Archive for category Health Care

Mandates For Thee, But Not For Me

Going over the latest list of HHS waivers to the new health care requirements, I notice both the Robert Wood Johnson Foundation and the Pew Charitable Trusts.  For those of you who listen to NPR even occasionally, these should be familiar names.

That’s right.  Two of the largest underwriters of the largest cheerleader for this turkey are getting a waiver from its requirements.  Wonder how that happened.

UPDATE: Also included, the SEIU Health & Welfare Fund, with its 1620 enrollees.  But I can understand.  They probably ran up a lot of injuries beating up people at Tea Party rallies.

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Selling The Cure For The Disease They’ve Caused

According to the New York Times, the federal government, apparently unhappy with drug companies’ productivity in the last 15 years, has decided to go into business for itself:

The Obama administration has become so concerned about the slowing pace of new drugs coming out of the pharmaceutical industry that officials have decided to start a billion-dollar government drug development center to help create medicines.

The new effort comes as many large drug makers, unable to find enough new drugs, are paring back research. Promising discoveries in illnesses like depression and Parkinson’s that once would have led to clinical trials are instead going unexplored because companies have neither the will nor the resources to undertake the effort.

The Times then goes on to note that, “drug companies have typically spent twice as much on marketing as on research, a business model that is increasingly suspect.”  NIH has long been involved in basic research, but this is the first time that the government will get into the business of actually developing and conducting clinical trials of drugs.

We’ll dwell for a moment – but only for a moment – on the Times’s, and by implication, the Administration’s, utter neglect of the possibility that the FDA’s culture of risk-aversion, insistence on testing for efficacy (as opposed to just safety), and the WTO’s failure to protect intellectual property have all contributed to a risk-aversion on the part of the drug companies.

But there may be something else going on here, too.  It’s entirely possible that we’re seeing a short-term phenomenon that’s being mistaken – or portrayed – as a long-term one.   In, City Journal (“Hooray for Blockbuster Drugs“), Paul Howard argues that the development of incremental improvements is a good thing. for a variety of reasons.  It’s certainly something that the regulatory regime encourages.  But aside from that, it’s the logical filling-out of major advances that came very quickly, based on basic research that was done much earlier.

Eventually, the diminishing returns from this sort of thing, and the increasing costs and uncertain returns of marketing them, should lead one or more major drug companies to take the leap and try to productize some of the results of gene-based research.  The first efforts are likely to be more risky and more expensive, and our current policies have probably exacerbated a reluctance to take large risks in a down economy by raising those costs, both certain and uncertain.

The worst part?  Paul Howard:

Some of these investments have been overhyped, but others will eventually produce breakthrough innovations, just as the investments of the sixties and seventies did. And when they do emerge, new technologies (including much more sophisticated diagnostics) will allow doctors to choose drugs for patients most likely to benefit from them. The advent of personalized medicine will also give companies powerful new marketing and pricing leverage. The size of the market for particular drugs may shrink—and drug companies may become smaller and more nimble to exploit fast-moving scientific discoveries—but insurers and governments will find it much more difficult to ration access to targeted therapies. (Emphasis added.)

Just at the time when the new drugs have the chance to democratize medicine in a way that the Internet has democratized political debate, the government is going to step in and make sure that doesn’t happen.

The $1 billion committed to the project so far is about 2% of what drug companies already spend on R&D.  It’s hard to believe that this is a better answer than lowering regulatory costs and uncertainties.

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Reflections on Speech and Speeches

Enabled by the excuse of being temporarily dislocated, I also decided to wait until the dust had settled on the Arizona shootings to comment on them, and on the political reaction to them.  It seemed to me better to wait, rather than jump in with all sorts of assumptions of the kind that have justly earned so many commentators on the left the disdain of most Americans.  Now, with things having settled down, I can safely put pen to pixel.

I’m pleased that Obama gave the speech he did, rather than the one we were afraid he would.  The audience’s behavior was atrocious, the fact that public officials rather than religious figures quoted the Bible was regrettable, and the administration bears responsibility for the program.  But all that doesn’t tell us anything new.

Obama’s speech itself did rise to the occasion, and I’ll refer people to Ross Kaminsky’s analysis here.  All of that said, there’s no particular reason to believe that it was sincere.  After all, it’s easy to call off the game when your side it getting creamed, and that’s largely what happened here.  If the President could score a few harmless points off people who’ll support him anyway, and by doing so, appear to move to the center on a matter of optics rather than policy, it was little more than a smart political move.  He gets some points for abandoning a shrill attack machine in its tracks.  Let’s not forget that he helped create that machine, and that it had apparently thrown a rod and was leaking oil all over the road.

Among the worst offenders was our own Representative Diana DeGette, who used an appearance on KOA on Monday afternoon to try to link the shooting to ObamaCare.  She argued that Speaker Boehner had taken a large step, doing the right thing by lowering the temperature of the political debate, by putting off the ObamaCare repeal vote.  The vote was, according to her, “controversial,” “not going anywhere,” and, “intended to appease the Republican base.”  This comment just about encapsulates DeGette’s unworthiness to represent us in Congress.

The vote, in fact, isn’t all that controversial -60% of voters consistently support repeal.  Which means that the Senate’s vote to keep ObamaCare in place, or more likely, its vote to kill repeal in committee and prevent a floor vote at all, is the real base-pandering going on here.  If we stipulate – for the purposes of discussion – that it’s a symbolic vote, then it ought not be controversial at all.  Controversy is what happens when you actually seek to pass a wildly unpopular bill into law, and what you seek to avoid by doing so at midnight on a Saturday.

The same interview saw DeGette claim that despite protests at her home, her church, her office (I’ve lived near DeGette for 13 years and can’t remember any newsworthy protests at her house), she bravely soldiers on, meeting with voters as before.  That, at least, is undoubtedly true, as her only town hall appearance during the health care debate was by telephone.

We shouldn’t lose sight of the fact that, essentially, there was nothing at stake here for the President and his party.  They continued to bull ahead pushing the health care overhaul despite its obvious unpopularity because the prize – nationalizing health care – was worth an election defeat, even a shellacking.  Here, they were launching a major PR offensive to score what would, in military terms, be a minor objective in a long campaign.  They may love censors and hate guns, but the FCC will or won’t try to reimpose the Fairness Doctrine anyway, and even the state where the attacks took place seems uninterested in revising its Vermont-style concealed carry.

But the campaign against self-protection and for “civility” by the Left isn’t over, it’s just looking for a better fight to pick, and the President signalled that, as well.  If a supposed lack of civility by the right didn’t cause or encourage this attack, then the attack, by definition, can’t provide us any lessons in the importance of civility.  And restraining my speech in response is an offense against society, not a protection of it.  If Arizona law would have permitted the family to keep an obviously unstable man off the streets, then restraining my right to carry a weapon on that basis is likewise an offense against society, not a protection of it.  (And if Arizona law didn’t permit that, then it ought have.)

We may allow the President his moment of appearing Presidential.  We ought not allow that to obscure the very real, very menacing agenda his party still holds.

UPDATE: I have been informed that Representative DeGette did indeed hold at least one live, in person, townhal during the health care debate.  It was called at the last minute, and timed to coincide with a large anti-ObamaCare rally at the state capitol.  Holding a townhall on the most contentious issue of your tenure at a time when you know that most of those hostile to your position will be otherwise occupied is hardly the most courageous stand for a member of Congressional leadership to take.


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Don’t Let The Bedbugs Bite

No, really.

And the Denver Post doesn’t seem to have any answers.  In a 760-word article about the problem, insecticides, the one thing that actually killed the bugs, are dismissed because the bugs seem to have mutated around them.  And we are told, “get over it,” rather than invent new pesticides.

Bedbugs are easy.  The bite, cause welts, and they hurt.  But they don’t actually carry disease.  Mosquitoes carry disease, and millions have died because we won’t spray them in Africa, either.

They’re also more invasive and troubling than coyotes, another old-new urban pest that the local authorities tell us we can’t do anything about, although we did something about them for decades.

Silent Spring has been thoroughly discredited, but its effects in the public imagination live on, to our detriment.

The point of civilization is to civilize, not to live in a higher-tech, but all-too-literal, state of nature.

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Donald Berwick’s America

As we all know, President Obama’s choice to head Medicare and Medicaid, Donald Berwick, is a big fan of the British National Health Service.

Powerline has made a practice of chronicling the NHS’s success, from dead babies, lack of basic diagnostic equipment, patients texting their own neglect, others not being able to do so, and tales of horror from those who made it here, to safety.

In case all that hasn’t convinced you that maybe we could do better with some other model, perhaps this will.  Britain is apparently unable to cope with the flu, H1N1:

The deaths are mostly among children and young adults, with five cases in the under-fives and eight cases among those aged five to 14.

The release of the HPA figures comes as hospitals across the country begin cancelling planned operations to free up intensive care beds to deal with rising numbers of seriously ill flu patients.

Managers of hospitals in Newcastle, Manchester, Norfolk, Leicester and London have already declared they have had to put some elective operations on hold, including heart surgery. That list is expected to grow.  (emphasis edded)

And this:

In one of the worst flu outbreaks in recent years, surgeries in Oxfordshire, Kent, Derbyshire, Hertfordshire and Gloucestershire have all reported vaccine shortages.

Dr Peter Holden, a GP in Matlock, said: “In Derbyshire – with just over one million people in total – we have 1,300 doses left.

H1N1 was last year’s flu scare, which for a number of reasons, never materialized here.  But with not one, but two flu cycles to prepare, Britain’s medical system couldn’t produce enough vaccine, and is now having to postpone heart surgery because of the rush of flu cases.

How long before Berwick’s recess appointment expires?

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Support Amendment 63

Contrary to the headline in this week’s Intermountain Jewish News, I support Amendment 63.  Here’s the full text of the letter to the editor, which Hillel Goldberg was kind enough to print:

Last week, the Jewish Community Relations Council voted note to take a position on Amendment 63.  While that was the correct decision, as voters, we should strongly support Amendment 63, the Right to Health Care Choice initiative.

Amendment 63 does two things: it keeps the state of Colorado from enforcing any state or federal health insurance mandate, and it ensures that Coloradans will always be able to spend their own money on their own health care, unless they voluntarily enter a program that prevents it.  These are protections of fundamental rights that we have as human beings.

Member organizations indicated that they knew of beneficiaries of their services who might not be able to obtain insurance, or had undergone serious financial hardship from medical expense.  Their conclusion is that the best solution to this problem is Obamacare.

In fact, the law’s benefits will prove illusory.  Both organizations explicitly said that the benefits depend on the mandate.  Implicit is that Obamacare isn’t insurance, it’s a direct transfer of wealth.

We can easily point to those who benefit; it’s much harder to point to those individuals who will bear the cost – young workers and families who are just starting out, but who will be forced to pay for benefits that they will not receive.  It’s a shame they have no advocate on the Council.

Instead of forcing young workers and families to transfer what should be their house, education, or retirement savings to the government, we should make their insurance more affordable by removing unused, expensive mandates that price them out of the market in the first place.

It has been claimed that Obamacare will save $1 trillion.  This double-counts $500 billion taken from Medicare, re-spending it, and classifying it as savings.  It includes 6 years of benefits for 10 years of revenue, and assumes Congress will cease an annual Medicare adjustment – the “doc fix” – that everyone expects will continue unabated.  After 10 years, it will add to our already gargantuan $100 trillion of unfunded liabilities.  No one reading (or writing) this piece truly comprehends that number.  But we’ll have to pay it.

Instead of strengthening our system, the law’s deleterious effects are already being felt.  Insurers are raising rates in anticipation of greater obligations.  Insurers are dropping child-only coverage.  Low-cost insurance policies for college students are endangered.  Employers are shifting costs to those who still have jobs, who will pay with after-tax dollars.  It will likely cost small insurance companies and brokers their businesses.  The IRS has asked to hire 17,000 new employees to enforce the provisions, a deadweight loss of billions to the economy.

While the effects of the current system on those organization’s members are real, by focusing on those needs as an excuse to oppose Amendment 63, the member organizations assume that the only, or even the best, way to address those needs is the current legislation.  Instead, we should encourage innovation and implement incentives for health care consumers to spend their dollars wisely, lowering costs for all.

There is good reason that the JCRC did not take a position.  It generally doesn’t take on these sorts of issues, preferring to conserve its voice for issues of distinctive importance to the Jewish community.  Supporting Obamacare would have placed the JCRC at odds with the 60% of Americans who want the thing repealed outright.  Instead of building bridges, it’s likely to isolate us, dilute our voice, and prevent us from being effective in the future.

Earlier this year, voters in Missouri approved a similar measure by a whopping 71% – 29%.  Voters in Arizona and Oklahome will likely also approve similar measures in a few weeks.  Democrats in 5 other state legislatures have blocked measures from their states’ ballots this fall, but count on them to be re-introduced this coming year.

Coloradans should seize the chance to protect our own health care choices, and continue the efforts to find sensible fixes to our troubled health care system.

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How Not To Fix Health Care

This, from this morning’s Wall Street Journal:

The Food and Drug Administration proposed shoring up medical-device approval rules that have been criticized as lax and inconsistent by consumer advocates and the agency itself.

The FDA aims to better define what devices can use an approval pathway known as 510(k), under which companies can get an accelerated decision on whether they can market a new product if they can show it is similar to an already approved device. The proposals, which will be open for public comment, will be closely watched by the device industry because more-stringent rules would raise development costs.

Since in politics, anything you say can and will be used against you, let’s start by saying that medical devices that are supposed to help us shouldn’t kill us, and the FDA plays a useful – although an exclusive – role in making sure that doesn’t happen.

That said, this is bad news for health care and bad news for Colorado.  Medical innovation is the single, surest way of bringing down costs.  New technologies cost more, sure, but they bring down the relative desireability, and thus the relative price, of existing technologies. 

Think about your cell phone.  Everything about it, from the signal to the network to the phone itself, is in a relentless drive towards being commoditized.  Which means that you can get an iPhone for about 1/2 the real cost of a cell phone ten years ago, and pay only slightly more for the network access.  The same factors are at work in every market.

And bad news for Colorado?  Well, we’re home to some of the best, most innovative biotech companies around, which up until last year, attracted a lot of venture capital money.

Let’s hope the FDA doesn’t make things worse, and that if they do, that our Congressional delegation has the sense to stand up for innovation, rather than demagogue about “rich” “companies” “profiting” “at our expense.”

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Political Effect of the Lawsuit

Despite the fact that this is a legal decision, not a political one, I do believe that it will have at least one positive political effect.

Go ahead, tell me you didn’t feel deflated last night.  No, you’re lying.  I read your comments on Facebook and on the blogs and on the newspaper sites.  I know what you were thinking: France called, they want their statue back.

Now, tell me you don’t at least have a little hope that we can pull back from the precipice.  That week-long planned media celebration of historic achievements is stopped cold, even before the bill is signed into law.

Tell me you don’t feel better now than you did 4 hours ago.

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Mandate This!

The Colorado legislative Republicans held a press conference this afternoon to announce that they had sent a letter (text below the fold) to Attorney General John Suthers, asking him to join with other states’ attorneys general in challenging the constitutionality of the individual health mandate here in Colorado.  Jon Caldara of the Independence Institute joined them, making an impassioned plea and invoking, as he has recently and reluctantly, his heroic son who has undergone 9 life-saving surgeries in his 5 years.  The legislators also pointed out a number of bills that the current Democrat majority has killed this session, including, reviewing new health care manates for cost and individual deductibility of health insurance.

The presser went on for a little over 20 minutes, so it’s in three segments:

For the record, the legislators were quite clear that they were signing sending the letter, and had not coordinated with the Attorney General in advance.  In fact, I saw the letter delivered with mine own eye, since I had headed over to the Law Office for…

About 90 minutes later, Attorney General John Suthers announced that he would, in fact, be joining the lawsuit.   The lawsuit not only challenges the constitutionality of the individual mandate, but also of the IRS enforcement of that mandate, the fine they’d be able to impose, under the guise of a tax.  While the Congress can regulate insterstate commerce, it can’t regulate commercial inactivity, which is what this bill tries to do.  In addition, the legislation mirrors what the Democrats here in Colorado have done by labeling “taxes” to be “fees,” in this case, labeling a fine a “tax” in order to give jurisdiction to the IRS.  As Randy Barnett points out, this essentially would give Congress the power to regulate anything, and the IRS power to enforce it.  Moreover, the tax, even as a tax, would violate Article I Sections 2, 8, and 9, which provide that any direct tax has to be proportional to a state’s population, not tied to an individual’s economic (in)activity.

Regardless, this collective action is almost certainly only the first of many that will be filed, both by the states and by third parties.

I hate to turn this into a media criticism piece, but the fact that Congress can’t regulate anything, and that the IRS can’t enforce it seemed to be unexplored territory for the other reporters in the room.  One lady tried twice to understand why this was different from the state requiring auto insurance (hint: the federal government isn’t a state, and there’s an action tied to car insurance, i.e. operating your car; merely being a breathing citizen isn’t sufficient justification for mandating interstate commerce, or punishing the refusal to participate in a market.

Second prize goes to Eli Stokol of Fox 31, who left the room convinced that this was a political decision, because thus far, only Republican attorneys general were involved.  The notion that the lack of participation by Democrats could be just as political apparently didn’t register.  Also, there are very liberal Democrats who don’t buy the mandate (so to speak) for a slightly different reason, that the government can’t force you to buy a private product, such as professor Tom Russell of the University of Denver School of Law.  (Mr. Russell ran in last election’s primary for HD-6, as it happens.)

Young Mr. Stokol also asked why, if the 10th Amendment were applicable, why it hadn’t broken through in discussion before.  The answer is that it has, and that if he had showed up having done his homework and done any sort of reading on the legal matters on display he’d know that.

The videos of the presser are here.

Read the rest of this entry »

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Happy Passover

Because of the tremendous amount of kitchen and household preparation involved in an Orthodox celebration of Passover, many affluent families choose to spend the holiday at hotels, with the seders and meals catered.  These deals are expensive, and sometimes a family can spend well into the five figures for them.  The complaints can be endless, over things you or I would normally consider trivial.  But when the eggs are underdone, or the french fries a little overdone, remember that to that family, it’s a $20,000 omelet, or a $30,000 burger platter.  It had better be perfect.

Obama and the Democrats are about to find out what it’s like to run a Pesach Program.

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