Public health care has no claim to moral superiority

Posted on February 22, 2012 by RalphWeber

http://www.nationalpost.com/m/wp/full-comment/blog.html?b=fullcomment.nationalpost.com/2011/03/22/lorne-gunter-public-health-care-has-no-claim-to-moral-superiority

Lorne Gunter: Public health care has no claim to moral superiority

Lorne Gunter, National Post             Tuesday, Mar. 22, 2011

Please tell me how this is better than two-tiered American health care?

Monday, the Ontario provincial government decided to cover the cost of Herceptin, a breast cancer drug, for patients with tumours smaller than 1 cm in diameter. Previously only patients whose tumours were 1 cm or larger had the drug paid for by the provincial health care plan, OHIP.

It’s clear the decision was prompted by unflattering news coverage that generated public pressure for the change. It was not the result of a different medical or scientific assessment by health professionals. The risk to small-tumour patients has not been recalculated and found greater than before. All that has changed is the public demand for a new policy, which means this was a political decision, period.

So how is that morally superior to the way things are done in the States?

This shows just how much alike the private, U.S. insurance system and our government monopoly system are, except that here instead of market incentives driving decisions, bureaucratic and political considerations do the steering. We smugly turn up our nose at the U.S. system because private insurers make life-and-death decisions all the time based on profit and loss calculations. But in Canada, similarly crucial decisions are based on civil servants’ desire to control their budgets and protect their turf.

Private insurers try to exclude treatments and patients – i.e. ration care – to save money. But, gee, so does our system. Our federal and provincial health ministries make economic calculations all the time to control public health budgets .

In the case of Herceptin, Ontario knew all along that without Herceptin, small-tumour patients had a one-and-a-half to two times greater chance of recurrence of their cancer than those taking the drug, but it calculated that that risk was acceptable if it saved the public health budget hundreds of thousands of dollars in prescription drug payments. That calculation hasn’t change in the past two weeks. All that has changed is that the public found out and put pressure on the Ontario Liberal government to stop making cold, economic calculations where patients’ lives are at risk — on this one treatment. The ministry hasn’t changed its medical opinion about the wisdom of Herceptin funding, it has simply decided to throw taxpayer dollars at a noisy problem to make it go away.

Squeaky wheels and all that.

You can be sure there are hundreds of other similar calculations made by health bureaucrats every year, hundreds that don’t get funding because the public is unaware of them. Heart transplants for grannies and new hips for nonagenarians, knee repair surgeries for weekend-warrior athletes and MRI tests for people with persistent, but not intense headaches all carry risks but are denied routine public funding because those risks are deemed acceptably small by government health economists.

That is no different than a private insurer’s actuaries calculating that this or that treatment cannot be covered because doing so threatens the bottom line. Especially to the denied patient, the real-life result is the same either way.

Sure, if you think profits and private enterprise are bad things, you will likely be able to convince yourself that the calculations in a public system are preferable because they “socialize” the risk – meaning the risk is spread throughout the community, no one is able to get better care because of their higher income.

But people still end up untreated and even dead based on mathematics.

It is also true in our system that if you are somebody – a premier, a federal party leader, a professional athlete, a health care worker – you get jumped to the head of the line and get preferential treatment not available to ordinary citizens. In other words, status can do for you in our system what cash does for Americans.

Patients here may not die on hospital steps due to lack of insurance (they don’t in the States either), instead in Canada they die at home on waiting lists, out of sight and out of mind of the friends of government monopoly health care.

On top of that, here there is no option of switching insurers for better value or coverage. We are stuck with a single insurer who is susceptible to political pressure and is as efficient as governments typically are.

Gimme some private options. Even such social democratic paradises as France, Germany and Sweden permit private health care delivery for those willing to pay. Canada is almost alone in making private options all but illegal.

National Post

Follow Lorne on Twitter @lornegunter

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Posted in Canadian Healthcare, Free market medicine, Health Care News Tagged , , , , |

Cancer Screening Budget Cuts May Prove Deadly for Some Women

Posted on February 21, 2012 by RalphWeber

http://www.huffingtonpost.com/2012/02/20/cancer-screening-budget-cuts_n_1284880.html

Low-income women are being hurt by having important preventative tests cut to make way for Obamacare’s unnecessary demands, such as for employer insurance to cover all birth control prescriptions.

Cancer Screening Budget Cuts May Prove Deadly for Some Women

Breast Cancer

Lanajh Jones, 2, waits patiently as her grandmother Rozeann Gorman, of Minneapolis, registers for a free screening at North Point Health & Wellness Center’s See, Test & Treat™, a program that provides free breast and cervical cancer screening and same day diagnosis and care, for patients 40 and older in Minneapolis, Minn. African American women have a 24% higher mortality rate for breast cancer then non-Hispanic white women in Minnesota.

Government budget cuts may prove deadly for low-income women who are increasingly unable to get critical cancer screenings that once were offered free by state governments.

Shrinking state and federal budgets, the elevated cost of top-notch testing and growing demand are leaving millions of uninsured women unable to access breast and cervical screening programs. (Click here to view the number of women screened for breast and cervical cancers through government programs in each state).

In Illinois, where a government-funded program screened more than 70,000 low-income women from 2005 to 2010, program administrators said they fear money for higher-cost but more accurate digital mammograms will run out before the July 1 start of a new funding year. Mammograms have been suspended at five program sites and a waiting list is developing, the Chicago Tribune reported Friday. And officials in Rhode Island temporarily suspended the state’s screening program in 2010 due to funding shortfalls.

“The problem is that there is absolutely an inverse relationship between funding and need,” said Cynthia Pearson, the National Women’s Health Network executive director.

Most forms of cancer, when detected in their earliest stages, are more responsive to treatment and less likely to kill. Based on that idea, Congress funded the Breast and Cervical Cancer Screening Program in 1991.

States willing to contribute funds to the program suddenly had a large-scale means though which low-income, uninsured women could access the same sort of regular cancer testing available to wealthier and insured women. Women’s health advocates said it was a crowning achievement, a moment where science and compassion overrode the politics of government-funded health care.

Programs that serve poor and low-income individuals always see a surge in demand when unemployment rises, Pearson said. But high unemployment also limits federal and state tax revenues, the money used to fund most social services. Breast and cervical cancer screening programs have endured cuts or struggled to balance flat funding with rising demand in many states, she said.

Although unemployment has made what many economists describe as a sustained turn in the right direction, nearly 13 million Americans still cannot find work. States also are reporting modest rebounds in tax receipts, but few are collecting what they were before the recession. And 41 states indicated they planned to slash social services spending, particularly state-funded health care, in a November survey released by the National Association of Governors and the National Association of State Budget Directors.

Over the course of the recession and the years that have followed, federal funding for most social safety net programs has also remained flat or been cut, PublicHealth Newswire reported in October. Current federal funding levels provide only enough money for one of every five women eligible for the nation’s Breast and Cervical Cancer Screening program to receive tests.

The impact of flat and falling state and federal funding for the screening program will not affect the population evenly. In 2011, blacks and Latinos made up just under 30 percent of the nation’s population and 47 percent of the country’s uninsured, according to the Department of Health and Human Service’s annual report. A dearth of private health insurance coverage has been identified as a major reason that black women are less likely to be diagnosed with breast cancer than others, but are more likely to die of the disease, according to the National Cancer Institute.

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Posted in Common Sense Health Care Solutions, Health Care News, Health Care Reform, Obamacare Tagged , , , , |

PPACA-Based Age Rating Pinch Could Leave a Million More Uninsured

Posted on February 20, 2012 by RalphWeber

http://www.lifehealthpro.com/2012/02/13/ppaca-based-age-rating-pinch-could-leave-a-million?utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs

PPACA-Based Age Rating Pinch Could Leave a Million More Uninsured

By                 February 13, 2012

(AP Photo/Ross D. Franklin)
(AP Photo/Ross D. Franklin)

Whatever states do about health insurance prices for older and younger adults, one thing remains certain: it will be unlikely to please everyone.

Frederic Blavin and his colleagues at the Urban Institute in Washington, D.C., have published data on how efforts to keep or eliminate age-based pricing differences might affect U.S. residents. The researchers published their data in Health Affairs,an academic journal that focuses on the finance and delivery of health care. The researchers discussed the choices states will have before them should the Patient Protection and Affordable Care Act of 2010 (PPACA) be implemented as written.

Mired in controversy, legal wrangling and political argument since its signing into law in 2010, PPACA faces a multiple-front effort to get the law repealed outright in Congress, as well as to have it overturned in the Supreme Court. Oral arguments before the Supreme Court over the constitutionality of PPACA’s individual mandate begin in March.

However, if PPACA survives these efforts to undo the law, and if PPACA is fully implemented on schedule (by 2014), it will create, among other thing, a Small Business Health Options Program (SHOP) exchange system for small businesses and another exchange system for individuals. Exchanges are no-frills online venues consumers can use to buy health insurance; each state must set up its own exchange by 2014 or let the federal government provide exchange services for its residents. The exchanges are supposed to help individuals meet new PPACA health insurance ownership requirements.

Individuals with incomes under 400% of the federal poverty level will be able to use new tax subsidies to buy coverage through the exchanges, and many small businesses will qualify for a 2-year health insurance purchase subsidy.

Insurers will have to see coverage on a guaranteed-issue, mostly community-rated basis, but the researchers point out that states will have the authority to let health insurers charge the oldest consumers in the individual market three times what they charge the youngest adults.

States also will be able to choose whether to merge their individual and small group markets, and, until 2016, they will be able to decide whether a “small group” is an employer group with 50 or fewer workers or 100 or fewer workers.

The researchers used a simulation model they have developed to predict how various decisions might affect the cost of coverage and who has what type of coverage.

The researchers found that the choice of small-group cut-off has little effect on how the health insurance market performed in their simulations. Groups with 50 to 100 lives would, for example, have little incentive to buy coverage through an exchange, the researchers say.

Merging the individual and small group markets seems likely to lower individual market rates without having much effect on small group rates, the researchers report.

Merging the markets might cut prices about 10% for individuals who buy through an exchange and about 8% for individuals with coverage outside the exchange system while leaving small group prices unchanged, the researchers say.

Because merging the markets could lower prices for some without having a significant impact on the rates that others pay, that change could increase the percentage of insured U.S. residents from 90.2% to 90.6%, the researchers say.

If a state chooses to eliminate age rating in an attempt to be kinder to consumers ages 45-64, it could decrease premiums by about 13% (to $8,300) for people in that age group who earn more than 400% of the federal poverty level, and it could decrease the total uninsurance rate in that age group to 6.6%, from 7.6%, or by about a million people, the researchers say.

But eliminating age rating would increase rates by 22% for relatively high-income consumers ages 18 to 34 and increase the uninsurance rate for those consumers from 9.9% to 10.6%. Moreover, the overall uninsurance rate for nonelderly adults might increase from 26.2% to 27.2%, the researchers say.

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Posted in Cost of Health Care, Health Care News, Obamacare Tagged , , |

Direct-Pay Medicine: A Free Market Approach to Healthcare Reform

Posted on February 17, 2012 by RalphWeber

http://cfif.org/v/index.php/commentary/56-health-care/1291-direct-pay-medicine-a-free-market-approach-to-healthcare-reform

Having a direct relationship between the physician and patient is the way medicine was meant to be.  Doctors are starting to break the confines of insurance programs and the hassles they bring with them.  By paying your physician directly, there are no restrictions in how they can treat you and no extra paperwork – just fee for service. 
This is how MediBid works!  Doctors in our network are looking for patients who wish to pay cash.  Patients who post requests might be uninsured, have a high-deductible insurance plan, or just want to get timely medical care outside of their network.

Direct-Pay Medicine: A Free Market Approach to Healthcare Reform

By Ashton Ellis
Wednesday, February 01 2012

While ObamaCare creates armies of bureaucrats in the public and private sectors, a small but growing number of doctors and patients are using a simple solution to improve medical treatment while cutting out middle men.

When it was signed into law in 2010, the Patient Protection and Affordable Care Act (ObamaCare) was estimated by Newt Gingrich’s Center for Health Transformation to create at least 159 new federal agencies.  An analysis by the non-partisan Congressional Research Service was even more frightening.  Due to its sweeping lack of specificity, CRS said that a careful review of the law’s nearly 2,000 pages made it “impossible” to speculate on the number of new bureaucracies.

Unlike CRS, the Internal Revenue Service had no problem calculating how many new employees it would need to enforce ObamaCare’s 40 changes to the federal tax code.  In its 2012 budget proposal, the IRS requested an additional $359 million to fund 1,054 new hires this year alone.

Left unsaid by cheerleaders of government’s takeover of the healthcare industry is the cost of compliance pushed onto doctors.  It’s no wonder that one of the few growth areas for jobs in today’s recessionary economy is medical coding; that is, people charged with interpreting the blizzard of regulations hitting doctor’s offices and insurance companies.  Thanks to more government intrusion, coping with rationed care is becoming a lucrative career path.

Not for doctors, of course.  Faced with a barrage of rules and financial incentives to treat patients as products rather than people, many doctors are turning to government-backed loans to keep their doors open.  According to the Small Business Administration, SBA increased its loans to doctors in private practice from less than $60 million to $675 million between 2000 and 2011.  Tom Blue, Executive Director of the American Academy of Private Physicians, says that doctors are seeing revenue drop precipitously as the costs of regulations, drugs and medical liability skyrocket, while reimbursements from public and private insurance providers plunge.

In response, Blue says that a growing number of doctors are converting their practices to a new business model that cuts out the middle men, and enhances the doctor-patient relationship.

Direct-pay medical contracts require a one-time annual fee that buys 24/7 access to a primary care physician, same day appointments and a doctor-patient relationship reminiscent of an era before third party insurers and government subsidies.

Some direct-pay practitioners prefer the term “concierge medicine” because it reflects the heightened level of personal service available to patients.  Many require or strongly urge patients to carry secondary coverage for catastrophic illnesses.

The benefits of direct-pay contracts cut both ways.

Patients experience the positive effects immediately.  Not only are waiting times and payment conflicts eliminated, so too is the widget factory mentality characteristic of so many doctor’s visits.  Under a third-party payment system a doctor’s compensation is tied to the volume of patients he sees per day.  Thus, an average primary physician carries a patient load numbering thousands in order to make enough money to stay in business.

Under a direct-pay model, however, the doctor knows that if he’s seeing a patient he’s already been compensated.  Because of cost certainty, most direct-pay doctors service a patient load in the low hundreds.  Moreover, the collected fees remove the costliest non-medical entity from his practice – the compliance officer.  Doctors are therefore free to spend much more time treating individual patients with substantially less overhead.

The fee schedule per patient for most direct-pay doctors ranges from about $1,000 to $3,000 a year for primary and preventive care such as physicals, blood tests and EKGs.

Criticisms of direct pay medical contracts boil down to one complaint: those who can’t afford the service are left to the mercy of the third-party system.  In a word, yes.  But the practice of direct pay medicine offers some interesting responses.

First, complaining about being trapped in the current system shows there is a need for reform that opens up the healthcare industry to a lower-cost, transparent pricing system.  Second, many direct-pay doctors admit a certain percentage of “scholarship” patients who can only afford a fraction of the annual fee, using the profits from full-pays to subsidize the others.  For scholarship patients, direct-pay is a godsend.

Defenders of healthcare’s middle men are fighting back.  Academics and government officials fret over whether there will be enough doctors serving the poor and middle-class.  Advocates of socialized medicine resent the ability of some to opt-out of one-size-fits-all healthcare.  What they really fear is the rise of an entrepreneurial generation of doctors who make a living and serve others free from bureaucratic fiat.

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Posted in Common Sense Health Care Solutions, Cost of Health Care, Free market medicine, Medical Tourism Tagged , , , , , |

Ontario’s health care system needs more than Band-Aid solutions

Posted on February 16, 2012 by RalphWeber

I can never understand how anyone can believe that having the government make it illegal to obtain medical care is a good thing. Whenever you put a politician in charge of picking winners and losers, there will be a lot of losers, because they will usually make decisions for political reasons.

How is that good?

http://www.fraserinstitute.org/research-news/news/display.aspx?id=2147484277

Ontario’s health care system needs more than Band-Aid solutions

Appeared in the National Post  Mark Rovere      Brett J. Skinner    February 7, 2012

This week, Ontario Health Minister Deb Matthews published her plan for controlling provincial government health spending. While the Minister is correct when she says the growth of provincial health care spending is not sustainable, her proposed solution – more government-imposed central planning and bureaucratic management – is wrong. Ontario’s health system does not have a ‘management’ problem; it has an ‘economics’ problem.

Rearranging where surgeries are performed, forcing doctors to work overtime, and re-allocating patients out of hospitals into the community will not have a significant effect on government spending. While reorganizing hospital funding from fixed global budgets to activity-based funding will introduce some helpful economic incentives to treat the sickest patients first, it will do nothing to curb overall health care expenditures. Toying with incremental reforms will not save Ontario’s sinking health care ship.

In contrast, the provincial health system’s financial predicament has three clearly identifiable economic causes: the province’s monopoly over funding for medical care, the politically planned allocation of medical goods and services, and the lack of consumer exposure to the cost of using health care.

Politically managed, 100 per cent redistributive financing produces unsustainable cost growth and rationed access. In other words, Ontarians payers are paying more and getting less. When a government faces budget constraints and unsustainable growth in health spending, it doesn’t have many options. Raising taxes and cutting publicly insured medical services are the default – which Ontarians are all too familiar with.

In 2004, the province cut funding for biannual eye exams for everyone except children and seniors while terminating funding for chiropractic and physical therapy services. In the same year, it introduced a new health tax under the pretext of a ‘premium.’ Unsurprisingly, the typical taxing/rationing approach has not fixed the province’s unsustainable growth in government health spending. At the end of 2010, government health spending accounted for 49.5 per cent of Ontario’s total available revenues; compared with 41.5 per cent in 2000/2001.

Since Ontarians are prohibited from purchasing private insurance for medically necessary services, the availability of insured medical services is at the mercy of the province’s politicians. When central planning is responsible for determining the scope of insured services, the entire process becomes politicized. As a result, Ontarians have no control of their health care coverage because politicians and bureaucrats determine what is considered medically necessary and worthy of insurance coverage.

By contrast, in a well-regulated, competitive private health insurance market, insurers are forced to compete on price and services. This means that if an insurer stops financing a particular medical service, an individual has the ability to shop around for another insurance scheme that meets their personal medical needs. The ‘one-size fits all’ approach does not work for health insurance – which is precisely why Ontario needs to relinquish its health insurance monopoly and end the prohibition on private insurance.

Moreover, in contrast to a typical insurance scheme, the provincial health insurance program is not designed as a true insurance plan with deductibles, premiums, and co-payments. Since patient spending is unrelated to use, it creates perverse incentives for patients and providers to over utilize medical goods and services.

The first reform Ontario should implement is reduce the public subsidy for consuming medical goods and services to less than 100 per cent. Ontarians should be exposed to a portion of the costs associated with the publicly funded health care services they use. The objective of patient cost sharing is not to acquire additional income for providers – it is simply a means of introducing price-sensitivity to costs.

Economic research and international evidence show that patients do react to price signals, and that cost-sharing is effective in reducing unnecessary use of medical goods and services without resulting in increased negative health outcomes. Canada is one of the only countries in the developed world with a universal-health care system that does not require patients to share the costs of the publicly-funded medical services they use. Notably, most of these countries have exemptions for low-income earners and people with chronic health conditions.

The other reform Ontario should consider is allowing people to voluntarily purchase private health insurance for hospital and physician services. Doing so would shift billions in expenditures off the public system. This is not radical stuff. Ontarians are currently allowed to obtain private insurance for drugs. In principle, a private health insurance option is no different than allowing a private education option to the public education system, which is something Ontario currently permits.

Ontario is currently facing a $16 billion deficit. Meanwhile, provincial health care spending accounts for half of every dollar the province obtains in total revenues (including federal transfers). Tough decisions will have to be made. Unfortunately the current provincial government is attempting to fix a deep wound with Band-Aid solutions.

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Posted in Canadian Healthcare, Free market medicine, Health Care News Tagged , , |

Ontario looks to change the rules for those with rare conditions

Posted on February 15, 2012 by RalphWeber

http://www.theglobeandmail.com/news/national/ontario/ontario-looks-to-change-the-rules-for-those-with-rare-conditions/article1939555/

Ontario looks to change the rules for those with rare conditions

lisa priest      From Saturday’s Globe and Mail         Published

Rose, who suffers from a rare spinal problem and had surgery at Kansas clinic and it was eventually funded by the Ontario government, poses for a photo in her home in Markham, Ontario, Canada. - Rose, who suffers from a rare spinal problem and had surgery at Kansas clinic and it was eventually funded by the Ontario government, poses for a photo in her home in Markham, Ontario, Canada. | Deborah Baic/The Globe and Mail

The operation was so risky and rare even the best neurosurgeons in the patient’s home province had performed it just a few times. But surgery was the only way to relieve the severe pain and numbness from the 50-year-old woman’s giant spinal cysts.

It took three years for that patient, Rose, to get an accurate diagnosis. Once she located the world’s foremost expert in the United States, getting the province to reimburse her $38,000 U.S. for the high-risk surgery required a year-long battle and a four-day hearing.

“It took everything to win,” said Rose, who spoke on the condition her last name not be used. Her operation was done in Kansas City in November, 2010.

Rose is believed to be the second Ontarian to argue successfully that a surgeon’s superior skill justified having the province pay, according to the recently released decision. She may also be the last.

Currently, patients like Rose – those with rare conditions that require treatment from experts outside the province – apply for government funding to have their procedures done. Under a suite of changes to the Ontario Health Insurance Plan called the Excellent Care for All Strategy, the province will make it virtually impossible for people whose applications are rejected to win under appeal, according to Perry Brodkin, a health lawyer who represents patients before the Health Services Appeal and Review Board.

Starting on April 1, surgeons in Ontario may perform even relatively rare operations so long as the procedures are considered within their “scope of practice,” he said. The public has until March 13 to voice concerns about the proposed regulatory changes for out-of-country treatment, expected to save $28.5-million annually.

“This legislation makes patients guinea pigs because they’re not going to get the foremost expert in the world,” Mr. Brodkin said. “Under the new rules, that surgeon may have never performed the surgery or may have performed it only once.”

Mr. Brodkin conceded the amendments may enhance patient safety in the long term because doctors will gain more expertise on rare procedures. In the interim, he said, some patients may be going under the knife with a doctor who has little experience.

More broadly, the changes are a reminder of how Canadians need to be savvy about their medical care and ask surgeons how many times they have performed a given operation, and about their death and complication rates. It also raises a delicate debate: How many operations does a surgeon have to perform to be considered proficient?

Neurosurgeon Frank Feigenbaum of the Research Medical Center in Kansas City, who operated on Rose’s Tarlov cysts, said in a letter entered as an exhibit before the appeal review board that the surgery is extremely intricate, complex and a “very scarce commodity.”

“There are only a few surgeons in the world with experience and proven good outcomes with surgery for these rare giant cysts who would even attempt this surgery,” he wrote. “I am one of those surgeons.”

Tarlov cysts are fluid-filled sacs that often affect nerve roots at the lower end of the spine. While smaller ones typically cause no symptoms, the larger ones Rose had cause bowel and bladder dysfunction.

Reta Honey Hiers, president of the Tarlov Cyst Disease Foundation, testified that no Canadian physicians were on her list as having expertise to operate on such cysts; the one Ontario surgeon that was listed had asked to be removed.

But Toronto neurosurgeon Charles Tator testified that Rose could be treated in a timely fashion in Ontario. He had treated five patients over his career of nearly 50 years and he believed other neurosurgeons treated a similar number of cases, according to the board decision.

Mr. Brodkin said government likely proposed the regulatory changes to prevent more successful appeals like that of Rose and Brad Remigis, who last year won his bid to have the province pay for him to have a bleeding lesion in his brain stem repaired by a U.S.-based world expert.

But Ontario Health Minister Deb Matthews said the legislation is about making decisions based on the best available medical evidence.

“In very rare cases where there isn’t that expertise here, then we will continue to fund the out-of-country,” Ms. Matthews said in a telephone interview. “We need to build up our expertise here, and doctors will not perform procedures for which they are not competent.”

Ms. Matthews said the public should expect a change in coverage as the province moves to finance only what is medically necessary. For example, as part of the same changes, government is limiting the number of sleep studies, bone mineral density testing and Vitamin D testing.

She said the health care system is precious and “we must take steps to ensure that the dollars we spend are actually improving patient care.”

As for the public consultation, Julie Ingo, manager of the fee-for-service program unit in Ontario’s health services branch, said that so far, two enquiries have come in from the public, both which were relatively positive.

Today, four months after her surgery, Rose says she is recovering well. Unusually, she represented her own case and won, and hopes the proposed changes don’t impair other patients to win their appeals.

“I need to advocate for those out there,” she said.

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Posted in Canadian Healthcare, Health Care News, Insurance Tagged , , |

Suggested Resolutions for Caucuses

Posted on February 14, 2012 by RalphWeber

http://www.cchfreedom.org/

Suggested Resolutions for MN Caucuses – Tuesday, Feb 7

by Twila Brase

NO CONFORMING WITH OBAMACARE

The federal health care reform law has been unconstitutionally imposed on all citizens and all States of the Union. Obamacare regulations on “exchanges” and “essential health benefits”  and other sections of the law now exceed the number of pages in the law itself. And the U.S. Supreme Court has not yet ruled on constitutionality.

Therefore, be it resolved that no part of the 2,700 page health care reform law or its thousands of pages of proposed or finalized regulations should be put into state law in Minnesota.

NO GOVERNMENT “EXCHANGES”

The health insurance “exchange” (HIX) is key to President Obama’s plan to implement national health care through the nation. In short, it is a health care takeover center. Under Obamacare, every exchange established by state government is an Obamacare exchange. Every so-called “state” exchange is a federal exchange, under the federal law and the federal rules. For example, Massachusetts with an exchange for five years, is in the process of conforming to Obamacare.

As an example of federal control, the first set of Exchange regulations mention the word “require” 811 times. One reguation requires the State to create individualized risk scores on its citizens and send them to the federal government. There are private market exchanges already (i.e. ehealthinsurance.com), but every government-established exchange is a government bureaucracy that once established, and filled with self-interested bureaucrats, will be difficult to undo. Governor Dayton has executive-ordered the design and development of Obama’s exchange but he cannot implement it without the state legislature passing a law.

Thus, to protect citizens and to protect 10th amendment state’s rights, be it resolved that no health insurance exchange of any kind will be established by law in the State of Minnesota.

REPEAL DATABASE LAW

The Minnesota Department of Health recently testified that their data on doctors and hospitals taken from the medical records of patients without their consent is bad data. Millions of taxpayer dollars have been spent in contracts with a data warehouse which collects patient data from insurers, and a data analysis unit, and the Department. Under Obamacare, this database would be used to create individualized risk scores on citizens and send them to the federal government to determine redistribution of premium dollars between health plans.

Therefore, be it resolved that the Minnesota state law, 62U.04 that requires insurance companies to send private patient data to the State of Minnesota and allows the State of Minnesota to analyze the data without patient consent be repealed.

CONSENT FOR HEALTH SURVEILLANCE

A national health surveillance system is being created. It’s called the National Health Information Network. It’s a network of networks. To build it the Obama Administration provided $38 billion in the stimulus bill. States are accessing those dollars to build state-based health formation exchanges (HIEs). Minnesota law requires all practitioners to have an electronic medical record by 2015. The national system will be a system of online medical records accessible to 2.2 million entities under the so-called HIPAA privacy rule.

Thus, be it resolved that no patient’s medical record be placed onto Minnesota’s health information exchange or the national health surveillance system without the written informed consent of the individual.

EVERY-OTHER-YEAR LEGISLATURE

The Minnesota legislative session is far too long and costs far too much in terms of real dollars, impact on the economy and impact on personal freedom. Shorter sessions would encourate legislators to keep their jobs and prevent full-time career politicians. New Mexico meets for approximately one month annually, and the Texas legislature only meets every other year.

Because every citizen’s life, liberty and property are threatened when the legislature is in session, be it resolved that the Minnesota legislature meet only every other year, and for no more than two months.

REPORT GOVERNMENT LOBBYING

Minnesota law requires every lobbyist to report the cost of lobbying to a division of state government. This is part of what some people call “sunshine” laws. However, bureaucrats from the various state agencies, who are often at the State Capitol lobbying for department bills and initiatives and budget increases, are not required by state law to report their lobbying expenses. These agency bureaucrats are paid by state taxpayers.

Thus, be it resolved that every government employee who proposes a bill or spends time at the legislature in an effort to change the law, increase a budget or push a taxpayer-funded initiative be required to register as a lobbyist and publicly report their expenses to the State of Minnesota.

 

 

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Posted in Health Care News, Health Care Reform, Health Law and Legislation, Healthcare Exhange, Obamacare, obamacare exchange, Patient Privacy Tagged , , |

OHIP turns blind eye to suffering

Posted on February 10, 2012 by RalphWeber

This is an unfortunate byproduct of government intervention in medicine. It’s very unfortunate, and it’s the reason so many Canadians use MediBid to get timely and affordable medical care.

http://m.lfpress.com/news/london/2012/01/20/19274441.html

OHIP turns blind eye to suffering

JONATHAN SHER, The London Free Press       Friday, January 20, 2012, 9:53 PM

Chastened by doctors for seeking speedier treatment for a painful disease threatening to rob her of fertility, Allison Jones writhed with pain so severe it was like a man continually passing large kidney stones.

Jones needed to see one of a handful of gynecological specialists who could remove the lining of a uterus where it grows outside that organ, a painful condition called endometriosis.

But after waiting seven months to see a specialist Jones, a resident of Southwestern Ontario, was told she’d have to wait at least seven more for surgery that might make her pain-free for the first time in years.

Only one specialist held an open door to her care, a Canadian schooled almost entirely in Ontario. But Dr. Ken Sinervo had committed a Cardinal sin as far as OHIP was concerned — he offered life-changing surgery outside the country in Atlanta, Georgia.

Twice, Jones’ family doctor wrote to OHIP, asking the agency to pay for Siverno’s surgery, but each request was met by quick refusals and a suggestion she check a list of specialists, none of whom had time to see her any quicker.

One specialist, Dr. Alexandre Nevin Lam, chastised Jones for seeking faster access, writing in a letter she should stop “doctor shopping, since this was a waste of both health-care resources and her time.”

Jones sought emergency care repeatedly, but the heavy-duty drugs prescribed did little to curb her pain.

So in April of 2010, she decided to go to Atlanta.

Three days later, she was on an operating table at the Northside Hospital Cancer Institute.

“That’s one of the big differences between the health-care system in Canada and the system here,” Sinervo told The Free Press this week from Atlanta.

The disease had progressed so quickly, Sinervo had to remove her uterus, fallopian tubes, ovaries and nearly 8 inches of her bowel.

The ordeal was traumatizing. Jones — not her real name — asked The Free Press last week to keep her identity secret.

But those who helped her spoke out.

It isn’t just the speed of access that’s different, Sinervo says. The surgeries he performs in Atlanta are more advanced than what’s available in Ontario, in part because he performs surgery four or five days a week — while Ontario docs might get a day and a half because of the rationing of operating-room time.

“That’s one of the reasons I didn’t go back to Canada after my fellowship in Atlanta,” he said.

Sinervo uses a carbon-dioxide laser to remove all of the abnormal tissue to lessen the chance of complication and reoccurrences, something he says most specialists do not do.

The surgery was done, but the struggle for Jones had just begun: She faced a $70,000 medical bill including close to a week in hospital.

The Atlanta hospital, Northside Hospital Cancer Institute, later forgave most of the bill, wiping $57,000 off the books as it sometimes does for patients who just can’t afford to pay.

But OHIP fought against covering the remaining $13,000, even though that amount is almost certainly no more than what Jones’ treatment would have cost in Ontario, Sinervo said.

That hard-nosed approach is nothing new for OHIP, says the lawyer who represented Jones. For 20 years, the agency has acted strictly like a private insurance company, going to great lengths to avoid having to pay for any out-of-country care.

“There’s no compassion at all,” said Perry Brodkin, who was the agency’s in-house counsel years ago, before regulatory change changed it from an agency that tries to help to one seeking any reason to reject coverage.

Most patients lose appeals to OHIP rejections because they can’t afford to hire a lawyer, as legal costs typically range between $5,000 and $20,000.

Patients argue on compassionate grounds not to be found in a law that restricts out-of-country coverage to necessary care that’s unavailable here or so delayed a wait would probably result in death or medically significant and irreversible tissue damage.

Pain alone isn’t enough to get OHIP funding, no matter how excruciating or debilitating, Brodkin said.

But this time the bad guys lost, Brodkin said.

Jones won her appeal this month before Ontario’s Health Services Appeal and Review Board.

Board members took issue not just with the stance of OHIP, but also with the Ontario specialists who had essentially told Jones to wait her turn.

The specialist she was to have waited for was Dr. Nicholas Leyland, top dog at Health Sciences Centre at Hamilton’s McMaster University.

But when Jones went to Sinervo, Leyland wrote to support OHIP’s denial of coverage.

“We could have carried out the same kind of care that was provided by Dr. Sinervo, who was a trainee of ours a few years ago. This patient would not have suffered death or irreversible tissue damage in waiting for this surgery. Many patients are waiting for this procedure much longer,” Leyland wrote.

The board rejected Leyland’s claim, noting in his letter, he didn’t mention Jones’ specific condition or if delay would cause irreversible tissue damage, dismissing her claim because some other women with the same general condition had to wait longer.

“It is unfortunate that Dr. Leyland did not testify at the hearing,” the board wrote.

The board also took aim at OHIP: “The Appeal Board is troubled by (OHIP’s) assertion that since endometriosis is by definition a progressive disease, any further progression in the form of tissue damage is expected and is not medically significant.”

The decision is timely, Brodkin said, as waits for surgery by Leyland have grown to nine months, with about 60 women affected.

“Most wait and suffer damage,” he said. “(This case) may open the doors (for care in Atlanta),” Brodkin said.

The Toronto lawyer challenged Ontario Health Minister Deb Matthews to change the rules and process to give patients a fighting chance, even if it’s to arrange for an advocate or ombudsperson for those who can’t afford a lawyer.

As for Sinervo, he’d like to negotiate a reduced rate with the health ministry for Ontario women going to Atlanta’s Center for Endometriosis Care, something close to half of the regular charges.

The Free Press requested interviews three days this week with Matthews, a London MPP, but she didn’t make herself available.

Messages left for Leyland and Lam also weren’t returned.

E-mail jonathan.sher sunmedia.ca, or follow JSheratLFPress on Twitter.

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Posted in Canadian Healthcare, Free market medicine, Health Care News, Medical Tourism Tagged , , , |

What about Interstate Compacts? A frank look at the problems

Posted on February 10, 2012 by RalphWeber

This is an interesting view on Compacts. Governor Jan Brewer vetoed the healthcare compact in AZ. Possibly because it increases government spending in Healthcare. They are now running a bill called the “Healthcare Freedom Compact”.

There are many compacts, such as the Insurance Compact, which can be found at www.InsuranceCompact.org. There are 41 states in the compact, and 15 of those states are represented on the board. Their budget is only $3 million a year, but there are 14 committees under it.

Could that compact be changed to include healthcare? Or since when we say “healthcare”, we actually mean “health insurance”, which is already covered by the compact.

Read on to see what the author has to say about the pro’s and cons of compacts.

http://constitution.i2i.org/2011/05/12/what-about-interstate-compacts-a-frank-look-at-the-problems/

What about Interstate Compacts? A frank look at the problems

In recent months, there has been interest in states forming compacts with each other to opt out of ObamaCare or other federal programs.  The idea is that because such compacts have the effect of federal law, they will supersede earlier federal laws (such as ObamaCare).

The strategy is apparently being driven by one or more enthusiastic financiers.  But I’d like to offer a few words of caution—not just as a constitutional/legal scholar but also as a former businessman and successful political activist.

Although the compact strategy is not a complete waste of time (see below), ultimately I think it is less cost-effective than other state “push-back” methods, such as local health care freedom laws, coordinated legal challenges, and (especially) applying for an Article V amendments convention.

Why so?  Well, let’s begin with the Constitution—Article I, Section 10:

“No State shall, without the Consent of Congress . . . enter into any Agreement or Compact with another State. . . . ”

As this section says directly, the states can negotiate all they want, but nothing is effective unless Congress approves.  Now what do you think the chances are of Congress approving states opting out of Congress’s own laws?

True, in some cases the states can reach agreement under a federal statute that gives pre-approval to state criminal law compacts.  But there is no assurance the courts will approve using a criminal law statute as a device for opting-out of federal law in areas like health care or education.

It gets worse:  Even if those hurdles are overcome, any future Congress may override the compact any time it wishes, for any reason or no reason.

It seems pretty obvious to me that the best ways of challenging Congress are ways that do not require the approval of Congress. State Health Care Freedom Acts require no such approval.  Neither do state lawsuits .  Neither does an amendments convention, because when two thirds of states have applied for one, Congress is required to call it.

There’s more: As anyone can tell you who has been involved in negotiating interstate compacts, they are notoriously time-consuming and difficult to work out—and as the number of states increases, the difficulties become exponentially greater. True, if the authorizing legislation in each state is precisely the same, this can speed the negotiations—assuming no unforeseen differences, which of course is a very optimistic assumption.

If everything goes perfectly, the interstate compact strategy may have some benefit, so I would not fault anyone committed to the process who decides to remain committed.  Personally, though, I’d prefer to put my time and effort into strategies that involve less effort and more assurance of success.

 

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Posted in Health Care News, Health Care Reform, Healthcare Exhange, Obamacare, obamacare exchange Tagged , |

HHS Unveils Final Design For Insurance Labels – Forgets pricing

Posted on February 9, 2012 by Ralph

Part of the PPACA is that the plan description will come to you in more easy to understand “government language”, see Kathleen Sebelius’ quote below. She talks about “confusing language”. I’ve read the new and improved government version, and it’s 8 pages long, and quite confusing to me. I noticed that they left the premium out. I wonder if they thing that things like the cost are “confusing language”?

HHS Unveils Final Design For Insurance Labels – Kaiser Health News.

HHS Unveils Final Design For Insurance Labels

By Susan Jaffe

Feb 09, 2012

The Obama administration today unveiled final regulations that detail what information health insurers must provide on new consumer labels mandated by the federal health law to explain their plans.

An example of an insurance coverage label released today by HHS. (Click to enlarge)

“All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said Health and Human Services Secretary Kathleen Sebelius in a printed statement. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”

The standardized forms will be available beginning Sept. 23 for about 150 million Americans with private health insurance, federal health officials.

View the labels

View the labels HHS will give consumers to inform them about their health insurance options:

Source: Department of Health and Human Services

The rules set the design for easy-to-understand forms describing health insurance benefits. The forms are intended to provide the same details on all policies using the same language – defined in an accompanying glossary — so that consumers can compare policies. The law also mandates coverage examples that explain how much a plan pays on average for common medical conditions. It even eliminates “fine print” by requiring that information be printed in 12-point type, which is larger than the print in a typical newspaper article.

But the bottom line – a policy’s price – is missing. Although an estimated premium price was included the draft rules announced last August, it has been dropped and won’t be required for the form. Other changes from the earlier rules include reducing the number of coverage examples from three to two (having a baby and diabetes care).

Marilyn Tavenner, the acting head of the Centers for Medicare and Medicaid Services, which held the media briefing, said the changes will improve consumers’ understanding of their health options.

“For too many Americans today, choosing a health plan means reading through a human resources book usually the size of a small phone book and important information about eligibility and benefits is often buried in the fine print,” she said. “And it can be confusing to compare one plan to another. For those who purchase health insurance on their own, this process can be even more frustrating. With these new rules we’re making it easier for consumers to find the plan that is right for them.”

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Posted in Cost of Health Care, Healthcare Exhange, Insurance, Obamacare, obamacare exchange Tagged , , |
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