The Food and Drug Administration (FDA) is on the verge of taking the highly unusual step of “decertifying” the cancer drug Avastin that it had previously approved. In addition to sparking concerns that this is another step towards medical rationing, the FDA’s proposal will worsen another important but less-frequently recognized danger of government-run health care — namely, the politicization of health benefits. Both problems will accelerate under ObamaCare unless our politicians repudiate the principle of government-run health care. …

If you had terminal cancer, who should decide what treatments you may receive during your last few irreplaceable months of life? You, in consultation with your doctor? Or politicians and bureaucrats in Washington, D.C.?

Unless we repeal ObamaCare [HR 3590], get ready for the latter choice.

Read the whole article at Pajamas Media: Avastin and Your Life.

During the year leading up to the final passage of the Patient Protection and Affordable Care Act (PPACA), the White House set up a special Web site and invited all Americans to post their own personal stories about insurance company abuses. During the days leading up to the final vote on the bill, the president and congressional supporters used almost every television opportunity to trot out these cases — sometimes in graphic detail.

Yet, in all the episodes of abuse, do you recall even a single instance where an insurer:

• Arbitrarily dropped coverage for tens of thousands of enrollees with the stroke of a pen — just to save money.
• Dropped entire categories of care — such as dental care or home health care — because it decided these services were too costly?
• Arbitrarily reduced the fees it paid to doctors and hospitals, pushing many out of its network, and leaving its enrollees with serious access to care problems?

Probably not. For a private insurer, each of these activities would be a serious violation of contract. There is one insurer that does these things routinely. It’s called Medicaid and about half of all the newly insured people under the PPACA will be enrolling in it.

Read the whole article on Medicaid rescissions, also published in Kaiser Health News.

Congress has no authority to require individuals to buy private insurance, which is the basis of the lawsuit filed by states. It has no such authority because the Constitution does not grant it, not by any twisting of any phrase. That might not bother a majority in Congress, but it will most certainly matter to federal judges when they determine which rights belong to whom — based entirely on their interpretation of the Constitution.

I hope he’s correct. Read the whole article in the Colorado Springs Gazette: Amendment 63 protects our freedom.

But the commerce clause of the U.S. Constitution has been interpreted rather liberally - or absurdly.  This Reason.tv video makes this clear:

Re. the above video, Erwin Chemerinsky, the legal scholar who supports the liberal interpretation of the commerce clause, could play Judge Narragansett’s nemesis in the Atlas Shrugged movie that’s in production. (I thought the novel did contain a second judge, but I did not find him listed in the Wikipedia page.)

For more on whether mandatory insurance and the constitution, see my earlier post: Randy Barnett on why mandatory insurance is unconsitutional.

See also: Medicare & Medicaid fraud far exceeds insurance company profits.

If you are unfamiliar with EMTALA or our take on it you can read about it here, but to be brief, EMTALA is an unfunded federal mandate passed in 1986, which, de facto, has made it a crime to tell anyone ‘no’ in the ER. Because of this, the specialists on call have learned to hate the ER. The ER is no longer a place from which one can build a practice, it is, rather, a place that compels you lose sleep, and money. It compels consultants to expose themselves to full malpractice liability EVERY SINGLE TIME they accept a patient from us whether they ever get paid or not.

… the specialists are fed up, and they have figured out how to fight city hall. For years their battle has been against the system or even the ER doc downstairs. But now (oh the genius!) they have turned the bureaucrats game against them. EMTALA and the bylaws, policies, and rules that it has generated are being followed to the letter.

For instance, almost all hospitals have an on-call policy for specialists that require them, if the ER doc requests it, to come in to the ER and evaluate the patient. Well, they can be forced to do this, but in many cases they CAN NOT be forced to treat the patient. Unheard of twenty years ago and before EMTALA, but specialists are now routinely coming in, evaluating the patient, and finding reasons why this particular case is out of their area of expertise, or not appropriate for their care, or not in need of surgery immediately, and the specialists are going home.

…

But how can a surgeon refuse to operate? Well, well… by way of example, consider the lowly gall bladder. When I was in training the gall bladder came out with pain and an abnormal ultrasound. Now it doesn’t. It used to be that surgeons would operate at the drop of a hat because they loved surgery. Not anymore. You see, if a patient with acute cholecystitis can be ‘cooled down’ with fluids and antibiotics, VOILA!, no need to remove it right now. Have the patient follow up with the surgeon as an outpatient. You can’t be sued for an operation you didn’t do.

Then the patient goes to the surgeon’s office a few days later and is no longer under the rubric of EMTALA, therefore, they must pay for their surgery (payment plans are accepted), or have insurance. Still sounds fair right? I mean, who gets surgery for free, right? Well, these folks do NOT follow through with the surgeon because it’s not free, they end up right back in the ER, and on the 28th time they are sick enough to go to the ICU. Some of them die, and they ALL chose to walk the streets with the ticking time bomb in their belly because they wouldn’t pay a single dime for surgery (but they happily pay ATT for their I-phones).

EMTALA compliant? Absolutely. Fair? Yes. Optimal? No. How to force the surgeons to operate? I don’t know… at the point of a gun? Otherwise, there’s no one that can do what they do, not even an attorney

(via FIRM)

Even if larger risk pools result in cost savings (for whom?), this no justification for mandatory health plans. How about legislation mandating that everyone who buys an iPhone also buy the extended warranty? A warranty is a type of insurance, after all. Mandatory warranties would expands the risk pool, and hence lower the costs of the warranty. But this exploits the people who prefer not to buy the warranty and insure against iPhone-related risks in other ways.

You might counter this by saying that a health plan is different, and that the uninsured are free-riders who increase everyone else’s health plan premiums when they don’t pay. As I’ve written before, this cost-shift from the uninsured is tiny, especially when compared to how much Medicaid and Medicare increase premiums.

Even if you think forcing people into a risk pool is OK, would this really result in health care cost savings?  Massachusetts is the only state that mandates the purchase of a health plan, but where are the cost savings?  The most affordable plans available on the exchange cost almost three times more than those available in Fort Collins. The Boston Globe reports that the premiums in Massachusetts are the highest in the country and emergency room visits and costs have increased.

One reason is that when politicians mandate that you buy a health plan, they get to define the minimum benefits a legal plan can have. Massachusetts has done this, and national health control legislation (HR 3590) defined them section 1302(a).  These can make many employer-based plans illegal.

With mandatory health plans, politicians pile on costly mandated benefits that increase premiums. Such “benefits” further distort insurance into a prepaid health plan, where customers are insulated from the true costs of treatment. Hence, they are not concerned with how much treatment costs or about more affordable alternatives. Since the patients isn’t paying, physicians have incentive to exaggerate diagnoses such that third-party payers will finance expensive treatment.

Health care prices stay in check when patients are the paying customers.  Examples include abortion (whatever your position on this), Lasik, and cosmetic surgery. When patients pay out of pocket, health care innovation benefits them and results in cost savings.

But mandatory health plans requires comprehensive plans such that the patient is rarely the customer, insurers are. mandatory insurance provisions such as the one in health control legislation (HR 3590) threatens high-deductible HSA-qualified policies, even though such policies can reign in health care costs. The American Academy of Actuaries reported that such “plans can produce significant (even substantial) savings without adversely affecting member health status.”

If you want to expand risk pools, then push politicians to allow Coloradans to buy insurance available in other states, and those in other states to buy policies sold here. One study predicts that this would make insurance affordable for millions. This method of expanding risk pools doesn’t exploit people entering it. Rather than being forced, they choose to buy the product.

Update: Linda Gorman’s article on direct-purchase insurance^* mentions how well such insurance already pools risk:

[Health economists Mark] Pauly and [Bradley] Herring report that direct-purchase insureds who had medical expenses about 4 times that of other people enjoyed premiums that were only 1.6 times as high. People who buy a policy and become ill have a strong incentive to continue paying. This may explain why age and sex were generally better predictors of direct-purchase premiums than chronic conditions.¹¹ Marquis et al. concur, reporting that the individual direct-purchase market is “an important source of long-term coverage for many who purchase it” and that “there is substantial pooling” that “increases over time because people who become sick can continue coverage without new underwriting.”¹²

^* That is, you buy the insurance policy (or health plan) directly from the insurer, not through your employer.

Reports Ben Smith at Politico:

Key White House allies are dramatically shifting their attempts to defend health care legislation, abandoning claims that it will reduce costs and the deficit and instead stressing a promise to “improve it.”

The messaging shift was circulated this afternoon on a conference call and PowerPoint presentation organized by FamiliesUSA — one of the central groups in the push for the initial legislation. The call was led by a staffer for the Herndon Alliance, which includes leading labor groups and other health care allies. It was based on polling from three top Democratic pollsters, John Anzalone, Celinda Lake and Stan Greenberg

Read the whole article: Dems retreat on health care cost pitch.

See the Wall Street Journal’s editorial on it:
Who’s ObamaCare’s Daddy? Now even liberals are denying paternity.

I really don’t like the term “liberal” to refer to left-wing authoritarians. But “left-wing authoritarian” is a mouthful.

With each passing week, it looks more and more like Republicans will retake control of Congress this fall. The latest Gallup poll gives the GOP a six-point edge. Rasmussen puts the Republican lead at seven points.

Even if Republicans take back Congress, they won’t be able to undo the Democrats’ legislative accomplishments right away. President Obama will be able to protect his signature achievements – like health reform – with his veto pen for as long as he calls the White House home.

But the GOP need not wait for a presidential victory in 2012 to begin repealing Obamacare. If Republicans assume congressional control this fall, they can – and should – start the repeal process as soon as the new Congress is seated in 2011 by refusing to fund the programs and initiatives created by the new law.

Read the whole article in Human Events: Repeal Obamacare by Choking Off Its Funding.

As I noted yesterday, this echoes my earlier post: ObamaCare: “debunk & defund” if you can’t repeal & replace.

Incremental revisions just won’t do. This 2,400-page law is the biggest entitlement since the Great Society. A wide-ranging program that puts one-sixth of our economy in the hands of politicians and bureaucrats can’t be fixed through a little tinkering. Lawmakers need to scrap the measure in its entirety.

Time is of the essence. Obamacare works like a one-way ratchet. Dismantling the huge new bureaucracies established by the measure will be effectively impossible once they’ve taken root.

Once all these taxes and government agencies are in full force, thousands of government employees will be dependent on the continued expansion of Obamacare for their livelihood. They’ll fight tooth-and-nail against any legislation that compromises their paycheck. If lawmakers don’t eradicate these taxes before they’re fully in place, all those bureaucrats will be here to stay.

Obamacare is also designed to make Americans dependent on government for insurance. …

Many Americans will get used to having other taxpayers foot the bill for ever-greater amounts of ever-more generous coverage.

This fall, Republicans will attempt to persuade the American people that they deserve to be put back in power. Exhibit A in their case should be a pledge to immediately repeal Obamacare. Scrapping the health-reform package in its entirety is the only way to prevent Obamacare from doing irreparable damage to the country.

Read the whole article: Repealing Obamacare: Politically Feasible, Morally Urgent.

Yet, if repealing is not possible, Merrill Matthews of the Council for Affordable Health Insurance suggests ways of curbing the harmful effects of the health control legislation, HR 3590.  I wrote a blog post about this in June.

Photo credit: Denver Post.

Wherever there is third-party payment [insurance, a health plan, Medicare, Medicaid], the goal of innovation is to produce more products that qualify for reimbursement, even if the effects on patient outcomes are only marginal. Wherever there is no third-party reimbursement, innovators are focused on ways to lower cost and raise quality.

Goodman provides many examples of innovation that benefits patients. Just imagine how much more there would be if patients paid more than 12% of all health care expenses. Read the whole article: Where Are the Innovators in Health Care Delivery?