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Who Pays for Wasted Money?

A friend of mine has a favorite story about a coworker — both in a career for highly intelligent professionals — who seemed sincerely convinced that the government could help the economy by building jet airliners and flying them into the ocean.  Obviously, that’s an extreme iteration of a common economic ignorance that one would hope would cause most people to pause and think, “No, wait, that can’t be right.”

The anecdote came to mind while reading an AP story by Ricardo Alonso-Zaldivar, about the big ObamaCare increases facing those who receive no subsidies for their individual plans:

“We’re caught in the middle-class loophole of no help,” said Thornton, a hairdresser from Newark, Delaware. She said she’s currently paying about $740 a month in premiums, and expects her monthly bill next year to be around $1,000, a 35 percent increase.

“It’s like buying two new iPads a month and throwing them in the trash,” said Thornton, whose policy carries a deductible of $6,000.

The point that needs to be stated is that it doesn’t make the waste any more palatable when other people are receiving those two trash-destined iPads per month courtesy of the U.S. government.  The number of people throwing out metaphorical iPads for which they’ve paid may be small, but adding all of the subsidies up amounts to a lot of airplanes at the bottom of the ocean.

Of course (to be fair), all that money isn’t just producing garbage but is buying insurance against risk, albeit at an exorbitant cost with unjustifiable increases.  Acknowledging that the money is buying somethinghowever, only directs our attention back to the underlying injustice:  The government is just forcing some Americans to buy something for other Americans… and undermining our rights and increasing our overall risk in order to do so.

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The Coincidence of Medicaid Expansion with Opioid Abuse

The Wall Street Journal recently put a spotlight on a matter that deserves more consideration:

A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015. Wisconsin Sen. Ron Johnson presents intriguing evidence that the Medicaid expansion under ObamaCare may be contributing to the rise in opioid abuse. According to a federal Health and Human Services analysis requested by the Senator, overdose deaths per million residents rose twice as fast in the 29 Medicaid expansion states—those that increased eligibility to 138% from 100% of the poverty line—than in the 21 non-expansion states between 2013 and 2015.

There were also marked disparities between neighboring states based on whether they opted into ObamaCare’s Medicaid expansion. Deaths increased twice as much in New Hampshire (108%) and Maryland (44%)—expansion states—than in Maine (55%) and Virginia (22%). Drug fatalities shot up by 41% in Ohio while climbing 3% in non-expansion Wisconsin.

A quick look around the Internet didn’t produce Senator Johnson’s evidence, so I’m not able to say how Rhode Island fits into the picture.  Still, data from the Family Prosperity Index (FPI) shows that Rhode Island’s illicit drug use (other than marijuana) as a percentage of population matches that of New Hampshire, with Maine well below.  Recall that Rhode Island’s government jumped right into the Medicaid expansion with scarcely any discussion.

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Want Cancer Progress, Keep Progressive Government Out of It

Allysia Finley recently wrote a fascinating interview article for the Wall Street Journal with cancer researcher Carl June about a new strategy for curing cancer.  The conversation delves into the power of market forces and the undue burdens of regulation.

He’s also confident that economic competition will spur innovation. The University of Pennsylvania has licensed its CAR T-cell treatment to Novartis, and other pharmaceutical and biotech companies are racing for their own cures. “There are at least 40 companies right now making CAR T-cells . . . and they are incentivized to make it more cheaply,” he says. “The rate of innovation is so fast, patent life is going to be irrelevant for T-cells because it will be like your phone. Every two or three years, you buy a new phone because it’s better even though the patent hasn’t gone out.”

Regulators can’t possibly keep up with the rate of technological change and, beyond the likelihood that incumbent players will capture them in order to hinder competition, that gives them incentive to hold innovation back to a rate that they can tolerate.  As June makes clear, the innovation and competition are more effective at regulation of products and prices than a handful of bureaucrats with their own incentive structures could be.

That was one of my central concerns when ObamaCare came online — that the anti-corporate, anti-profit Left, if allowed to dominate health care, would freeze our advances.  In short, if you really want progress in some area of society, your best bet is to keep the progressives out of it.

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The Government Caregiver Cometh

Editor of a Web site for seniors Carol Marak says she “made a very conscious decision” to remain single and childless.  One might question how conscious that decision could have been if this is accurate:

But today, Marak and her single, childless contemporaries are facing a repercussion of their decision that never crossed their minds as 30-somethings: “How in the world will we take care of ourselves?” she asks.

Having a spouse and children to take care of you is an obvious consideration and ought to be top-of-mind when making these sorts of major life decisions.  If that isn’t the case, our culture must be doing something to suppress this thought and make it seem less consequential.

In that context, it’s astonishing that Anna Medaris Miller’s article never raises one very probable response to Marak’s question:  Aging Baby Boomers will vote themselves massive amounts of government assistance, to be financed by subsequent generations without the help of the children those Boomers never had.

Apart from the direct costs of using government to replace families, if we’re not careful we’ll edge toward a generation that is dependent upon government for its senior-years support and vulnerable to a growing push to give government control of health care and to allow assisted suicide.  (On the bright side, doctors won’t have to rely on family members to hold down people they’re killing if the victims patients don’t have families.)

Miller’s article certainly points to a problem that we need to address, as a society, but we should do so culturally, not through government.

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Chilling: H5069, Single Payer Healthcare (And the Inconsistencies It Poses)

In the course of reviewing certain bills filed during this year’s General Assembly session, I clicked on H5069 — and stared in growing horror at all of the red-lining (i.e., everything to be struck from current law). I turned to the succinct description of this bill written by Justin Katz, Research Director for the RI Center for Freedom & Prosperity, for the Center’s Freedom Index and the horror did not abate:

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Single-Payer Healthcare is an Assault on Families’ Rights to Make Personal Medical Decisions

Recently on the world stage, we’ve witnessed the unthinkable results of a government-controlled health care system in Great Britain. The tragic story of Charlie Gard’s death and his parents battle against a socialist health care system has broken the hearts of you, me, and people around the world.

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Acceptance of Life’s Disappointments, U.S. and U.K. Attitudes

Here’s some interesting philosophizing on a rainy summer day.  Building on the observation that folks in England are too content to accept drying machines that don’t dry, Corinne Purtill draws broad conclusions about the difference between Brits and their American peers.

Purtill herself is an American just returning to her native country after five years across the Pond, and although she flirts with complimenting her fellow Americans, she can’t quite bring herself to side with us.  Indeed, in backing away from that conclusion, she may capture modern progressives’ true sense of trade offs:

This American bias toward change—newer, better, different—has fueled countless innovations. It has also fueled a culture of thoughtless consumerism.

Like progressives, one gets the sense that Purtill’s final analysis is that “thoughtless consumerism” outweighs “countless innovations” on the scale of human values:

Under the proper circumstances, [the British have] is a mature and useful perspective. Suffering—large and small—is an unavoidable feature of human existence. In the face of illness, loss, or heartbreak, the American insistence on looking on the bright side and fixing the problem can feel heartlessly clueless. Some things cannot be fixed.

Here’s what Purtill misses: Seeing a “bright side” shows that there is acceptance of suffering.  We accept what is and seek to improve what can be changed.  Why compound the loss of a loved one with the frustrations of a dryer that doesn’t work?

For that matter, why not work to reduce the amount of human suffering?  Let’s turn our lens in the other direction and witness Charlie Gard, whose parents the British government told they could not try to save his life, even though they had the money and a doctor willing to attempt new methods for helping him.  Where did the parents want to take the child for help? The United States.

Maybe it’s because I’m so thoroughly American that I can’t achieve an adequately “mature and useful” perspective, but I can’t quite see how innovating to fix problems while maintaining a fundamentally positive outlook on life is the “heartlessly clueless” attitude, here.

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“Converting” Our Form of Government

If we want to live under a government with the power to forbid children and their parents from seeing what therapeutic options might be available for unwanted feelings, I guess that’s a conversation that we can have, although I find myself on the side of the ACLU in worrying about giving legislators “wide latitude to ban unpopular medical treatments.”  But if we’re going to have this conversation, we should do so with accurate information about what the bans cover, and Linda Borg’s Providence Journal article on Rhode Island’s new ban of “conversion therapy” fails on that count:

The bill makes it illegal in Rhode Island for licensed health care professionals to advertise or engage in conversion therapy for anyone under 18. It does not affect religious counselors or leaders — or adults who choose such a program.

That “does not affect” sentence is just not correct.  Read this section of the law:

23-94-4. Prohibition on state funding for conversion therapy. No state funds, nor any funds belonging to a municipality, agency, or political subdivision of this state, shall be expended for the purpose of conducting conversion therapy, referring a person for conversion therapy, health benefits coverage for conversation therapy, or a grant or contract with any entity that conducts conversion therapy or refers individuals for conversion therapy.

This is separate from the section that bans “licensed professionals” from offering such therapy to minors, and it goes much farther.  It covers “any entity that conducts… or refers individuals for conversion therapy.”  So, while a licensed professional would only lose his or her Rhode Island license if he or she provides the therapy to minors, that professional would lose access to any state or local funds that somebody might complain subsides the therapy for for adults, as well as any “grant or contract” whatsoever, whether related to conversion therapy or not.

This would apply, as well, to any person, group, or organization that refers an adult to such a therapist.  An aggressive judiciary could find within this language justification for removing tax exemption from any church that even suggests trying therapy to any church member.

This bill is your supposed representatives using your government to tell you what you must believe about the universe and your very self.

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UPDATED: Raimondo’s Got Nothing to Say About Mercy

Ethan Shorey of The Valley Breeze is having a hard time getting an answer from Democrat Governor Gina Raimondo about a charitable dental effort that the Community College of Rhode Island (CCRI) shut down this year:

On June 28, Gov. Gina Raimondo sent out a mass email denouncing Trumpcare, calling it “immoral” and saying it would bring “disastrous ramifications” for “Rhode Island residents at risk of losing health care coverage.” The use of the word immoral got me to wondering about Raimondo’s thoughts on the Community College of Rhode Island’s decision to end the Mission of Mercy, an annual volunteer event giving some of Rhode Island’s poorest residents access to free dental care. …

It’s now July 12 and I still haven’t heard back from [spokeswoman Catherine] Rolfe. Perhaps my email was lost again?

Shorey’s background article gives the details.  CCRI didn’t technically kill the program.  The college just kicked the volunteers out of the campus’s dental facility and told them they’d have to set up in a field house, promising to kick in $10,000 toward the estimated $70,000 cost of setting up a mobile clinic each year.

CCRI may have a perfectly reasonable explanation for the decision, but it’s difficult to imagine one, and it’s impossible if government officials won’t even attempt to explain.  Shorey’s right, too, to wonder how rhetoric about reform of broad national health policy can be called “immoral” for removing mandates for insurance coverage and seeking to reform a welfare program when Raimondo’s extended administration directly removed access to actual health care.

ADDENDUM (4:01 p.m. 7/13/17):

I’m struggling to understand Ethan Shorey’s complaint about this post, but he seems to want some clarification to be made in this space.

His apparent insinuation in the text quoted above is that if one considers Trumpcare “immoral,” then the term could reasonably be seen as applying to CCRI’s treatment of Mission of Mercy.  This observation, of itself, does not tell the reader anything about Shorey’s own moral view, although one might infer from his attempts to get a comment from the governor that he finds the Mission of Mercy issue less ambiguous, if anything.

In paraphrasing Shorey’s sentiment at the end of my post, I kept the same structure, only adding more details about what partisans like Raimondo assert is “immoral” about Trumpcare.

Perhaps Shorey is worried that people might think he agrees with my broader views, which aren’t part of this post.  That would explain the “we both know” language in our tweeted exchange.  If that’s the case, I apologize for any detrimental effect that my approving citation of his work has on his social standing.

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Redefining Humanity with No Allowance for Dissent

On National Review Online, Wesley Smith writes about a push in the United Kingdom to publicly fund womb transplants for men who want to become women:

This would be wrong on so many levels, ranging from safety concerns for both patient and potential future baby, the prospect of doctors and hospitals being forced to participate even if it violates their religious or moral beliefs–already beginning to happen–to the question of whether going to such extremes to satisfy individual yearnings constitutes wise and public policy.

But make no mistake: Powerful political and cultural forces will be–are–pushing us hard in this direction.

An advocate for the policy quoted in the Daily Mail “predicts” that this technology will eventually be in demand among not only homosexual men, but also heterosexual men who want to experience childbirth.

Smith focuses on the way in which this episode illustrates the impossibility of ever controlling health care costs, when the incentive for providers and government is constantly to broaden the services for which other people must pay.  I’m not sure, though, that Smith isn’t writing with his tongue in his cheek, because health care costs and the concerns he articulates in the above quotation are among the least of the concerns in the envisioned brave new world.

Go right to the profound:  If this sort of technology advances to perfection, people could install and remove organs as they desire them, which would make us more like organic machines than human beings.

We’re coming to a decision point at which individuals and society will have to decide in a very fundamental way what it means to be human, or even to exist.  It greatly aggravates the dangers of that decision point if we accept a pervasive attitude that everything’s a civil right at public expense and those who disagree must be forced to accept and financially participate radical changes almost from the beginning of their possibility.

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Gee… Government Agencies Want to Expand Access to Government-Mandated Data?

Even good people with healthy political philosophies fall into the “we have to do something” trap.  So, when an opiate “epidemic” emerges, even people who would normally shy from creating government databases relent and allow the centralized, mandatory collection of prescription information because… “we have to do something.”

Well, this was inevitable:

The amended bill (S-656 Sub A) would remove the requirement that all law enforcement officials obtain a search warrant to access the database.The database contains information about highly addictive prescription opioids such as Vicodin and OxyContin, along with stimulants such as Adderall and sedatives, such as Xanax, and cough suppressants with codeine. The database allows health officials to track prescribing patterns as a way to identify possible over-prescribing and abuse.

The bill has passed the Senate on its way into law.  If it comes up short this year, it’ll be back next year… and the next.  Eventually, the advocates will find some story, some crime that could have been prevented if only law enforcement had been able to dip into the data without a search warrant, and that will push it over the top.  “We have to do something.”  (Or maybe the Speaker of the House will need a vote to pass something else, and that’ll be the lever.)

This pattern is becoming clear enough that there’s no excuse not to predict it.  Let’s get back to a healthy skepticism that stops government from getting on these paths in the first place.

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One Hundred New State Jobs Would Only Perpetuate Failures & Failed Approach

Both the proven failure of a budget-centric approach and Governor Raimondo’s dismal public policy track record should give the General Assembly real pause when considering her reported request for one hundred new state hires – and other initiatives, past and prospective.

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Journalists and RI Politicians to Blame for “Mounting Anxiety” over Medicaid Reform

Earlier today, I noted how willing Rhode Island politicians are to sacrifice the well-being of Rhode Islanders and then attempt to scare us into political activism against their opposition.  In wishing the news media would play a role in bringing them back toward more-reasonable rhetoric, I probably underplayed the degree to which journalists are complicit.  Consider Lynn Arditi’s Providence Journal article whipping up the panic about federal health care reform:

Now, Porreca and others like him could lose their coverage under a Republican plan to roll back that Medicaid expansion and limit future federal financing for the safety-net program. Able-bodied adults also could be required to work in order to qualify for Medicaid.

The first sentence is false, and the second is misleading.  The paragraph is partisan fear-mongering propaganda.  As I’ve already explained, the House Republicans’ AHCA legislation includes no cut to Medicaid.  Anybody claiming otherwise is wrong, and anybody claiming otherwise whose job it is to objectively inform people is either lying or committing professional malfeasance through his or her negligence.  Adding in the work requirement in that context makes frightening something that is arguably a reasonable policy and leaves out the reality that Rhode Island’s state government would have to go along.

If “anxiety” is “mounting,” as the Providence Journal headline suggests, the news media and Rhode Island politicians are to blame.  If only people would begin holding them accountable for the anxiety they cause out of their own selfish interests.

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Know Their Love for Innovation by Their Actions

Rhode Island politicians like to give lip service to making the state a hub for technology companies, but they seem to think that means encouraging interactions between groups that can only survive with government subsidies, mainly because of (and by means of) government’s imposition of high barriers to entry and costs of doing business.  The secret to generating new industries in Rhode Island is to lower costs so all variety of businesses can afford experiment (without government approval, as expressed through the subsidies) and reduce restrictions on what they’re permitted to do.

RI Center for Freedom & Prosperity CEO Mike Stenhouse and Taxpayer Protection Alliance Senior Scholar Drew Johnson highlight a great example in today’s Providence Journal:

Fortunately, the free market recently developed a way to bypass the optometrists’ office. New technology — known as “ocular telemedicine” — allows consumers to accurately measure their prescription strength on a smartphone or computer screen from the comfort of their own homes. A board-certified ophthalmologist then emails a vision prescription based on the results.

Patients can then use that e-prescription to purchase lenses or glasses wherever they choose, typically at much lower prices. With this technology, healthy adults only need to visit a brick-and-mortar eye doctor once every two years for a full eye health exam (as recommended by the American Optometric Association) instead of every time a lens refill is needed.

Naturally, entrenched interests have pushed for legislation to halt (or at least slow down) such innovations, and of course, some Rhode Island legislators are answering the call… no doubt with entirely selfless reasons.  It’s funny how protecting people from themselves so often seems to profit somebody else, at least when it comes to regulations.

Can we stop that sort of behavior, please?  Why not just let people figure out how to provide other people what they want?

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Demagoguing Pre-Existing Conditions

Rich Lowry gives an explanation, in the New York Post, of why the fear mongering about the American Health Care Act (AHCA)’s effects on those with pre-existing conditions is yet another manufactured outrage:

The perversity of it all is that the legislation is properly understood as doing more to preserve the ObamaCare regulation on pre-existing conditions than to undermine it. The legislation maintains a federal baseline of protection in such cases, and says only that states can apply for a waiver from it, provided that they abide by certain conditions meant to ensure that no one is left out in the cold.

Since these provisions only involve the individual insurance market, a small slice of the overall insurance picture (about 18 million are on the individual market), and merely make possible state waivers, they are inherently limited.

You’re not affected if you get insurance through your employer (155 million people), or through Medicaid or Medicare. You’re not affected if you live in a state that doesn’t request the waiver, a category that will certainly include every blue state and most red states, too. Even if you buy insurance on the individual market and live in a state that gets a waiver, you’re not affected if you’ve maintained insurance coverage continuously and not had a gap in coverage longer than 63 days.

By this point, we’re talking about a fraction of a fraction of a fraction of the population. If you do have a pre-existing condition in a waiver state and haven’t had continuous coverage, you can be charged more by your insurer only the first year. The state will have access to $8 billion in federal funds explicitly to ease the cost of your insurance, and the state must further have a high-risk pool or similar program to mitigate insurance costs for the sick.

People who oppose these sorts of measures — especially with as much heat and smoke as we’ve been seeing related to the AHCA — give the appearance of elevating their own access to power above any real policy consideration.

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Why Real Insurance Is Preferable to Centrally Managed Health Care

In The Washington Times, Cheryl Chumley tells the 2008 story of her husband’s sudden illness and brush with death.  Her insurer at the time, Blue Cross Blue Shield, didn’t deny any bills, even though the doctors keeping her husband alive told the family to prepare for his imminent death.

It was a few months after my husband left the hospital from his heart attack that we ran into one of the nurses who cared for him — at a presidential campaign event, no less. One chat led to another and the subject of socialized health care was raised. And this is what the nurse said: Had my husband been on Medicare or Medicaid at the time of his heart attack, the doctors would have quit their life-saving efforts long before his 10 comatose days had ended. Why? Because the government health care plan wouldn’t have paid for the around-the-clock intensive care. The situation would’ve quickly evolved into a pull the plug, wait and see what happens type of deal.

It occurs to me that, in a competitive market, of course this would be true.  The insurance companies are selling insurance, which means everybody who buys insurance is thinking of these sorts of horrible circumstances.  If it gets out that a particular insurance company doesn’t cover them, then the value of insurance for that company and generally goes down.

So, it’s in their interest to accurately price risk so as to charge a rate at which they can maintain their value proposition.  They do this with a mix of pricing features, including premiums, deductibles, and maximum out-of-pocket limits.  A consumer with a low tolerance for risk may choose to pay a high premium, while one who wants to save money understands that risk is part of the equation.

Central planning is a completely different thing.  In that scenario, supposed experts are figuring out how best to distribute resources.  They don’t have to have attractive products, because nobody has a choice.  ObamaCare’s hybrid system of planning and choice transforms the insurance incentives into hiding costs, not accurately assigning them.

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Important Questions for Rhode Island In A Reshaped Healthcare Landscape

If the final federal healthcare law that eventually emerges from Washington, D.C. is similar to the version that passed the House of Representatives in early May of 2017, Rhode Island lawmakers will find themselves in the middle of largely reshaped federal and state healthcare landscape. Soon they may be faced with multiple important questions; and they will also realize that they will be newly empowered to make state-specific decisions for the people of Rhode Island.

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