your request to BlackRibbonProject@gmail.com.

Here's a preview of the pamphlet (click to enlarge):

This month, I have had several opportunities to promote the Black Ribbon Project.

At a fund raising diner for John Dennis (running for Congress against Nancy Pelosi) I met the leaders of several organizations who support the repeal of ObamaCare.

Last week, I presented The Black Ribbon Project to the 67th annual meeting of the Association of Physicians and Surgeons. My talk was well received and I was able to distribute many ribbons and almost 20 bumper stickers. In addition, the board of AAPS voted to send a Black Ribbon and business card to each of their new members.

This coming weekend, I'll be in Washington DC at a conference of the American College of Surgeons to help staff an informational booth for Docs4PatientCare --which will include pamphlets, pins and other materials from the BRP. ACS has officially announced its opposition to the new health care control law, so I'm expecting a warm reception. I'll also participate in a special physician's forum on the impact of the Accountable Care Act (a.k.a ObamaCare) organized by D4PC and the Heritage Foundation. I look forward to meeting the leadership of D4PC, who have been enthusiastic supporters of the BRP. Docs4PatientCare will also be sending a Black Ribbon to each new member of their organization.

In addition to the above, I have mailed letters of appreciation accompanied by a complimentary Ribbon to several physicians who are speaking and writing in defense of health care freedom. Recipients include the following:

Dr. Lee Hieb, practicing orthopedic surgeon, President for AAPS, author of article in Human Events 10/08/08 “No Barak, Medical Care is NOT a Right.”

Dr. Jack Cassell, practicing urologist, famous for the sign he put on his office door after passage of ObamaCare

Dr. Milton Wolf, practicing radiologist and cousin of President Obama who is speaking out against ObamaCare; blogs at The Wolf Files

Dr. Marcy Zwelling, practicing internist, for participating in a panel discussion at Stanford University: “The Federal Government or Free Market: Which Can Offer the Most Compassionate and Effective Health-Care Plan for America?”

Dr. Reed Wilson, practicing cardiologist, for participating in a panel discussion at Stanford University: “The Federal Government or Free Market: Which Can Offer the Most Compassionate and Effective Health-Care Plan for America?”

Dr. Jane Orient, practicing internist and managing editor J Am Phys Sur, for her multiple articles and speeches promoting private medicine and the Hippocratic Oath. Latest article: “ObamaCare”: What Is in It”

Dr. Saul Greenfield, practicing pediatric urologist, for his 09/07/10 WSJ Op-Ed, “In Defense of Physician Autonomy.”

If you have suggestions for individuals you think deserve a letter of appreciation, please pass them along either in the comments or by email.

It's a been a busy month---and I am looking forward to October being even busier!!

Beth Haynes, MD

The Real Reason Medical Costs Are Rising

2010-09-29T12:21:00.000-07:00

If a doctor misdiagnoses the cause of a symptom, his treatment will not help and will likely make things worse.

If a President misdiagnoses the cause of rising health care costs, his solutions will not help, and will likely make things worse.

This is the situation we currently have with ObamaCare.

The new health care control laws are constructed on the belief that the large numbers of uninsured along with profit-driven behaviors of hospitals, doctors and insurance companies are the cause of run-away spending and cost increases. For these reasons, the new law concentrates its efforts on mandating insurance coverage and increasing government control over the private medical decisions made between patient and physician. Attempting to increase access, the law lowers or eliminates a patient's out-of-pocket payments, increases mandated benefits by third parties (both governmental and private) while simultaneously reducing payments to doctors and hospitals.

This analysis has it exactly wrong.

The numbers of uninsured are the result not the cause of rising costs. Patients are insulated from the cost consequences of their medical care while doctors, hospitals and insurance companies are blocked from competing on price and quality. This hinders innovation and interrupts the normal market signals to increase supply and decrease cost.

The REAL cause of spiraling health care costs is our current third-party payment system and the consequent economic separation of consumer from payer (and of effort from reward.) This disconnect is enhanced under ObamaCare. In "The Prognosis for National Health Insurance," Dr. Arthur Laffer (of Laffer Curve* fame) refers to this separation as "the health care wedge."

"The health care wedge is one way of thinking about government involvement in the economy. When the government or a third party spends money on health care, the patient is not. The patient is then separated from the transaction in the sense that the costs are no longer his concern. This separation--how far the supplier and consumers are separated from one an another--is what the economic wedge is measuring."**

Multiple segments of the new health control law aggravate this wedge: removal of co-pays, caps on the portion of premiums paid by the insured, government subsidies, price controls on provider payments, mandated benefits, and much more.

On the consumer side of the market, the wedge diminishes consumers' incentives to monitor costs...On the supplier side, doctors and other medical providers receive no incentive to provide higher quality services for less cost.

President Obama has no excuse for failing to grasp this vital connection. His Council of Economic Advisors stated in their June 2009 report, "The Economic Case for Health Reform":

There is well documented evidence that individuals respond to lower cost-sharing by using more care, as well as more expensive care, when they do not face the full price of their decisions at the point of utilization.

Americans have progressively been paying less and less of the costs of their personal medical care. In 1960, patients directly paid for almost 50% of their medical care. Today, out-of-pocket payments for patients in the private sector are only slightly more than 10% of the total cost for the medical care they receive.

"Accelerated medical inflation, consequently, is strongly correlated with a growing separation (wedge) in the medical market between doctors and patients."

What are the forces which cause this "wedge"? The primary forces are government actions themselves: rising government expenditures on health care, insurance mandates and regulations which favor third-party payment systems and "protect" patients from the financial consequences of their actions, cost-shifting due to medical welfare and entitlements programs, price controls integral to Medicare and Medicaid, to name just a few.

But it is not just the cost of medical care which is affected.

In the case of health care, the wedge also separates patients from doctors in determining what type of care should be provided. Decisions are made by government, insurers, and judges deciding medical malpractice liabilities.The government, lawyer, and third-party wedge in our current health care system causes [both] higher costs and diminished efficiency.

Additionally, as health care costs rise and government increasingly foots the bill, the damaging effects spill over into the wider economy leading to slower economic growth, rising tax burdens, as well as lower wages and standards of living.

The acceleration in health care costs needs to be brought under control. Because Obama has misdiagnosed the cause, the measures enacted in the new health care control law push us in exactly the wrong direction. ObamaCare increases the health care wedge, bolstering incentives to consume medical goods and services without the ability, let alone the requirement, to consider cost, efficiency or quality.

Laffer concludes this excellent article with a list of suggestions for a patient-centered health care reform which would remove the artificial and destructive incentives government currently has in place and "empower the patient and doctor to make effective and economical health policy choices":

1.Remove the tax advantage for employer-based health insurance by giving the tax deduction to individuals

2. Remove limits and disincentives on Health Savings Accounts

3. Allow interstate purchasing of insurance

4. Reduce [or preferably eliminate] mandated benefits that insurers must cover

5. Eliminate unnecessary scope-of-practice laws to allow non-physician health professionals practice to the extent of their education an d training

6. Reform tort liability laws.

Although written before the final passage of the health control law, this article provides an excellent analysis of the economic and governmental forces which created our current situation and explains how Obama's policies will only make things worse. I encourage you to read the whole 24 page paper.

Government has much to gain by following this key principle of medical ethics:

First do no harm.

*For a more humorous explanation of the Laffer Curve, you may enjoy watching this video clip by San Jose State University student, Gregory Downs, one of a series of ShortHand Politics clips he is producing to try and engage college students in economic ideas.

**All quotes are taken from Laffer's article.

The ACA is destroying independent medicine

2010-09-25T10:17:00.000-07:00

A few months ago, I had dinner with a couple from Pennsylvania. Knowing the husband was a physician, I asked what type of medicine he practiced.

He replied, "I am a dinosaur. Something that hardly exists anymore: a family practice doctor in solo practice."

In addition to being a primary care physician in a small town, he is a small business owner, doing his best to survive in an era of increasing government demands both on his business and on his practice of medicine. Solo and small group practice is becoming less and less financially viable within the third-party payer system.

For years, this doctor saw many Medicaid patients, willingly accepting payment less than his cost of providing care because of his loyalty to these individuals and his interest in offering charity care. Recently, he regretfully had to inform these patients he would no longer be able to be their doctor. Not because of the inadequate "reimbursement," but because of the onerous and expensive regulations Medicaid required. He provided the following example:

In order to provide immunizations for children on Medicaid, he could not simply have a special shelf in his office refrigerator. Medicaid required he purchase an entirely separate refrigerator in which to store the shots. This was in addition to reams of paperwork accounting for the purchase and use of the immunizations for Medicaid recipients.

Squeezed between falling payments and rising costs, the solo and small group practice of medicine is indeed endangered. More and more physicians are flocking to large group practices, frequently as employees. Maybe this is a good thing. But maybe not. However, patient demand is not the driver of this change, but rather the increasingly expensive government mandates placed upon the practice of medicine.

Dr. Richard Reece, physician, author, and health care policy commentator, has a recent blog post on the effect of the ACA on physician employment. He summarizes the findings of a recent survey, "Physician Alignment in an Era of Change."

• 74% [of hospital CEOs] plan to employ a greater percentage of physicians over the next 12 to 36 months.
• More than 70% say they have received increases in requests [from] physician groups for employment.

He concludes the post stating:

I spoke to John McDaniel, founder and CEO of Peak Performance Physicians, a practice management firm in New Orleans, and he pointed out to me that what’s driving hospital physician employment is not only anticipation of lower reimbursements under reform but the mounting costs and complexities of doing business.

Complexity per se is not the problem doctors are currently facing. Medicine and business are replete with complex problems which must be faced and dealt with on a daily basis. The problem is that far too much of the complexities doctors must deal with are the constantly shifting mandates and regulations which substitute the plans and values of the politically powerful for the plans and values of patients working privately in conjunction with their doctors.

Will the system of employee-physicians that is emerging be superior to the independent private practice of medicine? It depends on your criteria for judging.

If the goal is to meet the individual medical needs of patients according to their personal priorities, offered on a voluntary basis by physicians whose primary focus is the welfare of the patients he treats, then the ACA pushes us in exactly the wrong direction.

In Defense of Physician Autonomy

2010-09-24T12:56:00.001-07:00

Dr. Saul Greenfield, pediatric urologist and professor of medicine, wrote in the Sept. 7, 2010 WSJ:

In recent political debates, the autonomous physician has been portrayed as a problem to be solved, an out-of-control actor motivated by greed---and a major cause of rising health-care costs...

Physician autonomy is a major defense against those who comfortably sit in remote offices and make calculations based ont concerns other than an individual patient's welfare. Uniformity of practice is a nonsensical goal that fails to allow for differing expression of disease states.

this is not to say that critical research, randomized controlled trials, literature meta-analysis an guidelines are not necessary and useful. They are all essential...But we must recognize that many physicians will often make decisions that deliberately do not conform to "community standards"---and that patients will be better for it.

Dr. Greenfield correctly points out that quality medical care consists of physicians applying their independent assessments to the unique circumstances of each individual patient. Without autonomy, this goal can not be achieved.

Read the rest of what he writes "In Defense of Physician Autonomy."

ACA intentionally undermines the Doctor-Patient relationship

2010-09-21T15:43:00.000-07:00

The new healthcare law has multiple provisions which disrupt individualized decision-making between the physician and patient. This is no accident. It is by concerted design.

Dr. Donald Berwick, the new head of CMS, wrote the following on the doctor-patient relationship:

“Today, this isolated relationship is no longer tenable or possible… Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority...Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized, individualized decision making.” (emphasis added)

from New Rules, by Donald Berwick

Dr. Zeke Emmanuel and Nancy DeParle want and expect the new law eliminate solo and small group practices. Along with Dr. Robert Kocher, they wrote the following in an article in the August 23, 2010 issue of the Annals of Internal Medicine:

"To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put into motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups...

The health care system will evolve into 1 of 2 forms: organized around hospitals or organized around physician groups...Only hospitals or health plans can afford to make the necessary investments in technology and management skills."

Other revealing quotes from Dr. Berwick include:

"I can not believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for the leaders to do."

and

"I would place commitment to excellence--standardization to the best-known method--above clinician autonomy as a rule for care."

These health care policy makers believe the source of our health care problems stem from the autonomous decisions made by the private doctor-patient team, working together in the best interest of the individual patient.

They are wrong.

They have forgotten that the best interest of the individual patient is the purpose and standard of medicine--both morally and practically. The health of the nation depends on the sum of the health care provided to individuals. Nothing more or less.

Medicine for the masses is meaningless if the lives and health of individuals are sacrificed to the "common good."

UPDATE 9/28/2010:

Worthwhile related posts at Retired Doc's Thoughts:

Physician fiduciary duty-a thing of the past?

Crisis in medical professionalism

What is the fate of the doctor-patient relationship in a Donald Berwick designed health care system?

Socialized insurance IS socialized medicine

2010-09-04T10:08:00.000-07:00

“Socialized insurance necessarily leads to socialized medicine, and if the government controls well over half of the insurance sector through Medicare and Medicaid, and tightly regulates the rest, it is only inevitable that it will also seek to control how health care is bought and sold.”
— David Dranove on ObamaCare, at The Health Care Blog

The more the government controls health care delivery, the more it will have to control medical decisions themselves, which means less control for is left to individual doctors and patients.

Proponents of the ACA continue to claim that it is NOT "socialized medicine." The desire to distance the law from this term is because it is well known that socialized medicine does notimprove quality and access and does reduce individual freedom. Tthe essence of socialized medicine is centralized government control for the purpose of creating material equality by taking from some to provide for others--and that is exactly what the new law is designed to do.

Let's call it "socialized medicine"---because that's exactly what it is.

HT John Goodman's Health Policy Blog.

A Letter to all who are Patients

2010-08-31T22:19:00.000-07:00

Thousands of physicians will be distributing the following letter to their patients in the next few months and weeks. Speaking up about the detrimental effects of the new healthcare control law is becoming an important part of attending to the health and welfare of patients.

To My Patients,

Section 1311 of the new health care legislation gives the US Secretary of Health and Human Services and her appointees the power to establish care guidelines that your doctor must abide by or face penalties and fines. In making doctors answerable in the federal bureaucracy this bill effectively makes them government employees and means that you and your doctor are no longer in charge of your health care decisions. This new law politicizes medicine and in my opinion destroys the sanctity of the doctor-patient relationship that makes the American health care system the best in the world.

In addition to also badly exacerbating the current doctor short age, the law will bring major cost increases, rising insur ance premiums, higher taxes, a decline in new medical techniques, a fall-off in the development of miracle drugs as well as rationing by government panels and bureaucrats like passionate rationing advocate Donald Berwick forcing delays of months or sometimes years for hospitalization or surgery. Finally, studies show the legislation will adversely affect the elderly, the poor and rural residents.

Despite countless protests by doctors and overwhelming public opposition -- up to 60% of Americans opposed this bill -- the current party in control of Congress pushed this bill through with legal bribes and Chicago-style threats and is determined now to resist any “repeal and replace” efforts. This doctor’s office is non-partisan -- always has been, always will be.

But the fact is that every Republican voted against this bad bill while the Democratic Party leadership and the White House completely dismissed the will of the people in ruthlessly pushing through this legislation. In the face of voter anger some Democratic candidates are now trying to make a cosmetic retreat, calling for minor modifications or pret ending they are opposed to government-run medicine. Once the election is over, however, they will vote with their party bosses against repealing this bill. Please remember when you vote this November that unless the Democratic party receives a strong negative message about this power grab our health care system will never be fixed and the doctor patient relationship will be ruined forever.
I will be glad to discuss this with you at the end of our consultation.

Your Doctor

A message in consultation with Docs4PatientCare - a 501(c)6 national organization of of concerned physicians committed to the establishment of a health care system that preserves the sanctity of the doctor-patient relationship, promotes quality of care, supports affordable access to all Americans, and protects patients’ personal health care decisions. Learn more online at www.Docs4PatientCare.org

Good Medicine Requires Freedom

2010-08-18T16:05:00.001-07:00

Autonomy--one of the pillars of individual rights--is also a central principle of biomedical ethics and an essential ingredient of the doctor-patient relationship. Doctor and patient form a partnership of autonomous individuals--united in the goal of promoting the patient's health.

Autonomy includes the freedom to choose who your doctor is, and how you will pay for the doctor's services. The new health care control law (PPACA) severely reduces our autonomy by restricting the choice of payment methods to those pre-approved by government.

Efforts are on-going in multiple states to preserve freedom of choice in health care by resisting the federal mandate to purchase health insurance. In addition to a number of Health Care Freedom Initiatives (both legislative and ballot initiative,) many state attorneys general have filed lawsuits questioning the mandate's constitutionality.

Colorado has an interesting approach, which you can learn about through the links provided by Dr. Paul Hsieh at Freedom and Individual Rights in Medicine. Although federal law trumps state laws, states are not without power against the federal government. Read more here, and here, and here.

Good medicine is not simply a set of pre-defined protocols. Decisions must ultimately be made according to each individual's unique circumstances and values. Doctors must be free to advise patients of the full range of options--and patients must be free to choose.

UPDATE 8-21-10: as of May, 2010, 20 states had filed suit.

Social Justice and Medical Ethics

2010-08-10T14:07:00.000-07:00

The AMA is actively working in conjunction with Association of American Medical Colleges to inculcate young physicians with the ethics of "social justice."

Since 2005, the "Initiative to Transform Medical Education" has been working to correct what it views as deficiencies in the current training of physicians. These include an over-emphasis on the ability to acquire knowledge and problem solve-- to the detriment of "caring." Traditionally, physicians have expected to be autonomous decision-makers--but according to the Initiative this clashes with "increasing requirements...to be more accountable to various constituencies, including...the public, payers and government." Although physicians are recognized as "prepared to do what they believe is best for individual patients... [t]hey are not...prepared to participate in ethical and political discussions about the allocation of health care resources, which are not limitless." The solution proposed for allocating finite resources is John Rawls' principle of social or "distributive" justice.

"Social justice" is a euphemism for economic egalitarianism--and since people do not naturally come by equal wealth, "social justice" requires taking from some to give to others. "Social justice" is thus in direct conflict with the principles of equality before the law and the individual right to private property. "Social justice" also requires that a physician NOT advise his patients solely based on what is in the patients own best interest. He must instead somehow "balance" the patient's interests with those of the rest of society.

The concept of "social justice" has now been incorporated into several official statements of medical ethics. The Physician's Charter of the American College of Physicians now states:

[C]onsiderations of justice must inform the physician's role as citizen and clinical decisions about resource allocation. The principle of distributive justice requires that we seek to equitably distribute the life-enhancing opportunities afforded by health care. How to accomplish this distribution is the focus of intense debate. More than ever, concerns about justice challenge the traditional role of physician as patient advocate.

The Council of Medical Specialty Societies ethics statement includes the following:

The ethic of medicine must seek to balance the physicians' responsibility to each patient and the professional, collective obligation to all who need medical care.

Not only is this new ethic altering the curricula of medical schools to emphasize "social justice," but admission requirements will also be changed--deemphasizing a background in the sciences and MCAT scores. It is hoped that the selection of more "altruistic" and less competitively driven applicants will result in a larger number of residents opting for a less prestigious and less remunerative career in primary care.

This shift away from academic excellence and autonomy in the doctor-patient relationship toward serving the needs of society follows directly from centuries of medical ethics disavowing the legitimacy of physician self-interest. This error is compounded by a claim of moral superiority because "medicine is a profession not a business."

The distancing of medicine from business has done both a disservice. In claiming to be primarily an altruistic service, physicians have essentially invited the government to enforce this ideal while simultaneously denigrating the honorable occupations of production and trade. In failing to understand and defend the morality of profits, and the harmony of self-interest which characterize voluntary economic transactions, doctors have aided the enemies of freedom and capitalism-- who are now designing medical school curricula and admission requirements.

Capitalism is nothing more than the individual rights of life, liberty and property as applied to trade. Profits, in medicine as in any economic transaction, are not gained by exploiting patients or customers. Profits are simply the proper reward for successfully offering a value to others which is worth more to them than it costs to produce. In a system of free trade, self-interests are not in conflict--not even between a physician and a patient. In a direct-pay, fee-for-service relationship, it is in the best long term interest of the physician to offer advice and treatment based on the patient's best interest. And, it is in the best long term interest of the patient to only deal with a physician who does!

We can not defend patients' freedom without also defending the freedom of physicians. We can not protect the doctor-patient relationship without protecting the autonomy of both. Freedom of association and freedom to contract are interrelated principles fundamental to a free republic, to capitalism and to the ethical practice of medicine. "Social justice" requires that the individual be sacrificed to the collective. Such an act is as immoral in medicine as it is anywhere else.

"Social justice" claims to be what it isn't-- because true justice will never involve the violation of individual rights. The only way to assure justice and an ethical doctor-patient relationship is through the consistent, proud, principled defense of individual rights. The only way to assure justice and an ethical doctor-patient relationship is through the consistent, proud, principled defense of individual rights. In economics, that means capitalism. In medicine, that means the freedom of choice, not government mandates, for both doctors and patients.

Update 5-21-10 Two other articles on the training of physician to advocate for "health care reform"--by which is meant greater government control.

"Train physicians to participate in health care reform" by Sachiin Jain, Jordan Bolman in Skin & Allergy News, July 2010

"A Plea to Medical Students" by Joseph M Scherzer

ObamaCare Visual Aids

2010-08-04T17:00:00.000-07:00

How in the world are we to understand the explicit details of the new 2000+ page health control law, let alone make reasonable estimations of potential unintended consequences?

Although a picture is not an argument, sometimes it's worth 1000 words.

This chart is large and complex, but is reportedly still only about a third of the bill.

(Click on image to go to pdf to enlarge.)

More information here.

Here's a chart which focuses just on one small aspect of the "Affordable" Care Act.

Navigating the Small Business Tax Credit

(Click to enlarge)

A brief introduction to the chart is given by its creator, Committee on Ways and Means member Dave Camp here.

The IRS explanation is here.

And one last one that just attempts to diagram major deadlines:

Implementation Time Line for the ACA by Center for Health Transformation

(Click on the image to go to the PDF to enlarge for details.)

How much will each box cost to implement---both in money and in freedom?

How many new directives in this bill will replace the private decisions of patients and doctors with a bureaucratic decree?

How can a nation of independent, free citizens tolerate this massive invasion into private lives---no matter what the claimed justification?

Answers:

No one know, but too much.

No one knows, but too many.

We can't--if we desire to remain independent and free.

White House Releases Misleading Ad

2010-08-03T16:09:00.000-07:00

Today the White House released an ad campaign featuring actor Andy Griffith, hoping the friendly sheriff from Mayberrry will convince voters that ObamaCare is not the disaster we know it to be. Although technically correct, the ad falsely attempts to reassure Seniors that the new law won’t change Medicare benefits.

As FactCheck.org explains:

So how can the Obama administration claim that “guaranteed Medicare benefits will remain the same”? The answer is that the term “guaranteed” is a weasel word…It may sound to the casual listener as though this ad is saying that the benefits of all Medicare recipients are guaranteed to stay the same — and that may well be the way the ad’s sponsors wish listeners to hear it. But what the administration is really saying is that only those benefits that are guaranteed in law will remain the same…But here’s the catch: The extra benefits generally offered by Medicare Advantage plans aren’t guaranteed by law.

The White House is also counting on people forgetting that the original Medicare legislation made the following “guarantee”:

Sec. 1801: Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee or any institution, agency or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency or person.

In 2002, Dr. Lawrence Huntoon, MD collected more Medicare Myths and Facts including the myths that Medicare has lower administration costs, and that we can count on the government to keep its promises.

For more on the subtle duplicity of the White House ad campaign, read the rest of Mayberry Misleads on Medicare.

Minimum Insurance laws and the Uninsured

2010-07-31T15:15:00.000-07:00

Although not universally agreed upon, a strong theoretical and empirical connection exists between a legally mandated minimum wage and the rate of unemployment:

When the minimum wage that is legally-allowed increases, so does the number of unemployed.^{1, 2, 3}

A similar cause-and-effect relationship exists between insurance mandates and the uninsured. Understanding the effect of "minimum insurance laws" is complicated by the fact that different mandates have different cost consequences, and each state has its unique mix of mandates. There are four main types of health insurance mandates: benefit mandates (which are not cost equivalent across benefit types), community rating,guaranteed issue⁷, and mandatory insurance. Each of these categories will increase the cost of insurance, but to different degrees. Insurance mandates all raise the price of obtaining insurance, which in turn increases the number of people unable or unwilling to pay the premiums:

When the minimum insurance that is legally-allowed increases, so does the number of uninsured.^4,5,6

1. Mythology of the Minimum Wage http://mises.org/story/2130
2. Minimum Wages and Employment http://papers.ssrn.com/sol3/papers.cfm?abstract_id=961374
3. Minimum Wages http://www.econlib.org/library/Enc/MinimumWages.html
4. Health Insurance Mandates in the States 2008http://www.cahi.org/cahi_contents/resources/pdf/HealthInsuranceMandates2008.pdf
5. Mandated Health Insurance Benefits: Tradeoffs Among Benefits, Coverage and Costs?http://www.kff.org/insurance/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13995
6. The effect of State regulations on Health Insurance Premiums: A Revised Analysishttp://www.heritage.org/research/healthcare/cda06-04.cfm
7. Impact of Guaranteed Issue and Community Rating Reforms on Individual Insurance Markets, 2007 http://www.ahip.org/content/pressrelease.aspx?docid=20794

Previously posted on Wealth is Not the Problem 1/28/10 and on Sermo 4/25/10 (a physician-only online network.)

Health Care Re-education

2010-07-29T15:49:00.000-07:00

President Obama and the Democrats have started the Health Information Center which plans to spend $125 Million defending ObamaCare to the American public--a necessary effort because the majority of Americans still do not want this law. This campaign, plus the newly launched HealthCare.gov website, and the email campaigns of Kathleen Selbalius (Secretary of Health and Human Services) and Nancy-Ann DeParle, Director of the White House Office of Health Reform, are all aimed at reassuring citizens that freedom is not being taken away, only the rich will have to pay more in taxes, in the long run all this spending will save us money and reduce the debt, and this law will "strengthen" Medicare.

As Grace-Marie Turner of the Galen Institute points out below, even the National Council on Aging is in on the propaganda act. A recently published survey shows that Seniors have not been fooled into believing the political spin on ObamaCare and answered the questions correctly according to what the law will actually do, and not what the Democrats ridiculously claim it will do.

In order to keep the truth out in front, be sure to give your financial support to your favorite watchdog organization so they have the funds to challenge the audacious claims of the government. A list of suggested organizations is at the end of this post.

More Re-education

By Grace-Marie Turner

(Galen Institute email update. Subscribe here.)

The National Council on Aging got a lot of media attention this week for a survey that was astonishing in its misrepresentation of the facts.

The NCOA asked 636 seniors true or false questions about "the top twelve facts" they should know about ObamaCare. Only 17% knew the "right" answers to half of the questions and not a single person got a perfect score. The news release read: "Most Seniors Misinformed, Unaware of Key Provisions of the Affordable Care Act."

The infuriating thing is that the pollsters and the NCOA got the answers wrong, and seniors were right! With a lawyerly parsing of words, the questions were designed to obscure and even deceive. Here are a few examples:

"The new law will result in future cuts to your basic Medicare benefits." True or false? By more than two to one, seniors said the statement was true. But the survey said that was wrong.
"The new law is projected to increase the federal budget deficit over the next ten years and beyond."By more than three to one, seniors said that was true. Wrong answer.
"The health care reform law will cut Medicare payments to doctors." Seniors said true by three to one. Wrong answer.

The late Sen. Daniel Patrick Moynihan said, "You are entitled to your own opinion, but not your own facts."

A few facts:

The health overhaul law cuts Medicare by $575 billion over the next 10 years.
The Medicare actuary says that at least one in six Medicare providers, including hospitals, nursing homes, and physicians, could be operating at a loss by 2019 and could end their participation in the program, and "possibly jeopardize access to care for beneficiaries."
More than 7 million seniors will lose their Medicare Advantage coverage, and millions more will find access to care restricted. The Congressional Budget Office found that seniors enrolled in Medicare Advantage will lose an average of $800 a year in benefits.
As Rep. Paul Ryan explained at the Blair House summit in February, "when you strip out the double-counting and ... gimmicks, the full 10-year cost of the bill has a $460 billion deficit. The second 10-year cost of this bill has a $1.4 trillion deficit."
And the legislation keeps scheduled cuts in payments to doctors, which is why the Congress passed a separate "doc fix" bill in June to keep doctor payments from being cut by 21%.

Seniors know you can't take $575 billion out of Medicare and not have it affect their benefits. Many already are having difficulty finding providers that take Medicare.

NCOA also found that seniors are not satisfied the information they are getting about the new law is "accurate and reliable." Well the NCOA has certainly proved it is not the place to go for reliable information. This survey deserves to be tossed.

It almost seemed like push-polling where the pollsters try to "re-educate" people through the use of survey questions. Seniors get it, but this is unsettling at best.

Organizations to support:

AAPS

Americans for Free Choice in Medicine

Cato Institute

Docs 4 Patient Care

Freedom and Individual Rights in Medicine

Patient Power

National Center for Policy Analysis

The Lucidicus Project

Docs 4 Patient Care and Dr. Berwick

2010-07-19T13:15:00.000-07:00

Docs 4 Patient Care is an active, reputable physician's group working hard to promote health care freedom. I have personally talked with a number of the board members. They are hard working, honest individuals dedicated to providing quality care to their patients and restoring independence and freedom to medical decision making. Please check them out and provide them support.

My son thinks the following YouTube clip is "scaremongering" similar to the tactics of the global warming alarmists. Perhaps he is right about the tone and the style of message--but the major difference I see is that Dr. Scherz is correct in stating that socialized medicine increases pain, suffering and death. That statement is not conjecture but fact.

Dr. Berwick openly advocates the redistribution of wealth as necessary to the provision of health care. This is the fundamental premise of socialism: from each according to his ability, to each according to his need. This is the premise which led to the totalitarianism of the Soviet Union, and is causing the current economic stagnation of Europe, and increasingly in the United States. It's time that President Obama and Speaker Pelosi were honest about their socialist intentions so that the debate in America can center on the right issue.:

Do we still believe in individual rights, freedom and limited government, or do we submit to the directives and central planning of the political elite?

Freedom or Statism.

The choice is still ours.

Dr. Berwick:

"Any health care funding plan that is just, equitable, civilized and humane must, must, redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional."

New Lows in Newspeak

2010-06-01T12:36:00.000-07:00

When is price fixing not illegal price fixing? When it's done by the government.
When is price fixing illegal price fixing? When it's done by anybody else.

Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal “price fixing.”

--Christian Science Monitor 5/31/2010

In an landmark decision, the Justice Department has ruled that under the Sherman Antitrust Act, a group of Idaho orthopedists are guilty of conspiracy and price fixing. In this particular instance, the defendants were prosecuted under civil jurisdiction, but under antitrust law, it could just as easily been tried as a criminal case!

In an incredible act of economic ignorance and political hubris, the DOJ has announced that "Government prices are market prices." Additionally, refusal to accept government set prices has been equated with refusal to accept a private insurance company contract.

The degree of Newspeak is astounding.

The State is the Free Market.

Public is Private.

Government price-fixing is Competition.

The Sherman Antitrust Act long ago was demonstrated to be internally contradictory --which makes it impossible to understand, and arbitrary in its application, reducing business to the rule by men (as opposed to Rule by Law.)

The practice of medicine required that both patients and physicians be able to freely contract for remuneration in exchange for services offered. When physicians are denied the right of refusing payment which they deem to been unacceptable-jointly or individually, we no longer have freedom. Physicians become the indentured servants of the State and deprived the freedom of association---either with patients and insurance companies of their own choosing, as well as with their professional colleagues.

With the government's gun to their doctor's head, can patients really trust the workings of their doctor's minds?

Dr. Zwelling's Home Sweet Medical Home

2010-05-21T08:00:00.000-07:00

I learned of Dr. Marcy Zwelling through her participation in a debate at Standford University yesterday in which she defended the free market as THE compassionate and efficient way of delivering medical care.

Here is her description of her concierge practice as a far superior alternative to the "medical home" that government bureaucrats have in mind for us.

The Patient Centered Medical Home

When I became a doctor...I understood that hethcare was about relationships, communication, and cooperation: the patient/doctor relationship, doctor/doctor communications, and doctor/nurse cooperation...

The passion that my colleagues and I have to preserve the medical home and the sanctity of the relationship(s) that we have with our patients is as real as our patients’ trust and love. The necessity to safeguard the professionalism that we have earned so that we can provide the discretionary judgment to assist our patients with decisions about life and death is indispensable to the conservation of the integrity of the science...

Home sweet home is not an institution to be judged by the federal government. It is a place we go to belong, to reinvigorate, to strategize and build our lives. Medical homes belong to our patients and must never become government fashioned institutions.

Read the whole post here.

.

Physician Debate at Stanford

2010-05-19T11:57:00.001-07:00

The Federal Government or Free Market: Which Can Offer the Most Compassionate and Effective Health-Care Plan for America?

Four physicians will debate health care policy. I am thrilled to see compassion as the center of the debate. Proponents of greater government involvement in health care argue that it is necessary and right on the basis of caring for the disadvantaged. These arguments completely evade the facts that coercion is not compassionate, and central planning is not effective. This should be a lively and interesting debate.

More information.

The Benjamin Rush Society presents this debate at

Stanford University School of Medicine
May 20, 2010, 6pm
Location: James H Clark Center Auditorium
318 Campus Dr
Stanford, CA 94304

Co-sponsored by:
Stanford Federalist Society (Stanford Law School)
Stanford Chapter of the American Medical Students’ Association (Stanford Med School)
The Latino Medical Students’ Association (Stanford Med School)
Stanford Emergency Medicine Interest Group (Stanford Medical School)
Stanford Health Care Club (Stanford Business School)

The Hippocratic Oath

2010-04-27T13:27:00.000-07:00

Centuries old, the Hippocratic Oath is considered by most to be the fundamental ethical creed of medicine.

Central to the oath is the following promise of the physician to the patient:

"I will follow that system of regiment, which according to my ability and judgment, I consider for the benefit of my patients."

This promise is severely undermined by all third-party payment systems. When the third party is a private insurance company, at least patients voluntarily agree to the limitations placed on them and their physicians under the insurance contract --although the extent of contractual freedom varies widely from state to state.

When the third party is the government, and the restrictions and mandates hold the penalty of law, the voluntary nature of the agreement is changed to one based primarily upon coercion. The more the government mandates, the less the physician is able to legally offer advice and treatment based solely on his "ability and judgment." Instead, physicians are increasingly required to substitute their judgement and advice for the judgment of politicians and regulators.

Paperwork vs. Patient Care

2010-04-20T14:55:00.000-07:00

As the health care bureaucracy grows, so does the paperwork.

Paperwork, or documentation, takes up as much as a third of a physician’s workday; and for many practicing doctors, these administrative tasks have become increasingly intolerable, a source of deteriorating professional morale. Having become physicians in order to work with patients, doctors instead find themselves facing piles of charts and encounter and billing forms. –NYT 4/8/10

Paperwork is also taking more and more time away from patient contact and direct patient care during medical training-as much as 6 hours a day! This trend will only worsen with the recent massive increase in health care laws and regulation.

In 1965, when Congress created Medicare and Medicaid, the bill was 137 pages long… Thirty years later [the Mayo clinic] found 130,000 pages of rules they must comply with. –G-M Turner, 4/16/10

This time we are starting with a law over 2000 pages long which will create over 100 new federal agencies. Instead of spending time advancing medical expertise, how much time will physicians have to spend learning all the new regulations? (Especially now that coding errors are more likely to be interpreted as fraud and subject to felony changes. [2010HR 3590, Sec. 6402(f)(2)]

Medical training used to emphasize how to think in essentials and document only the information directly pertinent to the medical condition and care of the patient. This simplified future information retrieval–by oneself as well as medical colleagues. Now the essentials are buried in a morass of details required for payment and as protection against malpractice suits.

The switch to electronic records are no panacea as studies are showing they do not decrease administrative costs, only ”might modestly improve” quality of care provided, and may actually slow doctors down. In addition, electronic records combined with reporting requirements put patient privacy seriously at risk.

Doctors can spend time focusing on patients and their medical needs, or they can spend time being sure their paper trail is properly covered. More time on paper work means less time for patients.

Just one more way that the new laws are putting the government in between patients and their doctors.

The Black Ribbon Project goes to a Tea Party

2010-04-16T09:56:00.001-07:00

The San Jose Tea Party was a great introductory day for The Black Ribbon Project.

I talked non-stop with interested and concerned individuals--listening to their stories of how much they appreciated the wonderful care they have received from their doctors.

We gave away over 100 pins and received many generous donations.

What impressed me most was that each person had a story to tell about the importance of quality medical care in their lives. The personal doctor-patient relationship is a highly treasured value which they understand is threatened by the new health control laws. Many expressed concerns not only for themselves as patients, but for the freedom and respect which they believe their physicians deserve! The pins provided them with a way to express their support.

All in all, a very satisfying experience which raised my spirits about the generosity and the intelligent spirit of independence which characterizes so many Americans.

Thanks to all of you who made this an uplifting day.

Black Ribbon Project

2010-04-07T08:52:00.000-07:00

This ribbon is to raise awareness of the recent damage our government has caused to health care freedom and the integrity of the doctor-patient relationship. Under the new laws (PPACA), physicians will be compelled to base their advice and treatment on politically determined goals, even when in conflict with the best interest of their individual patients.

The Patient Protection and Affordable Care Act, signed into law on March 23, 2010, legalizes multiple infringements upo our rights to life, liberty and property. The government has been given wide and arbitrary powers to regulate, restrict and control not only the health insurance industry, but the provision of health care itself.

Employers and employees are no longer free to negotiate their own compensation packages but must fulfill the governments mandates for health insurance benefits.

Our most productive citizens and businesses will have a greater portion of their assets taxed away by the government to pay for increased entitlements---leaving investors and entrepreneurs with less money to expand employment, or create new businesses, or take risks on innovation.

The combination of guaranteed issue and community rating makes true health insurance illegal.

The harmful incentive system of third party payment is further entrenched and expanded, guaranteeing health care expenditures to spiral upward while simultaneously divorcing costs from efficiency-creating market competition.

Expansion of government's role in health care will eventually lead to price controls and rationing throughout of all health care--instead of existing primarily in Medicare and Medicaid as it is now.

Controlling costs must include controlling expenditures--which means that the government will have an increasing say in the medical decisions which previously have been left to a patient and his doctor.

Some individuals will benefit from this new law, and will do so in obvious ways. Many more people will suffer, but in ways that although directly traceable to this law are not obvious.

The purpose of the Black Ribbon Project is to call attention to the multiple ways that the new law undermines our freedom, erodes our prosperity and prospects for economic progress, and interjects politics into the private and intensely personal decisions which properly belong to physicians and patients.

We are now accepting contributions to distribute black ribbons accompanied by a caduceus pin to symbolize the destruction of health care freedom and the political undermining of the integrity of the doctor-patient relationship.

To kick off this project, the ribbons and pins will be distributed on April 15th at a Tea Party in San Jose, California along with a request for a minimum donation of $5.00 for one pin, $10.00 for three--and more discounting for larger orders. Each pin will be accompanied with a business card explaining the meaning of the symbol. On the back, will be contact information for the following organizations:

Freedom and Individual Rights In Medicine
Americans for Free Choice in Medicine
Patient Power
Lucidicus Project

This project is just starting out. Comments, suggestions, offers of help are welcome!!

Update 4/10/10: The project explanation has been expanded. Also, I have slightly increased amount of donation requested in order for the project to be self-sustaining. Straight donations are very welcome and will allow us to increase outreach and distribute more information with the pins.

Black Ribbon Project

Morality — Not Costs — As the Proper Basis for Health Care Reform

The ACA vs. Insurance Brokers

Calling All Doctors

Docs-4-Patient-Care National Annual Meeting Washington DC November 2-4 2011

Dr. Lee Hieb explains how regulation hurts patients

When is rationing not rationing?

What can medicine learn from McDonald's?

Amicus Brief filed to FL v HHS

There is no moral case for Obamacare

The Benevolence of Inequality

The Fight Against Tyranny Never Ends

Book Review: The Truth About ObamaCare

Black Ribbon Project: New Poster

"Nutrition Reform Act" And Accountable Grocers

Accountable Grocers: A Culture and Payment Change

Accountable Care: A Culture and Payment Change

The Changing Character of Medicine: Are We Headed in the Right Direction?

The Changing Character of Medicine: Are We Headed in the Right Direction?

Why You CAN'T Keep Your Current Coverage

Book Review: In Defiance of Death

Medicare Reform: Paying for the Cake You Want to Eat

Doctors Speak to Congress on behalf of Patient Care

Advancing Liberty, Creating Change, Part 2

Advancing Liberty, Creating Change

Cookie Cutter Medicine

Medicare "As Is" is Not an Option

Just ask

Black Ribbon Project Goes to Washington

"Quality Bonuses"--Grease for the Squeaky Wheels

Why the ACA is wrong and must be repealed.

How to Defend Health Care Freedom

Testimony on Fiscal Consequences of PPACA

A Tale of Two Emails on repeal of the PPACA

Federal Judge Rules Individual Mandate Unconstitutional

Debt Reduction and Health Care Freedom

Regulations and Arbitrary Rule

White House Healthcare Stories Ignore Hazlitt's Lesson

Health Care Rights and Wrongs

For Patient Autonomy: Repeal ObamaCare

ACOs Threaten Quality Medical Care

September BRP Update

The Real Reason Medical Costs Are Rising

The ACA is destroying independent medicine

In Defense of Physician Autonomy

ACA intentionally undermines the Doctor-Patient relationship

Socialized insurance IS socialized medicine

A Letter to all who are Patients

Good Medicine Requires Freedom

Social Justice and Medical Ethics

ObamaCare Visual Aids

White House Releases Misleading Ad

Minimum Insurance laws and the Uninsured

Health Care Re-education

More Re-education

More Re-education

By Grace-Marie Turner

Docs 4 Patient Care and Dr. Berwick

New Lows in Newspeak

Dr. Zwelling's Home Sweet Medical Home

Physician Debate at Stanford

The Federal Government or Free Market: Which Can Offer the Most Compassionate and Effective Health-Care Plan for America?

The Hippocratic Oath

Paperwork vs. Patient Care

The Black Ribbon Project goes to a Tea Party

Black Ribbon Project

Docs-4-Patient-Care

National Annual Meeting

Washington DC

November 2-4 2011