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Health, Wealth and Personal Responsibility

How much is Obamacare really worth? This is an important question as we approach the incoming Trump Administration. Should he backtrack on his campaign promise to repeal Obamacare on Day One? If Trump merely instructed his HHS Secretary to drop the appeal of House v Burwell most insurers would probably bail out of the market and it would collapse. If Congress uses a Budget Reconciliation process to repeal Obamacare provisions, such as the individual mandate, employer mandate, the Obamacare taxes and the subsidies, the health insurance exchange would probably collapse.

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Nov 18, 2016 | 79 comments | by

Health Policy Election 2016 Post-Mortem

America dodged a bullet on health care — but still has a lot of work ahead. The high cost of Obamacare is arguably one of the many issues that drove Americans to the polls to vote for Trump or against Clinton. If it did nothing else, Trump’s victory is important because it blocked the plethora of bad health policy ideas championed by Clinton. The leading presidential candidates’ positions on health reform could not be farther apart. Whereas Hillary Clinton wanted to double down on Obamacare and expand it, Donald Trump plans to repeal Obamacare in its entirety. Clinton wanted to expand Obamacare subsidies, she wanted to expand Medicaid eligibility in the remaining states that have not done so and she even wanted to expand eligibility for Medicare. She also wanted to enact a Soviet-style system of price controls on drugs and make drug makers justify their prices — whatever that means.

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Nov 09, 2016 | 117 comments | by

The Big Government Conspiracy to Protect Rich Guys

moneyI am not a proponent of conspiracy theories. That said: some conspiracies are real — and designed to protect the wealthy at everyone else’s expense. I’m referring, of course, to the conspiracy by the medical industrial complex to keep medicine costly. The conspiracy insulates the industry and its practitioners from competition using regulatory barriers and exclusive licensure cartels. At first glance these may all seem reasonable, but they extort one-fifth of our national income.

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Nov 04, 2016 | 28 comments | by

How Long Should You Have to Wait to See a Doctor?

dogvetwait

How long should you have to wait to see a doctor? Why not just call a doctor?

The patient in the photo was able to get a same-day appointment within 15 minutes of the request and was seen within 10 minutes after arriving. But that is an exception in the United States. A recent article in the American Journal of Managed Care estimated the average physician visit takes two hours (121 minutes). That includes travel time (37 minutes), waiting time (about an hour) and treatment time (10 to 20 minutes). Of course, that’s once you get an appointment.

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Nov 03, 2016 | 8 comments | by

Medicaid Expansion Also Expands ER Use

A new report in the New England Journal of Medicine found that Medicaid expansion in Oregon actually increased use of the emergency room (ER) by people newly covered by Medicaid. Policy experts had expected ER use to fall as people gained coverage and could have a usual source of care, such as a primary care physician.  Within the first 15 months after gaining coverage, ER use spiked by about 40%, and remained high for subsequent years. It did not appear the people using the emergency room were necessarily substituting ER visits for primary care physicians (PCP) visits. Rather, PCP visits and ER visits appeared to be complementary.

Mercatus senior research fellow Brian Blase covers the implications in much more detail at Forbes. Blase points out that the value of Medicaid benefits is less than the cost, enrollees are misusing their benefits (ER visits when primary care would suffice). ER overuse makes it harder for those truly in need of emergency care to be seen in a timely manner. It is also arguably why the cost of  Medicaid expansion is far above initial projections.

 

Oct 21, 2016 | 6 comments | by

Will 21st Century Cures Lower Drug Costs? Maybe… But it’s a Good Start!

House Minority Leader Pelosi agrees with Speaker Paul Ryan and Senate Majority Leader Mitch McConnell on at least one issue: all three support the 21st Century Cures Act. They presumably want to boost access to advanced drug therapies by making it easier to bring them to market.

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Oct 21, 2016 | 2 comments | by

EpiPen Maker Lobbied U.S. Preventive Services Task Force

According to a report in the Washington Examiner, drug maker Mylan lobbied the U.S. Preventive Services Task Force to require insurers to pay the full price of EpiPens by deeming the drug delivery device a preventative measure. Under the Affordable Care Act, health plans must cover preventive services 100% without cost-sharing regardless of whether deductibles have been met. EpiPens are used by people with severe allergies who go into anaphylactic shock.  They are not used to prevent anaphylaxis, they treat the symptoms once it occurs. For example, under ACA regulations, a flu shot is a preventive medicine. Once you have the flu, seeing your doctor for Tamiflu would be a treatment, not a prevention.

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Oct 13, 2016 | 3 comments | by

Is Obamacare’s Failure Intentional, to Promote Medicaid-for-All?

A recent commentary in the Wall Street Journal announced, “Obamacare’s meltdown has arrived.” Health insurance premiums all over the country have skyrocketed. Numerous insurers have pulled out of state and federal exchange marketplaces. Many consumers have only one choice of health insurer and can choose from only a couple different plans. State health insurance CO-OPs have been falling like dominos and the program is now all but defunct.

None of this should have come as a surprise. Over the years I’ve heard conspiracy theories that Obamacare was designed to fail to nudge a reluctant nation one step closer to a single-payer system of socialized medicine. Think of this as Medicaid-for-All.

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Oct 11, 2016 | 18 comments | by

Is Pet Health As Dysfunctional as Human Health Care?

clemvet1Health policy analysts have long blamed the inefficiencies that befall the U.S. health care system to our over-reliance on third party payment. About 89 percent of all medical care is paid for by third parties — either employer-sponsored health plans, Medicare, Medicaid or individual medical insurance. Indeed, about 90 percent of the U.S. population have some type of health coverage. Thus, one could make a valid argument that medical markets devoid of insurance should function more like normal consumer markets. For instance, there is significant evidence that cosmetic medicine and corrective eye surgery both experience lower price inflation than medical care. These services are rarely covered by insurance. Another notable medical market that does not rely on insurance is veterinary medicine.

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Oct 03, 2016 | 8 comments | by

Hillary’s Campaign to Lower Drug Costs is a Real Downer

captureSpending on prescription drugs has grown tremendously over the past few decades. This is mainly due to the increase in the number of diseases and conditions treated using drug therapy. The truth is: most drugs are dirt cheap! However, a small portion — maybe 1 or 2 percent — are rather costly. As a result of that small percentage, drug prices have become a campaign issue accompanied by plethora of bad ideas.

Early in his campaign, Donald Trump even came out with some doozies, such as having the government negotiate drug prices for Medicare and importing drugs from abroad (that is: importing other countries’ price controls). He has since ceded these populist talking points to Hillary in favor of free-market ideas. He now advocates getting government out of the way, allowing competition to flourish. He understands that bureaucratic red tape at the U.S. Food and Drug Administration often prevents competition from holding drug prices in check.

Hillary Clinton is another story.

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Sep 23, 2016 | 2 comments | by
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