Reporting about the budget’s change in payments to hospitals for uncompensated care raises more questions than it answers, pointing to the complexity of government spending and the vulnerability of taxpayers.
This, from a Weekly Standard article by Devorah Goldman, is terrifying:
In 2015, the Association of American Medical Colleges revised the Medical College Admissions Test (MCAT) for the first time in nearly 25 years, stretching the full exam-day experience from around five hours to eight or more. The test drew attention at the time for its sheer length; less widely noted was the explicitly ideological bent of the new exam.
The AAMC occupies a curious place in the world of medicine. It forms one-half of the only government-approved accrediting entity for U.S. medical schools, and it is solely in charge of administering both the MCAT and the national standardized medical school application. Unlike the American Medical Association, which represents physician groups without exercising much direct control over doctors, the AAMC has immediate and significant authority over its constituent medical schools and academic health centers. And in recent years, it has used this leverage to fundamentally alter the way medical schools assess applicants. …
In that address and others, [Dr. Darrell Kirch, president and CEO of the AAMC,] described the AAMC’s “Holistic Review Project,” which the organization launched in 2007 with the goal of “redefining what makes a good doctor.” The project’s objectives included revising the MCAT and a wide range of other reforms. A series of new guidelines (some of which have yet to be implemented) called on medical school admissions teams to place less emphasis on applicants’ grades, changed the requirements for letters of recommendation, and altered the standardized application by requesting a great deal more information about students’ upbringing and life experiences. The AAMC is also planning to add “situational judgment tests”—carefully crafted interviews in which applicants will be presented with a variety of hypothetical scenarios involving ethical conflicts—to the current admissions requirements. Along with the new MCAT, these changes are part of Kirch’s plan to shift the focus of medical-school admissions toward a “new excellence,” a standard based less on test scores and more on “the attitudes, values, and experiences” of applicants.
Sorry, but I’m much more concerned with whether my doctor knows how my body functions and how to fix it when things go wrong than what his or her attitude and values might be. Basically, if he or she values my business and my health, I’m good with whatever else he or she might believe.
As progressivism seeks to turn everything in our society to the single goal of political ends, it will seek not only to ensure that progressive doctors and other professionals are available to those who value them, but that no other options exist.
Some families don’t believe that the fact that their children go to school with other children gives the government the right to force them to take drugs related to sexually transmitted diseases. Many become more suspicious when they hear of terrible side effects that some appear to experience and observe the overlapping financial interests of state government and company behind the drug.
Mind you: If the government simply recommended the drug, there would be no problem. But as it is, dedicated families feel the need to become activists and testify in pursuit of legislation to return their freedom. On the other end are bureaucrats whose social concern is difficult to entangle from the pursuit of metrics:
Among her arguments against the “personal belief” exemption that some lawmakers are seeking: “The proposed legislation, if enacted, will potentially decrease our state’s vaccination coverage rates, putting people at risk … [especially] those who cannot be vaccinated″ for medical reasons. …
In one letter to the lawmakers, [Director of Health Nicole] Alexander-Scott wrote: “Most vaccine-preventable diseases are transmitted from person to person. When a sufficiently large proportion of individuals in a community are immunized, those persons serve as a protective barrier against transmission of the disease in the community thus indirectly protecting those who are not immunized … This phenomenon is referred to as ‘herd immunity.’”
Good of the government to have such concern about the “herd.” One doubts that Alexander-Scott highlighted the fact that Rhode Island’s HPV vaccination rate was already high, and that the mandate increased it almost not at all.
That is, acting of their own free will — not as herded cattle — Rhode Islanders were already doing what the government wanted. Knowing that, one can reasonably infer that making us do things is the point, establishing the principle that we have to go where they think we should.
George Will writes powerfully against the West’s efforts to “eradicate” Down Syndrome:
An Iceland geneticist says “we have basically eradicated” Down syndrome people, but regrets what he considers “heavy-handed genetic counseling” that is influencing “decisions that are not medical, in a way.” One Icelandic counselor “counsels” mothers as follows: “This is your life. You have the right to choose how your life will look like.” She says, “We don’t look at abortion as a murder. We look at it as a thing that we ended.” Which makes Agusta and Lucas “things” that were not “ended.”
Because Iceland’s population is only about 340,000, the problem (again, see the photos of problem Agusta and problem Lucas) is more manageable there than in, say, the United Kingdom. It has approximately 40,000 Down syndrome citizens, many of whom were conceived before the development of effective search-and-destroy technologies. About 750 British Down syndrome babies are born each year, but 90 percent of women who learn that their child will have — actually, that their child does have — Down syndrome have an abortion. In Denmark the elimination rate is 98 percent.
For many — maybe most— political or ideological positions with which I disagree, I can imagine my way around to understanding how reasonable differences about assumptions can lead people to conclusions with which I disagree. Especially with improved medical imaging technology, the reach of my imagination cannot make a pro-abortion stance reasonable. (I’ll also acknowledge that my thinking was objectively unreasonable back when I held that monstrous view in my youth.)
Aborting a pregnancy because a screening is suggestive of Down Syndrome is tantamount to saying, “My child will have a developmental disease; let me kill him or her before it becomes more morally complicated for me to do so.” The underlying assumptions that make such a statement seem rational must be either irrational or morally repugnant.
Encouraging Virginians not to expand Medicaid to able-bodied, childless adults, Brooklyn Roberts looks at some results from states that have moved forward with the change:
As an example, let’s look at Oregon, a state that began expanding Medicaid in 2008. Officials there lacked funding for the total number of applicants, so they conducted a random lottery and selected enrollees from a waiting list, thus making Oregon an ideal state for study. What they found was that gaining Medicaid coverage increased health care usage and costs across a wide range of settings, and emergency room visits increased by 40 percent in the newly covered group. Proponents of the expansion argued the initial spike in ER visits was due to pent-up needs and would decrease as time went on.
That has not been the case. Oregon’s growth in Medicaid spending between 2012 and 2016 was 83.1 percent. A follow-up study in the New England Journal of Medicine concluded the value of expansion for recipients was quite low — 20 to 40 cents per dollar of government spending.
So, the expansion increases health-care usage in ways that weren’t predicted by the officials who’ve implemented the expansion, and those officials have proven even more egregiously incorrect when it comes to predicting how many people would sign up. (We could argue about whether that was a flaw in their methodology or something more like deception; after all, they’ve ushered a lot of people into Medicaid by rerouting them through health benefits exchanges that were supposed to sell plans for actual money.)
In Rhode Island, our government officials signed up for the expansion almost before it was officially offered. We should force them to reconsider how they do things.
This story is utterly unremarkable, in this case reported by Jacqueline Tempera of the Providence Journal:
Two female lawmakers stressed the importance of protecting women’s access to birth control on a state level in a press conference Tuesday afternoon.
Rep. Katherine Kazarian, D-East Providence, and Sen. Dawn Euer, D-Jamestown, introduced matching bills this session that would protect a woman’s access to birth control in Rhode Island, regardless of any changes at the federal level….
A key provision in the ACA allows women to access birth control pills, as well as long-term options such as intrauterine devices, known as IUDs, or other implants, for a $0 co-pay.
In the past, I’ve mainly let this sort of rhetoric go with a simple question about why lawmakers want to forbid people from buying less-expensive insurance that only includes coverage for things that they need. That’s really what’s going on, here. Kazarian and Euer want men to pay for women’s birth control. (Note: The legislation explicitly leaves out coverage of male condoms and sterilization for men.) They want older women to pay for younger women’s birth control. They want people who aren’t having sex to pay for the birth control of people who are. They want Catholics and others who don’t use birth control because of their religious beliefs to have to pay for the very same products being used by other people.
Lately, I’ve been thinking of what the elevation of this particular type of health care fundamentally means. Every now and then, I’ll come across a request from some Rhode Island family asking people to donate to help them stay afloat while dealing with the sudden onset of a child’s life-threatening disease. Throughout Rhode Island, parents with children who have genetic diseases have no choice but to find some way to afford the copays for life-preserving treatments that will never become unnecessary, unless some miraculous cure is found. And of course, neither of these challenges goes away when the children become adults.
Perhaps Kazarian and Euer would insist that they’d support socialized health care that claims to make all medicine “free.” Put the wisdom of that proposal aside. What they’re pursuing right now is to make sure that women don’t have to pay for products that let them have sex while minimizing the chance of pregnancy. That’s their priority, and it tells us a whole lot about what they believe.
This statement by East Bay Democrat Senator Lou DiPalma, quoted in a WPRI article, struck a note worthy of elaboration:
“We have never seen a proposal where one of Rhode Island’s largest hospital systems would be acquired by a hospital network that is located in a state adjacent to Rhode Island,” DiPalma said in a statement. “The potential for patients, jobs and services to migrate to Massachusetts is a serious concern.” He added, “This proposal presents a unique risk to Rhode Island’s hospitals and health care system.”
Here’s the thing: That migration is already happening. For reasons I won’t go into, I’ve had reason to hear Rhode Islanders’ candid thoughts about medical care in the area, and just as “everybody knows” you need a federal judge for justice in the legal system, folks also know that you need a Boston hospital for top-notch care.
Some of that is just inevitable, because Boston is a higher-tier city than Providence, but that’s been true for a long time. But these mergers aren’t under consideration because Rhode Island hospitals are doing great and represent a great buy for an expanding corporation. Memorial Hospital in Pawtucket hasn’t been doing the dance of closing hospital because people aren’t using it.
As usual, Rhode Island’s government officials are looking to use the power of government to stop erosion when they should be evaluating what it is they are doing that starts the process. We need freedom and innovation, but that takes power away from political insiders, so… there you go.
Sometimes the legislation flowing through the Rhode Island General Assembly each year takes the form of series, with tweaks and additions to particular areas of law building on each other. One such series involves opioid abuse and overdose, with a subset for increasing (even mandating) the availability of emergency drugs to save people from overdoses. Unfortunately, Robert VerBruggen reports for National Review that this trend may have an undesired outcome:
Are Anti-Overdose Drugs Backfiring?
Yes, says an incredibly depressing new study. It suggests that opioid abuse rises when overdose-reversing drugs are easily accessible.
This could happen through two different mechanisms: “(1) saving the lives of active drug users, who survive to continue abusing opioids, and (2) reducing the risk of death per use, thereby making riskier opioid use more appealing.” (1) isn’t a bad thing, even though we would obviously prefer that addicts quit after nearly dying. But (2) is a serious problem, as it could mean that overdose-reversing drugs don’t actually save lives on balance.
Obviously, this finding (if further study validates it) doesn’t prove that we shouldn’t strive to save lives, but it should lead us to be humble as we attempt to use government to fix society’s problems. I mean, think of the choices that pile on each other: We decide that we’re going to use government to make anti-overdose drugs more readily available, and that increases drug abuse. This can get very expensive for other people very quickly, whether through taxes or health insurance premiums. Those resources necessarily have to come from elsewhere.
Perhaps to mitigate the financial and human cost, somebody will propose that anybody whose life is thus saved must be committed to a facility for recovery. Now, suddenly, we’re saving lives only to institutionalize people who may relapse once they’re let out, and when they do, they’ll have incentive to take their drugs in a more concealed environment. What then? Further erode their privacy? Or create safe places in which they can do their drugs, thus increasing the ease of drug usage?
Frankly, I’m not sure where I land on this series of questions, but it wouldn’t be irrational or inhumane to go back to the start of it and suggest keeping government out altogether. At least that would focus our attention on the social arena in which the solution to the problem ultimately lies.
This, from Clifton Leaf in Fortune, is one reason I find socialized medicine schemes (including, broadly, ObamaCare) so disturbing:
What the chart above shows is simply the percentage of 2017 revenue that derived from products launched in the previous five years. In other words, how much of each company’s sales are coming from drugs fresh out of the pipeline versus how much are coming from older meds?
In that regard, the picture above is worth a thousand words: Nearly all of Big Pharma is riding on fumes, it seems.
Now, a number of open questions make this analysis insufficient. Historically, for example, what has been the revenue mix?
But those questions aside, the reality is that profit motives spur risk and innovation. A balance must still be struck, but the class envy and central planning of socialism inevitably force a society to coast on fumes.
As we consider empowering law enforcement and judges to infringe on Constitutional rights based on things they think people might do in the future, and as we hear of parents’ losing custody of their children because the government has decided to enforce transgender ideology as law, and as progressives continue to push for socialized medicine despite British illustrations of what that means for parents’ rights, we must pay careful attention to warning signs like this:
Whiteman’s situation was not an isolated error but part of a scandal ripping through the Canadian child welfare system. The injustice was put in sharper focus this week with an independent commission report showing more than 50 custody cases like Whiteman’s were tainted by flawed drug and alcohol testing from the same Toronto lab. …
The commission found the lab’s testing did not meet international forensic standards and test results were “frequently misinterpreted.” Looking specifically at 1,271 cases handled by the lab between 1990 and 2015 in Ontario, the commission determined Motherisk’s flawed testing played a critical role in 56 cases.
… the commission was blunt about the irreparable damage done. Many of the children who were uprooted based on the tests are now in new living situations. Some have even been adopted. So far, children have been reunited with parents in only four instances, according to the Star.
As we come to put all-consuming faith in testing and planning and government’s ability to fix every problem, we may find ourselves in a nightmare that used to be only imaginable to novelists.
RI did it again 2nd worse for Elder care…..can this state have any worse leadership?… https://t.co/ONaP5zEkfZ
— michael riley (@ri1929shrugs) February 23, 2018
Stossel: Eye Test Innovators vs. Bottleneckers #RIghtToEarnhttps://t.co/SbBORq4YTr
— RI Center for Freedom⚓️ (@RICenterFreedom) February 21, 2018
In some ways, this is a minor critique of promotion, but in other ways, it seems related to huge problems in our country these days. WPRI’s Ted Nesi just retweeted the following, wherein CNN Executive Producer Katie Hinman promotes a story currently on her organization’s Web site. Keep in mind that the linked story is about a single controversy with a single insurer in a single state:
Outrageous, explosive @cnn reporting about how insurance companies actually function https://t.co/47TroqPNuR
— Katie Hinman (@khinman) February 12, 2018
Hinman is extrapolating from this one story — which is definitely newsworthy — to assert outrageous behavior by an entire industry. One needn’t be a fan of that industry in order to think that’s irresponsible behavior from a news executive.
Most definitely, CNN should keep digging to find out whether Aetna’s behavior is even more scandalous, because unique, or the scandal is much bigger in scope, because universal. Before doing that digging, though, CNN is just hoping that the story plays out in a particular way and trying to gain attention for a conclusion based on work that it hasn’t done.
If this is modern journalism, then that’s outrageous, explosive evidence of how news companies actually function.
If you can think freely beyond your talking points & had any understanding of economics, you would know that a truly free-market is the only way to provide high-quality, reasonable-cost care. The reason the healthcare industry is in distress is due to over-regulation by the gov't
— Mike Stenhouse (@MSten37) February 1, 2018
Leveraging the inefficiency of government to create incentives for good behavior is brilliant, but only highlights how backwards we’ve gotten things.
But they've done such a great job with UHIP. What could possibly go wrong?
— Russ St.George (@RussStGeorge7) January 30, 2018
For my weekly call-in on John DePetro’s WNRI 1380 AM/95.1 FM show, this week, the topics were the high-powered dinner about chit-chat, the lunacy of “Medicare for All,” and money sloshing around to insiders in Providence.
"The report also said 359 employees from companies getting Jobs Development Act incentives are covered by Medicaid, with their benefits worth $2.3 million." ?! https://t.co/sxuspOER0M
— OSTPA (@OSTPA1) January 27, 2018
The legislative onslaught from the left has begun. As the poster child of their desire for government-control over the lives of residents and businesses, Rhode Island’s progressive-Democrats announced they will introduce legislation this week to establish an estimated $13.2 billion single-payer health insurance system.
Land of Make Believe Alert! @AaronRegunberg sponsors #RIProgressiveBadBills that would bankrupt RI and lead to lower quality healthcare for your family. #HealthcareRI pic.twitter.com/cO2rGnaKcT
— Gaspee Project (@GaspeeProjectRI) January 26, 2018
Control someones healthcare, u control their life
— RI deplorable (@BlueStateRedLad) January 27, 2018
The story of vaping in schools has appeared in a number of places in the past few days. Here’s Jessica Picard reporting in the Valley Breeze:
“Our concern is that we are seeing an increasing trend in vaping. We thought it was important that we share with parents what we are seeing,” said Supt. Robert Mitchell.
Increased use of e-cigarettes is not just in the high school, but in the middle schools as well, said school officials.
According to the Centers for Disease Control and Prevention, current use of electronic cigarettes increased among middle and high school students from 2011 to 2016. The CDC reported that in 2016, about four out of every 100 middle school students and 11 out of every 100 high school students said they had used e-cigarettes in the past 30 days.
In isolation, this may indeed be a bad thing, but that’s not how we should look at it. According to the federal Department of Health & Human Services, “from 2011 to 2015, the percentage of 12th-grade students who had ever used an e-cigarette increased from 4.7 to 16 percent.” But over that same period of time, the percentage of seniors who said the same about actual cigarettes decreased from 10.3% to 5.5%. Smokeless tobacco (like snuff and chewing tobacco) is down from 8.3% to 6.1%. (These groups aren’t exclusive, meaning that there’s some overlap between them.)
As of 2014, more students had used an e-cigarette than an actual cigarette. The question that the advocates and (in turn) the journalists miss is this: If the alternative to e-cigarettes is not nothing, but smoking or chewing tobacco, isn’t this outcome positive?
Looking at the trend for teenage smoking, the line is down, down, down since the mid-90s. That’s what one would expect as the rules and social pressure have changed. When I was a high school smoker back then, we were still able to go out to the smoking area behind the library. No doubt as that convenience decreased, fewer kids bothered.
It could be that some percentage of teenagers will simply do something “adult” and addictive like smoking. It’s probably better to allow that to be something like smoking, rather than smoking itself.
The context of the society in which we actually live matters when it comes to legalizing drugs.
It is a ‘fake’ claim that healthcare is “a fundamental human right.” Nothing can be a right if somebody else is forced to pay for it or provide it. Conversely, ‘real’ rights are based on liberty, not coercion, and do not infringe on anyone else’s rights.
— Mike Stenhouse (@MSten37) January 25, 2018
So where will the $$$ come from. @GovRaimondo has proposed $166 million in Medicaid cuts mostly by paying providers less to service Medicaid clients.From Alice in Wonderland, "Imagination is the only weapon in the war against reality." https://t.co/xrO8qfB8Bm
— gary sasse (@gssasse) January 24, 2018
As Southern New England government squeezes everybody in order to keep growing, more people will begin paying attention to what they’re having to give up.
The idea that anti-nicotine activists have a right to ban products that might benefit the nicotine industry relies on speculation and an unhealthy understanding of the boundaries of a representative democracy.
Don’t be fooled: When the governor promises to strengthen health care coverage, in RI, she means that she’ll force everybody to buy more expensive insurance that most of them will never need.
Barely out of the gate in the new legislative session, progressive Democrat Representative Aaron Regunberg of Providence is proving exactly how dangerous he is to the health and well-being of Rhode Islanders:
The bill (2018-H 7042), which Representative Regunberg introduced Jan. 3, would establish a board of pharmacy to examine how prescription drug manufactures set the price for certain prescriptions, and give it the authority to set a maximum allowable price to protect the Rhode Island consumers.
The price-fixing scheme would give nine unelected board members, most of them pharmacists with a financial interest in the industry, deep access to the private information of drug companies and the power to set prices for drugs — particularly those that are among the most innovative and life changing — below the level that companies believe necessary to make it worthwhile to develop more.
There is no reason to expect pharmacists to understand every aspect of drugs’ production and sale generally, let alone the internal operations of a particular company. If companies are forced to justify pricing decisions to Rhode Island’s socialist-nine board members and beg their indulgence, the potential for corruption is immense. If the members are cycled out every three-year term, then they’ll lack a long-term perspective, but if they’re kept on the board for much longer, they’ll become less accountable.
The minimum price for a drug in the state will always be zero… in the sense of being unavailable.
Given the critical nature of its products, our health care market does need controls against price gouging, but we should go the route of reform and competition, not the philosophy that has brought Venezuelans into the gutter. Reform patent laws, giving generic drug manufacturers more opportunity. Take the thumb off of insurance companies so they’ll have more leverage against drug companies. Take the restrictions off of health care providers and consumers so they’ll have leverage to shop around for drugs, insurers, and types of treatments.
Above all, Regunberg’s bill illustrates how close we are to the end game of government control, and that’s an extremely unhealthy place to be.