Healthcare

Economic Freedom Declines Again; Government Control Is Bad For Your Health

by Hans Bader on January 24, 2013 · 1 comment

in Economy, Healthcare, International, Regulation

Economic freedom has declined under the Obama administration, and America’s rank has repeatedly fallen on the Index of Economic Freedom and other rankings issued by think-tanks and research foundations. (The Heritage Foundation just released the 2013 Index of Economic Freedom.) In their Economic Freedom of the World rankings, Canada’s Fraser Institute and the U.S.-based Cato Institute note that “The United States, long considered the standard bearer for economic freedom among large industrial nations, has experienced a substantial decline in economic freedom during the past decade. From 1980 to 2000, the United States was generally rated the third freest economy in the world, ranking behind only Hong Kong and Singapore.” But by 2010, America had fallen to 19th place, and its economic climate continues to deteriorate.

Shrinking economic freedom is bad for your health. Formerly communist countries like Russia (which still has a heavily state-dominated economy) tend to have shorter life expectancies than more pro-free-market countries, even when those countries have fewer natural resources to pay for health care. The average man in Russia lives around 60 years (59.2 years, according to the 2009 World Almanac), compared to over 70 years in Turkey and Thailand, even though Russia is richer due to factors like oil and mineral wealth (its per capita income was nearly twice as high as Thailand). Thai and Turkish life expectancy was also higher than in other formerly communist countries like Romania and Bulgaria, which had incomes similar to Turkey and higher than Thailand.

These disparities exist even among countries with very similar cultures, as is shown by the recent history of two neighboring countries, capitalist Colombia and socialist Venezuela. In 1999, just before Marxist Hugo Chavez took power in Venezuela, life expectancy was 3 years longer in Venezuela than in Colombia. But after 13 years of socialist rule, life expectancy in Venezuela is now a year shorter than in Colombia. (These figures are from the World Almanacs for 1999 and 2013.) Improvements in life expectancy have stalled in Socialist Venezuela even though Venezuela, unlike Colombia, has vast oil wealth, and has benefited from rapidly-rising oil prices during Chavez’s rule, enabling Venezuela to dramatically increase government health care spending. Under the Chavez regime, Venezuela’s capital, Caracas, has become one of the world’s most violent cities.

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Obamacare Increases Unnecessary Medical Tests, Wastes Doctors’ Time, Drives Up Billings And Costs

by Hans Bader on January 22, 2013 · 4 comments

in Economy, Healthcare, Regulation

President Obama claimed Obamacare would cut healthcare costs, but it actually increased them in many ways, some of which are chronicled here. Here are yet more Obamacare fees and cost increases. Another example is given by Mickey Kaus, a staunch supporter of universal health care (he once thanked Obama and Nancy Pelosi for passage of Obamacare), who points out that Obamacare’s $19 billion in taxpayer subsidies for electronic recordkeeping appear to have backfired and increased healthcare costs. It subsidized hasty, premature installment of electronic recordkeeping systems that waste physicians’ time (reducing interaction with patients), and result in the performance of more, rather than fewer unnecessary tests and medical procedures, as well as increased billings for trivial activities.

As one of Kaus’s readers put it,

My wife is a staff physician [at] a major East Coast hospital.
Her employer was one of the first to sign up for federal money to implement a system which hospital management freely acknowledges is “terrible” but there was so much money on offer that they couldn’t say no.
Probably the biggest problem with electronic records is simply that it requires the physician to input all notes and orders, rather than dictate them.
As a result, as my bride puts it, “they’ve taken the highest-paid person in the department and turned him/her into a data entry clerk”.
On average, she and her colleagues spend more time per patient wading through drop-down menus, clicking boxes and filling in required but utterly irrelevant information than they do at the bedside, actually treating the patient.
In short, it’s her experience that they see fewer patients per shift than they did previously, and spend less time with each one, now that they are required to sit down at a computer after seeing each patient and jumping through hoops to place orders instead of, as previously, simply telling the nurse what is needed and then moving on to the next patient.

Obamacare Imposes New Fees, Cost Increases On The Public

by Hans Bader on January 14, 2013 · 1 comment

in Economy, Employment, Healthcare, Regulation

Obamacare was sold to the public based on the fallacy that it would cut healthcare costs, but each month brings additional evidence that it will drive up healthcare costs instead. The New York Times reported last week that “health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers. Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own. In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders.” Earlier, Obamacare resulted in hikes of 41-47 percent in health insurance premiums for some policyholders in Connecticut. The Times notes that in “other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders.”

Writing in the The Wall Street Journal today, Merrill Matthews and Mark Litow say that some premiums in individual markets may double due to Obamacare. One reason is that the “Congressional Democrats who crafted the legislation ignored virtually every actuarial principle governing rational insurance pricing.”  “Although President Obama repeatedly claimed that health insurance premiums for a family would be $2,500 lower by the end of his first term, they are actually about $3,000 higher — a spread of about $5,500 per family.”

Most Americans will feel the brunt of a $63 per head fee imposed by the Obama administration, for which they will receive nothing in return. As the Associated Press notes, “Your medical plan is facing an unexpected expense, so you probably are, too. It’s a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Barack Obama’s health care overhaul. The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers. Employee benefits lawyer Chantel Sheaks calls it a ‘sleeper issue’ with significant financial consequences, particularly for large employers. ‘Especially at a time when we are facing economic uncertainty, (companies will) be hit with a multi-million dollar assessment without getting anything back for it,’ said Sheaks, a principal at Buck Consultants, a Xerox subsidiary. Based on figures provided in the regulation, employer and individual health plans covering an estimated 190 million Americans could owe the per-person fee. The Obama administration says it is a temporary assessment levied for three years starting in 2014, designed to raise $25 billion.”

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Appeals Court Overturns Dismissal Of Challenge To Obamacare Contraception Mandate By Religious Colleges

by Hans Bader on December 19, 2012

in Healthcare, Legal, Personal Liberty

According to law professor Jonathan Adler, the U.S. Court of Appeals for the D.C. Circuit effectively overturned a district court’s dismissal of a challenge to the so-called “contraception mandate,” a regulation issued by the Department of Health and Human Services that employer-provided health care plans include coverage for all FDA-approved forms of contraception without cost-sharing.

Various religious employers have objected to this requirement citing the First Amendment’s free-exercise clause and, more persuasively, the Religious Freedom Restoration Act (RFRA). The district court had dismissed the case because the Obama administration claimed it would change the mandate for religious schools and hospitals before it took effect, making the lawsuit unripe. As Adler notes, the appeals court turned that self-serving administration claim into a binding commitment:

“In its brief order, the D.C. Circuit explained that the district court was wrong to dismiss the suit against the mandate for lack of standing as ‘the colleges clearly had standing when these suits were filed.’  The ripeness question ‘is more difficult,’ the court explained, because HHS has promised to address religious employers’ claims in a new rulemaking. Taking HHS at its word, the D.C. Circuit concluded the lawsuits should be held in abeyance, pending further action by HHS.

At oral argument, the government . . . represented to the court that it would never enforce [the contraceptive mandate] in its current form against the appellants or those similarly situated as regards contraceptive services. . . There will, the government said, be a different rule for entities like the appellants, . .  and we take that as a binding commitment. The government further represented that it would publish a Notice of Proposed Rulemaking for the new rule in the first quarter of 2013 and would issue a new Final Rule before August 2013.

We take the government at its word and will hold it to it. . .

As a consequence of this ruling HHS will have little choice but to issue a rule relieving many religious employers of the obligation to provide coverage for contraception. The interesting question will be how this is to be accomplished under existing statutory authority. Moreover, the Administration’s proposed fix — allowing religious employers to exclude contraception coverage but requiring insurers to provide separate contraception coverage to employees at no charge — would do nothing to alleviate the burden on those religious employers that self-insure (which many do because, among other reasons, it provides a way to escape state-level contraception mandates).

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PolitiFact Is The Liar Of The Year

by Hans Bader on December 14, 2012 · 2 comments

in Environment, Global Warming, Healthcare, Legal, Regulation

PolitiFact falsely depicted Michael Cannon, the director of health policy studies at the Cato Institute, as suggesting that state law overrides federal law, erroneously attributing to him a radical claim that he never made (that states can forbid the federal government from setting up health insurance exchanges). Cannon merely observed that state law in 14 states forbids “state employees” to set up Obamacare health insurance exchanges, and he never said that federal employees could not set them up. (Under the Supreme Court’s Printz decision, the federal government cannot conscript state officials to administer even perfectly constitutional federal laws.)

After falsely putting words into Cannon’s mouth, PolitiFact then rated the claim he never made “false,” and prominently attributed it to him. PolitiFact cheerfully ignored the fact that it had wrongly maligned Cannon, a legally knowledgeable expert on health care regulation, even after its error was brought to its attention by Jonathan Adler, a leading law professor at Case Western Reserve University.

PolitiFact has also made repeated false claims about the Supreme Court’s Ledbetter decision that echoed false Democratic talking points against the Supreme Court in the campaign. PolitiFact resisted fixing its erroneous claims even after lawyers and law professors repeatedly pointed out and documented the falseness of its claims, people such as Professor Adler, and a former Justice Department lawyer at the Heritage Foundation.

After dragging its heels, PolitiFact finally corrected some of its false claims after criticism of its falsehoods spread beyond legal circles to the general public, drawing scrutiny from people like Megan McArdle of Newsweek/Daily Beast. (Their criticism of PolitiFact for making obvious factual errors put its (undeserved) credibility at risk if it failed to belatedly correct the most blatant of the errors they cited.)

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More Lawsuits Against Doctors, Hospitals Due To Senate Amendment 3215 To NDAA

by Hans Bader on December 4, 2012 · 1 comment

in Healthcare, Legal, Regulation

Earlier, I wrote about a proposed amendment to the National Defense Authorization Act for 2013, which would dramatically increase lawsuits against schools and colleges by allowing them to be sued for “disparate impact” and for punitive damages under Title VI of the Civil Rights Act of 1964, and Title IX of the Education Amendments of 1972. But I forgot to mention another area where the amendment, SA 3215, would have a huge impact: doctors and hospitals, which also are commonly subject to liability under Title VI.

The disparate-impact/punitive damages provision buried in the amendment several Senate Democrats want to add to the Defense Authorization bill (Amendment #3215) also would harm doctors, hospitals and other healthcare businesses by making it easier to sue them for failing to provide bilingual translators free of charge to patients. (Doctors or hospitals who lose Title VI lawsuits also can be forced to pay hundreds of thousands of dollars in attorneys fees, under the so-called Christiansburg Garment rule.)

Bilingual translation mandates imposed on doctors, hospitals and other businesses under Title VI regulations can be onerous. Here is a link to the Justice Department Title VI guidance on what providers must do to provide free bilingual translation for patients. This regulation will have a new lease on life, and lots more scary new teeth, thanks to the proposed Amendment to the Defense Authorization bill, SA 3215, which imposes punitive damages and authorizes private lawsuits for disparate impact, which previously could be enforced only, if at all, by federal agencies in administrative proceedings.

Healthcare providers are subject to the tentacles of Title VI if they accept Medicare, Medicaid, etc. — meaning they are generally subject to it. And Title VI may be about to radically expand, in ways trial lawyers will love.

Prior to this proposed amendment, which the Senate may vote on soon, doctors and hospitals weren’t subject to punitive damages under Title VI because the Supreme Court interpreted punitive damages as being barred under spending clause statutes such as Title VI, in Barnes v. Gorman (2002), and weren’t suable by private parties or special-interest groups for so-called “disparate impact”  since such disparate-impact lawsuits were barred by Alexander v. Sandoval (2001). This amendment (SA 3215) abolishes both of those limits, threatening doctors and hospitals with lots of liability. The provisions that affect hospitals and doctors are found in Section 1806 of the proposed amendment, which is reprinted at the end of this article. They can also be found on page S7233 of the Congressional Record (Volume 158).

Obamacare Will Increase Health Insurance Costs In California, Washington, D.C., And Elsewhere

by Hans Bader on October 31, 2012 · 1 comment

in Healthcare, Politics as Usual, Regulation

California officials concede that their state’s Obamacare exchange will hike premiums for policyholders by up to 25 percent. In the District of Columbia, small businesses are being forced to buy overpriced insurance on an Obamacare exchange by the “District of Columbia Health Benefit Exchange Authority,” which “voted . . . to require D.C. small businesses to buy coverage through the exchange. Although President Obama falsely claimed when Obamacare was enacted that “if you like your present health insurance, you can keep it,” Washington’s small “employers can stick with their current health insurer” only “if that provider opts into D.C.’s exchange.” Even if it does, employers “may see their rates increase . . . experts said.” The forced participation in the exchange will “apply to any company that has an office in the District with 50 or fewer employees. ‘If you have a business license here in the District of Columbia, then you participate through the exchange,’ said Dr. Mohammad Akhter, chairman of the D.C. Health Benefit Exchange board.” Earlier, Obamacare resulted in hikes of 41-47% in health insurance premiums for some policyholders in Connecticut.

Obamacare also increases costs to taxpayers.  Obamacare will increase welfare spending by reducing levels of employment, leading to more people being poor enough to qualify for means-tested government benefits. Employers are now cutting full-time workers and replacing them with part-time workers (which helps conceal high unemployment) to avoid Obamacare mandates that apply to full-time employees, a phenomenon chronicled at the Huffington Post and on Fox News. Obamacare will reduce employment by an additional 800,000 due to work disincentives and bizarre income-cliffs, in addition to wiping out thousands of jobs in medical device manufacturing. The Dean of Harvard Medical School, Jeffrey Flier, concluded that Obamacare will harm life-saving medical innovation. Obamacare taxes medical devices and cosmetic surgery, and raises taxes starting in 2013 on investors. The Associated Press and others have reported that it breaks a number of Obama campaign promises.

FDA Delay Likely Killed Thousands, Imposed Billions In Costs

by Hans Bader on July 13, 2012 · 1 comment

in Health and Illness, Healthcare, Legal, Precaution & Risk, Regulation

The FDA didn’t approve a home test for HIV until 24 years after it first received an application. According to an FDA advisory committee, the test “holds the potential to prevent the transmission of more than 4,000 new HIV infections in its first year of use alone.” That means thousands of people likely got infected with AIDS as a result of the delay in approving it. As Roger Parloff of Fortune notes, the FDA’s delay in approving the home HIV test is a “scandal.” It likely caused the deaths of thousands of people, given the mortality rate from AIDS.  It may also have caused billions of dollars in additional costs for taxpayers, given that AIDS is a costly and debilitating disease to treat, resulting in treatment costs of perhaps $600,000 per AIDS sufferer.

The FDA is also thwarting the production of certain life-saving drugs. The Obama administration also sought to restrict the market for bone-marrow transplants, potentially costing thousands of lives. It tried to convince a federal appeals court to extend the reach of the National Organ Transplant Act beyond its text, in order to ban compensation needed for the collection of peripheral blood stem cells. The federal DEA recently caused shortages of the drug Adderall, which is needed by narcolepsy sufferers. Earlier, government regulations caused cancer and burn victims in the Third World to die in agony without any pain relief.

Dietitian Licensing Board Attempts To Limit Free Speech, Silence Bloggers

by Michelle Minton on July 11, 2012 · 3 comments

in Features, Healthcare, Legal, Nanny State, Personal Liberty, Regulation

Post image for Dietitian Licensing Board Attempts To Limit Free Speech, Silence Bloggers

Have you ever given someone advice on how to lose weight through dietary changes? Have you ever recommended that certain foods could be consumed or avoided to aid in sleep, stress, or intestinal issues? Well then, according to the North Carolina Board of Dietetics and Nutrition, you should be thrown in jail for up to a month and a half. Now, newly leaked documents prove what many suspected from the beginning: the effort to silence unlicensed dietitians and online bloggers giving nutritional advice is all about eliminating competition for the Board of Dietetics’ licensed members.

The issue received national attention earlier this year after Steve Cooksey, an online blogger promoting the “Paleo” diet, received a letter from the Board of Dietetics telling him that his blog violated state law. By providing advice on his blog for free  and also providing coaching for a fee, the Board of Dietetics claimed he was guilty of practicing unlicensed dietetics, a crime worthy of fines, court orders to cease and desist, and even jail time. The Institute for Justice has taken up Cooksey’s case and they are fighting the charges of the Board on the grounds that such application of the law violates his First Amendment right to freedom of speech. According to IJ, not only did the Board demand that Cooksey cease his only advice giving, but that he may not even provide nutritional advice in private! According to IJ, the Board of Dietetics and Nutrition also told Steve that his private emails and telephone calls with friends and readers were illegal. The Board also ordered him to shut down his life-coaching service.

And while Cooksey is being challenged by a state board of licensed dietitians, it is important to remember that there is a nationwide effort to clamp down on unlicensed competition through legal and legislative means.

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Court’s Obamacare Decision — What Would John Locke Say?

by Marlo Lewis on July 2, 2012 · 2 comments

in Features, Healthcare, Legal, Regulation

Post image for Court’s Obamacare Decision — What Would John Locke Say?

Richard Epstein of the Hoover Institution and the University of Chicago Law School gives the Chief Justice some tough love in “What Was Roberts Thinking? The Chief Justice was neither an umpire nor a statesman. Only a lawyer.”

There are many wise words in Prof. Epstein’s column, which I heartily encourage anyone visiting this site to read.

My only quibble is that the professor could have been harsher on the Honorable John Roberts. Really, Roberts held that the Obamacare individual mandate is a penalty not a tax so the Court could take jurisdiction but that the mandate is a tax not a penalty so the Court could uphold mandate’s constitutionality. Why do Congress’s words (“penalty”) not the provision’s alleged function (“tax”) count for determining standing but the alleged function not the words count for determining constitutionality? This is “too clever by half,” as Epstein observes. The only “logic” operating here is political: pick and choose which meaning is convenient to get the outcome you want.

Even this ruse fails, as Epstein argues, because the mandate is in fact a penalty, not a tax. In the dissent, Justice Antonin Scalia notes that the word “penalty” occurs 18 times in the portion of the statute dealing with the individual mandate, whereas “tax” occurs in other provisions, demonstrating that Congress chose “penalty” deliberately, because, after all, the thing so labeled is not a tax. As Scalia argues, Roberts “saved” the Affordable Care Act (a.k.a. Obamacare) by “rewriting” it. Thus, Roberts’s “judicial modesty” was actually a case of “judicial overreach.” Roberts joined the liberals to legislate from the bench.

What Roberts the “statesman” doesn’t get is that when the judges engage in policy-driven, results-oriented, jurisprudence, they forfeit their claim to impartiality. Each time they do this, they reinforce the conclusion that the system is rigged and that justice is to be found only in the strength of one’s own party or faction — or one’s own arms. In other words, when justices are no better than politicians in black robes, they undermine the social compact and bring back the state of war.

Seventeenth century English philosopher John Locke, with his usual clarity, said it all in the Second Treatise (Chapter III, Of the State of War):

Sec. 20. But when the actual force is over, the state of war ceases between those that are in society, and are equally on both sides subjected to the fair determination of the law; because then there lies open the remedy of appeal for the past injury, and to prevent future harm: but where no such appeal is, as in the state of nature, for want of positive laws, and judges with authority to appeal to, the state of war once begun, continues, with a right to the innocent party to destroy the other whenever he can, until the aggressor offers peace, and desires reconciliation on such terms as may repair any wrongs he has already done, and secure the innocent for the future; nay, where an appeal to the law, and constituted judges, lies open, but the remedy is denied by a manifest perverting of justice, and a barefaced wresting of the laws to protect or indemnify the violence or injuries of some men, or party of men, there it is hard to imagine any thing but a state of war: for wherever violence is used, and injury done, though by hands appointed to administer justice, it is still violence and injury, however colored with the name, pretences, or forms of law, the end whereof being to protect and redress the innocent, by an unbiased application of it, to all who are under it; wherever that is not bona fide done, war is made upon the sufferers, who having no appeal on earth to right them, they are left to the only remedy in such cases, an appeal to heaven. [emphasis added]

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